The child who is routinely yelled at, demeaned, ridiculed, ignored or terrorized by a parent may bear no outward signs of abuse. But abused he is, and the negative consequences for the child’s mental health as well as his future relationships and sense of self-worth are generally significant, says a new clinical report from the nation’s pediatricians.
Psychological maltreatment of children by their parents or caregivers is “harder to identify” and “possibly the most underreported” to authorities, especially when it happens without physical or sexual abuse, write the authors of the report, published Monday in the journal Pediatrics. Studies conducted in the United Kingdom and the United States have found that 8% to 9% of adult women and about 4% of men “reported exposure to severe psychological abuse during childhood.”
The American Academy of Pediatrics underscored that “psychological maltreatment” goes beyond the occasional loss of patience with a willful child or an inconsolable baby. Such toxic parental behavior defines the relationship between caregiver and child, and it may not be limited to ridicule, belittling and rejecting comments routinely aimed at a child: The report notes that psychological maltreatment can include restricting a child’s interactions with people outside the home, placing a little one in unpredictable or potentially dangerous circumstances, modeling or encouraging behavior that is antisocial or inappropriate to the child’s age and development, failing to take steps that allow a child’s cognitive development, or simply refusing to interact with a child unless it’s necessary.
The report urges pediatricians to be attentive to the signs of a child’s emotional maltreatment at the hands of a caregiver, asking even a very young child in private about his or her experiences of discipline, self-worth, safety and being loved. And where there’s evidence of substance abuse, domestic violence or mental illness — including depression — within a child’s home, a pediatrician should be particularly attuned to the possibility of psychological maltreatment and be prepared to act.
The physician who suspects a child is a victim of parental neglect, verbal abuse or actions that sow fear, dependence or self-doubt should act quickly to see that a family gets evaluation and treatment, including positive parenting programs. In some cases, the report’s authors wrote, more stringent measures might be necessary to protect a child from psychological harm.
“Consideration of out of home care interventions should not be restricted to cases of physical or sexual abuse,” says the report. “Children exposed to psychological maltreatment may also require a level of protection that necessitates removal from the parental home.”
At the same time, the nation’s leading pediatric group acknowledged it was navigating murky waters. The clinical report published Monday notes that the authors’ ability to counsel pediatricians on the subject is tempered by “the absence of a strong societal consensus on the distinction between psychological maltreatment and suboptimal parenting.”
At the same time, the group acknowledged that neglect and other forms of psychological maltreatment might have their most devastating and long-term effects when babies — who cannot report them — are their victims. For infants who endure parental indifference, neglect or rejection, whether intended or not, such early experience often casts a shadow of antisocial behavior, relationship troubles, academic failure and poor mental health on adulthood.