"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," say the researchers in the paper published Monday in the journal Pediatrics.
The American Academy of Pediatrics (AAP) paper is an update to its 2000 report designed to guide pediatricians on ways to identify, prevent and treat child psychological abuse.
The many forms of child psychological abuse include belittling, denigrating, terrorizing, exploiting and being emotionally unresponsive, notes Dr. Harriet MacMillan, a professor in the departments of psychiatry, and behaviour sciences and pediatrics at McMaster University in Hamilton.
"We are talking about extremes and the likelihood of harm, or risk of harm, resulting from the kinds of behaviour that make a child feel worthless, unloved or unwanted," says MacMillan, who gave the example of a mother leaving her infant alone in a crib all day, or a father involving his teenager in his drug habit.
Abuse not just a momentary loss of temper
In a release, MacMillan, one of three authors of the paper also involving U.K. and U.S. experts, gave insight into what is and isn't considered abusive behaviour on the part of a parent or caregiver.
Raising your voice after asking children repeatedly to put on their running shoes is not psychological abuse, she says. "But, yelling at a child every day and giving the message that the child is a terrible person, and that the parent regrets bringing the child into this world, is an example of a potentially very harmful form of interaction."
Child psychological abuse in scientific literature dates back a quarter-century, but it remains under-recognized and underreported, MacMillan says, adding that its effects "can be as harmful as other types of maltreatment," and can lead to attachment, developmental and educational disorders, as well as socialization problems and disruptive behaviour.
"The effects of psychological maltreatment during the first three years of life can be particularly profound," she says.
Doctors should promote 'attuned parenting'
For that reason, the Pediatrics report says, pediatricians, when seeing parents with young children, should "promote sensitive and attuned parenting, including using a range of approaches [such as leaflets, books and videos], and keep an eye out for any interactions between parents and their children that may signal youngsters are being psychologically abused.
Few studies focus on the prevalence of child psychological abuse, but large population-based studies in Britain and the United States have found eight to nine per cent of women and four per cent of men reported exposure to severe psychological abuse during childhood.
The Pediatrics report suggests that pediatric, psychiatric and child protective service professionals work together in specific cases to help children at risk for or experiencing psychological abuse — even if it means removing a child from a home.
"Although efforts should focus on ways to assist the family with the child remaining in the home, it is important for the pediatrician to be alert to situations in which a child’s needs are better met outside the home, either on a temporary or permanent basis," write the researchers, who also include Indiana pediatrician Dr. Roberta Hibbard and Jane Barlow, professor of public health in the early years at the University of Warwick.
The Family Violence Prevention Unit of the Public Health Agency of Canada helped fund the work.