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Emotional, behavioral, and developmental features indicative of neglect or emotional abuse in preschool children: A systematic review

Naughton, Aideen Mary, Maguire, Sabine Ann, Mann, Mala K., Lumb, Rebecca Caroline, Tempest, Vanessa, Gracias, Shirley and Kemp, Alison Mary ORCID: 2013. Emotional, behavioral, and developmental features indicative of neglect or emotional abuse in preschool children: A systematic review. JAMA Pediatrics 167 (8) , pp. 769-775. 10.1001/jamapediatrics.2013.192

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Importance Early intervention for neglect or emotional abuse in preschoolers may mitigate lifelong consequences, yet practitioners lack confidence in recognizing these children. Objective To define the emotional, behavioral, and developmental features of neglect or emotional abuse in preschoolers. Evidence Review A literature search of 18 databases, 6 websites, and supplementary searching performed from January 1, 1960, to February 1, 2011, identified 22 669 abstracts. Standardized critical appraisal of 164 articles was conducted by 2 independent, trained reviewers. Inclusion criteria were children aged 0 to 6 years with confirmed neglect or emotional abuse who had emotional, behavioral, and developmental features recorded or for whom the carer-child interaction was documented. Findings Twenty-eight case-control (matched for socioeconomic, educational level, and ethnicity), 1 cross-sectional, and 13 cohort studies were included. Key features in the child included the following: aggression (11 studies) exhibited as angry, disruptive behavior, conduct problems, oppositional behavior, and low ego control; withdrawal or passivity (12 studies), including negative self-esteem, anxious or avoidant behavior, poor emotional knowledge, and difficulties in interpreting emotional expressions in others; developmental delay (17 studies), particularly delayed language, cognitive function, and overall development quotient; poor peer interaction (5 studies), showing poor social interactions, unlikely to act to relieve distress in others; and transition (6 studies) from ambivalent to avoidant insecure attachment pattern and from passive to increasingly aggressive behavior and negative self-representation. Emotional knowledge, cognitive function, and language deteriorate without intervention. Poor sensitivity, hostility, criticism, or disinterest characterize maternal-child interactions. Conclusions and Relevance Preschool children who have been neglected or emotionally abused exhibit a range of serious emotional and behavioral difficulties and adverse mother-child interactions that indicate that these children require prompt evaluation and interventions. Neglect is the most common form of maltreatment,1,2 with devastating lifelong consequences. The neurobiology of the infant brain can be altered in response to early emotional neglect,3 and brain imaging technology has confirmed the structural effect of neglect on the developing brain.4 The link between infant neglect and later aggression5,6 is highlighted by Kotch et al,7 who identified neglect in the first 2 years of life as a predictor of later aggression. Neglect means many things to many people,8 contributing to various working definitions and numerous tools to aid assessment and recognition. Social and health care professionals have a crucial role in recognizing and responding to signs of neglect, but when faced with subjective and value-based thresholds describing parental omission of good enough care, they may lack confidence in diagnosing neglect, unless there are clear physical signs (eg, faltering growth). The severe long-term consequences of emotional neglect and emotional abuse in the first 2 years of life9,10 have been identified, alongside the difficulty in recognition at such a young age.11,12 Underrecognition has implications for physical, mental health,13 and mortality.14 Emotional neglect and emotional abuse are variously defined within child abuse categories. In the United Kingdom and the World Health Organization definition, emotional neglect is included within the category of neglect with a separate category of emotional abuse, whereas the 2 aspects are encompassed in the broader term psychological maltreatment by the American Professional Society on the Abuse of Children (eAppendix 1 in Supplement), which describes patterns of damaging interactions between the parent-carer and child through acts of omission or commission, acknowledging that emotional neglect and abuse have equally damaging effects on the child. Elements of psychological maltreatment are present in most categories of abuse, but when psychological maltreatment occurs discretely, there is often delay in both recognition and intervention.15 To optimize outcomes, early recognition is paramount. This systematic review aims to identify the scientific evidence behind the emotional, behavioral, and developmental features of the child and characteristics of primary carer-child interactions associated with neglect and/or emotional abuse of preschool children.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Academic & Student Support Service
Subjects: H Social Sciences > HV Social pathology. Social and public welfare
R Medicine > RJ Pediatrics
R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Publisher: American Medical Association
ISSN: 2168-6203
Last Modified: 25 Oct 2022 10:08

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