Child Abuse & Neglect 35 (2011) 866–875

Contents lists available at SciVerse ScienceDirect

Child Abuse & Neglect

How to deal with emotional abuse and neglect—Further development

a r t i c l e i n f o a b s t r a c t

Article history: Objective: To develop further the understanding of emotional abuse and neglect.
Received 26 June 2011 Methods: Building on previous work, this paper describes the further development of a
Received in revised form 5 August 2011 conceptual framework for the recognition and management of emotional abuse and neglect.
Accepted 13 August 2011
Training in this framework is currently being evaluated. The paper also briefly reviews more
Available online 19 October 2011
recent work on aspects of the definition, harm caused by emotional abuse and neglect and
threshold.
Keywords:
Emotional abuse
Results: The paper arrives at a working definition as ‘persistent, non-physical, harmful
Emotional neglect interactions with the child by the caregiver, which include both commission and omission.’
Psychological maltreatment There are many forms of harmful caregiver-child interactions, which can be placed in five
Definition categories, each category reflecting the fulfillment of one of the child’s basic psycho-social
Intervention needs and requiring a different therapeutic approach for its alleviation. The caregiver-child
relationship is embedded within a psycho-social context. It is suggested that greater
clarity can be gained about the child and family when information is sorted into the
appropriate tiers of concerns: Tier 0 – Social & environmental factors, Tier I – Caregiver
risk factors, Tier II – Caregiver-child interactions and Tier III – Child’s functioning. It is
further suggested that while intervention is required, this is directed towards protection,
rather than providing immediate protection of the child. The work takes the form of a
time-limited trial of therapeutic work to gauge the capacity of the caregivers to change.
This initial work focuses Tiers 0–II. Statutory steps might be required in order to encourage
the caregivers to engage. If insufficient progress is achieved, active child protection may be
required which might include placing the child in an alternative family. However, some,
usually older, children will remain in the emotionally abusive environment and they will
require ongoing help and support.
Conclusion: While a greater understanding of emotional abuse and neglect is now possible,
further evaluation of the utility of this framework is suggested.
© 2011 Elsevier Ltd. All rights reserved.

Introduction

Emotional abuse and neglect is a common form of child maltreatment and the second commonest in England (Department
for Education, 2010). Emotional abuse and neglect is a cause of substantial harm to the child’s functioning and development,
often extending into adult life (Hart, Binggeli & Brassard, 1998). Evidence for this has come from a number of cohort, follow
up and longitudinal studies which have used different ways to define or infer emotional abuse and neglect from harmful
parent child interactions. Despite these differences, they all show consistent associations between emotional abuse and
neglect in childhood and a wide range of emotional, behavioral, and cognitive difficulties in childhood (Erickson, Egeland,
& Pianta, 1989; Glaser, Prior, & Lynch, 2001), adolescence (Herrenkohl, Herrenkohl, Egolf, & Wu, 1991; Skuse et al., 1998)

∗ Corresponding author address: 33 Camden Square, London NW1 9XA, England, UK.

0145-2134/$ – see front matter © 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.chiabu.2011.08.002
 D. Glaser / Child Abuse & Neglect 35 (2011) 866–875 867

and adulthood (Briere & Runtz, 1990; Mullen, Martin, Anderson, Romans, & Herbison, 1996). Moreover, the harm may only
become apparent in adolescence or adulthood.
There are, however, a number of factors which continue to contribute to a sub-optimal professional response. Leaving
aside primary prevention, uncertainties about definitions (Baker, 2009) and thresholds continue to lead to delayed recogni-
tion. There is also lack of evidence for the systematic management of emotional abuse and neglect, let alone evaluation of
such an approach. The evidence base for therapeutic approaches is limited and includes working with the parents as well
as providing out of home placements for children whose parents are unable to care for them safely (Barlow & Schrader
McMillan, 2010; Macmillan et al., 2009). In 2002, a paper was published describing a conceptual framework for emotional
abuse (Glaser, 2002). In it, I discussed the elements of a definition, the issue of threshold, categories of maltreatment and the
harm caused. The current paper mentions briefly more recent published additions to our understanding of emotional abuse
and neglect and, building on the previous paper, it describes further developments of this particular conceptual framework
(FRAMEA). This leads to a clear pathway for professionals to follow in their endeavor to recognize and intervene in emotional
abuse and neglect.

Definitional issues

The name of the entity

One of the main difficulties regarding emotional abuse has been the issue of defining it. The entity goes by different
names in different countries, jurisdictions and in the literature. They include emotional abuse which may or may not include
emotional neglect, emotional neglect, psychological maltreatment (APSAC, 1995) and psychological abuse (O’Hagan, 1995).
This leads to uncertainty about which entity is being addressed (Baker, 2009). Consensus would now suggest that there is
insufficient justification to distinguish between the terms ‘psychological’ and ‘emotional’. It is, however, important to be
sure to include both omission (neglect) and abuse (commission). In England, the government guidance Working Together
(2010) refers to Emotional Abuse and to Neglect under two separate headings; emotional neglect is subsumed under the
general heading of Neglect, while in the USA psychological maltreatment includes both abuse and neglect.

Ill-treatment, impairment or both?

Under the English Children Act (1989) the term Significant Harm replaces child maltreatment. Significant Harm is defined
as Ill-treatment of the child and/or impairment of the child’s development which is attributable to the care given to the child,
or likely to be given to him. . .. not being what it would be reasonable to expect a parent to give to him. Brassard and Donovan
(2006) have reviewed the empirical evidence on the harmful effects (impairments) caused by different forms of psychological
maltreatment at different ages. These effects are also summarized in Hart et al. (2010). The effects on emotional development
and functioning include anxiety, unhappiness, depression and low self-esteem. Behavioral problems include oppositional
behavior, aggression, antisocial behavior, drug misuse, difficulty in affect regulation, and eating disorders. Interpersonal
relationships are affected adversely with development of insecure or disorganized attachments, social isolation, and low
empathy. Learning is impaired with educational underachievement. Physical symptoms include disordered growth patterns,
faecal soiling, and non-organic pains. A definition of emotional abuse and neglect cannot rely solely on evidence of harm
to the child, since all the aspects of harm caused by emotional abuse and neglect could also be attributable to causes other
than ill-treatment.
The American Professional Society on Abuse of Children (APSAC, 1995) guidelines on psychological maltreatment use a
broad definition: “‘Psychological maltreatment’ means a repeated pattern of caregiver behavior or extreme incident(s) that
convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another’s
needs”. This definition refers to the nature of the harmfulness of the behaviors, but not to evidence of harm. The definition
of emotional abuse in England’s Working Together (2010) refers to ‘persistent emotional maltreatment of a child such as to
cause severe and persistent adverse effects on the child’s emotional development’. The wording ‘such as’ characterizes the
nature of the maltreatment rather than indicating the need for evidence of the harm. Thus, both of these guidelines rely on
the harmful interactions with the child (ill-treatment) as being sufficient to define psychological maltreatment or emotional
abuse and neglect.
However, Slep and Heyman (2006) suggest that an operational definition needs to include evidence of actual or likely
harm to the child as well as a ‘caregiver act’ (excluding physical and sexual abusive acts). This may be in deference to the
legal arena where there continues to be a tendency to require evidence of actual harm to the child before emotional abuse
and neglect is accepted as being a cause warranting legally mandated intervention. Baker (2009) provides legal definitions
from numerous US most of which rely on impact on the child rather than the maltreatment causing it. Baker also cites
several non-legal definitions which include actual harm to the child. There is thus less agreement about the extent to which
evidence of actual harm to the child is required in addition to evidence of ill-treatment.
For a number of reasons, it is not possible to predict the nature of the harm which will affect individuals in childhood
and adulthood following emotional abuse and neglect. It is clear that not all children and adults who experienced emotional
abuse and neglect will present with all of the difficulties mentioned above and, as with child sexual abuse, there is no
post-emotional abuse and neglect syndrome. Indeed, some children remain resilient to the potentially harmful effects, this