Exposure to violence: psychological and academic correlates in child witnesses.

BACKGROUND: Inner-city children are frequently exposed to violence; however, there are few data regarding the psychological and academic correlates of such exposure in young children at school entry. OBJECTIVES: To document exposure to violence in inner-city children aged 7 years; assess their feelings of distress; and evaluate the relationships of exposure to violence with school performance, behavior, and self-esteem. SETTING: A study center in an inner-city hospital. PARTICIPANTS: One hundred nineteen inner-city children evaluated at age 7 years; 119 caregivers (biological and foster). DESIGN: As part of a longitudinal study, children were administered the following by a masked examiner: Things I Have Seen and Heard (TISH) to assess exposure to violence; Levonn, a cartoon-based interview for assessing children's distress symptoms; and the Culture-Free Self-Esteem Inventory, Second Edition. School performance was assessed by school reports and child behavior by the Child Behavior Checklist (CBCL), the Parent Report Form, and the Teacher Report Form. Caregivers for children were administered the parent report version of the Checklist of Children's Distress Symptoms (CCDS-PRV) as well as the CBCL Parent Report Form. MAIN OUTCOME MEASURES: Exposure to violence (TISH); feelings of distress (Levonn); school performance; behavior (CBCL Parent Report Form and CBCL Teacher Report Form); and self-esteem (Culture-Free Self-Esteem Inventory). RESULTS: We found that these children were frequently exposed to violence. For example, 75% had heard gun shots, 60% had seen drug deals, 18% had seen a dead body outside, and 10% had seen a shooting or stabbing in the home (TISH). Many showed signs of depression and anxiety; eg, 61% worried some or a lot of the time that they might get killed or die and 19% sometimes wished they were dead (Levonn). Higher exposure to violence (TISH Total Violence score) was correlated with higher Levonn composite scores for depression and anxiety and with lower self-esteem (P< or =.04), and was also associated with lower grade point average and more days of school absence (P< or =.02). Caregiver assessment of child anxiety correlated poorly with child report of anxiety (P =.58). CONCLUSIONS: Young inner-city children have a high exposure to violence by age 7 years; many show signs of distress that frequently are not recognized by caregivers. Further, higher exposure to violence in children correlates with poorer performance in school, symptoms of anxiety and depression, and lower self-esteem.     

Witnessing violence among inner-city children of substance-abusing and non-substance-abusing women

OBJECTIVES: To determine if children of substance-abusing mothers witness more violence than children of non-substance-abusing (control) mothers, and to determine if children who witness violence have more behavioral problems and higher stress scores than children who do not witness violence. DESIGN: Cross-sectional research design comparing exposure to violence among children of substance-abusing mothers and control mothers of low socioeconomic status. SETTING: An inner-city pediatric clinic. PARTICIPANTS: Forty substance-abusing mothers and their children, and 40 non-substance-abusing mothers and their children, examined when the children were 6 years old. MAIN OUTCOME MEASURES: Maternal report of children's exposure to violence was assessed using the Exposure to Violence Interview and the Conflict Tactics Scale. Maternal report of children's behavior was assessed using the Child Behavior Checklist and the Children's Response to Stress Inventory. RESULTS: Children of substance-abusing mothers did not witness more violence than the control children (P>.05). However, 6-year-old inner-city children in the present study witnessed a high rate of violence: 43% had seen someone beaten up, 13% had seen someone threatened with a knife, and 7% had seen someone stabbed or shot. Children witnessing violence had significantly higher aggressive, delinquent, anxious/depressed, withdrawn, attention, and social problems (P<.05) on the Child Behavior Checklist, and higher stress scores (P =.05) on the Children's Response to Stress Inventory. CONCLUSIONS: More than half of the 6-year-old inner-city children in the present study witnessed some form of violence. Witnessing violence was associated with more behavioral problems and higher stress scores as assessed through maternal report. Subsequent research should examine the long-term effects of this exposure to violence among young children.     

Perception de la menace,sentiment de blâme et symptômes de stress post-traumatique de l’enfant exposé à la violence conjugale

Aim of study

The aim of this study is to examine the effect of children's exposure to domestic violence on the presence of post-traumatic stress symptoms and to analyze the role of threat perception and feeling of self-blame. We suppose that the more the children and mothers tell us that the domestic violence has been serious and frequent, the more the children will feel guilty for its appearance and will consider it as threatening. We postulate that the children's interpretation of domestic violence, through the perception of threat and self-blame, will lead them to show more post-traumatic stress symptoms when the children perceive a big threat and blame themselves for the violence. Finally, we consider the moderating role of threat perception and feeling of self-blame on the connection between domestic violence and post-traumatic stress symptoms of children.

Does watching violence on television cause apathy?

The hypothesis that exposure to televised violence serves to increase children's toleration of real-life aggression was investigated. Fifth-grade boys and girls were exposed to either a violent television excerpt or a nonviolent, exciting control program. Immediately thereafter, each child was lead to believe that he had been given responsibility for monitoring the behavior of two younger children. Subjects who had witnessed the aggressive television program were found to be significantly slower to summon appropriate adult aid when the younger children began to argue and fight than were subjects who had viewed the control film.     

Somatic complaints in children and community violence exposure

Somatic complaints of children in primary care settings often go unexplained despite attempts to determine a cause. Recent research has linked violence exposure to stress symptomatology and associated somatic problems. Unknown, however, is whether specific physical symptom complaints can be attributed, at least in part, to violence exposure. Urban African-American 6- and 7-year-old children (N = 268), residing with their biological mothers, recruited before birth, and without prenatal exposure to hard illicit drugs participated. Children and mothers were evaluated in our hospital-based research laboratory, with teacher data collected by mail. Community violence exposure (Things I Have Seen and Heard), stress symptomatology (Levonn), and somatic complaints (teacher-and self-report items) were assessed. Additional data collected included prenatal alcohol exposure, socioeconomic status, domestic violence, maternal age, stress, somatic complaints and psychopathology, and child depression, abuse, and gender. Community violence witnessing and victimization were associated with stress symptoms (r = .26 and .25, respectively, p < .001); violence victimization was related to decreased appetite (r = .16, p < .01), difficulty sleeping (r = .21, p < .001), and stomachache complaints (r = .13, p < .05); witnessed violence was associated with difficulty sleeping (r = .13, p < .05) and headaches (r = .12, p < .05). All associations remained significant after control for confounding. Community violence exposure accounted for 10% of the variance in child stress symptoms, and children who had experienced community violence victimization had a 28% increased risk of appetite problems, a 94% increased risk of sleeping problems, a 57% increased risk of headaches, and a 174% increased risk of stomachaches. Results provide yet another possibility for clinicians to explore when treating these physical symptoms in children.     

Parental cognitions and satisfaction: relationship to aggressive parental behavior in child physical abuse

There are limited data on cognitions and satisfaction with the child in parents who have physically abused their children. Therefore, we examined convergence among these constructs, and their relationships to parental aggression among participants in a treatment study for child physical abuse. Data were examined at two time points 12 weeks apart. The cognitions (unrealistic expectations of the child, perception of lack of control, and hostile attribution bias) and satisfaction with the child showed little convergence. Only parental satisfaction correlated significantly with aggressive parental behavior directed at the child, even after controlling for social desirability. Where there were significant correlations between externalizing child behavior and aggressive parental behavior and between parental depression and aggressive parental behavior, some limited support was found for an indirect path through parental satisfaction. If replicated, these findings suggest it may be useful to focus on parental satisfaction in research on child physical abuse.     

Children who witness violence,and parent report of children's behavior

OBJECTIVES: To examine how much distress children report in response to violence that they have witnessed and how this is associated with parental reports of children's behavior. METHODS: As part of a study of in utero exposure to cocaine, children completed the Levonn interview for assessing children's symptoms of distress in response to witnessing violence. The children's caregivers completed the Exposure to Violence Interview (EVI), a caretaker-report measure of the child's exposure to violent events during the last 12 months. The EVI was analyzed as a 3-level variable: no exposure, low exposure, and high exposure. The caregivers also completed the Children's Behavior Checklist (CBCL). RESULTS: Of 94 six-year-old children, 58% had no exposure to violence, 36% had low exposure to violence, and 6% had high exposure to violence, according to caretaker reports. The children's median+/-SD Levonn score was 64 (SD +/- 19.3). The mean SD +/- CBCL total T-score was 53 (SD +/- 10.2). In multiple regression analyses with gender, low and high exposure on EVI, Levonn, and prenatal cocaine exposure status as predictors, the Levonn score explained 4.8% of total variance in children's CBCL internalizing scores, 9.1% of the total variance in CBCL externalizing score, and 12.2% of the total variance in CBCL total score (P =.04, P =.004, and P<.001, respectively). CONCLUSIONS: After accounting for the caretaker's report of the level of the child's exposure to violence, the child's own report significantly increased the amount of variance in predicting child behavior problems with the CBCL. These findings indicate that clinicians and researchers should elicit children's own accounts of exposure to violence in addition to the caretakers' when attempting to understand children's behavior.     

Suicidal ideation among 8-year-olds who are maltreated and at risk: findings from the LONGSCAN studies

Suicidal ideation was examined among 1,051 8-year-old children identified as maltreated or at risk for maltreatment. Of these children, 9.9% reported suicidal ideation. Many variables, including maltreatment, had bivariate associations with suicidal ideation. Severity of physical abuse, chronicity of maltreatment, and the presence of multiple types of maltreatment strongly predicted suicidal ideation. In multivariate analyses of the domains of proximity, only ethnic background remained significant among demographic variables, only witnessed violence and maltreatment remained significant among family or contextual variables, and only child psychological distress, substance use, and poor social problem solving remained significant among child variables. The effects of ethnicity, maltreatment, and witnessed violence on suicidal ideation were mediated by child functioning. There were few interactions between maltreatment and other factors to predict suicidal ideation. Children who are maltreated and those exposed to community and domestic violence are at increased risk of suicidal ideation, even by age 8.     

Prospective effects of violence exposure across multiple contexts on early adolescents’ internalizing and externalizing problems

Background: Violence exposure within each setting of community, school, or home has been linked with internalizing and externalizing problems. Although many children experience violence in multiple contexts, the effects of such cross‐contextual exposure have not been studied. This study addresses this gap by examining independent and interactive effects of witnessing violence and victimization in the community, home, and school on subsequent internalizing and externalizing problems in early adolescence. Methods: A community sample of 603 boys and girls (78% African American, 20% Caucasian) participated in a longitudinal study of youth violence. During two assessments 16 months apart, adolescents reported on witnessing violence and victimization in the community, school, and home, and their internalizing and externalizing problems. Results: Multiple regressions tested the independent and interactive effects of witnessing violence or victimization across contexts on subsequent adjustment, after controlling for initial levels of internalizing and externalizing problems and demographic covariates. Witnessing violence at school predicted anxiety and depression; witnessing at home was related to anxiety and aggression; and witnessing community violence predicted delinquency. Victimization at home was related to subsequent anxiety, depression, and aggression; victimization at school predicted anxiety; and victimization in the community was not independently related to any outcomes. Finally, witnessing violence at home was associated with more anxiety, delinquency, and aggression only if adolescents reported no exposure to community violence. Conclusions: Violence exposure at home and school had the strongest independent effects on internalizing and externalizing outcomes. Witnessing community violence attenuated the effects of witnessing home violence on anxiety and externalizing problems, perhaps due to desensitization or different norms or expectations regarding violence. However, no comparable attenuation effects were observed for victimization across contexts.     

Forgiveness Education for Fourth Grade Students in Turkey

Research has indicated that living in an environment involving poverty and violence can have negative effects on young children. Forgiveness may be an important predictor of well-being among these children. Forgiveness education programs aim to heal these by increasing forgiveness, hope, and by being prosocial while decreasing anger and depression, which appear after deep hurt. The main aim of the study was to assess and evaluate the effectiveness of a forgiveness education program in classroom settings with fourth-grade Turkish students living in an impoverished environment. Two studies were conducted to evaluate the forgiveness education program, based on Enright’s process model of forgiveness. In the first study, students from impoverished backgrounds were found to exhibit significantly greater anger and depression than students representing an average socioeconomic status. In the second study, with 122 fourth-grade students (N?=?74 experimental, 48 control) in five primary schools, the forgiveness education program was implemented by school teachers with support from psychologists. Analysis reveals a significant increase in forgiveness and hope and a decrease in anger in the first posttest for the experimental group compared with the control group, although follow-up results indicate no significant differences between the two groups. Significant findings and the forgiveness education program are discussed.     

A multimedia program helps parents manage childhood aggression

Participants were 65 parents of 6- to 18-month-old children presenting for a well child checkup between September 2002 and February 2003 to one of two private pediatric offices. The intervention was a 30-minute multimedia program, Play Nicely, viewed at home, which teaches the basics in childhood aggression management. One year after intervention, parents were asked, "Do you feel that the CD program was helpful in managing aggressive behavior in your child?" Most (65%) parents who watched the program agreed that it helped them manage aggression with their own child (strongly agree, 31%; agree, 34%; uncertain, 28%; disagree, 7%; and strongly disagree, 0%). An inexpensive, brief, independently viewed, multimedia program helps parents manage aggression in their young children as long as 1 year after receiving it from their pediatrician. An easily implemented intervention may contribute to violence prevention efforts.     

Relationship between the decision to take a child to the clinic for abdominal pain and maternal psychological distress

BACKGROUND: Among adults with functional gastrointestinal disorders, psychological distress influences who consults a physician, but little is known about predictors of consultation when the patient is a child. OBJECTIVE: To determine the relative contributions of psychological symptoms of the mother, psychological symptoms of the child, severity of child abdominal pain, and family stress to consultation. DESIGN: Observational study. SETTING: Health maintenance organization. PARTICIPANTS: Two hundred seventy-five mothers of 334 children who had abdominal pain in the past 2 weeks, as per child self-report. MAIN OUTCOME MEASURES: Mothers completed questionnaires about themselves (Symptom Checklist 90-Revised) and their children (school absences, medication use, and the Child Behavior Checklist). Children completed the Pain Beliefs Questionnaire to assess perceived pain severity. RESULTS: Thirty-nine children had been taken to the clinic for abdominal pain symptoms at least once in the past 3 months (consulters), whereas 295 were nonconsulters. Logistic regression analyses revealed that both the child's self-report of perceived pain severity (P<.001) and maternal psychological symptoms (P = .006) predicted consultation. Although children who visited physicians had significantly more psychological symptoms, this was not a significant predictor of consultation after adjusting for maternal psychological symptoms. Family stress did not predict consultation. CONCLUSION: The decision to take a child to the clinic for abdominal pain is best predicted by maternal psychological distress and the child's perceived pain severity.     

Parents view a brief violence prevention program in clinic

Participants were parents of 1- to 7-year-old children presenting to a pediatric clinic. The intervention was Play Nicely, 2nd edition, a multimedia educational program that teaches childhood aggression management skills. On average, parents viewed 10 to 15 min in clinic. The average age of the 89 participants was 30 years; 49% were African American, 29% were married, and 12% had a college education. Preintervention, 90% of parents stated that they felt very comfortable managing aggression. Postintervention, 90% of parents planned to change how they discipline their own child. More than 90% had at least one positive comment about the program; there were no negative comments. A brief intervention that addresses childhood aggression is embraced by a relatively diverse group of parents who viewed it during their children's primary care visit. Parents' prior comfort level with managing aggression should not be used to screen who might benefit. The program has implications for violence prevention.     

Voluntary or required viewing of a violence prevention program in pediatric primary care

Participants were parents of children less than 7 years of age who presented with their child for a well child visit. Viewed in the waiting room, the intervention was Play Nicely, which teaches childhood aggression management skills. A total of 138 parents were invited to view the program; 57 (41%) accepted (voluntary group). A second group of 35 parents viewed the program as part of the clinic visit (required group); all 35 (100%) accepted. There were no differences between the groups in the proportion of parents who were pleased that the program was offered by their pediatrician (100%) and the proportion who felt more comfortable managing aggression after the viewing experience (94%). Approximately 75% of both groups reported an increased willingness to discuss child behavior and discipline strategies with their pediatrician. These findings have implications for how providers can more routinely introduce educational material into the well child visit that relates to childhood aggression, discipline, and violence prevention.     

Negative and atypical story content themes depicted by children with behaviour problems

Background: Specific thematic content arising from children’s doll play is often considered to give clinically meaningful information regarding their mental state, but has received little systematic enquiry. This exploratory study examined the negative and atypical content themes in the attachment story narratives of children with behaviour problems, and their associations with child symptomatology and parental depressed mood. Method: Videotaped mother–child attachment doll play completions of 77 children from a clinical sample were blind coded for negative content themes. Mothers completed questionnaires for maternal depression and child behaviour. Results: Children rating positive for behaviour disorder were more likely to represent maternal injury, role reversal and marked maternal sadness. Severe behavioural symptoms were associated with more pervasive negative themes. Half of the overall sample depicted child accidents and maternal unresponsiveness, whereas child aggression, child anger and maternal absence were rare. Girls with depressed mothers showed an absence of particular negative representations (e.g., child sadness) compared to boys. Conclusions: Specific atypical themes are associated with the extent of child psychopathology and may be modified by exposure to maternal depressed mood. The methodological limitations in this exploratory study are also discussed.     

The impact of peer victimization, parent distress and child depression on barrier formation and physical activity in overweight youth

OBJECTIVE: With the prevalence of childhood overweight reaching epidemic proportions, there is an increased need to identify factors which may aid in the development of successful weight intervention programs. Given that lower levels of physical activity are inversely correlated with weight status in children, research has focused on identifying and addressing reported barriers to physically activity. A relationship exists between the number of reported barriers and weight status such that children who are overweight report more barriers to being physically active. However, important demographic and psychosocial correlates of barriers have not been examined. METHODS: This study investigates the relationship among parent distress, peer victimization, childhood depression, barriers to physical activity, and physical activity among a sample of 95 clinically overweight children and adolescents. Higher levels of parent distress, peer victimization, and childhood depression are predictive of a variety of barriers to physical activity, with peer victimization emerging as the strongest predictor of barriers. Barriers to physical activity mediate the relationships between peer victimization, parent distress, child depression and physical activity. RESULTS: These findings have significant implications for the development/design of weight intervention programs. Interventions targeting increases in physical activity should not only focus on the barriers children report, but should also include a psycho-emotional component to address factors such as parent distress, peer victimization and child mood that may contribute to barrier formation/maintenance. CONCLUSION: Future interventions may benefit from the identification of additional factors that impact barrier formation and physical activity levels among children.     

Women's exposure to intimate partner violence and child malnutrition: findings from demographic and health surveys in Bangladesh

Domestic violence, in particular intimate partner violence (IPV), has been recognized as a leading cause of mortality and morbidity among women of reproductive age. The effects of IPV against women on their children's health, especially their nutritional status has received less attention but needs to be evaluated to understand the comprehensive public health implications of IPV. The aim of current study was to investigate the association between women's exposure to IPV and their children's nutritional status, using data from the 2007 Bangladesh Demographic and Health Survey (BDHS). Logistic regression models were used to estimate association between ever‐married women's lifetime exposure to physical and sexual violence by their spouses and nutritional status of their children under 5 years. Of 2042 women in the BDHS survey with at least one child under 5 years of age, 49.4% reported lifetime experience of physical partner violence while 18.4% reported experience of sexual partner violence. The prevalence of stunting, wasting and underweight in their children under 5 years was 44.3%, 18.4% and 42.0%, respectively. Women were more likely to have a stunted child if they had lifetime experience of physical IPV [odds ratio n = 2027 (OR)_adj, 1.48; 95% confidence interval (CI), 1.23–1.79] or had been exposed to sexual IPV (n = 2027 OR_adj, 1.28; 95% CI, 1.02–1.61). The present findings contribute to growing body of evidence showing that IPV can also compromise children's growth, supporting the need to incorporate efforts to address IPV in child health and nutrition programmes and policies.     

Identification of violence in the home: pediatric and parental reports

OBJECTIVES: To compare the rates of domestic violence reported by mothers with those identified by physicians, to compare the rates of harsh discipline practices reported by mothers with the rates of abuse identified by physicians, and to examine the relationship between reported domestic violence and harsh discipline practices. DESIGNS: Interviews with parents and pediatricians to compare pediatric detection of domestic violence and child abuse with parental reports of domestic violence and harsh discipline practices. SETTING: Community-based pediatric practices in the 13-town greater New Haven, Conn, area. PARTICIPANTS: Of the 23 practices invited, 19 agreed to participate. Of the 2,006 parents of eligible 4- to 8-year-olds asked to participate, 1,886 (94%) completed the Child Behavior' Checklist. Of those invited into the interview portion, 1,148 (83%) completed the 90-minute in-person interview. MAIN OUTCOME MEASURES: Percentages of cases of domestic violence identified by pediatricians and reported by mothers. Percentages of cases of child abuse detected by pediatricians and percentages of mothers reporting that they have hit their children and left a mark. RESULTS: Pediatricians detected domestic violence in 0.3% of the cases, but parents reported domestic violence in 4.2% kappa= 0.106 [95% confidence interval, -0.007 to 0.219]). Pediatricians identified physical abuse of children in 0.5% of the cases, while mothers reported hitting their children and leaving a mark in 21.6% (kappa = 0.003 [95% confidence interval, -0.018 to 0.024]). Mothers reporting domestic violence were significantly more likely to report hitting hard enough to leave a mark (relative risk, 1.6 ([95% confidence interval, 1.09-2.38]) compared with those not reporting domestic violence. Physicians identifying domestic violence were not significantly more likely to report child abuse than those not identifying domestic violence. CONCLUSIONS: Parents report more cases of violence than pediatricians detect. Pediatricians should ask parents directly about domestic violence and harsh discipline.     

Screening for behavioral and emotional problems in children and adolescents with congenital or acquired limb deficiencies.

Children with chronic physical handicaps have been found to be at risk for psychological and social adjustment problems. Accurately identifying in a timely manner those physically handicapped children who are functioning at clinically significant levels of maladjustment may aid in preventing further psychosocial morbidity. The parents of 111 children and adolescents with congenital/acquired limb deficiencies completed the Child Behavior Checklist as a screening instrument to facilitate the identification of behavioral and emotional problems and social incompetence. Based on normalized T scores, the children manifested significantly greater behavioral and emotional problems and lower social competence than the normative community sample. Twenty-three percent of the children were reported to function in the clinically significant maladjustment range for behavioral and emotional problems; 14% were reported in the social maladjustment range. Correlations between parent report and child, adolescent, and teacher reports of adjustment ranged from r values of .23 to .41. The findings are discussed in terms of the "new hidden morbidity" in pediatric practice.     

Multiple Mediators for Peer-Directed Aggression and Happiness in Arab Adolescents Exposed to Parent–child Aggression

This study aimed to examine a multi-mediator model explaining how exposure to parent-child physical aggression may link with adolescents’ peer-directed physical aggression and their own subjective happiness, in an understudied Israeli Arab population. Mediators included hostility, anger, need to belong, and self-control. Arab adolescents from northern Israel (N?=?155; 62 % girls, aged 16-17) completed questionnaires regarding parents’ physical violence toward them, their own aggression toward peers, need to belong, happiness, positive emotions, and selfcontrol skills. (a) Parent-child physical aggression linked positively with peerdirected aggression through the mediating associations of hostility with anger; (b) parent-child physical aggression linked negatively with peer-directed aggression and happiness through the mediation of adolescents’ increased need to belong; and (c) parent-child physical aggression was not directly linked with self-control, but selfcontrol directly linked negatively with peer-directed aggression and positively with happiness. Findings highlight pathways through which parent-child physical aggression may simultaneously influence adolescents’ aggressive behavior and happiness. The mediation detected possible process variables (e.g., yearning for belonging, self-control skills, hostile thoughts, and angry feelings) that researchers and clinicians can consider in designing prevention and treatment interventions to break the inter-generational cycle of violence.