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Teenage Neglect / EM

The objective was to answer the following question:


1. What are the self-reported or self-rated features of a child (13-17 completed years) currently experiencing neglect and/or emotional maltreatment in OECD countries?



Due to a number of constraints it was decided that a rapid systematic review using streamlined methods would be conducted for this particular review. A traditional systematic review attempts to focus on a research question and tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Although systematic reviews can be thought of as the gold standard of knowledge synthesis within research, they do have limitations, the main one being the length of time it can take to conduct a systematic review. They typically require anything from six months up to a number of years to complete, in addition to being heavy on resource personnel. Consequently rapid reviews have emerged as an efficient approach to synthesizing evidence; however whilst there are documented criteria 1,2, there isn’t an accepted or standardised methodology for these 3. Therefore, when designing this review we decided to use systematic review techniques 4 whilst employing limits in several areas for speeding up the process, including using a narrow research question, limiting the search dates, and reducing the number of databases searched.


We performed an English language literature search of original articles published since 1990.  The initial search strategy was developed across OVID Medline databases using keywords and Medical Subject Headings (MeSH) and was modified appropriately to search the remaining bibliographic databases.  The search sensitivity was improved by supplementary searching of key journals and references of all included full-text articles.


We limited our search strategy to Organisation for Economic Co-operation and Development (OECD) 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. Where applicable, authors were contacted for primary data and confirmation of information, such as data duplication across publications, age range of subjects or the confirmation of neglect / EA as appropriate. Abstracts of studies were scanned for eligibility by the lead researcher and selected for further review.


Articles were screened by two reviewers to determine relevance according to eligibility criteria. Where there was disagreement, a third reviewer decided on eligibility. The remaining studies then underwent full data extraction and critical appraisal by one reviewer, with independent verification by a second, using standardised data extraction and critical appraisal forms based on criteria defined by the National Health Service’s Centre for Reviews and Dissemination 4 and systematic review advisory guidance 5-9. In order to complete the review in a timely manner, the articles were reviewed only by child protection researchers, experienced in critical appraisal.


We included all primary studies addressing neglect and/or emotional abuse in adolescents aged 13-17 years, which was substantiated by child protection processes, with self-reporting data relating to emotion, wellbeing, and social behaviour.


Many authors combine emotional neglect and emotional abuse 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)10. Among international definitions of neglect and emotional abuse, we opted for those of the World Health Organization, as follows:


  • Neglect is defined as:

“Neglect refers to 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 thus distinguished from circumstances of poverty in that neglect can occur only in cases where reasonable resources are available to the family or caregiver.” 11


  • 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.” 11


  • In the absence of an identifiable UK / World definition of educational neglect, we developed our own for the purposes of the review:

Educational neglect involves one or more of the following:  The parent or caregiver’s –

  • Failure to enrol a child of mandatory school age in school
  • Failure to comply with state requirements regarding school attendance
  • Failure to access / provide appropriate home schooling
  • Failure to avail of recommended special educational provision
  • Failure to cooperate with treatment if the child is experiencing mental, emotional or developmental problems associated with school, and treatment is offered
  • Failure to show an interest in the child’s education at school and support their learning
  • Failure to provide a stimulating environment
  • Repeatedly keeping the child at home, thus failing to comply with state requirements
  • Allowing the child or youth to engage in chronic truancy

Adapted from: American Humane Association12, Public Health Agency of Canada13, Horwath14


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  1. National Collaborating Centre for Methods and Tools. Methods: Synthesis 1. Rapid reviews: Methods and implications. Hamilton, ON: National Collaborating Centre for Methods and Tools [PDF from The National Collaborating Centre for Methods and Tools]

  2. Public Health Wales Observatory. Rapid evidence review methodology (based on the Health Evidence Bulletins Wales Project Methodology). 2006 [Link to Public Health Wales Observatory]

  3. Ganann R, Ciliska D, Thomas H. Expediting systematic reviews: methods and implications of rapid reviews. Implementation Science. 2010;5(56) [Pubmed]

  4. 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]
  5. Critical Appraisal Skills Programme (CASP) [Website]

  6. 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.
  7. 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]
  8. 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]
  9. 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]
  10. [American Professional Society on the Abuse of Children website]
  11. 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]
  12. American Humane Association. Child Neglect. [American Humane Association Website]


    Public Health Agency of Canada. Canadian Incidence Study of Reported Child Abuse and Neglect. CIS-2008 Guidebook. 2010 [PDF from Public Health Agency of Canada]

  14. Horwath J. Child Neglect: Identification and Assessment. Palgrave Macmillan, Basingstoke. 2007


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