Psychological Abuse Devasting to Children and Adolescents

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July 30, 2012 — Psychological maltreatment during childhood can scar children for life and result in developmental and educational problems, disorders of attachment, disruptive behavior, and psychopathology in later years, new research shows.

“Psychological or emotional maltreatment of children and adolescents may be the most challenging and prevalent form of child abuse and neglect, but until recently, it has received relatively little attention,” write Roberta Hibbard, MD, from Riley Children’s Hospital, Indianapolis, Indiana, and colleagues of the Committee on Child Abuse and Neglect and the Child Maltreatment and Violence Committee of the American Academy of Child and Adolescent Psychiatry.

The report was published online July 30 in Pediatrics.

A technical report by the American Academy of Pediatrics reviewed the issue in 2000. The current report was done to update pediatricians on current knowledge and approaches to psychological maltreatment, including ways to identify such abuse, and methods of prevention, treatment, and intervention.

Psychological maltreatment is a repeated pattern of behavior on the part of the parent that makes the child feel unloved or unwanted. The abuse is often not recognized when other forms of maltreatment coexist, but when it occurs alone, it can be even harder to identify. As a result, opportunities for intervention may be missed, Dr. Hibbard and colleagues write.

Assessing children for psychological maltreatment is a challenge for pediatricians, who need to be alert to the possibility of such abuse and consider it whenever they are assessing psychological and behavioral conditions in childhood, they note.

It is important to develop approaches for asking children about their relationships with their caregivers, including how they are disciplined, as well as feelings of self-worth, safety, and being loved. Interviewing children alone, away from their caregivers, is important, the authors write.

Parental psychiatric illness, including depression and substance abuse, are risk indicators for psychological maltreatment, and pediatricians should be aware of these. Intimate partner violence is also considered a form of maltreatment.

Watching how the child and parent interact is also a valuable source of information about the quality of their relationship, the authors suggest.

Reporting psychological maltreatment can be difficult. In some jurisdictions, the child’s growth or development, or both, may need to be impaired for protective services to accept a report, and detailed documentation is essential in such situations, the authors write.

“It is important that the pediatrician record specific statements from the child, the family, and other sources and that the pediatrician is systematic in assessing the child’s behavioral, psychological, and physical status in relation to the baseline assessment,” they write.

There are no evidence-based interventions that have been identified that will prevent psychological maltreatment, but interventions such as the Nurse Family Partnership have been shown to be effective in reducing child maltreatment in general, and may be useful.

Finally, the authors suggest treatments that might be effective, including cognitive behavioral parenting programs and other psychotherapeutic interventions.

“Pediatricians are uniquely positioned to educate those working in child welfare, child health care, and the judicial system about the complex needs of children exposed to psychological maltreatment,” they write.

“The pediatrician is well situated to advocate on behalf of the child and can take on an important liaison role with professionals in the child welfare system,” they conclude.

This article was developed with the assistance of the Family Violence Prevention Unit, Public Health Agency of Canada. Dr. Hibbard has disclosed no relevant financial relationships.

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