Janis Wolak and David Finkelhor
Family Research Laboratory, University of New Hampshire
Copyright
Information
Introduction
Partner violence is often described as unseen, because it usually occurs in the privacy of a home. But violent homes often include children, and these children do see the violence (Hilton, 1992; Holden & Ritchie, 1991; Jaffe, Wolfe, & Wilson, 1990). Children hear their parents, the adults they love and depend on, screaming in anger, pleading in fear, sobbing in pain. They hear fists hitting bodies, objects thrown and shattered, people thrown against walls and knocked to floors. They may see blood, bruises, and weapons. Some children witness domestic rapes and even murder (Eth & Pynoos, 1994; Pynoos & Nader, 1988). These children often show signs of trauma, but partner violence has even broader implications because family relationships have such a profound influence on development (Aldwin, 1994; Davies, 1991; Hartup, 1989).
This chapter describes current knowledge about how partner violence impacts children and the different ways children respond to and cope with violence in their homes, focussing on developmental differences. It discusses approaches to assessing and treating child witnesses to partner violence.
Defining the problem
Childhood exposure to partner violence, as we define it here, occurs when children see or hear physical assaults between their parents or observe its effects. Most of the literature focuses on violence in two-parent families, but "parents" should be broadly construed to include step-parents or cohabiting or other intimate or even dating partners of a child. When we refer to parents in this chapter, we do not mean to exclude other family structures such as single-parent families. Practitioners should remember that no type of family is immune from this kind of violence.
Much of the research on child observers of partner violence has been based on data from battered women in shelters and thus tends to involve children who have seen their mothers victimized severely--often and chronically. Other patterns of violence can occur, but are not as well-documented in the literature. The assault victim can be someone besides the mother: a step-mother, live-in partner or dating partner of the child's father. In some cases the mother may be a perpetrator of assault, and the victim the child's father, step-father or a live-in or dating partner of the child's mother (Stets & Straus, 1990). The violence in a child's home may be entirely one-sided, or both parents may use it to varying degrees. Children may see their mothers use violence in self-defense or see their parents trading blows (Stets & Straus, 1990).
Other situations differ from typical shelter cases, too. Many children are exposed to less severe violence in homes where parents occasionally or routinely slap, shove and throw things at each other. Some children see severe violence but live in homes where the mother does not flee or where incidents are not reported to police or other agencies (Straus & Gelles, 1990a). The violence children observe can vary in its onset and duration. Children may live with parents who have been married and violent for many years, or violence may suddenly erupt over money problems or other transient or more chronic stressful events. Violence may set in as a marriage disintegrates and either cease or persist after parents are divorced or separated. Or children living with a single parent with no history of partner violence may suddenly witness attacks on their parent by a new step-parent or dating partner.
While children may be exposed to different degrees of violence under a variety of circumstances, the unique and salient characteristic of this exposure is that children observe violence done by and/or against their parents. These children may grow up fundamentally confused about the meanings of love, violence and intimacy. The parent-child relationship that a child relies on for nurture, security and guidance is often distorted as children attempt to cope with viewing their parents as victims and perpetrators of violence. The partner violence that children observe does not necessarily occur physically in the home. It can happen anyplace. But it occurs in children's families, within their core relationships, and its significance for a child lies in that fact (Aldwin, 1994; Davies, 1991; Hartup, 1989).
Scope of the problem
Researchers are beginning to establish how many children witness partner violence. Their estimates are primarily based on a few surveys asking adults to recall childhood experiences. This research suggests substantial numbers of children are exposed to adult violence in their homes as they grow up.
How many children witness partner violence?
Four surveys asking adults about childhood memories suggest that between 11% and 20% of adults remember seeing violent partner incidents when they were young (Henning, Leitenberg, Coffey, Turner, & Bennett, 1996; Straus, Gelles, & Steinmetz, 1980; Straus & Smith, 1990) (J.L. Jasinski, personal communication, June 19, 1996). More than 10% of adults surveyed recalled their mothers or fathers hitting each other in the two representative national Family Violence Surveys conducted in 1975 and 1985. In the 1975 survey, 11% of those responding recalled at least one occasion of violence, with 13% reporting their father hitting their mother and 9% their mother hitting their father. In the 1985 survey, 13% of adults remembered violent incidents between their parents (Straus, 1992; Straus, et al., 1980; Straus & Smith, 1990).
Sixteen percent of those surveyed in the 1992 National Alcohol and Family Violence Survey remembered their parents hitting or throwing things at each other. People were asked to recall incidents that happened when they were teenagers. Seven percent recalled their father as the perpetrator, 4% remembered their mother hitting and throwing things, and 5% recalled both parents being violent (Jana Jasinski, personal communication, June 19, 1996).
In a fourth survey where 617 women responded to a mail questionnaire in a small New England city, 20% remembered violence in their homes when they were 15 or younger (Henning, et al., 1996). Eight percent reported their father attacked their mother, 6% reported their mother as the assailant, and 6% reported violence by both parents.
At least one study asked children directly about observing partner violence. The 1991 National Child Victimization Prevention Survey, a telephone survey of 2000 children ages ten through sixteen, asked children, "Have you ever seen any of the adults in your household hit one another?" Seven percent of the children surveyed answered "yes." When children were asked who did the hitting, 3.4% identified their father or step-father and 1.5% their mother or step-mother, with the remainder identifying other adult relatives, mostly siblings. Children were not asked who was hit. Three percent of the children surveyed had seen such violence in the past year (David Finkelhor, personal communication, June 19, 1996).
While these surveys provide the best figures we have, it remains difficult to know precisely how many children see violence in their homes. People surveyed about such matters may forget experiences, or remember incorrectly or be unwilling to disclose painful or embarrassing events. At best, survey figures give a range in which the true rate for childhood exposure to partner violence exists. The 5% rate of exposure to parental violence found in the National Youth Victimization Prevention Survey underestimates true rates because these survey participants had not finished their childhood. The three national telephone surveys of adults which found rates between 11% and 16% may be low also, because some people forgot violent incidents or failed to disclose them for other reasons. Also, these surveys each asked only one question about violent behavior by parents. The Henning mail survey, which found that 20% of adult women saw violence between their parents, asked several detailed questions about types and severity of violence, but the sample in this study was based on a local survey of women only, and only 617 of the 6,000 in the sample returned questionnaires.
Researchers estimate that between 20% and 28% of couples who are dating, cohabiting or married experience at least one violent incident during the course of their relationships. (See Chapter 1.) Assuming that rates of violence for parents equal rates for couples in general, these figures are fairly consistent with a range of 11% to 20% for how many children witness assaults. The estimates for violence over the course of a relationship include couples who admit to occasional and relatively mild incidents like slaps and shoves that a child might not notice, as well as couples who engage in frequent and/or severe violence which would be harder for other household members to miss. This might account for the discrepancy in rates for couple violence and child observation of violence.
None of this is to say that partner violence only impacts children if they see it. As described later in this chapter, viewing violence between parents directly impacts children in several ways, yet partner assault also has an indirect impact because it physically and psychologically affects parents, particularly mothers, in ways that are consequential for parent-child relationships.
Partner violence in military families. Children in military families may witness more violence than children in the civilian population. Although little research exists, one study of American college students attending classes in Germany compared the partner violence observed by students from military families to that observed by students from civilian families. Students from military families reported significantly higher levels of violence overall. They were more likely to have witnessed one or both parents slapping, pulling hair, throwing objects and/or pushing down or into walls than were civilian students. Rates of partner violence were higher in the families of commissioned officers than in families of enlisted personnel (Cronin, 1995). (See Chapter 6 for a discussion of partner violence in military families.)
When violence exists, how much do children see?
When children witness violence, we know little about how many incidents they observe and how often violence occurs. Straus (1992) reports adults who recalled partner violence as they were growing up were aware of an average of nine incidents between their parents, with most people remembering at least four episodes. G. Kaufman Kantor and J.L. Jasinski (personal communication, June 19, 1996) found that of people who remembered their parents hitting and throwing things, 60% reported more than one violent incident. In the National Youth Victimization Prevention Survey, half of the children who had seen partner violence had seen it more than once (David Finkelhor, personal communication, June 19, 1996). While multiple incidents seem more prevalent than single ones, it is likely that children are more aware of and more likely to remember violence when it happens more than once.
How severe is the violence that children see?
Henning (1996) asked women about the severity of violent behaviors they recalled between their parents. About one-third of the women who grew up with partner violence (7% of all women surveyed) had seen their fathers kick or bite their mothers or hit them with fists. Six percent of all women surveyed had seen their fathers beat up their mothers, 3% had witnessed choking and threats with weapons and 1% had seen their fathers use knives or guns. Somewhat smaller numbers of women had seen their mothers engaged in severe violence.
One percent of children in the National Youth Victimization Prevention Survey (11% of those who reported witnessing violence) had seen violence so severe that the victim required hospitalization (David Finkelhor, personal communication, June 19, 1996), but researchers did not ask more specific questions about the types of violence.
Some parents may try to protect their children from violent marital fights, but people who work with children of women who have sought refuge in shelters note: "...we find that almost all [children] can describe detailed accounts of violent behavior that their mother or father never realized they had witnessed." (Jaffe, et al., 1990, p. 20). Most children in shelters have witnessed acts of severe violence (Giles-Sims, 1983; Hilton, 1992; Holden & Ritchie, 1991).
Exposure to sexual violence.
While growing numbers of researchers have become interested in children's exposure to partner violence, few have broached the topic of exposure to domestic sexual assault, even though substantial percentages of women who are assaulted by their partners also suffer rape. (See Chapter 5.) In one study of 115 women from a battered women's shelter who had been sexually abused as well as physically assaulted, 18% reported that their children witnessed sexual attacks (Campbell & Alford, 1989). The small body of research into marital rape recounts many instances of children seeing or hearing their mothers raped and sexually abused (Finkelhor & Yllo, 1985; Russell, 1990).
Different ways children are exposed to partner violence
When we speak of children being "aware" of or "exposed" to violence, it implies that children are passive observers. This does not mean children are at a distance from what they see. One researcher who reviewed police reports of partner assaults notes the disturbing contexts for children who were witnesses:
They sat crying and frightened and watched what was going on, or they ran into the adjoining room and put their hands over their ears. A seven-year-old girl... fainted from fear. A seven-month baby girl lay in her crib in the living room when an explosive fight broke out. It ended with the mother getting beaten and landing on top of the little girl. A four-year-old girl sat weeping in her mother's lap as the father threatened with a knife... (Hyden, 1994, p. 123).
Sometimes children are more than observers. They can be participants in the battles of their parents in varying degrees:
The children were still in the kitchen during all the squabbling. When they saw the knife being waved like a sword, they both started to scream and run for the door... He yelled, 'I'm going to cut you all into tiny little pieces.'...I'll never forget my kids faces. They were really scared... (Roy, 1988, p. 174).
A seven-year-old girl witnessed how her father was trying to choke her mother. The girl forced her way in between her parents, and begged and pleaded for her father to spare her mother. (Hyden, 1994, p. 123-124)
Another woman told of her 3-year-old son coming to defend her, saying: 'No, daddy, no!' And he came behind his father and started hitting him. (Hoff, 1990, p. 204)
Some children are targets of attack, along with their mothers, as in this mother's account:
... He got me down and started kicking me... He kicked me three times in the head... That's when he started to abuse the kids. He grabbed Amy by the neck and broke Bobby's arm. (Hoff, 1990, p. 34)
Children are also witnesses to sexual abuse:
Then he forced me to lean forward, forced himself into me from behind... the whole time he had the knife against my leg... I thought he was going to kill me... And the whole time I could see Anna [their pre-schooler] standing in the kitchen... (Hyden, 1994, p. 113-114)
It is easy to see from these accounts how children can become overwhelmed by witnessing violent, emotion-laden scenes between their parents. Children may react intensely to these frightening adult displays, and their reactions may include acute fear for their own and their parent's safety. Many children have difficulty coping with the feelings of fear, anger and pain aroused by the violence they witness in their homes (Roseby & Johnston, 1995; Rosenberg & Rossman, 1990).
Symptoms of children exposed to partner violence
Children who observe partner violence cannot be described as having one particular pattern of response to their experience. A recent summary of 29 different studies of children who have witnessed partner assaults (Kolbo, Blakely, & Engleman, 1996) reports harm in several areas of functioning: behavioral, emotional, social, cognitive and physical.
Behavioral problems include aggression, tantrums, "acting out," immaturity, truancy and delinquency (Davies, 1991; Dodge, Pettit, & Bates, 1994; Graham-Bermann, 1996c; Hershorn & Rosenbaum, 1985; Hughes & Barad, 1983; Jouriles, Murphy, & O'Leary, 1989; Sternberg, Lamb, Greenbaum, Cicchetti, Dawud, Cortes, et al., 1993). Common emotional problems are anxiety, anger, depression, withdrawal, and low self-esteem (Carlson, 1990; Davis & Carlson, 1987; Graham-Bermann, 1996c; Hughes, 1988; Jaffe, Wolfe, Wilson, & Zak, 1986). Social problems refer to poor social skills, peer rejection, and an inability to empathize with others (Graham-Bermann, 1996c; Strassberg & Dodge, 1992). Cognitive difficulties generally include language lag, developmental delays and poor school performance (Kerouac, Taggart, Lescop, & Fortin, 1986; Wildin, Williamson, & Wilson, 1991). Physical problems include failure to thrive, problems sleeping and eating, regressive behaviors, poor motor skills, and psychosomatic symptoms like eczema and bed wetting (Jaffe, et al., 1990; Layzer, Goodson, & Delange, 1986).
Symptoms of Children Exposed to Partner Violence
(Table 1)
| Behavioral | Emotional | Physical | Cognitive | Social |
|---|---|---|---|---|
| Aggression, Tantrums, Acting out, Immaturity, Truancy, Delinquency | Anxiety, Depression, Withdrawal, Low self-esteem, Anger | Failure to thrive, Sleeplessness, Regressive behaviors, Eating disorders, Poor motor skills, Psychosomatic symptoms | Poor academic performance, Language lag | Lack of empathy, Poor social skills, Rejection by peers |
Note: Researchers are uncertain whether these types of problems are attributable to exposure to partner violence alone, or to the cumulative effect of exposure and other problems prevalent in violent homes.
Most of the research cited uses various standardized instruments that measure psychological and other problems. Researchers compare the scores of children exposed to partner violence to normed scores or to scores of control groups. Most, but not all, of this body of research finds that children who witness violence are significantly more likely to have problems in one or more of the five areas cited than children who do not. In Kolbo's opinion, the findings in the behavioral, emotional and cognitive realms are particularly consistent, while the evidence for difficulties in social relationships and physical complaints is weaker (Kolbo, et al., 1996). Fewer studies have focused on social relationships and physical health.
These findings do not imply that every child who witnesses partner violence, even frequent and severe violence, will have problems. Many children are able to cope successfully with disturbing events. Moreover, this body of research is relatively recent, and its findings are limited by methodological and other difficulties detailed later in this chapter. At this point, it is also difficult to conclude that any problems these children exhibit are attributable to witnessing partner violence alone, and not characteristic of other difficulties that may be prevalent in violent homes.
Why does exposure to partner violence harm children?
Researchers believe that partner violence damages children developmentally in several ways. A model of these influences is described by Jaffe and his colleagues (1990) who theorize that children are affected by partner violence both directly and also indirectly through the impact the violence has on their parents.
Indirect effects ensue from:
Direct influence: Physical danger.
Some children are in physical danger because of the violence in their homes (Jaffe, et al., 1990). Proximity to an assault can imperil a child who is nearby when objects are thrown, weapons used, or people shoved and hit. Children may be injured while being held in their mother's arms, fleeing, or trying to intervene in an assault. Some children become targets of assault.
Exposure to physical danger is also sometimes associated with Post-Traumatic Stress Disorder (PTSD) and related symptoms. PTSD is a specific psychiatric disturbance caused by exposure to an extreme stressor that results in the involuntary re-experiencing of the event (in the form of intrusive recollections or dreams), a residue of heightened physiological arousal (as in difficulty falling asleep, irritability and exaggerated startle responses) and a pattern of avoidant behavior (feelings of detachment or estrangement and emotional constriction). (See DSM-IV for exact criteria for diagnosis.) Exposure to violence seems to trigger PTSD in children more consistently than other stressors (McNally, 1993). Studies have found that 100% of children who witnessed parental homicide (Malmquist, 1986) or who witnessed a mother's violent sexual assault by strangers (Pynoos & Nader, 1988) qualified for the diagnosis of PTSD. Current theory about PTSD views it as resulting from overwhelming levels of fear and helplessness, particularly combined with perceptions that one is going to be killed or seriously injured, so it is easy to see how PTSD could be triggered by exposure to partner violence. However, it is not clear how many children who witness less serious forms of partner violence may suffer from PTSD. In one study of 64 seven to twelve year old children whose mothers had been assaulted by partners in the past year, 13% were suffering from clinically diagnosable PTSD, while the majority of children exhibited some PTSD symptomatology: 52% experienced intrusive, unwanted memories of traumatic events, 19% exhibited traumatic avoidance, and 42% suffered from traumatic arousal symptoms (Graham-Bermann, 1996d).
C. Persistent, increased arousal
Note: This list of symptoms is derived from the Clinician-Administered PTSD Scale, Child and Adolescent Version (Nader, Blake, & Kriegler, 1994). Clinical diagnosis requires that a child exhibit one symptom of reexperiencing the event, three avoidance symptoms, and two arousal symptoms. (This chart is not meant to be used as an instrument for diagnosis.)
Direct influence: Emotional and behavioral problems.
Some children from violent homes exhibit symptoms of emotional and behavioral problems that appear to be attributable to the violence they witness (Jaffe, et al., 1990). These children are fearful because they are subjected to frightening domestic scenes. They suffer from low self-esteem because they feel responsible for the violence, or because they have tried and failed to stop it. They are anxious because they are worried about their safety and the safety of other family members. They are listless from sleepless nights, sad from seeing a parent victimized, angry at one or both of their parents, and depressed because the situation seems hopeless.
Some of the coping mechanisms children use to deal with partner violence may cause them trouble. Fearful children may alienate parents, teachers and day care providers by being aggressive or clingy and dependent (Davies, 1991; Holden & Ritchie, 1991). Some children isolate themselves from peers to keep the family secret of partner violence hidden (Jaffe, et al., 1990). Adolescents may run away from home (Carlson, 1990) or anesthetize themselves with alcohol or drugs.
Direct influence: Learning aggressive behavior patterns.
There is considerable evidence that children whose parents are violent at home are more aggressive, both at home and in other settings, than children from nonviolent families (Davis & Carlson, 1987; Dodge, et al., 1994; Holden & Ritchie, 1991; Thornberry, 1994). One simple and widely accepted explanation of this, called social learning theory, proposes that children with aggressive parents learn to be aggressive by imitating their parents' behavior (Bandura, 1973). When parents use violence to exert control, deal with problems and settle conflicts, children come to see aggression as a powerful and appropriate tool for interpersonal relations. Children may identify with parents who use violence. Also, children from violent homes may not have the opportunity to learn negotiation and other peaceful methods of conflict resolution.
Indirect influence: Disciplinary practices.
Some researchers have explored the association between the quality of marital relationships and the quality of parenting skills, finding that parents who are in violent conflict with each other may tend to have qualities that can interfere with healthy child development, including irritability, harsh disciplinary practices, fewer positive interactions with their children, and more inconsistency in child rearing (Belsky, 1984; Holden & Ritchie, 1991). Holden and Ritchie (1991) note that inconsistency may be a particular problem in these families for two reasons: Parents may disagree more about child rearing and may communicate poorly, and mothers may respond to their children one way when they are alone with them, and a different way when fathers are present. Parents who are coping with their own violent relationships may be unable to provide consistent supervision and guidance to their children (Holden & Ritchie, 1991; Jaffe, et al., 1990). Parents may fail to teach their children to control aggression and may even unwittingly reinforce aggressive tendencies by ignoring them or backing down from confrontations over violent acts (Patterson, 1982; Patterson, DeBaryshe, & Ramsey, 1989).
Indirect influence: Maternal stress.
For children, the risk of harm comes not only from exposure to frightening and emotional scenes involving parents, but also from the toll on parents' abilities to maintain close and positive parent-child relationships. Most children turn to their mothers for help in coping with problems. However, when the problem is partner violence, a mother's life may be so disrupted by the stress of her own victimization that she is unable to respond to her children's concerns and fears.
High levels of maternal stress, particularly stress related to parenting, are associated with emotional and behavioral problems in children living in battered women's shelters (Graham-Bermann, 1996b; Holden & Ritchie, 1991; Wolfe, Jaffe, Wilson, & Zak, 1985). Mothers may be physically injured, in poor health and overwhelmed with anxiety and depression. (See Chapter 2 for a discussion of depression associated with partner assault.) Moreover, partner violence is often accompanied by additional burdens so that mothers may be dealing with stresses from divorce, money problems, unemployment, or homelessness, as well as assault (Jaffe, et al., 1990). All of these factors may interfere with a mother's ability to help her children cope with their distress.
Indirect influence: Paternal characteristics.
It seems apparent that children who witness assaults between their parents would be affected by their fathers' actions, but data allowing for the assessment of paternal behavior are rarely gathered in partner violence research. One exception is Holden and Ritchie (1991), who interviewed battered mothers about their husbands' child rearing behaviors. They found that paternal "irritability" was one of two significant predictors of child behavior problems in children of battered women. (The other significant factor was maternal stress.) They also found that, compared to fathers in a control group, fathers in violent families did less child care, were angry at their children more often, were less affectionate, less likely to reason with their children and more likely to spank them. At least one other study found that paternal irritability predicted antisocial behavior in boys (Patterson & Dishion, 1988).
Hartup (1989) , reviewing the research on fathers, notes that "father-child attachments show many of the same qualities that mother-child attachments do" (p. 122). Where a mother is the primary caretaker, Hartup speculates that the father's support of maternal care giving, or lack of support, will have important implications for a child. Disagreements about child rearing are rife between parents in violent families (Salzinger, Feldman, Hammer, & Rosario, 1992; Straus, et al., 1980). If Hartup is right, in violent families where mothers are the primary caretakers and fathers are disengaged from child rearing, paternal challenges to a mother's parenting ability may weaken and damage mother-child relationships. The impact of paternal behavior on children who exposed to partner violence is an important area for future research.
Factors determining the extent of the impact of partner violence
While the above mechanisms help explain why exposure to partner violence can result in trauma and symptomatic behavior, it is not possible to generalize about the form or the magnitude of harm to an individual child. Each child will have a different experience, and the consequences of exposure to partner abuse will depend on a variety of characteristics unique to each child. Several factors are particularly likely to determine how a child perceives, responds to and copes with observing parental violence and how any harm is manifested: The age and developmental level of the child, the severity of the abuse, the family context of the violence, the nature of social interventions, and the cumulative quality of the possible multiple stress factors acting on the child.
Age and developmental level.
Children's levels of understanding and coping abilities differ with age, and the impact of exposure to violence cannot be assessed without considering a child's developmental level (Davies, 1991; Jaffe, et al., 1990; Roseby & Johnston, 1995; Rosenberg & Rossman, 1990).
Infants through five year old children. Infants are cognizant of the emotional states of others at an early age (Cummings, Zahn-Waxler, & Radke-Yarrow, 1981), and they may be disturbed by the anger and turmoil of a violent household. Moreover, babies require sensitive, responsive caretakers, and mothers who are suffering in violent relationships may be too injured or under too much stress to respond to their infants' distress or to give them the intense physical care they need. As a result, some infants from violent homes may show signs of health problems and neglect. They may be underweight, have problems eating and sleeping, cry inconsolably and be unresponsive to adults (Jaffe, et al., 1990; Layzer, et al., 1986). Also, infants are fragile and at risk of being injured in violent homes.
Toddlers and preschool age children still rely heavily on their caretakers to help them control emotions and behavior. Children this age may become increasingly aware of and disturbed by the chaotic atmosphere generated by partner violence. They lack the resources to cope with confusing and frightening events on their own and are particularly dependent on caretakers for explanations and reassurance (Davies, 1991; Jaffe, et al., 1990). Because they are too immature to regulate their own behavior and emotional responses without help, they tend to show signs of behavioral and emotional problems if their mother is too depressed or otherwise incapacitated to provide responsive care (Davies, 1991; Graham-Bermann, 1996b). As they get older, they also begin to think about and try to understand the things that go on around them. Young children who have observed violent domestic scenes need to talk about their experiences with adults who can help them explain and clarify what they have seen. If they can't do this, they may try to express themselves by "acting out" (Davies, 1991).
Many toddlers and preschoolers who are exposed to partner violence will attempt to intervene between their parents in some way, a tendency which increases with age (Cummings, Pelligrini, Notarius, & Cummings, 1989). Also, children between the ages of two and five often behave aggressively (Graham-Bermann, 1996c), possibly "to ward off imagined aggression" (Davies, 1991, p. 521). Boys may do this more often than girls (Cummings, et al., 1989; Davies, 1991). Davies suggests little boys tend to cope with their anxiety by identifying with the aggressor. Children this age may also become whiny and clingy, have trouble sleeping, regress in behaviors like toilet training, be anxious and/or sad, and have trouble interacting with peers and adults (Davies, 1991; Graham-Bermann, 1996c; Jaffe, et al., 1990). Some researchers believe that pre-school age children are especially likely to feel responsible for violence between their parents because of their developmentally appropriate egocentrism and inability to view things from the perspectives of others (Jaffe, et al., 1990; Roseby & Johnston, 1995).
Six through twelve year old children. School age children usually have more resources to cope with exposure to violence. They have more control over their emotions and more sophisticated cognitive skills, including more realistic understandings of events. They develop problem solving and reasoning skills, and their social circles broaden to include friends and adults outside of their families (Aldwin, 1994). However, they are still very oriented within their families and tend to see their parents as role models (Jaffe, et al., 1990). Because of this, they may feel particularly confused and conflicted about partner violence. For instance, they may admire a powerful father but also fear him, or love and worry about a victimized mother, but feel angry at her for appearing weak. Boys may feel particularly ambivalent about their fathers (Hughes, 1982).
As children get older, they tend to blame themselves less for parental conflict (Jaffe, et al., 1990; Jenkins, Smith, & Graham, 1989). However, this doesn't mean they stay out of it. Jenkins (1989) found that while only 24% of nine to twelve year olds blamed themselves for their parents' quarrels, 71% intervened in various ways, trying to stop the disputes. Children this age also worry about the vulnerability of their mothers and siblings (Graham-Bermann, 1996a).
Behavioral problems resulting from exposure to violence may become apparent as children enter school and start interacting with peers and teachers. Aggressive behavior is often a particular concern (Davis & Carlson, 1987; Hughes & Barad, 1983; Jaffe, Wilson, & Wolfe, 1988), but these children may also "act out," have conduct problems, and/or be emotionally needy, fearful, and anxious (Davis & Carlson, 1987; Hershorn & Rosenbaum, 1985; Jaffe, et al., 1986; Jouriles, et al., 1989; Rosenbaum & O'Leary, 1981; Sternberg, et al., 1993). They may have academic problems (Kerouac, et al., 1986), difficulties with peers (Strassberg & Dodge, 1992), and suffer from sadness, depression, and low self-esteem (Davis & Carlson, 1987; Hughes, 1988; Jaffe, et al., 1986). Isolation may also be a problem. In some cases, children are ashamed of their homes and concerned about keeping the violence a secret. In other cases, children may be isolated by a domineering father who seeks to control the family by limiting access to outsiders (Jaffe, et al., 1990).
Adolescents. By adolescence, most children are able to understand the perspectives of others, come to independent conclusions about events, and appreciate what they can and cannot control (Aldwin, 1994). Adolescents are more able to view partner violence as their parents' problem and to turn to friends and adults outside of their families for support. They may be less fearful and anxious about the situation than younger children, and less likely to feel responsible for violent events (Jaffe, et al., 1990).
However, some teenagers will have lived with partner violence for many years and may show evidence of long-term effects. Children who have grown up with violence are more prone to delinquency and violence than other teens (Dodge, et al., 1994; Thornberry, 1994). These teens may assault peers, siblings and parents. Some teens may use drugs and alcohol to escape from their problems, or they may escape literally by running away. Suicide is also a concern with troubled adolescents, particularly those who are withdrawn and depressed (Carlson, 1990; Spirito, Overholster, & Stark, 1989). While some adolescents from violent homes find ways to escape, others stay at home and assume parenting duties for younger children in the household. These adolescents bear heavy burdens of responsibility (Jaffe, et al., 1990).
Gender Differences.
Some researchers have considered whether gender differences contribute to the extent or type of problems exhibited by children who witness partner violence. Some studies indicate that boys from battered women's shelters or other clinical populations are more likely to behave aggressively or to exhibit conduct problems than girls (Davis & Carlson, 1987; Hughes & Barad, 1983; Jaffe, et al., 1990; Jouriles & LeCompte, 1991), or that girls have more problems with depression, anxiety and other internalizing behaviors (Davis & Carlson, 1987; Holden & Ritchie, 1991; Jaffe, et al., 1990). Other studies finding various problems have not reported significant differences between boys and girls (Cummings, et al., 1989; Fantuzzo, DePaola, Lambert, Martino, Anderson, & Sutton, 1991; Hughes, 1988; Hughes, Parkinson, & Vargo, 1989; Jaffe, et al., 1988). One study found that girls who witnessed violence, were abused, or both had more problems with aggression and other externalizing problems than boys and were also more depressed (Sternberg, et al., 1993).
The evidence here is inconclusive for several reasons. Studies that find boys have more problems with aggression may simply be reflecting a trend in the general population where boys exhibit more aggression outside the home than girls (Dodge, et al., 1994). Moreover, most of these studies are based on mother's reports and there is some evidence that women who are victims of partner violence rate their sons as more aggressive than other observers would rate them (Hughes & Barad, 1983). Also, these studies use small groups of children, and when the groups are divided by gender, they become even smaller, reducing the statistical reliability of the results. The Sternberg research (1993), which found that girls exhibited more problems than boys, was done in Israel and its findings may not apply to children in other countries. Clearly, this is another area where more research needs to be done.
Severity of the violence witnessed.
Besides developmental stage, another factor that can influence the impact of witnessing partner violence is the nature and the severity of what is seen. There has been little research on this within the field of partner violence, but there is extensive literature describing what characteristics of other kinds of violence are more likely to result in serious effects. It is clear that the greater and more threatening the violence, the more likely there is to be an impact.
Research with crime victims demonstrates that people who are injured, or who believe they could be seriously injured or killed, are more likely to experience later traumatic stress symptoms (Kilpatrick, Edmunds, & Seymour, 1992). In studies of PTSD in children, being physically close to an act of violence, hearing screams or cries for help, being closely related to the victim, and seeing bloody wounds or serious injury tend to correlate with the amount of trauma, along with duration of the episode, the number and nature of threats and degree of brutality of the act witnessed (Pynoos, Steinberg, & Wraith, 1995). Thus in the case of partner violence, we would expect children to be more impacted by long episodes which they actually witnessed (as opposed to heard or heard about), which they witnessed at close hand (as opposed to from a distance), in which there was a weapon, in which the victim expressed great distress, and in which there was blood spilled or some other obvious injury and, of course, an actual murder.
The trauma literature has also made an important distinction between exposure to single traumatic events and multiple or chronic traumatic events (Terr, 1990). The chronic exposures tend to produce more devastating and difficult to treat problems. Thus, we would expect that children exposed to multiple, ongoing episodes of partner violence over an extended period of time would be more affected than those who witnessed isolated episodes. This expectation is supported by research showing that children who live in homes with high levels of parental discord are more psychologically disturbed when parental quarrels are frequent and severe (Grych & Fincham, 1990; Jenkins, et al., 1989).
The family context of partner violence.
Partner violence rarely takes place in the context of an otherwise happy or stress free family. In addition to marital conflict, there can also be other major stressors like poverty, unemployment, mental or physical illness, alcohol abuse, and entanglements with the legal or criminal justice system. (See Chapter 1.) Moreover, there may be other violence, particularly directed toward children (Jaffe, et al., 1990). All these factors can affect the impact of exposure to partner violence.
Marital conflict. In trying to understand the impact of exposure to partner violence, one of the important theoretical questions is the extent to which it can be distinguished from the effects of exposure to marital conflict without violence. The research into the effects of observing partner violence has produced findings that are consistent with a body of research that looks at how overt parental hostility affects the emotional and behavioral development of children. When children who live in "discordant homes," where parents are overtly hostile but the hostility stops short of violence are compared to children from harmonious homes, they tend to have the same sorts of problems as children from violent homes (Grych & Fincham, 1990).
Researchers have tried to determine whether children who are exposed to actual violence are somehow different from children who are exposed to parents' verbal hostility with no violence. While more research in this area is needed before firm conclusions can be drawn, there is evidence to suggest that children who witness partner violence are at greater risk of adjustment problems than children who whose parents are simply angry and hostile, but not violent (Fantuzzo, et al., 1991; Jouriles, et al., 1989). However, some studies have found no differences between discordant homes and violent homes (Hershorn & Rosenbaum, 1985) and some studies have found only weak differences (Hughes, 1988; Hughes, et al., 1989; Sternberg, et al., 1993). These studies do find that children from both groups have significantly more problems than children from nonviolent, harmonious homes. Taken together these studies suggest that pervasive conflict which takes the form of overt verbal hostility or violence harms children by causing stress, impairing effective parent-child relationships and training children to be aggressive (Grych & Fincham, 1990). Overall, children from violent homes appear to be at greater risk for showing clinical level behavioral and emotional problems, but it is likely that some of the symptoms are due to the conflict and not necessarily the violence.
Child maltreatment. In understanding the impact of witnessing partner violence, another fact to keep in mind is that many of these children are not just witnesses to violence, but victims themselves. Children exposed to adult partner violence are at high risk for being physically abused (Kenning, Merchant, & Tomkins, 1991). In a national sample of the population in 1985, 22% of husbands who had hit their wives in the previous year had also physically abused their children, compared to 8% of husbands in other families (Straus & Smith, 1990). This figure included men whose violence against their wives had been limited to slapping, shoving and throwing things. Similarly, 23% of women who had hit their husbands had also physically abused a child in the previous year (Straus & Smith, 1990). Even higher rates of physical child abuse are found among children living in battered women's shelters. One review of several studies notes that researchers have consistently found that 25% to 45% of children of women in shelters have been physically abused (Hotaling, Straus, & Lincoln, 1989). A survey of several shelter populations found that more than half of children in residence were abused or neglected, frequently both. The physical abuse was often severe. Five percent of these children had been hospitalized for injuries caused by physical abuse. Eight percent had been identified as sexually abused (Layzer, et al., 1986).
In addition, the issue of emotional maltreatment is important. One could argue that, by definition, children exposed to partner violence experience emotional maltreatment. But even independent of this, it is very likely that children in violent homes have been yelled at, threatened, manipulated, or triangled into the parental conflict--other forms of emotional abuse separate from the witnessing.
The consequences of physical child abuse can be particularly dire. Abused children may show evidence of behavioral, emotional, social, cognitive and physical difficulties and their problems can range from minor physical injuries, low self-esteem, poor peer relations and school performance to major physical disabilities, psychosis and severely violent behaviors (Malinosky-Rummell & Hansen, 1993; National Research Council, 1993). Children who are abused or who witness partner violence or both are more likely to hit their siblings, exhibit violence toward parents, and commit violent crimes as adolescents and as adults (Dodge, Bates, & Pettit, 1990; Hotaling, et al., 1989; Thornberry, 1994).
At least three studies have attempted to compare children exposed to partner violence and abused children, with inconclusive results. One small study found that abused children had more behavioral and emotional problems, but the differences between the two groups were not reliable (Hughes, et al., 1989). A second study found the same number of problems in the two groups (Sternberg, et al., 1993). A third study measuring the relative effects of being abused and witnessing violence found that physical abuse wielded the most powerful effect on a child's behavior, but witnessing partner violence added to that effect (Salzinger, et al., 1992).
Again, it needs to be recognized that some of the effects seen in children who witness partner violence are probably due to the physical and emotional maltreatment that they have additionally suffered, and that these effects may be hard to distinguish from the witnessing itself. Based on available research, it also seems plausible that when physical and emotional maltreatment are present in addition to partner violence, we would expect more severe difficulties for a child.
Effects of children's involvement in outside agencies.
Many children who live with partner violence become involved with social service and governmental agencies which are attempting to intervene in the situation (Jaffe, et al., 1990). These agencies are usually focused on the adult parties to the violence and are often not cognizant of or equipped to deal with the special needs of children. Two of the most common agencies are battered women's shelters and the criminal justice system.
Battered women's shelters. When mothers escape from violent relationships by fleeing with their children to shelters, the flight and shelter residence are distressful in themselves. Children find themselves abruptly severed from their homes, toys and belongings, pets, and daily routines (Jaffe, et al., 1990). These families are often in hiding, with children cut off from the supports of school, close friends and most relatives. Children may miss their fathers, resent the move and press their mothers to return home (Jaffe, et al., 1990).
Many children in shelters score in the clinical range for behavior and other problems measured with standardized instruments like the Child Behavior Checklist (Achenbach & Edelbrock, 1984). In one study, 70% had clinical level behavior problems and 53% appeared to be clinically depressed (Davis & Carlson, 1987), although the extent to which these symptoms can be attributed to shelter residence is unclear. One study looking at children who were exposed to violence and comparing children in shelters to children living at home found higher internalizing behaviors in shelter residents. The children in shelters were sadder and more withdrawn and depressed than the children at home (Fantuzzo, et al., 1991). These children may also be more anxious (Hughes, et al., 1989).
Shelter stays are often short and many of the problems exhibited by children in shelters may be temporary reactions to family disruption. At least one study has shown that behavioral and emotional problems decrease for most children living with their mothers in nonviolent homes, within six months after leaving the shelter (Wolfe, Zak, Wilson, & Jaffe, 1986). Because these children tend to have many family problems, it is difficult to isolate the effects of shelter residence. Many battered women's shelters have become sensitive to children's needs and instituted special programs to assist children during their stay (Jaffe, et al., 1990).
Criminal justice agencies.
When police, prosecutors and criminal courts become involved in partner violence, it does increase the potential for additional negative effects on children. On top of the upsetting exposure to violence, children may now have to deal with the embarrassment of public disclosure, the fears and confusion engendered by the presence of police and the legal system, the disruption of routine and possible conflict of loyalties. For example, when police arrive at the home, children are often afraid that they will be accused of the crime. Police are sometimes not adept at handling children and their fears, and in the confusion surrounding arrest, children can be very disturbed, not understanding what is happening, and may get separated from parents.
Police and prosecutors will often want to interview children, and they may have to repeat their stories on many occasions (Whitcomb, Shapiro, & Stellwagen, 1985). Children may experience a crisis of loyalty, not wanting to be responsible for putting their parent in jail. They may also fear retribution by the offending parent and so they may lie, change their stories, forget details and end up suffering the ire and frustration of investigators.
Most of the research on children's involvement in the legal system has been done in regard to child sexual abuse and relatively little in regard to partner violence cases. Sexual abuse cases are similar in some of the stresses they impose on children (crisis of loyalty, police investigation, public exposure), although they do differ in that the child him or herself has been the direct victim and is the primary witness in legal actions, which certainly adds to the stressfulness. Children rarely have to testify in cases of partner violence.
Interestingly, the research from the sexual abuse literature does not suggest that a case becoming involved in the criminal justice system (in addition to the child protection system, which is always involved in any disclosed case) automatically increases the trauma for the child (Goodman, Taub, Jones, England, Port, Rudy, et al., 1992; Runyon, Everson, Edleson, Hunter, & Coulter, 1988). Rather, trauma from criminal court involvement only seems to be elevated when the child is required to testify on multiple occasions or when the criminal case drags on for an extended period of time and this prevents the child from getting on with his/her life. This is not to say that police and court involvement is not stress-provoking or upsetting for children. The research findings probably reflect the fact that the whole experience of sexual abuse and its disclosure is very distressing for children to start with, and the police and court involvement do not necessarily increase that burden. It is plausible that this pattern would also be true in the case of police and criminal justice involvement in partner violence. However, it is important that comparative research be done on this issue.
Cumulative stress.
As can be seen from reviewing all these potential contributing factors, it is difficult for researchers to isolate exposure to partner violence from other stressful factors in a child's life. Children who live with violent parents may be particularly prone to experience cumulative stresses. They generally grow up in discordant homes, suffer high rates of abuse, and often cope with family separation and divorce. In extreme cases they are forced to flee their homes for a shelter, leaving behind their friends, school and possessions. They may have to cope with the intrusions of child protective services, police and criminal justice agencies. In other words, many of these children live with overt hostility between their parents, magnified by exposure to parental assault, exacerbated by ineffective and unresponsive parenting, with parental anger and frustration spilling over into child abuse, all leading to family dissolution.
Witnessing partner violence is often part of a "cumulative stressor" chain of events (Jaffe, et al., 1990), meaning that children with more than one serious difficulty in their lives are more likely to show signs of harm from exposure to violence, maltreatment and other problems than children who have only one serious problem. The number of stress factors may be even more important than the exact type of stress factor in determining whether a child is harmed (Rutter, 1985). Ultimately, there are probably specific effects associated with specific stressors, and generalized stress effects associated with the number of stressors and magnitude of the total stress burden. But the important point is that witnessing of partner violence must be seen in this total context.
Protective factors
Despite the harmful influence of violence and abuse on children's lives, we know that many children who live in difficult circumstances do not show signs of great disturbance. This can be because protective factors in these children's lives buffer them against the harmful impact of the violence. Although not a great deal of research exists in the partner violence literature specifically on these child buffering effects, findings from other literatures point to the nature of these factors.
Protective factors are sometimes divided into three categories: characteristics of the child, quality of family support and quality of extrafamily support. Certain children appear to weather stressful events better than others. Children who are adaptable, particularly intelligent, have unusual talents or strong interests, or who have other internal resources tend to overcome adversities. The style with which children tend to attribute causes to bad events also can be a protective factor, particularly if they can avoid pessimism and self blame. Children who have a strong supportive relationship with some significant adult also tend to fare well. In the case of partner violence, since the attentions of both parents tend to be compromised, frequently the buffering bond needs to be with someone from the extended family. Other protective factors can include support from peers and teachers, success in school and athletics (Herrenkohl, Herrenkohl, & Egolf, 1994; Mrazek & Mrazek, 1987; Rutter, 1985).
Long-term effects
While some of the problems that children develop in response to exposure to violence constitute immediate reactions to a difficult situation, there is a risk that these children will develop chronic behavioral and psychological problems that may mark their lives into adulthood. One area of concern is the association of witnessing partner violence as a child with behaving aggressively as an adult. Adults who recall partner violence in their homes when they are young are more likely to use violence against their spouses, be abusive with their children, and commit violent crimes outside of their homes than adults who grow up in nonviolent homes (Straus, 1992). Among married couples, both men and women exposed to partner violence as children are about three times more likely to hit their own spouses (Straus, et al., 1980). Moreover, adults who witnessed severe violence are much more likely to perpetrate severe violence than those who witnessed milder violence or no violence. In the National Family Violence Survey, 20% of men who remembered witnessing extreme violence between their parents severely abused their wives, compared to 2% of men who never observed partner violence (Straus, et al., 1980).
The idea that children brought up in violent homes may be more likely to become perpetrators or victims of partner violence than children raised in nonviolent homes has been characterized as the "intergenerational transmission of violence, where aggressive or victimizing family patterns are passed from parent to child. While much, but not all, of the research in this area supports this idea, intergenerational transmission is certainly not an inevitable process, and much remains to be learned about the mechanisms by which such family patterns may be passed from parent to child. (See Chapter 2 for a more detailed discussion.)
There is also some evidence of an association between exposure to partner violence as a child and enduring psychological problems as an adult. One study found that college students who observed partner violence were more anxious than those whose parents had harmonious relationships, and that women were more depressed and more aggressive (Forsstrom-Cohen & Rosenbaum, 1985). Another study comparing women who recalled violence between their parents to women who did not, reports that the former showed more symptoms of psychological distress and lower levels of social competence (Henning, et al., 1996). The women in this study who were exposed to violence also reported more physical child abuse by parents, more verbal conflict between parents, and less caring and support, making it difficult to attribute their problems to any one source. Another study found that adults who witnessed partner violence as teenagers had more symptoms of stress and depression and more drug and alcohol problems than other adults (Straus, 1992).
Limitations of the research.
The body of research concerning children exposed to violence is relatively recent, and much of it is limited in some respects. In a 1989 review of 29 studies, Fantuzzo and Lindquist (Fantuzzo & Lindquist, 1989) point out many of the shortcomings in this literature:
Research is also lacking about the effects of a child's relationship to the perpetrator and/or to the victim of partner violence. While the most frequent scenario may be mother as primary caretaker and victim of violence, this is not always the case. Mothers can be assailants and violence can be mutual. Children may perceive violence perpetrated by a caretaker quite differently from the way they view violent attacks against a caretaker, and perpetrators of violence may be more or less responsive to the needs of their children than victims of violence are.
The closeness of a child's relationship with the perpetrator is also an unexplored factor. When the mother is the victim of violence, the child's relationship to the perpetrator may range from that of a barely known new dating partner to that of an involved father with whom the child has complicated intimate ties. If the assailant is a father who is also a close caretaker, the situation for the child may be particularly convoluted.
This is a relatively new area of research and, despite these weaknesses, its quality has steadily improved. It is hard to do this kind of research. It is difficult to locate children who have been exposed to partner violence in the general population, and women's advocates and social service and medical practitioners who know of and work with these children may be reluctant to participate in research. Parents may distrust the research process, or feel that participating is burdensome. Once a research project is started, the instability in the lives of these children presents obstacles to data gathering and to follow-up, but the need to expand this research is compelling given the large percentage of children who may be affected by partner violence.
Responding to the problem
Responding to children caught up in partner violence is a complex challenge. Concentrating attention and resources on these children requires special efforts because frequently neither they nor their parents are requesting assistance or attending to the children's crisis, and the urgent situation between the adults is often the overwhelming and compelling focus of those trying to intervene. To insure that the children are a priority, wherever possible, there should be professionals who can devote their full attention to the situation of these children. It has been demonstrated that children have fewer symptoms when a trained professional is available to advocate for them (Rossman, 1994).
It should be kept in mind that child victims of partner violence come to professional attention in a variety of ways:
Some have raised questions about the utility of intervening on behalf of a child witness when the parents are not ready to admit to or deal with their own situation (Jaffe, 1990 cites Gentry & Eaddy, 1982), but it is generally believed that there are interventions that can be helpful.
Several authors have conceptualized the intervention in three phases: 1) crisis intervention and initial assessment, 2) short-term therapy, and 3) long-term therapy.
| Guidelines for crisis intervention | General practice guidelines |
|---|---|
|
Conduct lethality assessment Formulate safety plan Train children in security procedures Report child abuse, if situation warrants Provide crisis counseling |
Screen children for partner violence Assess children who have been exposed Recognize possible need for child abuse report Assign independent worker to children Consider crisis intervention needs Be developmentally and culturally appropriate Coordinate with other professionals Encourage healthy parenting practices Be aware of child custody issues Promote parent education that teaches about the impact of exposure to partner violence |
Crisis intervention.
In a crisis situation where police have been called or a mother is fleeing her home, a number of crucial, special issues need to be attended to (Rossman, 1994):
Non-crisis situations.
Although sometimes children's contacts with professionals will come as a result of a crisis created by an acute violence episode, frequently a situation of partner violence exposure will occur outside of a crisis situation. Since more and more professionals are following the recommended practice to screen for possible partner violence in all child, marital and family assessment situations, they are turning up an increasingly large number of exposed children.
When disclosure of violence exposure comes through contact with the child's parent, parents should be asked in detail about the circumstances of exposure and their assessment of its impact on the child. However, parents are frequently unable to make an accurate assessment of impact on children. An independent interview with the child is required in order to make that assessment (Jaffe, et al., 1990).
The discovery of violence can also come through contact with the child, who might disclose it to a school guidance counselor or pediatrician in a routine visit. These situations are a challenge to handle because of the competing needs to protect the child's confidentiality and the child's and possibly other household members' safety. It should be kept in mind that it may expose the child to violence and retaliation if the abusive parent finds out that the child has divulged the family secret. Thus the practitioner receiving the disclosure must explore the situation with the child to know whether the child is in danger of retaliation, what kinds of dangers other household members face and whether the child is comfortable with any practitioner communications with either parent. Adding to the dilemma, depending on the age of the child, practitioners in many states cannot provide counseling to a child without parental permission. Moreover, children who have been abused and threatened are subject to mandatory child abuse reports, whatever the wishes of the child. Thus, while the goal is generally to get support and counseling for the child and assistance to the family, the route to these outcomes may be complicated depending on the details of the situation.
Assessment.
A thorough assessment should be made of a child who has been exposed to partner violence, using screening protocols that are suited to the child's developmental level. In the course of this assessment, practitioners need to establish a respectful, understanding relationship with the child and not press prematurely for disclosures before adequate trust is established.
Particularly for preschool children, assessment requires observation of the child, alone, with mother, and even in the whole family context at home or in the clinic. Starting with preschoolers and up through adolescence, clinical interviews with children are possible. These interviews are often greatly facilitated by the use of drawings, art materials and other forms of creative nonverbal expression.
Among the information that needs to be elicited during the clinical interview: what kinds of violence the child has been exposed to, whether the child him/herself has been the target of violence, the identity of all the individuals who may be violent in the child's environment, including sibling and peer violence, and the nature of any physical punishment the child may have been receiving. It is important to explore whether the child is concerned about his or her own safety or about the safety of a parent or other family member. If violence has been directed toward the child, a medical examination is likely warranted to check up on the child's health and establish any evidence of child abuse. As in the case of a crisis evaluation, an assessment needs to be made of whether the child is at risk for abuse or neglect, and whether he/she is receiving adequate parental care.
Assessments are generally facilitated by the use of some structured instruments and assessment protocols. One that exists for exposure to violence, although not specifically marital violence is the Survey of Children's Exposure to Community Violence (Martinez & Richters, 1993). The Conflict Tactics Scale (Straus, 1979; Straus & Gelles, 1990b) can be used for a specific inventory of partner violence, but it has been so far primarily developed as a research tool rather than a clinical instrument, particularly in regard to child interviews.
A good instrument is important for assessing the various kinds of symptoms and problem areas that a child may be manifesting. The Child Behavior Checklist (Achenbach & Edelbrock, 1984) has forms both for parent administration and for child self-administration for children. Sources for several other instruments are listed at the end of this chapter.
General case management issues.
Cases involving children who have been exposed to marital violence often entail some difficult case management issues that professionals need to anticipate and have some plan for.
One common problem is unwillingness to accept treatment or intervention. Parents may prohibit help for the child because they are afraid of further disclosures of family violence, or because of general hostility toward "meddling outsiders." The control tactic in some violent families is for the abusers to try to isolate the family. Children themselves may decline help, seeing it as stigmatizing in some way or focussed on an area of their lives they would rather deny than deal with.
Another common case management problem is the involvement of other agencies and professionals. These cases frequently come to attention through police, courts or shelter agencies that continue to be involved with the family. The case may entail a child abuse report or on-going child welfare investigation. There may be criminal actions about which the child needs to testify. The parents may have their own therapists and attorneys who are actively involved in the problem. These entanglements can create rapid developments in the case -- a court order, a child protection finding, a police interview, the calling of a family therapy meeting -- that the professional working with the child needs to respond to. Good liaison with other involved parties is important (Ammerman & Hersen, 1990).
An important concern is that other agencies and other professionals may have different priorities and different points of view that do not necessarily mesh well with the therapeutic needs of the child. Thus police and courts may not be willing to take the child's needs into consideration in deciding how to conduct investigations or how to pursue charges. Other professionals may hold blaming attitudes toward the perpetrator or victim parent that do not correspond to the child's view. Ideologically oriented agencies may have agendas for the child that are not the child's own.
Unfortunately, in some communities there are tensions and unresolved conflicts between partner violence professionals and child protection agencies. Partner violence professionals have sometimes been concerned that child protection agencies, lacking sufficient awareness about and sympathy for the situation of battered women, were overly hasty to remove children from the mother's care. Child protection agencies, for their part, have been concerned that over identification with mothers has kept partner violence professionals from recognizing children who were in such danger that they needed separate child welfare intervention, apart from partner violence services. Fortunately, an increasing number of communities have developed collaborative protocols among these groups of practitioners.
Child therapists should be prepared also for parents to have strong and often contradictory views about what should be done for the child. Some of this may be displaced anger, as parents vent ire at each other or the system or the therapist. Parents should not be allowed to dictate treatment, but child therapists are in a more difficult situation than those with adult clients, since parents can decide to terminate treatment.
Custody issues.
One of the challenging case management dilemmas in this area concerns issues of child custody. Violent relationships often end in divorce, which then leaves important questions to be resolved about custody and visitation rights of parents. Delicate assessments and resolutions need to be made to insure the welfare of children -- who need parental contact but also need safety, security and healthy parenting -- while at the same time protecting adults who may have been victims of partner violence. Among the complex factors that need to be weighed in custody decision are:
These issues have challenged family courts, which have not always had good information about partner violence and its consequences on children. In the past, some courts completely ignored the matter of partner violence in custody decision making, on the presumption that the roles as spouse and parent were distinct, and violence in one role did not presuppose it in another. But research has suggested that there is clearly some interrelationship. (See Saunders (1994) for a review of this research.) The question begging for more research concerns in what circumstances partner violence is or is not a risk factor for violence and abuse toward children, and whether and under what circumstances there are other negative effects for children from continued frequent association with parents who have committed partner violence.
Another factor that needs sensitive assessment concerns the situations of the victims of partner violence in the course of custody decision-making. Since courts often examine carefully the material and psychological resources that parents will bring to their parenting, victims of partner violence can appear at a disadvantage because they may be suffering from the psychological effects of their abuse, and possible homelessness and financial instability related to their need to leave in a precipitous fashion. Moreover, custody arrangements determined by courts often entail the need to exchange children and communicate about the details of the children's needs and living arrangements. Sometimes these can set up victims for additional harassment and possibly violence from their violent partners.
There is thus a need for those who work with children who have witnessed partner violence to be familiar with the many sensitive and difficult issues that custody decisions can pose for children and parents. They need to be prepared for the rancor and intensity with which these issues can be battled -- including the possibility of exaggerated or false claims on all sides and attempts to triangulate children into the conflict. They should try to be aware of and anticipate the impact these disputes may have on children. They also need to recognize that they may be called upon to make assessments that will play an important role in court decision making.
Specialized agencies and professionals now exist to provide assistance in this process. For example there are visitation centers where children can be with parents under supervised conditions or where ex-partners can meet to exchange children or negotiate child management issues. Those who may have contact with child witnesses to partner violence should be familiar with these resources.
Treatment issues.
While all children who are exposed to partner violent need to be assessed, not all children need treatment or can necessarily benefit from it, although many can. It is important to assess this before referring for or starting a course of treatment. Children who are not symptomatic, who have good coping abilities andsupport systems, who have not been exposed to lengthy or highly disturbing violent episodes or who are not particularly interested in therapy, may not be appropriate for therapy. Such children can be given some brief prophylactic information, which may facilitate their getting help if they should begin to experience difficulties.
Decisions about the type of treatment and length of treatment should be based on an assessment of the child's problems, the child's developmental level and the family context. Sometimes the clinician does not have enough information at the outset and may wish to set a course of treatment which will be reassessed at a later point.
Short term treatment may be sufficient for a child who is suffering from traumatic stress and adjustment problems, but not more deeply rooted behavioral problems. These more readily treated problems tend to involve anxiety and fears, feelings of self-blame, hopelessness and discouragement, anger and revenge fantasies.
One component of short-term work with children, especially those who have witnessed disturbing scenes, is trauma processing. This involves getting the child to describe, often with the assistance of drawings and play activities, all the details of the traumatic event and the emotions that were evoked. The goals are to help the child to begin to master and gain some ability to manage the strong feelings and images evoked by the experience (Rossman, 1994 , citing Terr, 1989 . Trauma processing can be done in play therapy or in mother-child dyad situations for younger children and in individual or group therapy for older children and adolescents. Some children will need time before they are ready to deal with the traumatic events in the therapeutic setting.
Another component of short-term work involves reduction of feelings of responsibility and self-blame. Steps need to be taken to lessen the child's sense of responsibility by making clear to the child that their own behavior or qualities are not the basic source of the violence or conflict, and that as children they are not capable of stopping the violence or protecting their parent on their own.
A child's developmental level will be an important consideration in the form that treatment will take. Infants primarily require a re-establishment of a safe and secure environment where a caretaker can deal reliably and responsively with infant needs for food, sleep and physical contact. Therapy with toddlers and preschoolers is largely organized around play activities. For school age children and adolescents, group settings can be a particularly effective form of treatment. School age children and adolescents often have acute feelings of isolation and stigma resulting from their family situation that is readily dealt with in groups where there are children from similar violent families. Peled and Davis, (1995) describe in detail a short-term group approach to working with 8 to 13 year olds, in a model that is widely accepted as a way of working with children who have been exposed to partner violence (Jaffe, et al., 1990). Some preliminary evaluation studies of these support groups have been done (Grusznski, Brink, & Edleson, 1988; Peled & Edelson, 1992). These groups seem to work best with children exposed to less severe levels of violence who have mild to moderate, but not severe, adjustment problems.
Short-term treatment of adolescents has some additional challenges that may not be present for younger children. As a result of neglect, resentful feelings toward violent parents and socialization to violent modes of conflict resolution, adolescents from violent families may be engaged in a variety of acting-out behaviors. One of the therapeutic goals for such adolescents is to help parents re-establish appropriate limits, boundaries and discipline (Harway & Hansen, 1994). To this end, resources that are intended to ease the stress on the parent, such as gaining safety from the abusive partner so that she may attend to the child, may very much help the child. Such parents need to have specific help in how to set clear and appropriate limits without getting into protracted conflicts with the child that may resemble conflicts with the partner. They also need help learning effective non-violent disciplinary practices. This is particularly challenging because parents, out of guilt for their neglect and responsibility for exposing the child to violence, as well as fear that the child may develop the patterns of the violent partner, may easily overreact in their attempts to deal with adolescent acting-out.
A difficult issue that may confront therapists who work with child witnesses concerns the advisability of whole family treatment sessions including the violent partner. Although child therapists can often see many valuable reasons for such sessions, this form of treatment has been very controversial among those who work with partner violence. (The issues in the debate are discussed in more detail in Chapter 8.) In general, it is important for the child therapist who sees some possible benefit from a whole family session to accept the lead from and judgement of those professionals who may be working with parents. Similarly, a therapist working with a child who sees a family session as contraindicated for the child should not allow the child to be pressured into participation.
The situation is more difficult in families with episodes of partner violence, where the parents are not themselves in treatment. In such a situation, a child's therapist would want to convene a family session only after some careful assessment ascertaining that there is no risk of provoking violence or retaliation from an abuser, that the session is desired by all parties, and that the children feel safe and capable of coping with the situation (Rossman, 1994). It may be important in such a situation to ensure that there are multiple professionals present, one who can take responsibility for the parents and their reactions, so that one is available to respond to the child, should such a response be necessary.
Long-term treatment.
Long-term treatment is possibly indicated for children manifesting problems of serious depression, suicidality or self-injury as well as children with conduct disorders and aggressive behavior. These problems probably stem from more than the witnessing of partner violence, and may arise from an environment of chronic conflict, emotional deprivation, and actual abuse and neglect of the child. There are good resources concerning the treatment of such children, but it is beyond the scope of the present chapter to review this literature.
Implications for practice in the military
General implications for public policy.
The widespread prevalence of partner violence and its clear association with negative impacts on children contain an important message for public policy: that screening for exposure should take place much more consistently and universally than is currently the case in every environment where children are screened for problems, including pediatric visits, school counseling programs, emergency rooms, and child welfare investigations. This means that those agencies and professionals who screen for spouse abuse should make sure that they inquire about children's exposure (Jaffe, et al., 1990). Likewise, it means that those agencies and professionals who screen for child abuse should also be looking for exposure to partner violence.
Moreover, the realization that children can be traumatized by violence from a variety of possible sources suggests that screening should be as broad as possible and not limited to one or two narrow forms of violence or abuse. There is increasing recognition that in addition to child abuse and parental violence, children are traumatized by exposure to peer and sibling violence, that they encounter violence at the hands of nonfamily caretakers, and that in some communities children witness a great deal of violence in their streets and neighborhoods. Discussions are available about the wide range of children's violence exposure (Finkelhor & Dziuba-Leatherman, 1994) and protocols exist for screening systematically for such exposure (Martinez & Richters, 1993).
Conclusion
Research and practice concerning child witnesses of partner violence are still in the beginning phases, and have yet to achieve the maturity of work with adult victims. However, a great deal is now recognized, and the clear message is that practitioners need to make concern about such children a central aspect of interventions. One of the most serious challenges is learning how to integrate this concern in a natural and organic way into the work with adult victims and perpetrators. The result is certain to be a major advance in the mitigation of suffering caused by partner violence and a stronger bulwark against its transmission onto future generations.
Appendix: List of Instruments for Use with Chapter 4
Achenbach, T. M., & Edelbrock, C. S. (1984). Child Behavior Checklist. Burlington, VT: University of Vermont.
Briere, J. (in press). Professional manual for the Trauma Symptom Checklist for Children (TSCC). Odessa, FL: Psychological Assessment Resources.
Nader, K. O., Dudley, D. B., & Kriegler, J. (1994). Clinician-Administered PTSD Scale, Child and Adolescent Version (CAPS-C). National Center for PTSD.
Pynoos, R. S., & Eth, S. (1986). Witness to violence: The child interview. Journal of the American Academy of Child Psychiatry, 25, 306-319.
Shaffer, D. (1992). Diagnostic Interview Schedule for Children. National Institute for Mental Health.
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