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Emotional, Behavioral, and Developmental Features Indicative of Neglect or Emotional Abuse in Preschool Children A Systematic Review

Aideen Mary Naughton, MB, BCh, BAO, DCH, FRCPCH1; Sabine Ann Maguire, MRCPCh, FRCPI2; Mala Kanthi Mann, MIInfSc, MCLIP3; Rebecca Caroline Lumb, BA2,5; Vanessa Tempest, BScEcon, MA, GDL/CPE, PgDChild2; Shirley Gracias, MBChB, DCH, MRCPsych4; Alison Mary Kemp, MRCP, FRCPCH2,6
[+] Author Affiliations
1Safeguarding Children Service, Public Health Wales, National Health Service Trust, Cardiff
2School of Medicine, Cardiff University, Cardiff, Wales
3Support Unit for Research Evidence, Cardiff University, Cardiff, Wales
4Families Inc CIC, Wilshire, England
5currently with Department of Mathematics, London School of Economics and Political Science, London, England
6currently with the School of Medicine, Cardiff University, Cardiff
JAMA Pediatr. 2013;167(8):769-775. doi:10.1001/jamapediatrics.2013.192.
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Importance  Early intervention for neglect or emotional abuse in preschoolers may mitigate lifelong consequences, yet practitioners lack confidence in recognizing these children.

Objective  To define the emotional, behavioral, and developmental features of neglect or emotional abuse in preschoolers.

Evidence Review  A literature search of 18 databases, 6 websites, and supplementary searching performed from January 1, 1960, to February 1, 2011, identified 22 669 abstracts. Standardized critical appraisal of 164 articles was conducted by 2 independent, trained reviewers. Inclusion criteria were children aged 0 to 6 years with confirmed neglect or emotional abuse who had emotional, behavioral, and developmental features recorded or for whom the carer-child interaction was documented.

Findings  Twenty-eight case-control (matched for socioeconomic, educational level, and ethnicity), 1 cross-sectional, and 13 cohort studies were included. Key features in the child included the following: aggression (11 studies) exhibited as angry, disruptive behavior, conduct problems, oppositional behavior, and low ego control; withdrawal or passivity (12 studies), including negative self-esteem, anxious or avoidant behavior, poor emotional knowledge, and difficulties in interpreting emotional expressions in others; developmental delay (17 studies), particularly delayed language, cognitive function, and overall development quotient; poor peer interaction (5 studies), showing poor social interactions, unlikely to act to relieve distress in others; and transition (6 studies) from ambivalent to avoidant insecure attachment pattern and from passive to increasingly aggressive behavior and negative self-representation. Emotional knowledge, cognitive function, and language deteriorate without intervention. Poor sensitivity, hostility, criticism, or disinterest characterize maternal-child interactions.

Conclusions and Relevance  Preschool children who have been neglected or emotionally abused exhibit a range of serious emotional and behavioral difficulties and adverse mother-child interactions that indicate that these children require prompt evaluation and interventions.

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