1. Emotional Abuse & Neglect Dr.Hjh. Fauzi Ismail Child & Adolescent Psychiatrist Hospital Kuala Lumpur

2. Abuse Definition: í a child is abused if he/she is treated in an unacceptable way, by an adult in a given culture, at a given time Cultural and temporal relativity are ** Cultural and temporal relativity are important in defining abuse

3. Emotional Abuse Definition: Definition: í sustained, repetitive, inappropriate emotional response to the child’s experience and expression of emotions

4. Common forms : Harsh words Belittling Discriminating Ostracising / isolating Insinuating Emotional detachment

5. Emotional abuse Signs and symptoms vary with age Signs and symptoms vary with age – infants: failure to thrive developmental delay

6. Emotional abuse Preschool: Preschool: – behaviour » short attention span » poor social interaction » inability to play cooperatively

7. Emotional abuse Preschool: Preschool: – behaviour » » indiscriminate attachment and friendliness (crave for physical contact and intimacy)

8. Emotional abuse Preschool: Preschool: – physical » short stature » small head circumference

9. Emotional abuse School age: School age: – deprivation dwarfism » due to long term emotional abuse » short below 3rd centile » below average circumference

10. Emotional abuse School age: School age: – behaviour towards food çcharacteristic  stealing and hoarding food  Pica  left to eat on his own - gorges food till sick

11. Emotional abuse \ Generally : - emotional problems - behaviour difficulties

12. Emotional abuse - poor social adjustment * failure to make friends * lack social sills * identify with abusive parents * abusing others * eneurisis * encorporesis -learning difficulties - learning difficulties - self injury

13. Neglect Neglect Definition: Definition: í í absence of appropriate care rather than positively inappropriate acts. í an act of omission rather than commission

14. Usual forms of Neglect : Not caring for physical needs Not providing consistent love Not nurturing tenderly Not showing concern Not giving attention

15. Effects : Physical : Recurrent infections Short stature Failure to thrive

16. Neglect Effects – lack of emotional warmth and availability: disorganised attachment pattern no experience of normal reciprocal intimate relationship low self worth (sometimes depressed) lack social interest and responsiveness

17. Neglect Effects – lack of cognitive stimulation and encouragement – leads to: delayed language acquisition lower IQ poor attainment in school diminished sense of initiative and competence

18. DO YOU KNOW KNOW SUCH CHILDREN SUCH CHILDREN ?

19. X Often there is an overlap of abuse. X More than one abuse occurs concurrently. X “Pure” one type abuse is seldom seen. Therefore the effects of abuse also overlap.

20. Management Handling disclosure Refer for psychiatric assessment & intervention Inform social worker Counsel parents

21. Handling Disclosure your eyelevel is same as the child’s When talking to a child, make sure your eye level is same as the child’s. This shows that there is no power difference between you and the child. eye contact withthe child It is very important to keep the eye contact with the child when listening and talking. It shows that you are listening and paying attention. non verbal reaction and our body language Our non verbal reaction and our body language also plays important part when listening to children.

22. Handling Disclosure Appropriate attitude Appropriate attitude Appropriate language Appropriate language Support child Support child Report to appropriate agencies Report to appropriate agencies Protect child from further abuse Protect child from further abuse - network - network

23. Handling Disclosure Believe the child Believe the child Be calm Be calm Be affirming Be affirming Prepare the child for what will happen next Prepare the child for what will happen next Be supportive Be supportive Report the abuse Report the abuse

24. Handling Disclosure DO’sDON’T’s Believe the child Do not belittle the child Be calm Do not act shocked, outraged or fearful Listen Do not ask probing questions Reassure Do not ask “why” questions Affirm Do not make promises Give choices Do not force the child to make decision immediately

25. Handling Disclosure DO’sDONT’s Report Do not add your personal impressions or assumptions Document Do not rephrase or add information Follow up Do not harass personnel involved in investigation Take care of self Do not be a “hero”

26. Do not Belittle the child Do not blame for reporting late Do not blame for reporting late Do not belittle the story Do not belittle the story - e.g: “It’s only words …” - e.g: “It’s only words …” Do not doubt the child Do not doubt the child Do not show negative reaction Do not show negative reaction - i.e either verbal or non-verbal - i.e either verbal or non-verbal

27. Be Calm Children are sensitive to your reactions Children are sensitive to your reactions Do not act shocked, outrage or fearful Do not act shocked, outrage or fearful It may inhibit child It may inhibit child Make child feel more anxious & ashamed Make child feel more anxious & ashamed

28. Listen Pay attention Pay attention Do not ask probing questions Do not ask probing questions Do not interview or interrogate the child Do not interview or interrogate the child Do not be judgmental Do not be judgmental You do not have to prove anything You do not have to prove anything Do not attempt your own investigation Do not attempt your own investigation

29. Affirm Tell child that he/she has done the right thing Tell child that he/she has done the right thing Tell child you feel sorry & will try to help to get protection Tell child you feel sorry & will try to help to get protection Do not make promises that you can’t keep Do not make promises that you can’t keep - e.g :… offender will be removed - e.g :… offender will be removed immediately immediately … police will jail offender … police will jail offender

30. Give choices Do not force child to report immediately Do not force child to report immediately Tell child it is important to report,to help protect child Tell child it is important to report,to help protect child Ask if she would like to it herself or with you Ask if she would like to it herself or with you Inform child of the process, resources & support available Inform child of the process, resources & support available Tell child a few relevant people need to know to help keep him/her safe Tell child a few relevant people need to know to help keep him/her safe

31. Reassure Tell child what happened wasn’t his/her fault Tell child what happened wasn’t his/her fault Convince child that he/she will not get into trouble for telling Convince child that he/she will not get into trouble for telling Praise them for being “ courageous ” to tell Praise them for being “ courageous ” to tell Do not ask why questions Do not ask why questions - child may feel as if he is being - child may feel as if he is being “ blamed ” for the abuse “ blamed ” for the abuse

32. Reporting Report Report - do not add personal impressions & assumptions - do not add personal impressions & assumptions - has to be truthful, consistent & accurate - has to be truthful, consistent & accurate

33. Reporting Document Document - keep notes on disclosure - keep notes on disclosure - including statements - including statements (verbatim),drawing,dates & (verbatim),drawing,dates & time of disclosure time of disclosure - do not rephrase or add - do not rephrase or add information or personal information or personal interpretation interpretation

34. Reporting Follow – up Follow – up - check with investigating officer or social worker to learn about progress - check with investigating officer or social worker to learn about progress - do not harass the investigating officer - do not harass the investigating officer

35. Reporting Take care of self Take care of self - disclosures can be emotionally difficult - disclosures can be emotionally difficult - do not be a “ hero ” - do not be a “ hero ” - do not get over-involved - do not get over-involved