Emotional, behavioural, interpersonal and social functioning

Alerting features that should prompt you to CONSIDER child maltreatment:

• Any behaviour or emotional state in a child if it is inconsistent with their age and developmental stage or there is no medical explanation (including a neurodevelopmental disorder, for example, ADHD or autism spectrum disorders) or other stressful situation unrelated to maltreatment (for example, bereavement or parental separation). Behaviour or emotional states that may fit this description include:

  • fearful or withdrawn emotional state

  • low self-esteem

  • aggressive or oppositional behaviour

  • habitual body rocking

  • indiscriminate contact or affection-seeking

  • over-friendliness to strangers

  • excessive clinginess

  • persistently resorting to gaining attention

  • demonstrating excessively ‘good’ behaviour to prevent parental or carer disapproval

  • failing to seek or accept appropriate comfort or affection from an appropriate person when significantly distressed

  • coercive controlling behaviour towards parents or carers

  • very young children showing excessive comforting behaviours when witnessing parental or carer distress.

• Child or young person regularly has responsibilities that interfere with essential normal daily activities (for example, school attendance).

• Marked change in behaviour or emotional state not expected for the child or young person’s age and developmental stage (for example, recurrent nightmares with similar themes, extreme distress, becoming withdrawn, markedly oppositional behaviour or withdrawal of communication) in the absence of a medical explanation or known stressful situation unrelated to maltreatment.

• Repeated, extreme or sustained emotional responses shown by a child that are out of proportion to a situation and are not expected for the child’s age and developmental stage (for example, frequent rages at minor provocation, anger or frustration expressed as a temper tantrum in a school-aged child or distress expressed as inconsolable crying) in the absence of a medical explanation, neurodevelopmental disorder (for example, ADHD or autism spectrum disorders) or bipolar disorder when the effects of any known past maltreatment have been explored.

• Dissociation (transient episodes of detachment that are outside the child’s control and that are different from daydreaming, seizures or deliberate avoidance of interaction) displayed by a child, not explained by a known traumatic event that is unrelated to maltreatment.

• Deliberate self-harm. Self-harm includes cutting, scratching, picking, biting or tearing skin to cause injury, pulling out hair or eyelashes and deliberately taking prescribed or non-prescribed drugs at higher than therapeutic doses.

• Child or young person who has run away from home or care, or is living in alternative accommodation without the full agreement of parents or carers.

• Unusual, unexpected or developmentally inappropriate response by a child to a health examination or assessment (for example, extreme passivity, resistance or refusal).

• Secondary day- or night-time wetting in a child, which persists despite adequate assessment and management, if there is no known stressful situation unrelated to maltreatment or medical explanation (for example, urinary tract infection).

• Deliberate wetting by a child.

• Encopresis (repeatedly defecating a normal stool in an inappropriate place) or repeated, deliberate smearing of faeces by a child.

Alerting features that should prompt you to SUSPECT child maltreatment:

• Child who repeatedly scavenges, steals, hoards or hides food with no medical explanation.

• Indiscriminate, precocious or coercive sexual behaviour in a child or young person.

• Repeated or coercive sexualised behaviours or preoccupation in a prepubertal child (for example, sexual talk associated with knowledge, drawing genitalia or emulating sexual activity with another child).