Children Exposed to Domestic Violence: Effects and Interventions

Introduction

Domestic violence is an ongoing experience of physical, psychological, and even sexual abuse in the home that is often a method used by one adult to establish control and power over another person (Flitcraft et al., 1992). Exposure by children to marital aggression is now a recognized public health concern, and the investigation of its effects on children's functioning is a significant societal issue. Marital conflict is generally defined as any difference of opinion between marital or domestic partners, whether minor or major, and can assume many different forms including displays of both negative and positive emotions and constructive or destructive tactics. Marital aggression is characterized by physical and/or psychological abuse and falls at the negative extreme on a continuum of marital conflict (Cummings, 1998). Marital psychological and verbal aggression refers to behaviors such as threats, insults, and throwing objects. This has been considered a form of psychological abuse, whereas marital physical violence — domestic violence — is indicated by a physical assault on one partner's body (Jouriles, Norwood, & McDonald, 1996). Children who witness domestic violence are at risk for a number of developmental, psychological, and social difficulties. Treatment for exposure is often aimed at reducing or preventing domestic violence, but treatment for primary victims and batterers is not more successful than legal interventions (Evans, Davies, & DiLillo, 2008).

Discussion of Problem Area and Issue

Although public awareness about the rate of domestic violence is increasing, the public health consequences of domestic violence have only recently begun to be recognized in the medical community. The majority of the early literature focused on the effects of domestic violence on the primary victim, largely ignoring questions about the potential effects of witnessing domestic violence on secondary victims — such as children and adolescents who live in homes where such abuse occurs (Carlson, 2000). It has been estimated that between three and ten million American children and adolescents witness occurrences of domestic violence annually (Carlson, 2000).

The following ten facts from the U.S. Department of Justice illustrate the scope of the problem (Rennison, 2003):

1. Eighty-five percent of domestic violence cases involve female victims.

2. An estimated 1.3 million women are victims of physical assault by an intimate partner each year.

3. Females between the ages of 20 and 24 are at the greatest risk of nonfatal intimate partner violence.

4. Nearly one-third of female homicide victims reported in police records are killed by an intimate partner.

5. Less than one-fifth of victims reporting an injury from intimate partner violence actually sought medical treatment.

6. The cost of intimate partner violence exceeds $5.8 billion each year, with four billion dollars going to direct medical and mental health services.

7. Victims of intimate partner violence lost nearly eight million days of paid work due to the violence perpetrated against them — a loss equivalent to more than 32,000 full-time jobs — and nearly 5.6 million days of household productivity.

8. Thirty to sixty percent of perpetrators of intimate partner violence also abuse children in the household.

9. Witnessing violence between one's parents or caretakers is the strongest risk factor for transmitting violent behavior from one generation to the next.

10. Boys who witness domestic violence are twice as likely to abuse their own partners and children when they become adults.

Regarding domestic violence specifically in the State of California, several additional issues have been documented (California Partnership to End Domestic Violence, 2008):

1. California law enforcement received 176,299 domestic violence-related calls in 2006. Over 80,000 of those calls involved weapons, including firearms and knives.

2. Nearly 44,000 people were arrested for domestic violence offenses in 2006; of these, 80% were men and 20% were women.

3. In 2008, ninety-nine women were murdered by their husbands, ex-husbands, or boyfriends in California, while fourteen men were killed by their wives, ex-wives, or girlfriends.

4. California law enforcement received a total of 166,343 domestic violence calls in 2008, of which over 65,000 involved weapons.

Previous research has estimated that at least 3.3 million children witness physical and verbal spousal abuse each year. The range of behaviors in this estimate spans from insults and hitting to fatal assaults with weapons (Carlson, 1984; Jaffe, Wolfe, & Wilson, 1990). As alarming as this statistic is, it may actually underestimate the true number of children exposed to domestic violence, because the data were gathered over 20 years ago and at that time did not include divorced parents or children under three years of age. More recent estimates suggest that more than 10 million children in the United States may be exposed to domestic violence, and that over 40% of all households in which domestic violence occurs contain children under 12 years of age (Rennison & Welchans, 2000).

Theoretical Framework and Research Findings

Understanding the effects of witnessing and being exposed to domestic violence on children and adolescents has been the focus of concentrated research efforts since the seminal studies on this subject appeared in the 1980s. Numerous scholarly reviews of this literature have concluded that exposure to domestic violence results in significant and measurable negative effects on children's functioning when compared to children from nonviolent families (Fantuzzo & Lindquist, 1989). These negative effects span emotional functioning, behavioral functioning, social competence, school achievement, cognitive functioning, psychological functioning, and general health. Several of these effects have been replicated across different studies and generally conform to expected theoretical predictions and clinical expectations, though a number of methodological issues complicate their interpretation.

The majority of researchers recognize that exposure to domestic violence is a nonspecific risk factor for developmental harm, illustrating the process of multifinality of development (Sameroff, 2000). This means that exposure to domestic violence is one of several harm-producing factors — including child abuse, harsh parenting practices, and other trauma — that hamper normal development and can lead to negative, though largely unpredictable, short- and long-term outcomes. The literature also indicates that exposure to domestic violence creates a negative impact on children's and adolescents' behavioral adjustment above and beyond other coexisting factors; in other words, such exposure is not simply a confound or correlate but a separate additive risk factor.

Different terms have been used by researchers and clinicians to refer to children in households where domestic violence occurs. In early research, these children were referred to as either "observers" or "witnesses" of domestic violence (Fantuzzo & Lindquist, 1989; Kolbo, Blakely, & Engleman, 1996; Margolin, 1998). In the mid-to-late 1990s, those terms were replaced by the broader term "exposure" to domestic violence, which is more inclusive and avoids assumptions about the specific nature of children's experiences. Exposure to domestic violence encompasses watching or hearing violent events, direct involvement in the situation (e.g., trying to intervene or calling the police), or experiencing the aftermath (e.g., witnessing physical damage or observing maternal depression).

Early reviews of the literature regarding the effects of domestic violence on children (Fantuzzo & Lindquist, 1989; Kolbo, Blakely, & Engleman, 1996) indicated that children exposed to domestic violence demonstrated significantly more externalizing and internalizing behaviors than children from nonviolent homes. Regarding externalizing behaviors, studies found that children exposed to domestic violence tended to be more aggressive and exhibited more behavior problems in school and in their communities, ranging from temper tantrums to physical altercations with others. Internalizing behavior issues among exposed children included depression, suicidal thoughts and behaviors, increased anxiety (including more generalized fears and higher rates of phobias), higher rates of insomnia, more bed-wetting, and lower self-esteem compared to children from nonviolent homes.

Several studies in these reviews also assessed cognitive and academic functioning. In general, they found significant differences between children reared in violent homes and those raised in nonviolent homes. Children exposed to domestic violence demonstrated an impaired ability to concentrate, more difficulty completing schoolwork, and significantly lower performance on measures of verbal and motor skills.

Results across studies were less consistent regarding the effects of witnessing domestic violence on social development. Fantuzzo and Lindquist (1989) reviewed 23 studies published between 1967 and 1987 and noted that studies examining social development found that both boys and girls from violent homes displayed significantly lower levels of social competence — as measured by poorer problem-solving skills and lower levels of empathy — compared to children from nonviolent homes. However, Kolbo, Blakely, and Engleman (1996) observed that five of eleven studies published between 1988 and 1996 that assessed social functioning variables did not find a significant relationship between child exposure to domestic violence and decreased social competence.

Kolbo, Blakely, and Engleman (1996) also reported that studies measuring physical health differences between exposed and non-exposed children did not find evidence of a causal link between exposure to violence and physical health problems. More recent research has examined specific measures of emotional and cognitive functioning in greater depth.

Animal models have suggested that exposure to stress at a young age is associated with reductions in cortical volume. Koenen et al. (2003) assessed IQs for a sample of 1,116 monozygotic and dizygotic five-year-old twin pairs in England whose mothers reported experiencing domestic violence in the previous five years. Children exposed to high levels of domestic violence had IQs that were, on average, eight points lower than those of non-exposed children. This relationship was maintained after controlling for maltreatment and genetic factors.

More recent research has also sought to determine specifically how witnessing domestic violence affects children's psychological well-being. Maikovich, Jaffee, Odgers, and Gallop (2008) examined how externalizing and internalizing symptoms were distributed among children who reported witnessing domestic violence and children whose caregivers reported using harsh physical discipline. They studied nearly 3,000 children over the age of five who had been maltreated and exposed to domestic violence. Child Behavioral Checklist assessments were taken at several time points and analyzed via structural equation modeling. They found that children exposed to harsh discipline (especially physical and extreme punishment) did not demonstrate the typical developmental decrease in externalizing behaviors (e.g., aggression, acting out), whereas children exposed to domestic violence did not demonstrate the expected developmental decrease in internalizing behaviors (e.g., depression and anxiety). Interestingly, Taylor, Guterman, Lee, and Rathouz (2009) found that being a victim of domestic violence was itself a significant risk factor for maltreating children with harsh discipline in a sample of 2,523 mothers. Numerous other studies have confirmed that families with domestic violence face an increased risk of child maltreatment (e.g., Koenen et al., 2003). Thus, the effects of domestic violence can potentially harm children from multiple directions.

Meta-analytic studies have helped identify the most salient effects on children exposed to domestic violence. Kitzmann, Gaylord, Holt, and Kenny (2003) reported that 63% of exposed children perform more poorly than non-exposed children; however, the remaining 37% fare as well as or better than non-exposed children. Evans, Davies, and DiLillo (2008) analyzed 60 studies and found effect sizes of .48 for internalizing and .47 for externalizing symptoms in relation to domestic violence exposure. A smaller set of six studies revealed an effect size of 1.54 for the relationship between exposure and childhood trauma symptoms. Gender was identified as a moderator for exposure and externalizing symptoms, with males at higher risk. However, Wolfe et al. (2003) found only small effects in their meta-analysis of 41 studies. Differences in inclusion criteria across meta-analyses frequently lead to varying outcomes, underscoring the need for methodological consistency in this literature.

References

Babcock, J. C., Green, C. E., & Robie, C. (2004). Does batterers' treatment work? A meta-analytic review of domestic violence treatment. Clinical Psychology Review, 23(8), 1023–1053.

California Partnership to End Domestic Violence. (2008). DVAM 2008 statewide press release. Retrieved December 3, 2011, from www.cpedv.org/docs_2007/DVAM_2007_STATEWIDE_PRESS_RELEASE.pdf.

Carlson, B. E. (1984). Children's observations of interparental violence. In A. R. Roberts (Ed.), Battered women and their families (pp. 147–167). New York: Springer.

Carlson, B. E. (2000). Children exposed to intimate partner violence: Research findings and implications for intervention. Trauma, Violence, and Abuse, 1(4), 321–340.

Cummings, E. M. (1998). Children exposed to marital conflict and violence: Conceptual and theoretical directions. In G. W. Holden, R. Geffner, & E. N. Jouriles (Eds.), Children exposed to marital violence: Theory, research, and applied issues (pp. 55–93). Washington, DC: American Psychological Association.

Dutton, D. G. (2007). The complexities of domestic violence. American Psychologist, 708–710.

Dutton, D. G., & Corvo, K. (2007). The Duluth model: A data-impervious paradigm and a failed strategy. Aggression and Violent Behavior, 12(6), 658–667.

Evans, S. E., Davies, C., & DiLillo, D. (2008). Exposure to domestic violence: A meta-analysis of child and adolescent outcomes. Aggression and Violent Behaviour, 13, 131–140.

Fantuzzo, J., & Lindquist, C. (1989). The effects of observing conjugal violence on children: A review and analysis of research methodology. Journal of Family Violence, 4, 77–94.

Feder, L., & Wilson, D. B. (2005). A meta-analytic review of court-mandated batterer intervention programs: Can courts affect abusers' behavior? Journal of Experimental Criminology, 1, 239–262.

Flitcraft, A. H., Hadley, S. M., Hendricks-Matthews, M. K., McLeer, S. V., & Warshaw, C. (1992). Diagnostic and treatment guidelines on domestic violence. Chicago: American Medical Association.

Jaffe, P. G., Wolfe, D. A., & Wilson, S. K. (1990). Children of battered women. Newbury Park, CA: Sage.

Jouriles, E. N., Norwood, W. D., & McDonald, R. (1996). Physical violence and other forms of marital aggression: Links with children's behavior problems. Journal of Family Psychology, 10, 223–234.

Kitzmann, K. M., Gaylord, N. K., Holt, A. R., & Kenny, E. D. (2003). Child witnesses to domestic violence: A meta-analytic review. Journal of Consulting and Clinical Psychology, 71, 339–352.

Koenen, K. C., Moffitt, T. E., Caspi, A., Taylor, A., & Purcell, S. (2003). Domestic violence is associated with environmental suppression of IQ in young children. Development and Psychopathology, 15, 297–329.

Kolbo, J. R., Blakely, E. H., & Engleman, D. (1996). Children who witness domestic violence: A review of empirical literature. Journal of Interpersonal Violence, 11, 281–293.

Maikovich, A. K., Jaffee, S. R., Odgers, C. L., & Gallop, R. (2008). Effects of family violence on psychopathology symptoms in children previously exposed to maltreatment. Child Development, 79, 1498–1512.

Margolin, G. (1998). Effects of domestic violence on children. In P. K. Trickett & C. J. Shellenbach (Eds.), Violence against children in the family and the community (pp. 57–101). Washington, DC: American Psychological Association.

Rennison, C. M. (2003, February 1). Intimate partner violence, 1993–2001. Bureau of Justice Statistics. Retrieved December 1, 2011, from http://www.bjs.gov/index.cfm?ty=pbdetail&iid=1001.

Rennison, C. M., & Welchans, S. (2000). Intimate partner violence: Bureau of Justice Statistics special report. Washington, DC: U.S. Department of Justice.

Sameroff, A. J. (2000). Developmental systems and psychopathology. Development and Psychopathology, 12, 297–312.

Taylor, C. A., Guterman, N. B., Lee, S. J., & Rathouz, P. J. (2009). Intimate partner violence, maternal stress, nativity, and risk for maternal maltreatment of young children. American Journal of Public Health, 99(1), 175–183.

Wolfe, D. A., Crooks, C. V., Lee, V., McIntyre-Smith, A., & Jaffe, P. G. (2003). The effects of children's exposure to domestic violence: A meta-analysis and critique. Clinical Child & Family Psychology Review, 6(3), 171–187.