The little boy, maybe 3, was running up the hill of a city park. It was a pristine day and I thought at first that he was playing a game of hide-and-seek with the young man and woman I assumed were his parents.

But the couple, barely in their 20s, kept running away. I heard them laugh as they ducked behind trees. The little boy rushed toward the vast emptiness, frantic, crying, desperate to find them. This wasn't a game. This was torment.

Over the years, and it's been so many years, I've thought about that little boy. He returned to me recently as I reviewed a groundbreaking study published by the American Psychological Association.

The title: "Unseen Wounds."

We are in the middle of a crucial dialogue about what it means to truly protect our children from harm. The Adrian Peterson story is pushing us to define what is and is not physical abuse. The heartbreak of 4-year-old Eric Dean of Starbuck, Minn., killed by his stepmother despite more than 15 abuse reports, demands policy change around reporting of physical violence.

On another front, long-awaited resolutions in the clergy sex abuse scandal are moving us away, at last, from institutionalized denial, and may encourage more victims of childhood sex abuse to come forward.

"Unseen Wounds" challenges us to spread our critical arms wider still.

The study, soon to be published, revealed that psychological abuse — difficult to define and rarely addressed in prevention programs — is often more harmful to children than sexual or physical abuse.

Children who have been psychologically abused suffer the highest rates of depression, social anxiety, attachment problems and substance abuse, the study found.

It's important to state that any form of child abuse is the worst form of child abuse. This is no contest where parents get to pick the least harmful option. All three must be eliminated, through early childhood education and mental health support programs, better screening and more willingness on all of our parts to reach out and help instead of sitting back and judging.

But even lead author Joseph Spinazzola was surprised by what his team uncovered.

"We see the damage done to our clients, and it looks different," said Spinazzola, referring to chronic insults and humiliation. Abuse for his study's purpose included bullying, terrorizing, coercive control, severe insults, debasement, threats, shunning and isolation.

(This does not include yelling at our kids on occasion, for which the best remedy is taking a breather, then apologizing.)

"The unseen scars that come from being told repeatedly, 'You're ruining my life,' 'You're just like your father,' 'I wish you were never born' — the effects of that hostility and scorn can be lifelong," Spinazzola said.

Those scars include difficulty in developing healthy relationships, and becoming parents who dispense the same hostility to their own children.

While the American Academy of Pediatrics in 2012 identified psychological abuse as "the most challenging and prevalent form of child abuse and neglect," many professionals, caregivers and parents continue to dismiss its unique risks and consequences.

Where's the proof if there are no physical wounds? This study could change some minds.

Spinazzola and colleagues at the Trauma Center at Justice Resource Institute in Brookline, Mass., analyzed data from more than 5,600 youths from 2004 to 2010, making it one of the largest studies of its kind. The average age was 11, many with lifelong histories of more than one type of abuse.

While victims of sexual abuse are more often girls, and victims of physical abuse often tend to be boys, both genders "are highly vulnerable" to psychological abuse, he said.

He said he hopes that the study leads to better detection, improved mental health services and a public awareness campaign to help parents understand the potentially devastating consequences of their words.

But he has empathy for them. Many parents, he said, may be struggling with their own unresolved childhood trauma, or are themselves victims of domestic abuse. Some are challenged by significant mental health issues or substance abuse problems. "This can lead them to feel chronically overwhelmed and ill-equipped to meet the needs of their children," Spinazzola said.

He said he remains optimistic that families can heal with the right resources in place. "The earlier we get to it, the better."

One program showing encouraging results is the family-centered Minneapolis-based Washburn Intensive In-Home Program. Once or twice a week, therapists go into homes, observing parent-child interactions, building trust and teaching skills to strengthen families.

"Parents may be experiencing so much pain that it might be coming out sideways," supervisor Jenny Britton said. "Rejection of the child becomes a defense mechanism. 'I'm going to keep you at arm's length because there's so much pain with love that I can't let you be too close to me.' "

A therapist, she said, might attain slow and steady shifts in a parent's thinking or actions by gently questioning certain beliefs: "Why do you worry about him turning out like his dad? What do you hope is different?"

"A parent might say, 'Well, your father hurt me and I don't know how to act because you look like him and you talk like him.' It's really sifting through what the messages mean," Britton said.

Her team also reminds families to do something they rarely consider: have fun together.

"Sometimes, we'll encourage them to play a game to create positive experiences. Some families think it's silly, but they'll do it anyway. Kids need their parents to be playful and engaging."

That sad moment in the park decades ago was anything but playful. I hope it was isolated. I hope that when the couple finally grabbed his little hand, which they did, they saw terror in his eyes.

I hope that little boy grew into a confident and loving father. I hope that the deck wasn't forever stacked against him.


Follow Gail on Twitter: @grosenblum