A new study from the U.S. and England finds that yelling at children can be just as harmful as sexual or physical abuse. The research, published in the journal Child Abuse & Neglect, says that childhood emotional abuse has now surpassed other forms of maltreatment.

The authors of the study say that childhood verbal abuse (CVA) is a key type of emotional abuse, yet CVA is not yet recognized as its own form of maltreatment and because of this, has not received adequate attention. The most common perpetrators of CVA are parents (76%), other adults in the home (2.4%), and teachers (12.71%). Researchers said CVA definitions include negative speech, volume, tone and speech content, and their immediate impact on children.

According to the New York Post, the researchers from Wingate University in North Carolina and University College London (UCL) analyzed 149 quantitative and 17 qualitative studies examining CVA. The study, commissioned by Words Matter, a U.K. charity working to end verbal abuse of children, called for CVA to be officially recognized as a “form of maltreatment.”

The nature of CVA involves behaviors that can be detrimental to a child’s well-being, such as belittling, shouting, threatening language, says a statement from UCL.

The effects of CVA could last a lifetime, said the researchers, and the abuse can create “underlying emotional and psychological repercussions,” which include obesity, increased risks of anger, substance abuse, depression, and self-harm.

The team noted that currently there is a noticeable void in acknowledging CVA by adults as a distinct maltreatment subtype and that doing so would a be a starting point for its identification and prevention.

“This systematic review is timely and of significant clinical value,” said co-author Peter Fonagy, of UCL Psychology and Language Sciences. “Preventing the maltreatment of children is the most effective way we can reduce the prevalence of child mental health problems. A sharp focus on childhood verbal abuse by adults around them by the new charity Words Matter, and this new review will help make a significant change, and support and direct our efforts to identify and respond to this risk in an effective and timely manner.”

Data from the World Health Organization has found that emotional abuse is now the most prevalent form of child maltreatment, ahead of physical or sexual abuse. However, the researchers said that the term “emotional abuse” focuses more on the victim and is ambiguous. They prefer using the term “childhood verbal abuse” to zero in on the adult’s actions with more precision.

Shouting and screaming were the most documented characteristics of verbal abuse, says the UCL paper. The authors of the study emphasized that it is not only the words used that are harmful to children but also the intent, delivery, and their immediate impact.

“It’s paramount to grasp the true scale and impact of childhood verbal abuse,” said Jessica Bondy, founder of Words Matter. “All adults get overloaded sometimes and say things, unintentionally. We have to work collectively to devise ways to recognize these actions and end childhood verbal abuse by adults so children can flourish. Words have weight, they can uplift or destroy. Let’s build children up, not knock them down.”