The objective was to answer the following questions:
- What are the emotional, behavioural and developmental (EBD) features in the child indicative of any type of neglect / emotional abuse?
- What features in the child-primary carer interaction demonstrate emotional neglect and / or emotional abuse?
We performed an all-language literature search of original articles, their references and conference abstracts published since 1960. The initial search strategy was developed across OVID Medline databases using keywords and Medical Subject Headings (MeSH headings) and was modified appropriately to search the remaining bibliographic databases. The search sensitivity was augmented by the use of a range of supplementary ‘snowballing’ techniques including consultation with subject experts and relevant organisations, and hand searching selected websites, non-indexed journals and the references of all full-text articles.
We limited our search strategy to Organisation for Economic Co-operation and Development populations due to similarities in culture and patterns of health status.
Identified articles, once scanned for duplicates and relevancy, were transferred to a purpose-built Microsoft Access database to coordinate the review and collate critical appraisal data. Relevant studies with an English-language version available were scanned for eligibility by the lead researcher and selected for review (Figure 1).
Standardised data extraction and critical appraisal forms were based on criteria defined by the National Health Service’s Centre for Reviews and Dissemination1. We also used a selection of systematic review advisory articles to develop our critical appraisal forms 2-6. Articles were independently reviewed by two reviewers. A third review was undertaken to resolve disagreement between the initial reviewers when determining either the evidence type of the article or whether the study met the inclusion criteria. Decisions related to inclusion and exclusion criteria were guided by Cardiff Child Protection Systematic Reviews, who laid out the basic parameters for selecting the studies.
Our panel of reviewers included pediatricians, psychologists, psychiatrists, social science researchers, information specialists and social workers. All reviewers underwent standardised critical appraisal training, based on the CRD critical appraisal standards 3, and this was supported by a dedicated electronic critical appraisal module.
We included all studies addressing neglect, emotional abuse or emotional neglect in children less than six years of age. We combined these latter two conditions since, in practice, these descriptions appear concurrently, and this acknowledges the broader term of ‘psychological maltreatment’ as defined by the American Professional Society on the Abuse of Children (1995) 7. Among international definitions of neglect and emotional abuse, we opted for those of the World Health Organization, as follows:
- Neglect (including emotional neglect) is defined as:
“The failure of a parent to provide for the development of the child – where the parent is in a position to do so – in one or more of the following areas: health, education, emotional development, nutrition, shelter and safe living conditions. Neglect is distinguished from circumstances of poverty in that neglect can occur only in cases where reasonable resources are available to the family or caregiver.” 8
- Emotional abuse is defined as:
“Emotional abuse includes the failure of a caregiver to provide an appropriate and supportive environment, and includes acts that have an adverse effect on the emotional health and development of a child. Such acts include restricting a child’s movements, denigration, ridicule, threats and intimidation, discrimination, rejection and other non-physical forms
of hostile treatment.” 8
- Centre for Reviews and Dissemination. Systematic Reviews: CRD's Guidance for Undertaking Reviews in Health Care, 2009 Centre for Reviews and Dissemination, University of York. [PDF from York University]
- Weaver N, Williams JL, Weightman AL, Kitcher HN, Temple JM, Jones P, Palmer S. Taking STOX: developing a cross disciplinary methodology for systematic reviews of research on the built environment and the health of the public. Journal of Epidemiology and Community Health. 2002;56(1):48-55. [Pubmed]
Critical Appraisal Skills Programme (CASP) [Website]
- Polgar A, Thomas SA. Chapter 22. Critical evaluation of published research in Introduction to research in the health sciences. 3rd edition. Melbourne: Churchill Livingstone, 1995.
- Weightman AL, Mann MK, Sander L, Turley RL. Health Evidence Bulletins Wales: A systematic approach to identifying the evidence. Project Methodology 5. Cardiff: Information Services UWCM, January 2004. [PDF from Health Evidence Bulletins Wales]
- Rychetnik L, Frommer M. A schema for evaluating evidence on public health interventions (version 4). National Public Health Partnership, Melbourne 2002. [PDF from The National Public Health Partnership]
- [American Professional Society on the Abuse of Children website]
- World report on violence and health (2002) page 60. Edited by Etienne G. Krug, Linda L. Dahlberg, James A. Mercy, Anthony B. Zwi and Rafael Lozano. [World Health Organization website]