Parent-child interaction: systematic review

Child Protection Evidence is a resource for clinicians across the UK and internationally to inform clinical practice, child protection procedures and professional and expert opinion in the legal system.

Summary

This systematic review evaluates the scientific literature on parent-child interactions published up until October 2014 and reflects the findings of eligible studies. The review aims to answer the following clinical question:

    • What are the features of parent-child interactions amongst neglected and/or emotionally abused children aged 0-14 years?

Key findings:

    • Only two studies to date have addressed emotional maltreatment.
    • All practitioners involved with children have the opportunity to observe parent-child interactions. Children who experience poor parent-child interactions may fail to develop a secure attachment relationship with their parent, which can lead to long-term social and psychological problems. While neglect is a failure to provide adequate care, there are identifiable features in the interaction between neglected and/or emotionally abused children and their care-givers

This systematic review evaluates the scientific literature on parent –child interactions up until October 2014 and reflects the findings of eligible studies. This literature predominantly relates to children less than six years of age. The review aims to answer the following clinical question:

    • What are the features of parent-child interactions amongst neglected and/or emotionally abused children aged 0-14 years?

This Parent-Child interaction review used the methodology and tools from the early years neglect and School-Age neglect reviews.

To summarise, a literature search was performed using a number of databases for all original articles and conference abstracts published since 1960. Supplementary search techniques were used to identify further relevant references. See Appendix 1 for full methodology including search strategy and inclusion criteria.

Potentially relevant studies underwent full text screening and critical appraisal. To ensure consistency, ranking was used to indicate the level of confidence that abuse had taken place and also for study types.

    • 27 studies (28 articles) addressed this question1-28
    • These 27 studies all met our inclusion criteria (early years / school aged neglect) and quality ranking of confirmation of neglect / emotional abuse (early years / school aged neglect)
    • Two articles were published on the same study25,26
    • We wished to identify features in the primary carer-child relationship; unfortunately there are still no studies relating to fathers in the context of early neglect, thus this review addresses solely mother-child interactions.
    • Age: Due to the varying ages encompassed in the studies, results are grouped by mean age; it was not possible to separate smaller age bands between 6 and 14 years
    • Gender: One study analysed the results by the gender of the child but found no difference1
    • Two studies included fathers, but no study analysed the father-child relationship specifically3,16

Influence of ethnicity and socio-economic group

    • Among the included studies, 25/27 of the study populations were well-matched for ethnicity, maternal education, socio-economic grouping (insurance status for North American studies) and maternal age. In one study the maltreated mothers had lower educational attainment and were younger than the control mothers25,26

1.1. Features of the parent-child interaction (neglect / emotional abuse)

Mean age 0-17 months

    • The parents of the youngest children were not attuned to the infants and provided inconsistent attention
    • The mothers used fewer commands and gave less positive feedback to their babies4
    • The mothers lacked sensitivity5 and were uninvolved with the infants6,7, providing little in the way of stimulation or positive interactions8,22
    • In response to the infant cues, mothers were either unpredictable and inconsistent18 or became extremely wound up by infant crying13
    • The mothers perceived their infants as being irritating and demanding5

Mean age 18 months – 3 years

    • Amongst the toddlers, the mothers remain withdrawn and uninvolved 4,5 or lacking attunement or competence interacting with the children12,20
    • They may either ignore the child’s cues for help or criticize the child17,21 or may in fact make no effort to relieve their child’s distress19
    • Parenting style within this age group was lacking in affection23, empathy24 or was controlling and hostile25,26
    • On measuring regulatory capacity in the form of respiratory sinus arrhythmia (RSA) the neglected child showed lower RSA levels while interacting with their mothers to complete a challenging task compared to controls26
    • The mothers were unresponsive to changes in the babies facial expressions24
    • Neglected children did not show any more negative reactivity than non-maltreated controls28

Mean age 4-5 years

    • In one study there was no difference between neglected children and controls in a structured play task1
    • The mother-child interaction in this age group is characterized by a low level of utterances between mother and child2,10,14
    • The parents are verbally aggressive in their disciplining of the child11,14
    • The neglectful mothers showed less positive parenting and more strict hostile control than non-maltreating mothers. The neglectful mothers showed a greater variation in positive parenting over time25
    • The children’s perception is that their parents are unlikely to relieve their distress19, and are not perceived as loving by the child27

Mean age 6-14 years

    • Mothers self-reported that they were so caught up in themselves, they were unable to show or tell their child that they loved him / her20
    • The neglectful parents are more negative towards their children, demonstrating fewer positive behaviours with the child and giving more commands in comparison to controls3
    • In a comparison of two-parent and single-mother households, there was no difference in the level of positive interaction between neglectful mothers and their children16
    • The neglectful single mothers showed more negative interaction than neglectful mothers in two-parent households16
    • Neglectful mothers are less likely to talk to their children about emotional experiences in an appropriate way9
    • The children perceived their mothers as less likely to be supportive when they express emotions, particularly anger9
    • An evaluation of emotionally neglectful parents demonstrated that they were lacking in mutual attunement. In addition, these parents were more demanding and showed less support or involvement with their children15

1.2. Implications for practice

    • Careful observation and documentation of the parent-child interactions is an essential element in the recognition of the emotionally abused / neglected pre-school child
    • It is a significant omission from the scientific literature that no studies have been conducted on neglect / emotional abuse between fathers and young children
    • When evaluating children for possible neglect / emotional abuse, it is essential to obtain detailed reports from all those working with the family, including nursery nurses, health visitors, playschool teachers, etc
    • It is important to determine the child’s perception and expectations of their parents and what the parents view of their child is

1.3. Research implications

    • There is an urgent need to conduct studies relating to neglect / emotional abuse of children by fathers, and to include the role of fathers in evaluating maternal neglect / emotional abuse
    • Studies of neglect / emotional abuse in an international context outside North America would be of value as parenting practises differ widely across different cultures and are not currently represented in the literature (25/27 studies were conducted in the USA, one in Denmark and one in Spain)
    • Future studies should incorporate naturalistic observations of primary carer-child interactions in addition to laboratory-based assessments
    • There is a dearth of literature regarding parent-child interactions in children of school-age

1.4. Limitations of review findings

    • The included studies of carer-child interactions were predominantly based on mother-child interactions
    • Although many authors attempted to separate children suffering from neglect from those with mixed neglect and abuse, it is possible that some subjects will have experienced multiple forms of maltreatment
    • The included studies predominantly related to neglect, and there are far fewer studies relating to emotional maltreatment (only two studies addressed emotional maltreatment)

The review identified a number of interesting findings that were outside of the inclusion criteria. These are as follows:

Clinical question 1

Interventions

    • Interventions to improve parenting and increase sensitivity of mothers to their infants29

Indicators for neglect in parents

    • A systematic review of how neglected children and their parents indicate their needs30
    • A comparison of parent-child interaction as measured by the global rating scale (GRS) versus health visitors subjective assessment showed that the latter focussed on maternal attributes more than the infant behaviour, those who did address the infant features had a higher correlation with the GRS31
    • Paternal depression when a child was 3-years old was associated with increased odds of child neglect at age 5 [adjusted odds ratio: 1.94 (95% confidence interval: 1.18–3.19); P < .01]. This was independent of maternal and other risk factors32

To date there are no studies that have been carried out as a result of this review.

This Parent-Child interaction review used the methodology and tools from the early years neglect and School-Age neglect reviews.

This review aims to document the features observable in the parent-child interactions amongst children aged 0-14 who have been neglected or emotionally abused. To date, we have conducted two systematic reviews on the features in the child indicative of neglect and/or emotional abuse; our Early Years Neglect review, which includes data on children aged 0-6 and our School-Age Neglect review, which includes data on children aged 6-14. We were able to identify additional studies which include parent-child interaction data on children spanning both of these age ranges.

Inclusion criteria

Early years neglect

 

Inclusion Exclusion
Children aged 0-5 completed years Studies of sexual abuse
Documented features of the impact of neglect on the child during the period of exposure to neglect Studies of physical abuse alone, or studies combining physical abuse and neglect, where the data from the neglect cases could not be extracted
Studies conducted in Organisation for Economic Co-operation and Development countries Studies of management or complications of neglect
Child / carer interaction documented using standardized recording Studies addressing risk factors for neglect
Studies of the interaction between the child and their primary carer
Confirmation of neglect ranks A- C2

School age neglect

 

Inclusion Exclusion
Children aged 5-14 completed years (studies included if majority of cases fall within 6 to 12 completed years) Studies of physical or sexual abuse alone, or studies combining physical or sexual abuse and neglect / emotional abuse, where the data from the neglect/ emotional abuse cases could not be extracted
Documented features of the impact of neglect / emotional abuse on the child during the period of exposure to neglect / emotional abuse Studies relating to secondary carer, either exclusively or where relevant data relating to primary carer cannot be extracted
Confirmed cases of neglect / emotional abuse (A-C Quality Standards for Confirmation of Neglect / Emotional Abuse) Studies of management or complications of neglect
Studies conducted in Organisation for Economic Co-operation and Development countries Studies addressing outcomes of neglect
Studies with no data or documentation relating to the impact on the child (emotional, behavioural, psychological, developmental)
Single case studies or case series of fewer than three cases, formal consensus articles, expert opinions, personal practice, review articles, systematic reviews
Neglect / emotional abuse defined by unreferenced criteria / tool, not specified in our standards (D Quality Standards for Confirmation of Neglect / Emotional Abuse)

Confirmation of neglect

 

Ranking Criteria used to define neglect
A1 Neglect/emotional abuse confirmed at child protection case conference, multi-disciplinary assessment, including social services or Court proceedings
A2 Diagnosis of emotional neglect/emotional abuse by clinical psychologist, psychiatrist or other mental health specialist
B Neglect/emotional abuse confirmed by referenced criteria/tool
C1 Neglect/emotional abuse confirmed by unreferenced criteria/tool
C2 Observations of emotionally harmful carer-child interaction (not categorized as neglect/emotional abuse)
D Neglect/emotional abuse/harmful carer-child interaction suspected or stated, with no supporting detail

Search strategy

The below table presents the search terms used in the 2014 Medline database search for early years neglect, truncation and wildcard characters were adapted to the different databases where necessary.

 

1. exp Child/

2. exp Child Preschool/

3. exp Infant, Newborn/

4. exp Infant/

5. infancy.ti,ab.

6. child*.ti,ab.

7. infant*.ti,ab.

8. (baby or babies).ti,ab.

9. toddler*.ti,ab.

10. neonat*.ti,ab.

11. (pediatric* or paediatric*).ti,ab.

12. or/1-11

13. limit 12 to (“all infant (birth to 23 months)” or “newborn infant (birth to 1 month)” or “infant (1 to 23 months)” or “preschool child (2 to 5 years)”)

14. (pre-school* or preschool* or preschool-age Child*).ti,ab.

15. 13 or 14

16. (abus* adj neglect*).ti,ab.

17. (maltreat* or mistreat* or deprive* or ignor*).mp.

18. neglected.ti,ab.

19. neglectful.ti,ab.

20. psychological neglect.ti,ab.

21. ((lack* or absen* or fail*) adj3 (care* or childcare)).ti,ab.

22. ((social* or emotional* or psychosocial* or contact or psychological*) adj3 (deprived or deprivation)).ti,ab.

23. overlook*.ti,ab.

24. neglect* psychological*.ti,ab.

25. emotion* neglect*.ti,ab.

26. emotion* abus*.ti,ab.

27. emotion* harm*.ti,ab.

28. child neglect.ti,ab.

29. neglect* child*.ti,ab.

30. emotion* depriv*.ti,ab.

31. emotional trauma.ti,ab.

32. ((neglect* or ignore or deprive*) adj1 (psychologic* or emotion*)).ti,ab.

33. or/16-32

34. Failure to Thrive/

35. (failure to thrive adj5 (emotion* or nonorganic or non-organic)).ti,ab.

36. (failure to thrive adj5 (abus* or neglect* or maltreat* or mistreat* or depriv* or psych)).ti,ab.

37. ((fail* or inadequa*) adj2 emotional support).ti,ab.

38. (unkempt or ungroomed).ti,ab.

39. Psychosocial Deprivation/

40. unhealthy appearance?.ti,ab.

41. exp Internal-External Control/

42. (internal* adj3 extem*).ti,ab.

43. (anxiety or anxious* or anguish*).ti,ab.

44. (withdrawn or apath*).ti,ab.

45. (indifferen* or disinterest*).ti,ab.

46. ((lack* or low or flat*) adj3 (affect or emotion*)).ti,ab.

47. (clingy or clinginess).ti,ab.

48. ((attention or affection* or love) adj3 (inappropriate* or improper* or unsuitabl*)).ti,ab.

49. ((mental or psychological* or emotional*) adj3 (stress* or distress*)).ti,ab.

50. internali?ation.ti,ab.

51. Irritable Mood/

52. ((emotion* or affect*) adj3 (labil* or regulat*)).ti,ab.

53. (aloof or avoid*).ti,ab.

54. Shyness/

55. ((avoid* or withdraw*) adj3 (contact or touch* or physical*)).ti,ab.

56. ((avoid* or withdraw*) adj3 social*).ti,ab.

57. unsociable.ti,ab.

58. ((lack or poor* or avoid*) adj3 communicat*).ti,ab.

59. (watchful or wary or vigilan*).ti,ab.

60. (unhappiness or unhappy).ti,ab.

61. (overly responsible or perfectionis*).ti,ab.

62. “ATTENTION DEFICIT and DISRUPTIVE BEHAVIOR DISORDERS”/

63. Conduct Disorder/

64. Aggression/

65. ((aggression or aggressive*) adj3 (behavio* or escalat*)).ti,ab.

66. acting out.ti,ab.

67. out of control.ti,ab.

68. ((chaotic* or challenging) adj3 behavio*).ti,ab.

69. (bully* or bullie?).ti,ab.

70. Anger/

71. ((destructive* or disruptive*) adj3 behav*).ti,ab.

72. Impulsive Behavior/

73. impulse control.ti,ab.

74. (impulsive* or impulsivity or impulse control).ti,ab.

75. Developmental Disabilities/

76. Child Development/

77. Child Behavior/

78. Infant Behavior/

79. Personality Development/

80. ((chang* or alter* or deviat* or transition?) adj3 personality).ti,ab.

81. Helplessness, Learned/

82. sad.ti,ab.

83. Social Behavior/

84. Attention Deficit Disorder with Hyperactivity/

85. avoidant attention.ti,ab.

86. (normative adj3 avoidance).ti,ab.

87. (abandoned or abandonment?).ti,ab.

88. psychological neglect.ti,ab.

89. ((lack* or absen* or fail*) adj3 (care* or childcare)).ti,ab.

90. ((social* or emotional* or psychosocial* or contact or psychological*) adj3 (deprived or deprivation)).ti,ab.

91. “lack of supervison”.ti,ab.

92. unsupervised.ti,ab.

93. (temper or hostil* pr hypervigilan*).ti,ab.

94. Child Behavior Disorders/

95. (rage of raging or rageful).ti,ab.

96. attun*.ti,ab.

97. Nonverbal Communication/

98. Sensory integration.mp.

99. Dissociat*.ti,ab.

100. *”Dissociative Disorders”/

101. Dysregulation.mp.

102. Affect mirroring.mp.

103. *”Facial Expression”/

104. Mind-mindedness.mp.

105. Object Attachment/

106. attachment.ti,ab.

107. persecut*.ti,ab.

108. Speech delay.mp.

109. Language delay.mp.

110. Language Disorders/

111. Perspective taking.mp.

112. Demanding.mp.

113. Poor concentration.ti,ab.

114. listless*.mp.

115. Isolated.mp.

116. *”Social Isolation”/

117. Inhibited.mp.

118. Reactive Attachment Disorder/

119. Disinhibited.mp.

120. Social skills.mp.

121. Emotional skills.mp.

122. False positive affect.mp.

123. touch sensitive.mp.

124. Apparent compliance.mp.

125. Language comprehension deficit.mp.

126. Grasp of reality.mp.

127. Immatur*.ti,ab.

128. impatien*.ti,ab.

129. Socialization/

130. cognitive delay.mp.

131. cognitive* stimulat*.ti,ab.

132. attachment disorder.mp.

133. eye contact.ti,ab.

134. *Stress, Psychological/

135. stunting of growth.mp.

136. stunt* growth.mp.

137. Hospitalism.ti,ab.

138. environmental retardation.ti,ab.

139. affect deprivation.ti,ab.

140. emotional* depriv*.ti,ab.

141. or/34-140

142. 15 and 33 and 141

143. Family/

144. Mother-Child Relations/

145. Maternal Behavior/

146. Parent-Child Relations/

147. ((parent* or mother or father or maternal or paternal or carer*) adj3 (depression or depressed or depressive or dysthymi? or dysphori?)).ti,ab.

148. ((parent* or mother or father or maternal or paternal or carer*) adj3 mood disorder*).ti,ab.

149. ((parent* or mother or father or maternal or paternal or carer*) adj3 negative mood).ti,ab.

150. ((parent* or mother or father or maternal or paternal or carer*) adj3 partner violence).ti,ab.

151. ((parent* or mother or father or maternal or paternal or carer*) adj3 (anger or angry or angst or rage)).ti,ab.

152. ((parent* or mother or father or maternal or paternal or carer*) adj3 depress*).ti,ab.

153. ((parent* or mother or father or maternal or paternal or carer*) adj3 emotion*).ti,ab.

154. ((parent* or mother or father or maternal or paternal or carer*) adj3 substance abuse).ti,ab.

155. ((parent* or mother or father or maternal or paternal or carer*) adj3 domestic violence).ti,ab.

156. ((parent* or mother or father or maternal or paternal or carer*) adj3 punitive).ti,ab.

157. ((parent* or mother or father or maternal or paternal or carer*) adj3 unavailab*).ti,ab.

158. ((parent* or mother or father or maternal or paternal or carer*) adj3 (instab* or unstab*)).ti,ab.

159. Learning disability/ or Learning disability.mp.

160. (spouse or partner).mp.

161. (Interpersonal violence or IPV).mp.

162. Psychologica* unavailab*.mp.

163. Emotion* inatten*.mp.

164. Emotion* unattach*.mp.

165. Authoritative.mp.

166. Disengaged.mp.

167. Emotion* unavailab*.mp.

168. ((Parent* or mother or father or maternal or paternal) adj1 anger).ti,ab.

169. Rough handl*.mp.

170. Unresponsiv*.mp.

171. Non-physical punishment.mp.

172. “Family Relations”/

173. Interpersonal Relations/

174. (child* adj3 (mock* or taunt* or denigrat* or threat* or hostil*)).mp.

175. Inappropriate expectation*.mp.

176. inappropriate development.mp.

177. (over-protective or over protective*).ti,ab.

178. *”Parenting”/

179. (dysfunctional family or family dysfunction).ti,ab.

180. “Rejection (Psychology)”/

181. Negative attribution*.mp.

182. High criticism.mp.

183. parent* unresponsiv*.mp.

184. Child Rearing/

185. family interact*.ti,ab.

186. home environment*.ti,ab.

187. Neglect* mother*.ti,ab.

188. over* critical.ti,ab.

189. (families or family or dyad).ti,ab.

190. or/143-189

191. 15 and 33 and 190

192. assessment.mp.

193. Diagnosis/

194. diagnostic tool.mp.

195. assessment tool.mp. or “Severity of Illness Index”/

196. Needs Assessment/

197. graded care profile.mp.

198. (identification or identify).ti,ab.

199. Pattern Recognition, Visual/

200. detect*.ti,ab.

201. Classification/

202. Decision Making/

203. Early Diagnosis/

204. screening.mp. or Mass Screening/

205. “Risk Factors”/

206. HOME inventory.mp.

207. Risk Assessment/

208. Risk/

209. or/192-208

210. 15 and 33 and 209

211. Environment/

212. Hostile atmosphere.mp.

213. Environment Design/

214. depriv*.ti,ab.

215. chao*.ti,ab.

216. “Play and Playthings”/

217. Absence of toys.mp.

218. Absence of play.mp.

219. Absence of stimulation.mp.

220. home.ti,ab.

221. buggy.mp.

222. “Walkers”/

223. Infant Equipment/

224. (pram or pushchair).mp.

225. stroller.mp.

226. ((view* or watch*) adj3 television).ti,ab.

227. Social Environment/

228. or/211-227

229. 15 and 33 and 228

230. 142 or 191 or 210 or 229

231. Stress Disorders, Post-Traumatic/

232. sexual abuse.mp. or Sex Offenses/

233. “Child Abuse, Sexual”/

234. (Algeria$ or Egypt$ or Liby$ or Morocc$ or Tunisia$ or Western Sahara$ or Angola$ or Benin or Botswana$ or Burkina Faso or Burundi or Cameroon or Cape Verde or Central African Republic or Chad or Comoros or Congo or Djibouti or Eritrea or Ethiopia$ or Gabon or Gambia$ or Ghana or Guinea or Keny$ or Lesotho or Liberia or Madagasca$ or Malawi or Mali or Mauritania or Mauritius or Mayotte or Mozambiq$ or Namibia$ or Niger or Nigeria$ or Reunion or Rwand$ or Saint Helena or Senegal or Seychelles or Sierra Leone or Somalia or South Africa$ or Sudan or Swaziland or Tanzania or Togo or Ugand$ or Zambia$ or Zimbabw$ or China or Chinese or Hong Kong or Macao or Mongolia$ or Taiwan$ or Belarus or Moldov$ or Russia$ or Ukraine or Afghanistan or Armenia$ or Azerbaijan or Bahrain or Cyprus or Cypriot or Georgia$ or Iran$ or Iraq$ or Israel$ or Jordan$ or Kazakhstan or Kuwait or Kyrgyzstan or Leban$ or Oman or Pakistan$ or Palestin$ or Qatar or Saudi Arabia or Syria$ or Tajikistan or Turkmenistan or United Arab Emirates or Uzbekistan or Yemen or Bangladesh$ or Bhutan or British Indian Ocean Territory or Brunei Darussalam or Cambodia$ or India$ or Indonesia$ or Lao or People’s Democratic Republic or Malaysia$ or Maldives or Myanmar or Nepal or Philippin$ or Singapore or Sri Lanka or Thai$ or Timor Leste or Vietnam or Albania$ or Andorra or Bosnia$ or Herzegovina$ or Bulgaria$ or Croatia$ or Estonia or Faroe Islands or Greenland or Liechtenstein or Lithuani$ or Macedonia or Malta or maltese or Romania or Serbia$ or Montenegro or Slovenia or Svalbard or Argentina$ or Belize or Bolivia$ or Brazil$ or chile or Chilean or Colombia$ or Costa Rica$ or Cuba or Ecuador or El Salvador or French Guiana or Guatemala$ or Guyana or Haiti or Honduras or Jamaica$ or Nicaragua$ or Panama or Paraguay or Peru or Puerto Rico or Suriname or Uruguay or Venezuela or developing countr$ or south America$).ti,sh.

235. “Africa South of the Sahara”/

236. or/231-235

237. 230 not 236

238. limit 237 to yr=”2013 – 2014″

The below table presents the search terms used in the 2014 Medline database search for school-aged neglect.

 

1. exp child/

2. child*.mp.

3. school age child*.mp.

4. pupil.tw.

5. (pediatric* or paediatric*).tw.

6. school child*.tw.

7. Middle childhood.mp.

8. or/1-7

9. exp Schools/

10. exp Education, Special/

11. special education.mp.

12. Elementary school*.tw.

13. Junior high school*.tw.

14. middle school.mp.

15. Primary school.mp.

16. Key Stage 1.mp.

17. Key Stage 2.mp.

18. Key Stage 3.mp.

19. or/9-18

20. (or/9-18) and 8

21. 8 or 20

22. (abus* adj neglect*).tw.

23. (maltreat* or mistreat* or deprive* or abandon*).mp.

24. neglected.ti,ab.

25. neglectful.ti,ab.

26. neglect.tw.

27. ((lack* or absen* or fail*) adj3 care*).tw.

28. neglect* psychological*.tw.

29. emotion* neglect*.ti,ab.

30. emotion* abus*.ti,ab.

31. emotion* harm*.ti,ab.

32. child neglect.ti,ab.

33. neglect* child*.ti,ab.

34. emotion* depriv*.ti,ab.

35. emotional trauma.ti,ab.

36. Psychological maltreat*.tw.

37. ((neglect* or deprive*) adj1 (psychologic* or emotion*)).tw.

38. Supervis* neglect.tw.

39. parental supervision.tw.

40. unsupervised.tw.

41. lack of supervision.tw.

42. (lack adj3 supervision).tw.

43. psychological neglect.tw.

44. medical neglect.mp.

45. Nutrition* neglect.mp.

46. physical neglect.mp.

47. (neglect* adj3 (care or medical or physical or psychological or supervisory or emotional or educational)).tw.

48. ((noncompliance or poor compliance) adj3 (treatment or therapy or intervention)).tw.

49. (failure to comply adj3 (treatment or therapy or intervention)).tw.

50. (educat* adj3 (failure or neglect)).mp.

51. inadequate supervision.tw.

52. or/22-51

53. Failure to Thrive/

54. (failure to thrive adj5 (emotion* or nonorganic or non-organic)).ti,ab.

55. (failure to thrive adj5 (abus* or neglect* or maltreat* or mistreat* or depriv* or psych)).ti,ab.

56. ((fail* or inadequa*) adj2 emotional support).ti,ab.

57. (unkempt or ungroomed).ti,ab.

58. Psychosocial Deprivation/

59. unhealthy appearance?.ti,ab.

60. exp Internal-External Control/

61. (internal* adj3 extem*).ti,ab.

62. (anxiety or anxious* or anguish*).ti,ab.

63. (withdrawn or apath*).ti,ab.

64. (indifferen* or disinterest*).ti,ab.

65. ((lack* or low or flat*) adj3 (affect or emotion*)).ti,ab.

66. (clingy or clinginess).ti,ab.

67. ((attention or affection* or love) adj3 (inappropriate* or improper* or unsuitabl*)).ti,ab.

68. ((mental or psychological* or emotional*) adj3 (stress* or distress*)).ti,ab.

69. internali?ation.ti,ab.

70. Irritable Mood/

71. ((emotion* or affect*) adj3 (labil* or regulat*)).ti,ab.

72. (aloof or avoid*).ti,ab.

73. depressive symptom*.tw.

74. Shyness/

75. ((avoid* or withdraw*) adj3 (contact or touch* or physical*)).ti,ab.

76. ((avoid* or withdraw*) adj3 social*).ti,ab.

77. (unsociable or lying or cheat*).tw.

78. ((lack or poor* or avoid*) adj3 communicat*).ti,ab.

79. (watchful or wary or vigilan*).ti,ab.

80. (unhappiness or unhappy).ti,ab.

81. (overly responsible or perfectionist*).ti,ab.

82. “ATTENTION DEFICIT and DISRUPTIVE BEHAVIOR DISORDERS”/

83. Conduct Disorder/

84. Aggression/

85. ((aggression or aggressive*) adj3 (behavio* or escalat*)).ti,ab.

86. acting out.ti,ab.

87. out of control.ti,ab.

88. ((chaotic* or challenging) adj3 behavio*).ti,ab.

89. (bully* or bullie?).ti,ab.

90. Anger/

91. ((destructive* or disruptive*) adj3 behav*).ti,ab.

92. Impulsive Behavior/

93. impulse control.ti,ab.

94. (impulsive* or impulsivity or impulse control).ti,ab.

95. Developmental Disabilities/

96. Child Development/

97. Child Behavior/

98. Infant Behavior/

99. Personality Development/

100. ((chang* or alter* or deviat* or transition?) adj3 personality).ti,ab.

101. Helplessness, Learned/

102. sad.ti,ab.

103. Social Behavior/

104. Attention Deficit Disorder with Hyperactivity/

105. avoidant attention.ti,ab.

106. (normative adj3 avoidance).ti,ab.

107. (abandoned or abandonment?).ti,ab.

108. ((social* or emotional* or psychosocial* or contact or psychological*) adj3 (deprived or deprivation)).ti,ab.

109. (temper or hostil* pr hypervigilan*).ti,ab.

110. Child Behavior Disorders/

111. (rage of raging or rageful).ti,ab.

112. Nonverbal Communication/

113. Sensory integration.mp.

114. Dissociat*.ti,ab.

115. *”Dissociative Disorders”/

116. Affect mirroring.mp.

117. *”Facial Expression”/

118. Mind-mindedness.mp.

119. Object Attachment/

120. attachment.ti,ab.

121. persecut*.ti,ab.

122. Speech delay.mp.

123. Language delay.mp.

124. Language Disorders/

125. Perspective taking.mp.

126. Demanding.mp.

127. Poor concentration.ti,ab.

128. listless*.mp.

129. Delinquen*.tw.

130. Isolated.mp.

131. *”Social Isolation”/

132. Inhibited.mp.

133. Reactive Attachment Disorder/

134. Disinhibited.mp.

135. Social skills.mp.

136. Depression/

137. False positive affect.mp.

138. touch sensitive.mp.

139. Apparent compliance.mp.

140. Language comprehension deficit.mp.

141. Grasp of reality.mp.

142. Immatur*.ti,ab.

143. impatien*.ti,ab.

144. Socialization/

145. cognitive delay.mp.

146. cognitive* stimulat*.ti,ab.

147. attachment disorder.mp.

148. eye contact.ti,ab.

149. *Stress, Psychological/

150. stunting of growth.mp.

151. stunt* growth.mp.

152. Hospitalism.ti,ab.

153. environmental retardation.ti,ab.

154. affect deprivation.ti,ab.

155. emotional* depriv*.ti,ab.

156. Hostility/

157. hostile behaviour.tw.

158. risk?taking.mp.

159. psychosocial disorder*.mp.

160. alcohol misuse.mp.

161. substance misuse.mp.

162. Smoking/

163. truancy.mp.

164. (indiscriminate adj3 (familiarity or socialism or attachment)).tw.

165. indiscriminate friendliness.mp.

166. Juvenile Delinquency/

167. (anti social or antisocial or anti-social).mp.

168. Self Concept/

169. self esteem.tw.

170. self confidence.tw.

171. emotional recognition.tw.

172. emotional dysregulation.tw.

173. (dysregulation adj3 emotion*).tw.

174. attention seeking.tw.

175. (Sociali?ation adj3 behavio?r).tw.

176. (emotional adj2 (skills or literacy or intelligence)).mp.

177. (cognitive adj2 (impairment or deficit)).tw.

178. Bullying/

179. bullying.tw.

180. peer interaction.tw.

181. peer acceptance.mp.

182. Intelligence/

183. educational attainment.mp.

184. (poor adj2 (balance or coordination or vocabulary or concentration)).tw.

185. poor expressive language.tw.

186. (lack adj2 (focus or concentration)).tw.

187. ((inadequate or poor) adj3 nutrition).tw.

188. lack of food.tw.

189. failed appointment*.tw.

190. missed appointment*.tw.

191. No-show.tw.

192. failure to turn up.tw.

193. (non-attendance or non attendance).tw.

194. “did not attend”.tw.

195. Phthiraptera/

196. Pediculus/

197. (lice or louse or nits).tw.

198. Mother-child aggression.tw.

199. Father-child aggression.tw.

200. Parent-child aggression.tw.

201. Carer-child aggression.tw.

202. Mother-Child Relations/

203. Failure to enrol.tw.

204. ((guilt or shame) adj3 proneness).tw.

205. (Obesity adj3 neglect*).mp.

206. Disab* child*.mp.

207. learning needs.mp.

208. non-school attendance.mp.

209. Faltering growth.mp.

210. Peer Group/

211. “Rejection (Psychology)”/

212. Social Desirability/

213. Adaptation, Psychological/

214. *Emotions/

215. *Fantasy/

216. Crime Victims/

217. Sociometric Techniques/

218. Educational Status/

219. Academic Achievement.mp.

220. Peer Relations.mp.

221. Victimi*.mp.

222. Emotional Adjustment.mp.

223. or/53-222

224. 21 and 52 and 223

225. (physical abuse* adj3 neglect*).mp.

226. (sexual abuse* adj3 neglect*).mp.

227. (post traumatic stress disorder* or PTSD).mp.

228. Stress Disorders, Post-Traumatic/

229. or/225-228

230. 22 or 24 or 25 or 26 or 32

231. 21 and 229 and 230

232. ((bmi or body mass index) adj2 (gain or loss or change)).tw.

233. ((maltreat or neglect*) adj3 (obesity or obese or overweight or over weight)).mp.

234. ((maltreat* or neglect*) adj3 (adiposity or overeating or weight gain or body weight)).mp.

235. (maltreat* or neglect*).mp.

236. 232 and 235

237. 233 or 234 or 236

238. 21 and 237

239. ((maltreat* or neglect*) adj3 (obesity or obese or overweight or over weight)).mp.

240. 234 or 236 or 239

241. 21 and 240

242. 238 or 241

243. 224 or 231 or 242

244. (Adolescen* or teen* or youth).mp.

245. “Young Adult”/

246. “Africa South of the Sahara”/

247. (Algeria$ or Egypt$ or Liby$ or Morocc$ or Tunisia$ or Western Sahara$ or Angola$ or Benin or Botswana$ or Burkina Faso or Burundi or Cameroon or Cape Verde or Central African Republic or Chad or Comoros or Congo or Djibouti or Eritrea or Ethiopia$ or Gabon or Gambia$ or Ghana or Guinea or Keny$ or Lesotho or Liberia or Madagasca$ or Malawi or Mali or Mauritania or Mauritius or Mayotte or Mozambiq$ or Namibia$ or Niger or Nigeria$ or Reunion or Rwand$ or Saint Helena or Senegal or Seychelles or Sierra Leone or Somalia or South Africa$ or Sudan or Swaziland or Tanzania or Togo or Ugand$ or Zambia$ or Zimbabw$ or China or Chinese or Hong Kong or Macao or Mongolia$ or Taiwan$ or Belarus or Moldov$ or Russia$ or Ukraine or Afghanistan or Armenia$ or Azerbaijan or Bahrain or Cyprus or Cypriot or Georgia$ or Iran$ or Iraq$ or Jordan$ or Kazakhstan or Kuwait or Kyrgyzstan or Leban$ or Oman or Pakistan$ or Palestin$ or Qatar or Saudi Arabia or Syria$ or Tajikistan or Turkmenistan or United Arab Emirates or Uzbekistan or Yemen or Bangladesh$ or Bhutan or British Indian Ocean Territory or Brunei Darussalam or Cambodia$ or India$ or Indonesia$ or Lao or People’s Democratic Republic or Malaysia$ or Maldives or Myanmar or Nepal or Philippin$ or Singapore or Sri Lanka or Thai$ or Timor Leste or Vietnam or Albania$ or Andorra or Bosnia$ or Herzegovina$ or Bulgaria$ or Croatia$ or Faroe Islands or Greenland or Liechtenstein or Lithuani$ or Macedonia or Malta or maltese or Romania or Serbia$ or Montenegro or Svalbard or Argentina$ or Belize or Bolivia$ or Brazil$ or Colombia$ or Costa Rica$ or Cuba or Ecuador or El Salvador or French Guiana or Guatemala$ or Guyana or Haiti or Honduras or Jamaica$ or Nicaragua$ or Panama or Paraguay or Peru or Puerto Rico or Suriname or Uruguay or Venezuela or developing countr$ or south America$).ti,sh.

248. or/244-247

249. 243 not 248

250. limit 249 to (humans and yr=”2012 -Current” and “child (6 to 12 years)”)

 

Pre-review screening and critical appraisal

Papers found in the database and hand searches underwent three rounds of screening before they were included in this update. The first round was a title screen where papers that obviously did not meet the inclusion criteria were excluded. The second was an abstract screen where papers that did not meet the inclusion criteria based on the information provided in the abstract were excluded. In this round the pre-review screening form was completed for each paper. These first two stages were carried out by clinical experts. Finally a full text screen with a critical appraisal was carried out by members of the clinical expert sub-committee. Critical appraisal forms were completed for each of the papers reviewed at this stage. Examples of the pre-review screening and critical appraisal forms used in previous reviews are available on request (clinical.standards@rcpch.ac.uk).

Disclaimer: This is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

Original reviews and content © Cardiff University, funded by NSPCC

Published by RCPCH July 2017

While the format of each review has been revised to fit the style of the College and amalgamated into a comprehensive document, the content remains unchanged until reviewed and new evidence is identified and added to the evidence-base. Updated content will be indicated on individual review pages.

References

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Christopoulos C B.J., Crittenden PM. Maternal language input and child maltreatment. Infant Mental Health Journal 1988; 9(4): 272-286.

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DiLalla DL C.P. Dimensions of maltreated children’s home behavior: A factor analytic approach. Infant Behavior and Development 1990; 13(4): 439-460.

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Fagan J D.M. Mother-child play interaction in neglecting and non-neglecting mothers. Early Child Development and Care 1993; 87: 59-68.

(15)

Jacobsen SL M.C. A music therapy tool for assessing parent–child interaction in cases of emotional neglect. Journal of Child and Family Studies 2014.

(16)

Kimball W S.R., Conger R, Burgess RL. A comparison of family interaction in single versus two parent abusive, neglectful and control families. In: In T Field, S. G., D Stern, A Sostek (Eds). ed. High Risk Infants and Children: Adult and Peer Interactions. New York: Academic Press; 1980. p. 43-59.

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Mustillo SA D.S., Conover K, Burns BJ. Parental depression and child outcomes: the mediating effects of abuse and neglect. Journal of Marriage and Family 2011; 73(1): 164-180.

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Pianta R E.B., Erickson MF. The antecedents of maltreatment: Results of the Mother-Child Interaction Research Project. In: Cicchetti D, C. V. ed. Child maltreatment: Theory and research on the causes and consequences of child abuse and neglect. New York: Cambridge University Press; 1989. p. 203-253.

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PM C. Abusing, neglecting, problematic, and adequate dyads: Differentiating by patterns of interaction. Merrill-Palmer Quarterly 1981; 27(3): 201-218.

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Research Brief: Noticing and helping the neglected child literature review. Department for Children, Schools and Families; 2009.