Overlooked harm echoing across age groups

In a recent study published in the journal Child Abuse & Neglect, researchers consolidate evidence on the definition, measurement, and outcomes of childhood verbal abuse for its proper classification and prevention.

Study: Childhood verbal abuse as a child maltreatment subtype: A systematic review of the current evidence. Image Credit: KieferPix / Shutterstock.com

Background 

Over the past several decades, researchers have confirmed the negative lifelong impacts of child maltreatment on behavioral, social, mental, and physical health. Maltreatment is broadly categorized into four subtypes, including physical, emotional, and sexual abuse, as well as neglect.

The prevalence of childhood emotional abuse is rising, especially verbal abuse from adults, like shouting, belittling, or threatening. Despite its harm being comparable to physical and sexual abuse, verbal abuse receives less recognition.

Existing evidence indicates a higher prevalence of emotional abuse than other types. Several factors might contribute to this higher prevalence, including the broadness of emotional abuse definitions, the possibility of verbal abuse replacing physical forms due to prevention interventions, the lack of precise forensic assessments, and varied cultural norms.

Thus, additional research is needed to precisely define, categorize, and address the rising prevalence of Childhood Verbal Abuse (CVA) as a distinct form of maltreatment.

About the study

The present study, which adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, utilized four databases including Psychological Information Database (PsycINFO), Excerpta Medica Database (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), and ProQuest.

Search terms were determined by field experts and used to analyze titles, abstracts, and keywords of works published from 1976 to May 2022. Although “authoritarian parenting” was excluded, terms that depict harsh verbal disciplinary practices were considered for the analysis. 

A citation search was also conducted on identified articles, their references were screened, and the review was subsequently published in the International Prospective Register of Systematic Reviews (PROSPERO). Studies included in the analysis that were published in peer-reviewed English journals on childhood verbal abuse encompassing various terms, whereas workplace, peer, healthcare, romantic relationship studies, as well as non-primary articles, were excluded from the analysis.

Using CADIMA software, initial screenings of titles and abstracts were performed by three researchers. Subsequently, full articles that met the criteria were subjected to a second screening. Any disagreements were settled through discussions.

Eligible studies were categorized, critically appraised by two researchers, and assessed for quality using ratings of ‘weak,’ ‘moderate,’ or ‘strong.’ Only quantitative and qualitative studies were used, whereas those using mixed methods were excluded due to unclear definitions.

Quantitative studies provided insights into the risks, prevalence, and consequences of childhood verbal abuse. Researchers scrutinized outcomes to categorize the type of impact on individuals using parameters like psychological and physical effects.

For qualitative studies, researchers codified those with clear definitions. Analytical tests were applied to generate statistical insights, in which Fisher’s exact test was selected over the chi-square test due to data assumptions.

Study results 

A comprehensive search yielded 13,577 articles and rigorous filtering processes, which removed duplicates and articles not meeting criteria such as language, type, and context of verbal abuse.

A total of 170 studies were ultimately identified, 149 of which were quantitative, 17 qualitative, and four mixed-methods studies. Of the quantitative studies, 106 were selected for detailed analysis due to their focused terms and measurements.

Most of the quantitative studies were cross-sectional and primarily investigated the negative consequences or prevalence of childhood verbal abuse, particularly that by parents or guardians. These studies comprised different age groups ranging from infants to seniors. Among these studies, 21 different terms related to verbal abuse were identified, with “verbal abuse” and “verbal aggression” being the most prevalent.

Regarding terms and their definitions, the primary perpetrators in the context of CVA were parents; however, other adult figures such as teachers and coaches were also highlighted. “Verbal aggression” mostly pertained to parental behavior, whereas “verbal hostility” was used in the context of disciplinary actions by parents. The definitions of these terms commonly included elements like yelling, screaming, name-calling, and other aggressive behaviors, all with negative consequences for the child.

The various terms for abuse were often associated with specific measurement tools, including the CDC-Kaiser Adverse Childhood Experiences Study questionnaire, Conflict Tactics Scale, and Parenting Styles and Dimensions Questionnaire. Interestingly, specific terms were significantly more likely to be associated with certain tools.

The outcomes of the abuse varied based on the specific term used. For example, “verbal abuse” was associated with a broad spectrum of psychological, behavioral, and neurological consequences across all age groups. This ranged from mental distress in children to neurobiological changes and even chronic health conditions in adults.

“Verbal aggression” was associated with poor self-esteem, depression, and relational difficulties in both children and adults. Meanwhile, “verbal hostility” was associated with aggressive and oppositional behaviors in young people, with severe implications for their adolescent outcomes.