TPC Journal-Vol 11-Issue-3 - FULL ISSUE

286 The Professional Counselor | Volume 11, Issue 3 PM in children may prevent mental health professionals from intervening early, providing crucial care, and referring victims for psychological health services (Marshall, 2012; Spinazzola et al., 2014). The Psychological Maltreatment Inventory (PMI) is the first instrument of its kind to address these deficits. Child Psychological Maltreatment Although broadly conceptualized, child PM experiences are described as literal acts, events, or experiences that create current or future symptoms that can affect a victim without immediate physical evidence (López et al., 2015). Others have extended child PM to include continued patterns of severe events that impede a child from securing basic psychological needs and convey to the child that they are worthless, flawed, or unwanted (APSAC, 2019). Unfortunately, these broad concepts lack the specificity to guide legal and mental health interventions (Ahern et al., 2014). Furthermore, legal definitions of child PM vary from jurisdiction to jurisdiction and state to state (Spinazzola et al., 2014). The lack of consistent definitions and quantifiable measures of child PM may create barriers for prosecutors and other helping professionals within the legal system as well as a limited understanding of PM in evidence-based research (American Psychiatric Association [APA], 2013; APSAC, 2019; Klika & Conte, 2017). These challenges are exacerbated by comorbidity with other forms of maltreatment. Co-Occurring Forms of Maltreatment According to DHHS (2018), child PM is rarely documented as occurring in isolation compared to other forms of maltreatment (i.e., physical abuse, sexual abuse, or neglect). Rather, researchers have found PM typically coexists with other forms of maltreatment (DHHS, 2018; Iwaniec, 2006; Marshall, 2012). Klika and Conte (2017) reported that perpetrators who use physical abuse, inappropriate language, and isolation facilitate conditions for PM to coexist with other forms of abuse. Van Harmelen et al. (2011) argued that neglectful acts constitute evidence of PM (e.g., seclusion; withholding medical attention; denying or limiting food, water, shelter, and other basic needs). Consequences of PM Experienced in Childhood Mills et al. (2013) and Greenfield and Marks (2010) noted PM experiences in early childhood might manifest in physical growth delays and require access to long-term care throughout a victim’s lifetime. Children who have experienced PM may suffer from behaviors that delay or prevent meeting developmental milestones, achieving academic success in school, engaging in healthy peer relationships, maintaining physical health and well-being, forming appropriate sexual relationships as adults, and enjoying satisfying daily living experiences (Glaser, 2002; Maguire et al., 2015). Neurological and cognitive effects of PM in childhood impact children as they transition into adulthood, including abnormalities in the amygdala and hippocampus (Tyrka at al., 2013). Brown et al. (2019) found that adults who reported experiences of CM had higher rates of negative responses to everyday stress, a larger constellation of unproductive coping skills, and earlier mortality rates (Brown et al., 2019; Felitti et al., 1998). Furthermore, adults with childhood PM experiences reported higher rates of substance abuse than those compared to control groups (Felitti et al., 1998). Trauma-Related Symptomology. Researchers speculate that children exposed to maltreatment and crises, especially those that come without warning, are at greater risk for developing a host of trauma-related symptoms (Spinazzola et al., 2014). Developmentally, children lack the ability to process and contextualize their lived experiences. Van Harmelen et al. (2010) discovered that adults who experienced child PM had decreased prefrontal cortex mass compared to those without evidence of PM. Similarly, Field et al. (2017) found those unable to process traumatic events produced higher levels of stress hormones (i.e., cortisol, epinephrine, norepinephrine); these hormones are produced from the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal-medullary (SAM) regions in