Developmental Psychopathology

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Sandra Graham-BermannUniversity of
Michigan November 14, 2006 University of
Washington HUB Center
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Effects Of Domestic Violence Exposure On Children

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CENTERS FOR DISEASE CONTROL INJURY
PREVENTIONDAVID LUCILLE PACKARD
FOUNDATIONBLUE CROSS AND BLUE SHIELD OF
MICHIGAN FOUNDATIONBETTER HOMES FUND JUNIOR
LEAGUE OF ANN ARBORUNIVERSITY OF
MICHIGAN Rackham School of Graduate
Studies Department of Psychology
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Thanks to those who helped!

• Ellen DeVoe, Ph.D Victoria Banyard, Ph.D.
• Jennifer Robohm, Ph.D. Kathy Kelly, MSW
• Shirley Thomas, MSW, Ph.D. Erica Stovall, Ph.D
• Shannon Lynch, Ph.D. Theresa O'Neil
• Carita Anderson Ph.D. Dawn Kerstorski, MSW
• Victoria Brescoll, M.A Jacqueline Mattis, Ph.D
• Rachel Brown, B. A Alytia Levendosky, Ph.D.
• Michelle Byrd, B.A Alexandra Okun, Ph.D.
• Bonnie Holiday, MSW Wendy Schwartz, Ph.D.
• Jane Meyers, MSW Lucinda Orwell, MSW
• Brad Schweda, M.A. Linda Sherman, MSW
• Betsy Losoff, MD Meena Desai, MSW
• SAFEHOUSE CENTER

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Aims of Todays Presentation

• To explore the range of effects of violence on
  children of different ages and to identify their
  needs.
• To present a model of risk and protective factors
  that explains why some children are more
  negatively affected by exposure to violence than
  others.

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Bill MoyersDocumentary

• Two-hour documentary that showcased promising
  programs in America designed to reduce violence
  in the lives of children.

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Childrens Exposure to Intimate Partner Violence

• 10-15 million children 3-17 exposed IPV year
• 40 Co-occurring child maltreatment and IPV
• Younger children more likely to witness domestic
  violence
• (Fantuzzo, et al., 1997)

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How have we studied the effects of domestic
violence on children?
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Early Studies Direct Effects Model (1970s 1980s)

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Child Adjustment problems
Violence
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1980s Studies Children exposed to domestic
violence

• Individual outcomes - CBCL, CDI
• Small sample sizes
• Primarily sheltered families
• Few comparative designs

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Research Questions

• How much and what kinds of violence are mothers
  exposed to in a given year?
• Are children exposed to IPV also exposed to other
  forms of maltreatment of the mother, including
  psychological maltreatment?

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Sample Demographics

• mothers age 33.10 (5.29)
• child age 8.49 (2.16)
• monthly income 1,366 (1,315)
• maternal education
• lt high school 15
• high school 23
• gt college, tech 62 N221 Children

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Child Ethnicity
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Violence Exposure

• Violence Against Women Scale (Marshall, 1992)
• Frequency of tactics within last year
• Psychological Maltreatment ? .89
• Conflict Tactics Scale (CTS) (Straus, 1979)
• Frequency of tactics within last year
• Mild and Severe Physical Violence ? .88
• Extent child eyewitness to violent events
• Violence demographics -
• Number violent partners Injuries
• Length of most violent relationship
• Still in contact with violent partner

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Mean Frequency of Conflict Events within Past
Year
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Family Violence Demographics

• Length violent relationship (mos) 125 SD72
• Living with violent partner 18
• Contact with violent partner 69
• Contact days per year 158 SD142
• Physical Child Abuse 36
• Child Sexual Abuse 4

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How much and what kinds of violence do children
actually witness?
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Witnessed Domestic Violence

• 87 Coercion
• 85 Physical Threats
• 28 Sexual Violence
• 83 Mild Physical Violence
• 77 Severe Physical Violence

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1990s Studies Children exposed to domestic
violence

• Community samples
• Comparative designs
• Use of moderating variables
• Expanded range of outcomes
• Traumatic response
• Resilience
• Cognitive schemas
• Social behavior

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Expanded Context of Violence Child Outcomes
Violence to Mother physical violence emotional
maltreatment sexual assault child
eyewitness Violence To Child child physical
abuse sibling violence emotional
maltreatment History of violence
Child Adjustment Social behavior Gender
Stereotypes Mental Health Trauma Resilience Physic
al Health

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1990s Studies of attitudes and beliefs

• Children exposed to domestic violence
  significantly more likely to have
• Fears and worries about family members
• Negative family images
• Blame themselves for the violence
• Incorrect attitudes and beliefs about violence

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Impact on the Child

• EMOTIONS
• Anxiety, afraid
• Depression
• Low self-esteem
• Trauma
• PTSD

• BEHAVIOR
• Academic performance
• gt Aggression
• Social skills
• Social expectations

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Traumatic Stress Reactions of Children Exposed to
Violence

• Traumatic re-experiencing
• nightmares, intrusive thoughts, repetitive play
• Avoidance, emotional numbing
• Physiological reactions
• hypervigiliance, startle, heart rate
• Behavioral changes
• aggression, regressions, fears and worries

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Traumatic Stress Symptoms of Children Exposed to
Domestic Violence
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Children with Traumatic Stress Symptoms
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of Children Diagnosed with PTSD
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Impact on the Mother

• Death
• Injury
• Anxiety
• Trauma, PTSD
• Self-esteem

• Parenting stress
• Depression
• Social isolation
• Work disruption

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Injuries after Violence
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Do children differ in how they react when
exposed to domestic violence?
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Clustering Child Outcome Variables

• The Child Behavior Checklist (Achenbach
  Edelbrock, 1993)
• CBCL Internal Score ? .90
• CBCL External Score ? .93
• CBCL Total Score ? .96
• The Child Depression Inventory (Kovacs, 1985)
• CDI Total Score ? .90
• Perceived Self-Competence Scales for Children
  (Harter)
• Self-Worth
• Social Self-Competence

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Sources of Resilience

• Perceptions of self-worth
• Not feelings of shame and guilt
• Have high self-regard
• Perceptions of social competence
• Agentic, not powerless or helpless
• Feel socially connected
• Positive social regard

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Profiles of Child Adjustment Following Violence
Exposure N221 Principal of Multifinality
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2000s Studies -

• Physical Effects of Violence Exposure
• Childrens Health
• Physiological reactivity
• Effects on young children
• Cultural similarities and differences in effects

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Research Questions

• At what age were these children first exposed to
  domestic violence?
• Is age at first exposure associated with outcome,
  such that the younger the child at first
  exposure, the worse the outcome?

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Does this mean a lifetime of exposure?

• Recall, in this sample of 221 children ages 6 to
  12 exposed to domestic violence, their mothers
  reported that the average length of their abusive
  relationship was 9.5 years.

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Age of First Exposure

• The children were first exposed to domestic
  violence
• in infancy 64
• as toddlers 18
• as preschoolers 7
• as school-aged 12
• Age of exposure did not differ significantly for
  boys versus girls nor for Caucasian compared to
  African-American children.

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Age at first Exposure (n)
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• In general, the younger the first exposure, the
  more adjustment problems noted in the child.
• Age of first exposure was significantly
  correlated with
• Boys Externalizing behavior problems r -.28
• Girls Total adjustment problems r -.21
• plt.05, plt.01.

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Research Question

• What factors predict to child adjustment,
  including the age at which the child was first
  exposed to violence?

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Factors predicting to negative child adjustment
outcome

• Regression analyses
• Controlling for
• Child sex
• Ethnicity
• Family income
• Amount of violence the child witnessed
• Entering
• Age at first exposure
• Mothers depression (Beck Depression Inventory)

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Hierarchical regression analyses predicting to
child aggression problems ß R R2 F Step
One .25 .06 11.85 Child sex -.24 S
tep Two .36 .13 8.49 Ethnicity
-.22 Income .10 Step Three .41 .17
7.18 Witnessed Violence .16 Step
Four .44 .19 6.89 Age at first
exposure -.15 Step Five
.50 .25 8.10 Mothers depression .24
Adj R2.22
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Hierarchical regression analyses predicting to
child anxiety/depression ß R R2 F Step
One .06 .003 0.61 Child sex -.06 Step
Two .29 .09 5.60 Ethnicity -.26
Income .08 Step Three .39 .15 6.36
Witnessed Violence .07 Step Four
.40 .16 5.38 Age at first exposure -.05
Step Five .50 .22 8.15 Mothers
depression .31 Adj R2.22
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Hierarchical regression analyses predicting to
child total behavioral problems ß R R2 F
Step One .17 .03 5.34 Child
sex -.17 Step Two .35 .12 8.10
Ethnicity -.27 Income .10 Step
Three .43 .19 7.84 Witnessed Violence
.09 Step Four .45 .20 7.31
Age at first exposure -.14 Step Five
.54 .29 9.96 Mothers depression .30
Adj R2.26
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Physical Effects of Violence Exposure

• Children exposed to domestic violence
  significantly more likely to have
• Overweight defined as gt95 BMI
• Children distressed by domestic violence
  significantly more likely to have
• 4 X Asthma
• 4 X Allergies
• 4 X Gastrointestinal problems

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Factors predicting to 8 health problems in
preschoolersGraham-Bermann Seng, J Pediatrics,
2005.

• Monthly Income .029
• Minority Status .073
• Child's Gender .039
• Marital Status -.029
• Child Abuse .186
• Domestic Violence .171
• Community Violence .070
• Mother Depression -.034
• Mother Substance Use .167
• Mother Current Health -.247
• Child Traumatic Stress .291

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Effects of Young Childrens Exposure to Domestic
Violence

• 3-5 year olds 60 - 74 in clinical range on
  behavioral problems
• aggression, anxiety, social withdrawal
• Rate is 30 times higher than expected
• Young children more likely to be rejected by
  peers
• Young children express more negative emotions
• Young children struggle with emotion expression
• Young children not less happy or less cooperative

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2000s Theories and Models

• Social learning theory
• but not every child learns to be aggressive
• others learn more than fighting
• Trauma theory - symptoms not accounted for
• Relationships theory - attachment, object
  relations
• Ecological model
• Developmental psychopathology model
• Emotion Regulation Model

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Context of Risk Protection
Protective Factors Community Resources Social
Support Parenting Strengths Education
Violence Domestic Violence Child Abuse Violence
History
Child Adjustment Social Behavior Emotion
Regulation Resilience

Mediated by Trauma Attitudes and Beliefs
Risk Factors Community Violence Poverty
Stress Moms mental health Child age
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Ecological Model of Risk and Protection

• Individual Level
• Family Systems Level
• Community Level
• Societal Level

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Risk and Protective Factors

• Risks
• Existing mental health problems
• Child age
• History of trauma
• Less cognitive ability
• Mothers mental health problems
• Lack of helping sources

• Protection
• Parental coping ability
• Adequate parenting skills
• Community resources
• Parent education
• SES

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• The Problems for Kids Club
• Children exposed to violence and abuse
• May think that violence is the best way to solve
  problems
• May have been blamed for the violence or neglect
• May have learned stereotyped gender roles
• Father as tyrant, violent
• Mother as passive, dependent
• May have been traumatized by their experiences
• May have difficulty in emotion regulation

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Conclusions

• Severe physical violence to the mother is
  accompanied by other forms of assault - coercion,
  physical threats, sexual assault, mild violence.
• Children exposed to domestic violence are at-risk
  for exposure to other forms of violence - child
  abuse, child sexual abuse, sibling community
  violence.
• When violence occurs in the home, children are
  eyewitness to almost all of it.
• The majority of children in this study (64) were
  exposed to domestic violence in the first year of
  their life AND the duration of domestic violence
  exposure was more than 9 years on average.

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Conclusions

• Age of first exposure was inversely related to
  adjustment problems such that younger age of
  first exposure was associated with greater
  problems in adjustment. Early exposure for boys
  was related to externalizing behavior problems
  and early exposure was related to total behavior
  problems for girls.
• The age at which the child was first exposed to
  violence made a unique contribution to child
  aqggression problems and total problems after
  age, ethnicity, family income, and the amount of
  violence were taken into account.
• Children should be evaluated for exposure to
  domestic violence very early in their lives in
  order to identify them and to provide for their
  needs!

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Conclusions

• Studies on the effects of violence on children
  have become more sophisticated, and include
  models and theories.
• Research has been successful in identifying both
  risk and protective factors for children
  associated with violence exposure.
• More than half of the children exposed to
  domestic violence manifest serious problems in
  adjustment, inclusive of aggression, withdrawal,
  anxiety, traumatic stress and cognitive problems.
• However, some children appear to be resilient at
  least when first assessed.
• Recent studies have documented physical health
  consequences of exposure to violence.

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Conclusions

• The effects of domestic violence on children can
  be identified and are amenable to intervention!
• Interventions have proven to be effective in
  reducing adjustment problems and improving
  coping!

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Sandragb_at_umich.edu

• Sandragb.com

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Hypothesis

• Children whose mothers experience severe physical
  assault have more fears and worries than do
  children in similar but nonviolent families.

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Family Fears and Worries

• concerns and fears of children
• self report measure
• mother, father, brother, sister, self, friend
• two reliable factors - harm, vulnerability
• test-retest, construct validation

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Sample
Violent Compare Diff
Age 9.42(1.79) 9.48(1.82) t-.18 Age
mom 30.7(4.91) 31.7(5.06) t.02 Ethnicity 60
minority 61 Fam size 3.22(1.43) 2.55(1.28) t-2.6
9 Income 752(814) 817(422) t.54
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Family Fears and Worries Vulnerability
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Family Fears and Worries Harm
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• Levels of childrens fears and worries are
  associated with both internalizing and
  externalizing behavioral problems.