Psychological maltreatment is child abuse

Psychological or emotional maltreatment is a pattern of caregiver abuse that affects a child’s cognitive, social, emotional, and physical development.

Unlike physical abuse, signs of psychological maltreatment often are hidden. However, pediatricians who are able to assess the risk factors for psychological and emotional abuse and identify a patient’s subtle cues can effect prevention.

The American Academy of Pediatrics (AAP) has released a new clinical report to help pediatricians identify psychologically abusive behaviors by caregivers.

Maltreatment can be verbal or silent, active or passive, or intentional or unintentional in nature. It includes acts of ridicule, rejection, or humiliation; threats of violence; isolation; exploitation; detachment or lack of nurturing; and mental, medical, or emotional neglect that lead a child to feel unloved and unwanted. As adults, children who were abused often repeat the behaviors toward their own children.

The AAP advises physicians to be alert to the possibility of psychological maltreatment in their assessments of a child’s behavioral and developmental problems; to interview children alone about their relationships with caregivers; to talk to caregivers about relationships within the family and stresses in the home; to observe interactions between parent or caregiver and child; to follow up with teachers, child care personnel, and other clinicians to clarify any issues of concern; and to document all observations, assessments, and referrals.

The effects of psychological and emotional abuse are “profound” in the first 3 years of life, according to AAP, because rapid growth of the child’s brain and body systems are taking place, and early parenting affects the child’s attachment to those caregivers in his or her environment. Maltreatment at this stage has been associated with incidence of adult mental illness and other comorbid disorders.

Go back to the current issue of the eConsult.