Diagnostic Signs a Child has Been Manipulated to Reject a Parent

‘Attachment based “parental alienation” is not a child custody issue, it’s a child protection issue’

Dr C A Childress 2014

The following is an example of diagnostic criteria that can be used by psychologists to assess families where an emotional cutoff has occurred.

Dr Craig Childress, a Clinical Psychologist in the USA, uses established long standiding, highly evidenced, widely accepted psychological principles and constructs relating to the attachment system, family systems, complex trauma and personality disorders to explain the cross-generational trauma that leads to a child rejecting a normal range/”good enough” parent.

His Attachment Based “parental alienation” (AB-PA) model is a model for severe cases where an emotional cutoff has occurred. It is documented fully in An Attachment-Based Model of Parental Alienation: Foundations but a short summary is provided in Strategic Family Systems Intervention for AB-PA: Contingent Visitation Schedule. Those who prefer a visual presentation may prefer to view a talk he gave on Attachment Based “Parental Alienation” at the California Southern University School of Behavioral Sciences.

A child having an emotional cutoff from a parent is a sign of significant psychopathology in the family. In cases where parents can’t agree as to why the child is rejecting a parent, Childress maintains it is necessary to perform a differential diagnosis to identify the circumstances surrounding the child’s rejection. In undertaking an assessment there are key questions to answer:

  • Is there a neurological reason why the child is unable to maintain a relationship with their parent e.g. do they have ADHD or Autism?
  • Is the parent being rejected abusive or is the other parent being abusive by employing behaviours that manipulate the child to emotionally cutoff from the other parent?

If there is no neurological reason it is important to look at the parenting practices of the parents involved i.e. is the rejected parent a normal range/”good enough” parent. Child abuse is a valid reason for the failure of the child’s attachment system but Childress explains that children of abusive parents are not likely to reject that parent. They are more likely to develop an “insecure attachment” where the child tries to please the dysfunctional parent in order to bond more with them to stop the abuse or avoid abandonment. Where the rejected parent is abusive, rejection usually occurs at later stages of life from 12 years onwards depending on the type of abuse. Childress maintains that in about 25-30% of cases where a parent claims to have been rejected for no good reason, they are in fact an abusive parent with little empathy for the child.

Whilst it is more likely that one parent is causing pathology in the family and the other is reacting to their behaviours, some families can have two pathological parents and it is important to know this as part of the treatment plan e.g. one parent may be physically abusive and another psychologically abusive, they might both have personality disorders.

The following diagnostic indicators and associated clinical signs of AB-PA are a useful tool for parents and people working with children to identify areas of concern which link to patterns of behaviour/events during the history of the parental separation but assessment of this family dynamic can only be conducted by skilled and experienced psychologists.

Diagnostic Indicators

Dr Childress suggests that the appearance of the following 3 diagnostic indicators are indicative of pathogenic parenting that result in a child rejecting a safe, loving parent. He maintains these symptoms are NOT present in the child where a rejected parent has engaged in child abuse.

1. Attachment System Suppression

The child seeks to stop all contact with the normal range parent. A parent who is assessed on the parenting scale to be using parenting practices widely recognised as acceptable is considered to be normal range (20-80% on the scale). If there was evidence of abusive parenting such as medical reports, pictures, verified witness statements etc. they would not score 20-80% and would not be classed as normal range. If the rejected parent is within the normal parenting range there should be no breakdown of the attachment system. The only time a child has an emotional cutoff is as a result of narcissistic parenting. Therefore, if investigation into any alleged abuse and a clinical assessment indicates that the rejected parent is not a dysfunctional parent then the other parent, who most likely has Narcissistic Personality Disorder (NPD) or Borderline Personality Disorder (BPD), has caused the child’s rejection through coercive and controlling behaviours.

When this is the case Childress suggests courts and therapists need to move away from micro analysing the parenting skills of the normal range parent. Accepting that the parent has the authority to discipline their child and instil family values as they see fit.

2. Personality Disorder Symptoms

Childress identifies a set of 5 NPD/BPD personality traits that rub off from the aligned parent onto the child where AB-PA has been established, like a personality finger print. He is not suggesting the child has a personality disorder just that they have learned behaviours from the parent to whom they are aligned.

  • Grandiosity – the child is elevated in the family hierarchy to a status above the rejected parent. The child then feels entitled to negatively judge the rejected parent.
  • Empathy – the child will say and do cruel things to the rejected parent without any compassion for them what so ever.
  • Entitlement – if the rejected parent does not meet the child’s every need to the level of satisfaction of the child, the child feels entitled to retaliate against the rejected parent.
  • Haughty and arrogant attitude – towards the rejected parent. They show disdain for who that parent is as parent and as a person.
  • Splitting – the child sees the rejected parent as all bad and the parent with whom they are aligned as all good. The child is not able to hold a realistic view that there is good and bad in both parents.

Childress also describes an “anxiety variant” where around the age of 4-6 years old the child is terrified of their parent. This is usually the result of the manipulative parent communicating to the child that the other parent is a threat to the child. This can be diagnosed using DSM5 criteria for a Phobic Anxiety.

3. Delusional Belief System

The child believes they are a victim when no real abuse has occurred. Yes, no parent is perfect and a normal range parent may make mistakes in how they handle certain situations but that is normal. This temporary and normal breach of trust needs to be repaired for healthy relationship to be maintained (breach-and-repair sequence identified by Tronick). The difference comes when the child says that they have been abused physically, emotionally or psychologically by the rejected parent when there is no evidence and or when what the child characterises as abuse is not abuse e.g. removal of mobile phone privileges as a punishment for bad behaviour or asking them to do chores like emptying the bin. In having these false beliefs, the child justifies their rejection of the normal range parent. The parent from whom they have emotionally cutoff deserves to be rejected and punished.

Childress views the process of AB-PA by a NPD/BPD parent as a child protection issue which if not tackled properly will lead to psychological damage. This will likely result in the child not being able to have good relationships with future partners and most likely continue the cycle of abuse with their own children in future.

Associated Clinical Signs (ACS)

While they are not diagnostic indicators there may be additional associated clinical signs alongside the 3 diagnostic indicators above.

ACS-1: Use of the Word “Forced.” The allied parent or child uses the term “forced” in describing the child’s opportunity to spend time with the targeted-rejected parent.

ACS-2: Empowering the Child to Reject the Parent. The allied parent seeks to empower the child’s rejection of the other parent e.g. “The child should be allowed to decide on visitation.”, “We need to listen to what the child wants.”. The allied parent seeks to have the child testify in court to reject the other parent.

ACS-3: The Exclusion Demand. The child seeks to exclude the targeted-rejected parent from the child’s activities, such as sporting events, award ceremonies, musical concerts and recitals, school plays etc

ACS-4: Parental Replacement. The child begins to call the targeted-rejected parent by this parent’s first name rather than by the possessive parental titles of “mum” or “dad,” and/or the child begins to call the step-parent spouse of the allied parent by the parental titles of “mum” or “dad”.

ACS-5: The Unforgiveable Event. The child maintains that the reason for the child’s rejection of the targeted parent is due to some past event that is supposedly too heinous to be forgiven.

ACS-6: “Liar” – “Fake”. The child discounts the targeted parent’s overtures of affection as the targeted parent being a “liar,” and the child discounts the targeted parent’s signs of hurt at the child’s rejection by alleging that the parental expression of hurt is “fake”.

ACS-7: Themes for Rejection. The child expresses one or more of the following characteristic themes for justifying the child’s rejection of the targeted parent:

  • Parent is too controlling and doesn’t listen to what the child wants.
  • Parent is too prone to anger.
  • Parent doesn’t take responsibility and doesn’t apologise for past failures in parenting.
  • The child suggests the targeted parent’s new romantic relationship or marriage results in the parent neglecting the child, leading the child to reject the parent.
  • Parent didn’t spend adequate time with the child before the divorce so the child doesn’t want to spend time with the parent now.
  • The child asserts the reason for rejection is something vague about the general personhood of the targeted parent.
  • The child maintains the reason for the the current rejection is a past event that is supposedly so heinous it cannot be forgiven.
  • The child (and the allied parent) assert that the targeted parent doesn’t adequately feed the child.

ACS-8: Unwarranted Use of the Word “Abuse.” Use of the term “abuse” entails two differential diagnostic probabilities, 1) authentic abuse, and 2) borderline personality traits in the person making the allegation. The term “abuse” is socially inflammatory and immediately provokes a risk management response from others. Normal-range people tend to use less inflammatory words, such as “mean,” “cruel,” “unkind,” “rude,” etc. and normal-range people tend to reserve the term “abuse” for more extreme situations of actual abuse. Borderline personalities, however, use the term “abuse” abundantly, partly because their “victimisation” pathology perceives all interpersonal conflict as being “abusive,” and partly to achieve a manipulative goal of obtaining a protective response from others who are recruited into being allies.

ACS-9: Excessive Texting & Phone Calls. The allied parent and child engage in excessive texting and phone contact during the child’s time with the targeted parent.

ACS-10: Role-Reversal Use of the Child. The child is manipulatively placed out front as supposedly making an “independent” decision that just happens to coincidently align with the desires of the allied parent, and are opposed to the desires of the targeted parent. “It’s not me, it’s the child who…”

ACS-11: “Deserves” to be Rejected. The child (and allied parent) present a theme that the targeted parent “deserves” to be rejected because of some parental failure.

ACS-12: Disregard of Court Orders. The allied parent frequently disregards Court orders and the authority of the Court, and the child may also then display a similar disregard for Court orders and Court authority.


In making a diagnosis in these cases Childress refers to the following sections of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD) 10.

Document: DSM-5
Code: 309.4 Adjustment Disorder with mixed disturbance of emotions and conduct
Description: Relating to the development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s). Both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct are predominant.

Document: DSM-5
V61.20 (Z62.820) Parent-Child Relational Problem
 Cognitive problems may include negative attributions of the other’s intentions, hostility toward or scapegoating of the other, and unwarranted feelings of estrangement. Affective problems may include feelings of sadness, apathy, or anger about the other individual in the relationship.

Document: DSM-5
V61.29 (Z62.898) Child Affected by Parental Relationship Distress
 This category should be used when the focus of clinical attention is the negative effects of parental relationship discord (e.g., high levels of conflict, distress, or disparagement) on a child in the family, including effects on the child’s mental or other medical disorders.

Document: DSM-5
V995.51 (Z62.898)Child Psychological Abuse, Confirmed
Child psychological abuse is nonaccidental verbal or symbolic acts by a child’s parent or caregiver that result, or have reasonable potential to result, in significant psychological harm to the child. (Physical and sexual abusive acts are not included in this category.)

Description: ICD-10
F24 Induced delusional disorder. Under section V Mental and behavioural disorders.
 A delusional disorder shared by two or more people with close emotional links. Only one of the people suffers from a genuine psychotic disorder; the delusions are induced in the other(s) and usually disappear when the people are separated.

Childress maintains that a diagnosis of AB-PA is child psychological abuse and a form of Intimate Partner Violence (IPV) where the child is being used as a weapon to emotionally abuse an ex.

‘What clinical psychology understands is that IPV is not simply about physical violence. The core of Intimate Partner Violence is power, control, and domination. It can be financial, it can be psychological, it can be through physical intimidation and threat – the core theme is one of power, control, and domination.’

Dr C A Childress 2019

How should AB-PA be treated?

Childress emphasises that AB-PA requires specialist treatment by those with specialist skills. The diagnosis of AB-PA needs to be tackled swiftly in order to avoid further damage to the child, estimating a period of 6 months to complete the treatment.

Unfortunately, where a child has experienced a complete emotional cutoff it is unlikely to be resolved without specialist input. In order to be effective they require an enforceable court order to ensure the child and alienating parent participate with the interventions.

The following 4 phase reunification plan is his recommended approach:

  1. Rescue the Child (Protective Separation)The child must be removed from the care of the NPD/BPD parent because they want to keep the child aligned with them. They will try to thwart therapy. If the child is not removed it will result in a tug of war between the therapist who is trying to help the child and the NPD/BPD parent who needs them to play the victimised child role. This may end up splitting the child psychologically, thus causing significant harm.Where the other parent has been assessed as being a normal range parent the child should reside with them whilst this treatment is being undertaken.It is likely that the child will initially experience distress and act out. Some of this behaviour may be dangerous e.g. running away or self-harm. It is important that the normal range parent is prepared for this and that the child receives sufficient support from their family, the therapist and the court. The more the child acts out the greater the degree of pathology and, therefore, the greater the damage that has been done by the NPD/BPD parent.Therapy will not be successful without removing the child from the influence of the NPD/BPD parent.
  2. Recover the Child’s Self-authenticityThe child needs specialised treatment to understand how they have been brainwashed. They need to be re-attuned to the other parent and misatuned to the NPD/BPD parent’s pathological distortions. The child needs to re-gain their empathy.
  3. Restoration of the Parent-Child RelationshipThe therapist needs to elicit a grief response and get the child to re-form their attachment bond to the rejected parent. The child needs to be encouraged to see that they are a normal range parent.
  4. Reintroduce the Pathology of the NPD/BPD ParentThe child loves the NPD/BPD parent. Just as it is not in the interest of the child to be cutoff from the normal range parent it is not in the child’s interest to be cutoff from the NPD/BPD parent, unless there is any indication that there is a risk to the child in the form of violence/sexual abuse/abduction/continued psychological abuse etc. The aim is to get as close to a 50/50 shared parenting plan as possible. The re-introduction needs to be monitored to ensure the progression of the child’s mental health. The child needs to be given mechanisms to cope with the NPD/BPD parent’s behaviour.

Childress warns that validating the child’s feelings is the absolute wrong thing to do because this is colluding with the pathology and, therefore, colluding with the child abuse.

Under normal circumstances it would be appropriate to suggest both parents enter therapy.

Dr Childress recommends that families where a child has experienced an emotional cutoff should enter into the High Road to Reunification workshop developed by Dorcy Pruter of the Conscious Co-parenting Institute (CCI). CCI also has a series of training programmes to teach parents how to co-parent and deal with a child’s resistance to see them with empathy of the child. See Solutions to Restore Child/Parent relationships for further information.