ScienceDaily (July 30, 2012) — Child abuse experts say psychological abuse can be as damaging to a young child’s physical, mental and emotional health as a slap, punch or kick.

While difficult to pinpoint, it may be the most challenging and prevalent form of child abuse and neglect, experts say in an American Academy of Pediatrics (AAP) position statement on psychological maltreatment in the August issue of the journal Pediatrics.

Psychological abuse includes acts such as belittling, denigrating, terrorizing, exploiting, emotional unresponsiveness, or corrupting a child to the point a child’s well-being is at risk, said Dr. Harriet MacMillan, a professor in the departments of psychiatry and behavioural neurosciences and pediatrics of McMaster University’s Michael G. DeGroote School of Medicine and the Offord Centre for Child Studies. One of three authors of the position statement, she holds the David R. (Dan) Offord Chair in Child Studies at McMaster.

“We are talking about extremes and the likelihood of harm, or risk of harm, resulting from the kinds of behavior that make a child feel worthless, unloved or unwanted,” she said, giving the example of a mother leaving her infant alone in a crib all day or a father involving his teenager in his drug habit.

A parent raising their voice to a strident pitch after asking a child for the eighth time to put on their running shoes is not psychological abuse, MacMillan said. “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.”

Psychological abuse was described in the scientific literature more than 25 years ago, but it has been under-recognized and under-reported, MacMillan said, adding that its effects “can be as harmful as other types of maltreatment.”

The report says that because psychological maltreatment interferes with a child’s development path, the abuse has been linked with disorders of attachment, developmental and educational problems, socialization problems and disruptive behaviour. “The effects of psychological maltreatment during the first three years of life can be particularly profound.”

This form of mistreatment can occur in many types of families, but is more common in homes with multiple stresses, including family conflict, mental health issues, physical violence, depression or substance abuse.

Although there are few studies reporting the prevalence of psychological abuse, the position statement says large population-based, self-report studies in Britain and the United States found approximately eight-to-nine per cent of women and four per cent of men reported exposure to severe psychological abuse during childhood.

The statement says pediatricians need to be alert to the possibility of psychological abuse even though there is little evidence on potential strategies that might help. It suggests collaboration among pediatric, psychiatric and child protective service professionals is essential for helping the child at risk.

Funders for the paper’s development included the Family Violence Prevention Unit of the Public Health Agency of Canada.

Along with MacMillan, the statement was prepared by Indiana pediatrician Dr. Roberta Hibbard, an expert on child abuse and neglect; Jane Barlow, professor of Public Health in the Early Years at the University of Warwick; as well as the Committee on Child Abuse and Neglect and the American Academy of Child and Adolescent Psychiatry, Child Maltreatment and Violence Committee.

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ScienceDaily (July 30, 2012) — Emotional problems in childhood are common. Approximately 8 to 22 percent of children suffer from anxiety, often combined with other conditions such as depression. However, most existing therapies are not designed to treat coexisting psychological problems and are therefore not very successful in helping children with complex emotional issues.

To develop a more effective treatment for co-occurring youth anxiety and depression, University of Miami psychologist Jill Ehrenreich-May and her collaborator Emily L. Bilek analyzed the efficacy and feasibility of a novel intervention created by the researchers, called Emotion Detectives Treatment Protocol (EDTP). Preliminary findings show a significant reduction in the severity of anxiety and depression after treatment, as reported by the children and their parents.

“We are very excited about the potential of EDTP,” says Ehrenreich-May, assistant professor of psychology in the College of Arts and Sciences at UM and principal investigator of the study. “Not only could the protocol better address the needs of youth with commonly co-occurring disorders and symptoms, it may also provide additional benefits to mental health professionals,” she says. “EDTP offers a more unified approach to treatment that, we hope, will allow for an efficient and cost-effective treatment option for clinicians and clients alike.”

Emotion Detectives Treatment Program is an adaptation of two treatment protocols developed for adults and adolescents, the Unified Protocols. The program implements age-appropriate techniques that deliver education about emotions and how to manage them, strategies for evaluating situations, problem-solving skills, behavior activation (a technique to reduce depression), and parent training.

In the study, 22 children ages 7 to 12 with a principal diagnosis of anxiety disorder and secondary issues of depression participated in a 15-session weekly group therapy of EDTP. Among participants who completed the protocol (18 out of 22), 14 no longer met criteria for anxiety disorder at post-treatment. Additionally, among participants who were assigned a depressive disorder before treatment (5 out of 22), only one participant continued to meet such criteria at post-treatment.

Unlike results from previous studies, the presence of depressive symptoms did not predict poorer treatment response. The results also show a high percentage of attendance. The findings imply that EDTP may offer a better treatment option for children experiencing anxiety and depression.

“Previous research has shown that depressive symptoms tend to weaken treatment response for anxiety disorders. We were hopeful that a broader, more generalized approach would better address this common co-occurrence,” says Bilek, doctoral candidate in clinical psychology at UM and co-author of the study. “We were not surprised to find that the EDTP had equivalent outcomes for individuals with and without elevated depressive symptoms, but we were certainly pleased to find that this protocol may address this important issue.”

The study, titled “The Development of a Transdiagnostic, Cognitive Behavioral Group Intervention for Childhood Anxiety Disorders and Co-Occurring Depression Symptoms,” is published online ahead of print in the journal Cognitive and Behavioral Practice. The next step is for the team to conduct a randomized controlled trial comparing the EDTP to another group treatment protocol for anxiety disorder.