I
managed to get to an interesting seminar this week - looking at issues of
emotional neglect and emotional abuse. The main presentation was devoted to
what the academic literature has to say about the consequences (sequelae) of
what Americans, who undertake nearly all of this research, call ‘psychological
maltreatment’.
There
were no real surprises. Insecure attachment, delayed development, cognitive
delay, negativity and aggression during play, poor peer relationships, low
self-esteem and language delays; all featured prominently. It was reassuringly,
if tragically, familiar. But what I suddenly found myself taking a great deal
of interest in was an aside about research methods, particularly relating to
observation of parent-child interaction in longitudinal cohort studies such as
the Minnesota Mother-Child Interaction Project [1]
It
was blindingly obvious really, but I had never thought about it with such
clarity before. Researchers are trained to be objective and dispassionate. They
try to minimise observer effects, to be like a fly on the wall. And that, it
occurred to me, is why they can produce such clear and incisive descriptions of
emotional abuse and neglect. They
watch for a long time and so they see the negative, but often subtle,
behaviours of some parents - lack of eye contact, failure to respond to
distress, mechanical handling, disparagement, subtly conveying to the child that s/he
is worthless/unloved/inadequate, having developmentally inappropriate
expectations of the child, preventing the child participating in normal social
interactions etc.
On
the other hand social workers and other service providers may find it much more
difficult to spot the signs of emotional abuse and neglect. That’s not because they
do not know what it is, but because the nature of the service encounter [2] makes sustained observation difficult. Unlike
the researcher, the social worker often has only a relatively brief encounter
with the family. Perhaps a couple of visits of less than an hour each in order
to assess child-parent interaction. So it’s not surprising
that emotional abuse and neglect, in the absence of other types of abuse, are
often missed; or at the very least, not confirmed by social workers during a
child protection episode.
Another
consideration needs to be entertained at this point. The impact of emotional
abuse and neglect – which, of course, will always accompany other types of
abuse –
is known to be particularly significant during the first two years of life, not
only because babies are highly dependent and vulnerable, but also because the
impact is long-term, involving both emotional and physical consequences. Studies [3] of young
children emotionally neglected in Romanian orphanages found that their brains
did not grow at the normal rate and were significantly smaller than those of
normal children [4]. Such studies point to the need for the earliest possible
intervention, before the long-term physical damage becomes established.
Applying
some of these thoughts to the design of child protection service encounters it
seems to me that we need to think much more imaginatively about how they take
place. Following-up a concern of emotional abuse and neglect may be, quite literally, a different
sort of job to following up an allegation of physical abuse where there is
often clear, objective evidence in the form of a bruise, fracture or lesion. It may involve longer and more sustained
observation in the early stages of involvement. Working practices that mean
that contacts are brief, and procedures that mandate that decisions be taken
quickly, may simply result in lots of emotional abuse and neglect being ruled
out because of lack of evidence in what are, in effect, fleeting involvements.
End notes
[1]
See Erikson, M.F., Egeland, B. and Pianta, R. (1989) "The effects of
maltreatment on the development of young children", in Cicchetti, D. and
Carlson,V. (eds) Child Maltreatment:
theory and research on the causes and consequences of child abuse and neglect,
Cambridge University Press, pp. 647–84.
[2]
The term ‘service encounter’ is used extensively in
services management and services marketing, referring to the moment of
interaction between the service-user or customer and the service. Thus a
service-user will typically have several service encounters with the same
service. (See Mary Jo Bitner, (1990), "Evaluating Service Encounters: The
Effects of
Physical Surroundings and Employee Responses," Journal of Marketing, 54
(April), 69-82.) A home visit by a social worker to investigate a concern that
a child is being abused is an example of what I call ‘a child protection
service encounter’.
[3]
See Perry, B. D. (2001). The neurodevelopmental impact of violence in childhood. In
D. Schetky
& E. Benedek (Eds.), Textbook of child and adolescent forensic psychiatry (pp.
221-238). Washington, DC: American Psychiatric Press, Inc.
[4]
A good summary of research in this area can be found on the Child Welfare
Information Gateway, http://www.childwelfare.gov/pubs/issue_briefs/brain_development/effects.cfm
