(Originally published May 2019)

Since the publication of The Psychologically Battered Child in 1986, James Garbarino’s thinking about emotional maltreatment (aka emotional abuse and neglect, psychological maltreatment) has had a major influence on both research and, to a lesser extent, child welfare practice. Garbarino’s insistence that “All maltreatment is psychological maltreatment,” i.e., contains emotionally injurious messages, has intensified the interest of child welfare scholars in the emotional and developmental effects of child abuse and neglect. Garbarino’s categories of emotional maltreatment –

terrorizing, isolating, ignoring, corrupting and rejecting, have been widely used in child welfare training programs and policy manuals, and have served as the starting point for longer, more detailed lists of emotionally maltreating behaviors developed by researchers. However, it is Garbarino’s conceptualization of emotional maltreatment as ways of parenting that undermine positive child development that has shaped all subsequent discussions of practice and policy. He asserts that “We know that terrorizing, ignoring, isolating, corrupting and rejecting children can undermine their mental functioning, their personality development, their moral reasoning, their motivation and their ability to behave pro-socially” (2011).

 

Garbarino acknowledges that cultural and social values have great influence on how communities define and respond to emotional maltreatment. He writes, “the best definition of child maltreatment” is “acts of omission or commission by a parent or guardian that are judged by a mixture of community values and professional expertise to be inappropriate and damaging.” Garbarino’s goal is for communities and policymakers “to keep at the task of bringing social and cultural realities in line with our developing understanding of the basic needs - and thus human rights - of children to bodily integrity, to emotional and psychological safety, and to being nurtured.”

 

For several decades in multiple books and articles, Garbarino has discussed the cross-cultural effects of rejecting and shaming children, which is to increase aggression, conduct disorder, anti-social behavior and violence in childhood and adolescence. Research over many decades has found that caring for babies and other young children in institutional settings endangers their cognitive and emotional development and (often) their lives, given the negative effects of the lack of mothering on young children’s immune system. During the past 10-15 years, there has been an evolving consensus among scholars and child advocates that trauma and toxic stress developmentally harms children, regardless of the cultural context in which children live. However, policymakers and child advocates in many countries (including the U.S.) have pretty much ignored evidence that physical discipline of children is usually ineffective in suppressing misbehavior, and often increases unwanted aggressive behaviors. Cultures that permit – and even endorse – parenting practices called into question by developmental science seem to have no problem in ignoring research findings inconsistent with their social values.

 

More recent research regarding emotional maltreatment

 

In 2015, English, et al, published an article titled “Why should child welfare pay more attention to emotional maltreatment?” in Children and Youth Services Review. The study discussed in this article utilized a sample of 877 children from LONGSCAN, a longitudinal study of at-risk children from five sites around the country, including Seattle, that began in the mid 1990’s. Some, but not all, of these children had been reported to CPS before they were first assessed at age 4. Subsequent assessments were completed at ages 6, 8, 12, 14, 16 and 18.

 

This study divided emotional maltreatment into four subtypes:

 

  1.  Failure to support psychological safety and security (PSS)

  2.  Failure to promote acceptance and self-esteem (ASE)

  3.  Failure to allow age-appropriate autonomy

  4.  Restriction

 

These sub-types were broken down into 27 parenting behaviors. Some of the elements of PSS included ‘discipline through intimidation’, ‘threat of injury’, ‘extreme marital violence,’ and ‘abandonment’. Failure to promote acceptance and security included ‘ridicules child’, ‘rejection/inattentive to child’, ‘derogatory names’ and ‘negativity/hostility’. Failure to allow age appropriate autonomy included ‘prohibits age appropriate socialization’ and ‘places child in role reversal’. Restriction included ‘confinement/isolation’ and ’binding’.  

 

Trained “abstractors” coded CPS reports at each site using a classification system developed by Barnett and modified by LONGSCAN investigators. Thirty six percent of children in the sample had an allegation of emotional maltreatment (EMT) in a CPS report by age 18. Almost all (98%) of these children also had allegations of other forms of maltreatment:

 

  • Physical abuse (70%)

  • Sexual abuse (34%)

  • Neglect (89%)

 

Stand-alone allegations of EMT rarely occurred in this sample. Approximately two-thirds (64%) of allegations “were for behaviors that can be classified as “attacks” on children’s psychological safety and security,” (p.57). The largest percentage of allegations of PSS “were for exposing a child to extreme, unpredictable and/or inappropriate behaviors” such as violence toward other family members other than intimate partner violence. Only 8% of allegations were for exposure to extreme marital violence.  

 

Approximately one quarter (26%) of allegations of EMT fell into the Acceptance and Self Esteem (ASE) category. ‘Rejection’ accounted for only 4% of allegations in this study.  ‘Negativity/hostility’ was the most common allegation (9%) under ASE. Allegations of compromised Autonomy and Restriction comprised 11% of allegations in CPS reports.

 

Exposure to violence, threats of violence and intimidation appeared frequently in the CPS records of these children. The authors comment that

“These parental behaviors are not simply poor parenting skills of otherwise

adequate parents. The acts described in this study were egregious and harmful on multiple levels.” PSS predicted the following trauma symptoms: Anger/Irritability, Anxious Arousal, and Depression, as well as Suicidal Thoughts, Arrests, Cigarette Smoking and Illegal Drugs. ASE predicted Problem Drinking. Autonomy, “even with low base rates,” predicted Risky Sex. The authors comment that “These data suggest that EMT results in long term consequences …” (p.60).  

 

 

CPS responses to emotional maltreatment    

 

State child welfare systems have remarkably different ways of categorizing and reporting child maltreatment. Consider the following percentages of substantiated child victims classified under Psychological Maltreatment in Child Maltreatment 2017, the annual report on child maltreatment issued by the federal Administration for Children, Youth and Families.      

 

State                                   % of child victims substantiated          

                                             for psychological maltreatment  

 

Delaware                                       38.4%

Maine                                             34.4%

North Dakota                                39.8%

Rhode Island                                 35.3%

West Virginia                                 62.3%

Wyoming                                        30.4%                                

 

Alabama                                           0.4%

Idaho                                                   --

Illinois                                               0.2%

Maryland                                          0.1%

Vermont                                               --

Washington                                         --       

 

In 6 state child welfare systems, 30-62% of child victims were substantiated for Psychological Maltreatment, while 3 states, including Washington, classified no child victims under Psychological Maltreatment. Several other states had percentages of psychologically maltreated child victims at or less than 0.5%. Differences of this magnitude are highly unlikely to be due to incidence rates. This data almost certainly reflects differences in how child maltreatment is categorized, reported and (possibly) understood in various state child welfare systems.  At first glance, it appears that child protection systems in this country have very different ideas about how to define – or whether to define – emotional maltreatment in law and policy, and how to categorize incidents of maltreatment that have both physical and emotional dimensions.  

 

All child protection programs have “blind spots,” i.e., threats to child safety and well-being that CPS is unable to recognize, or purposely ignores, due to state law or policy, community standards or resource deficits. Common blind spots in child protection programs include adolescent abuse, youth homelessness, food insecurity that periodically leaves children and parents hungry and in danger of gradual starvation, sibling abuse and (in Washington State) witnessing domestic violence. However, to be unable to recognize emotional maltreatment in child protection is less like a blind spot than having lost vision in one eye, the eye that is sensitive to characteristics of the nurturing environment in families. Of course, it’s possible that substantiation practices do not accurately reflect casework practices; possible but unlikely. As a rule, conceptual frameworks shape practice. Why would a child welfare system that does not even recognize emotional maltreatment in its operational definitions of child maltreatment develop guidelines for responding to EMT? 

 

Why do some state child welfare systems refuse to recognize emotional maltreatment in their data systems and reporting practices? The answer may lie in the difficulty of articulating a threshold for EMT that separates this form of maltreatment from instances of emotional cruelty that occur in many families who never come to the attention of CPS. Like many readers (I assume), I grew up in an era when insults, ridicule, harassment, bullying, threats and other types of emotional cruelty were widespread in families, neighborhoods, schools and communities. In my childhood and adolescence, many of the behaviors listed in studies of EMT were perpetrated by siblings. The idea that any of this behavior could have been reported to and investigated by a government agency would have been viewed by community members as completely ridiculous! Possibly because incidents of emotional cruelty are so commonplace in families, agencies are reluctant to screen in reports of EMT that describe incidents, absent information regarding developmental effects on the child.  It is usually only after a child or youth has experienced large doses of EMT, and has been developmentally harmed in an extreme way, that EMT is recognized and responded to by CPS caseworkers, often during investigations of other forms of maltreatment.   

 

One approach CPS programs may take in responding to EMT is to develop lists of types incidents/events that warrant an immediate investigative response, absent information regarding patterns of parenting or developmental effects on a child. Such lists might begin with examples of terrorizing, shaming or corrupting children:

 

  • Threats of bodily harm, including threatening a child with a weapon

  • Harming or killing a family pet in the presence of a child

  • Locking a child in a closet or room for extended periods of time

  • Locking a child out of the house in inclement weather

  • Forcing a child to stand with arms raised for several hours

  • Teaching a child to steal, purchase or sell illegal drugs

  • Abandoning a young child in a public place such as a park or mall

  • Forcing a child to physically harm a younger sibling

 

It is usually easier to develop internal consensus about reports of incidents of EMT that will be screened in and investigated when alleged maltreatment has a physical component. Nevertheless, some alleged incidents of shaming or humiliating a child should receive a CPS response even if there is little or no chance of physical harm. Torture of   a child always includes demeaning and humiliating caregiving practices. Gabriel Fernandez, 8 years old, was tortured and killed by his mother and mother’s boyfriend in Los Angeles in 2013. During the months prior to his death, Gabriel was forced to wear girl’s clothes to school and eat his own vomit, along with other grotesque punishments. Deliberately shaming or humiliating a child should be viewed in child protection as a red flag for other safety threats.

 

EMT is internalized

 

Most inflicted physical injuries completely heal, or at least heal so that

physical functioning is not affected. However, emotional maltreatment has the potential to act like a psychic poison pill with a long shelf life. EMT, like all severe and/or chronic maltreatment, generates dysfunctional beliefs that undermine interpersonal relationships and the capacity to develop social skills, beliefs such as “people treat me like trash, so I must be trash,” or “the only time I’m safe is when other kids and adults are afraid of me,” or “if anyone knew my thoughts and feelings, they wouldn’t like me.” Beliefs of this type can mushroom into a world view which youth will seek to confirm despite the misery it brings them.

 

Mood disorders are an indication that one or more psychic “poison pills” are influencing mental/emotional functioning through obsessive, damaging self-talk.  Dysfunctional beliefs and attitudes cannot be eliminated with psychotropic medications or (solely) through behavior management programs, as important as it is to increase the behaviors of children that will lead to more frequent positive experiences. These beliefs must be repeatedly shown to be false in interpersonal relationships and/or in social institutions such as schools, athletic teams, churches, etc. It is difficult to convince children that their beliefs are false when they remain hidden or ignored. Dysfunctional beliefs must be made explicit though careful observation and frequent interaction with children. Caregivers such as foster parents and adoptive parents have   critical roles in discerning and invalidating children’s negative beliefs that cannot be delegated to therapists or other professionals.

 

Judith Herman in Trauma and Recovery (1992) articulated a perspective regarding recovery from trauma that also describes what’s required to ameliorate the effects of emotional maltreatment:

 

    Recovery can only take place in the context of relationships; it cannot     

    occur in isolation. In her renewed connections with other people, the

    survivor recreates the psychological faculties that were damaged or  

    deformed by the traumatic experience. These faculties include the

    basic capacities for trust, autonomy, initiative, competence, identity

    and intimacy. Just as these capabilities are originally formed in

    relationships with other people, they must be reformed in such

    relationships. 

 

The injurious messages of EMT must be countered rather than reinforced by foster care and other child welfare interventions.

 

References

 

English, D., Thompson, R., White, C. & Wilson, D. (2015). Why should child welfare pay more attention to emotional maltreatment?”, Children and Youth Services Review, 50, 53-63.

 

Garbarino, J., (2011). Not all bad treatment is psychological maltreatment, Child Abuse and Neglect, 35, 797-801. 

 

Herman, J., (1992). Trauma and Recovery: The aftermath of violence- from domestic abuse to political terror. Basic Books. ©

 

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