Distinguishing between poor/dysfunctional parenting and child emotional maltreatment: Appendices

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• Continuum of Parental Emotional Sensitivity and Expression
• Diagnostic Criteria for Parenting Problem
• Criteria for More Than Inconsequential Fear Reaction / Physical injury
• Diagnostic Criteria for Child Emotional Abuse

Appendices

Continuum of Parental Emotional Sensitivity and Expression

Appendix 1

Continuum of parental emotional sensitivity and expression

Positive, Healthy Parenting Style	Poor/Dysfunctional	Emotionally Abusive/ Neglectful
Stimulation and Emotional Expressions	Stimulation and Emotional Expressions	Stimulation and Emotional Expressions
provides a variety of sensory stimulation and positive emotional expressions expresses joy at child’s effort and accomplishments	shows rigid emotional expression and inflexibility in responding to child seems unconcerned with child’s developmental/ psychological needs	expresses conditional love and ambivalent feelings towards child shows little or no sensitivity to child’s needs
Interactions	Interactions	Interactions
engages in competent, child centered interactions to encourage development friendly, positive interactions that encourage independent exploration	often insensitive to child’s needs; unfriendly poor balance between child independence and dependence on parent	emotionally or physically rejects child’s attention takes advantage of child’s dependency status through coercion, threats, or bribes
Consistency and Predictability	Consistency and Predictability	Consistency and Predictability
demonstrates consistency and predictability to promote their relationship	often responds unpredictably, sometimes with emotional discharge	responds unpredictably, accompanied by emotional discharge
Rules and limits	Rules and limits	Rules and limits
makes rules for safety and health appropriate safeguards for child’s age	Unclear or inconsistent rules for safety and health	Sporadic, capricious exploits or corrupts for parent’s benefit
Disciplinary practices	Disciplinary practices	Disciplinary practices
occasionally scolds, criticizes, interrupts child activity teaches child through behavioural rather than psychological control methods	frequently uses coercive methods and minimizes child’s competence uses psychologically controlling methods that confuse, upset child	uses cruel and harsh control methods that frighten child violates minimal community standards on occasion
Emotional delivery and tone	Emotional delivery and tone	Emotional delivery and tone
uses emotional delivery and tone that are firm but not frightening	uses verbal and non verbal pressure, often to achieve unrealistic expectations	frightening, threatening, denigrating, insulting

  View Continuum Table in original format.

Diagnostic Criteria for Parenting Problem

Appendix 2

Diagnostic Criteria for Parenting Problem

A. Considering the developmental needs of the child, caregiving to the child is markedly

outside the bounds of normal, as evidenced by one of the following:

(1) Pervasive caregiving difficulties involving either or both of the following:

a.       Underinvolvement (e.g., parent is not bonded to and does not provide loving relationship for the child).

b.      Overinvolvement (e.g., parent is so protective that young adolescent is not afforded any private communication with friends; child is not able to participate in choices about how they will spend their time).

(2) Marked difficulties in at least one aspect of parenting, including, but not limited to:

a. failure to adequately monitor child (e.g., not supervising a young child’s activities; being insufficiently aware of adolescent’s activities)

b. marked lack of support of, or active interference in, a key major life activity

c. excessive or inappropriate discipline (not meeting criteria for child abuse)

d. excessive pressure on child to engage in a single activity or interest (e.g., sport)

e. failure to socialize child through nonexistent or poorly enforced limits

B. Significant impact on the child involving any of the following:

(1) More than physical injury*

(2) Psychological harm, including either

a. More than inconsequential fear reaction* 

b. Psychiatric disorder, at or near diagnostic thresholds related to, or exacerbated by, the caregiving difficulty

(3) Stress-related somatic symptoms (related to or exacerbated by the caregiving difficulty) that significantly interfere with child’s normal functioning.

(4) Reasonable potential for more than inconsequential physical injury due to the inherent dangerousness of the caregiving difficulty and the child’s physical environment

(5) Reasonable potential for psychological harm. Note: The child’s level of functioning and the risk and resilience factors present should be taken into consideration.

a. Reasonable potential for the development of a psychiatric disorder (at or near diagnostic thresholds) due to the caregiving difficulty.

b. Reasonable potential for significant disruption of the child’s physical, psychological, cognitive, or social development due to the caregiving difficulty.

* These criteria are defined further in Appendix 3

Source: Richard E. Heyman and Amy Slep, Family Translational Research Group, Department of Psychology, State University of New York at Stony Brook, Stony Brook, NY 11794-2500. Used with permission.

Criteria for More Than Inconsequential Fear Reaction / Physical injury

Appendix 3

Criteria for More Than Inconsequential Fear Reaction

Victim’s significant fear reaction, as evidenced by both of the following

A. Fear (verbalized or displayed) of bodily injury to self or others

B. At least one of the following signs of fear or anxiety lasting at least 48 hours:

(1) Persistent intrusive recollections of the incident

(2) Marked negative reactions to cues related to incident, as evidenced by any of the following

a. avoidance of cues

b. subjective or overt distress to cues (Note: perpetrator can be a cue)

c. physiological hyperarousal to cues (Note: perpetrator can be a cue)

(3) Acting or feeling as if incident is recurring

(4) Persistent symptoms of increased arousal, as evidenced by any of the following:

a. Difficulty falling or staying asleep

b. Irritability or outbursts of anger

c. Difficulty concentrating

d. Hypervigilance (i.e., acting overly sensitive to sounds and sights in the environment; scanning the environment expecting danger; feeling keyed up and on edge)

e. Exaggerated startle response

Criteria for more than Inconsequential Physical Injury

An injury involving any of the following:

A. Any injury to the face or head

B. Any injury to a child under 2 years of age

C. More than superficial bruise(s) (i.e., bruise that is other than very light red in color [for example, violet, blue, black] OR bruises with total area exceeding that of the victim’s hand OR are tender to light touch)

D. More than superficial cut(s)/scratch(es) (i.e., would require pressure to stop bleeding)

E. Bleeding internally or from mouth or ears

F. Welt (bump or ridge raised on the skin)

G. Burns

H. Loss of consciousness

I. Loss of functioning (including, but not limited to, sprains, broken bones, detached retina, loose or chipped teeth)

J. Heat exhaustion or heat stroke

K. Damage to internal organs

L. Disfigurement (including, but not limited to, scarring)

M. Swelling lasting at least 24 hours

N. Pain felt (a) in the course of normal activities and (b) at least 24 hours after the  physical injury was suffered.

Source: Richard E. Heyman and Amy Slep, Family Translational Research Group, Department of Psychology, State University of New York at Stony Brook, Stony Brook, NY 11794-2500. Used with permission.

Diagnostic Criteria for Child Emotional Abuse

Appendix 4

Diagnostic Criteria for Child Emotional Abuse

A. Verbal or symbolic act or acts (excluding physical abuse and sexual abuse by a parent/caregiver with the potential to cause psychological harm to the child. Such acts include, but are not limited to,

(1) Berating, disparaging, degrading, humiliating child

(2) Threatening child (including, but not limited to, indicating/implying future   physical harm, abandonment, sexual assault)

(3) Harming/abandoning — or indicating that the parent/caregiver will   harm/abandon — people/things that child cares about, such as pets, property, loved ones (including exposing child to criteria-meeting or subthreshold partner maltreatment)

(4) Confining child (a means of punishment involving restriction of movement, as by tying a child’s arms or legs together or binding a child to a chair, bed, or other object, or confining a child to an enclosed area [such as a closet])

(5) Scapegoating child

(6) Coercing the child to inflict pain on him/herself (including, but not limited to, ordering child to kneel on hard objects such as split peas or rice for long periods; ordering the child to ingest a highly spiced food, spice, or herb)

(7) Disciplining child (through physical or non-physical means) excessively (i.e., extremely high frequency or duration, though not meeting physical abuse criteria)

B.  Significant impact on the child as evidenced by any of the following:

(1) Psychological harm, including any of the following

a. More than inconsequential fear reaction*

b. Significant psychological distress (i.e., psychiatric disorders, at or near diagnostic thresholds) related to, or exacerbated by, the act(s)

(2) Reasonable potential for psychological harm, as evidenced by either or the following:

a. The act (or pattern of acts) creates reasonable potential for the development of a   psychiatric disorder (at or near diagnostic thresholds) related to, or exacerbated by, the act(s).  Note: The child’s level of functioning and the risk and resilience factors present should be taken into consideration.

b. The act (or pattern of acts) carries a reasonable potential for significant   disruption of the child’s physical, psychological, cognitive, or social development. A significant disruption would involve development that is   substantially worse than would have been expected, given the child’s developmental level and trajectory evident before alleged maltreatment

(3) Stress-related somatic symptoms (related to or exacerbated by the acts) that  significantly interfere with normal functioning.

C. The act/acts do not include culturally accepted practices intended to promote child safety/development, such as child car seats, safety harnesses, swaddling of infants, and discipline involving “grounding” a child or restricting the child to the home or a room for reasonable periods.

Source: Richard E. Heyman and Amy Slep, Family Translational Research Group, Department of Psychology, State University of New York at Stony Brook, Stony Brook, NY 11794-2500. Used with permission.

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