VIOLENCE, CHILDREN'S EXPOSURE TO

general effects
anna marie medina
gayla margolin
elana b. gordis

community violence
joy d. osofsky
howard j. osofsky

domestic violence
debbie miller

GENERAL EFFECTS

Children's experience with violence has been linked to a variety of negative outcomes, one of particular importance being children's school adaptation and academic success. Since the early 1980s researchers and professionals working with children have become increasingly aware of the extent to which many children experience or observe violence within the confines of their own homes or within their own neighborhoods. Data from 1999 reports by states to the National Child Abuse and Neglect Data Systems indicate that approximately 826,000 children (nearly 12 out of every 1,000 children) were confirmed by child protective services as victims of maltreatment. With respect to exposure to interparental violence, Murray A. Straus estimated, in a report published in 1992, that more than 10 million children in the U.S. witness physical aggression between their parents each year, with prevalence rates throughout childhood being at least triple the rates of exposure within a given year.

Community violence also has an impact on many children. Estimates of community violence exposure are based on data gathered through interview or survey methods, and generally reflect the number of children who were personally victimized as well as those who witness community violence involving their family members, schoolmates, neighbors, and peers as victims. Whereas attempts are made to keep child abuse and interparental aggression private and secret, community violence is discussed widely, often resulting in rapidly spreading ripple effects. Thus, even children who do not directly observe community violence often have knowledge of violent events within their community or hear repeated accounts of a specific incident, and may form their own mental imagery of the violence. Studies suggest that in inner city neighborhoods, almost all children have been exposed to community violence, and at least one-third of pre-teenage and teenage children have been directly victimized. Exposure to violence (i.e. children's experience as either targets or witnesses to violence) affects children's views of the world and themselves, their ideas about the meaning and purpose of life, their expectations for future happiness, and their moral development. Moreover, exposure to violence often interferes with developmental tasks children need to accomplish in order to become competent members of society.

Two key developmental tasks frequently compromised by exposure to violence are children's adaptation to school and academic achievement. Children exposed to either familial or community violence (or both) often demonstrate lower school achievement and poorer adaptation to the academic environment. Exposure to violence affects these developmental tasks both directly and indirectly. Violence exposure can lead to disturbances in cognitive functioning, emotional difficulties such as depression and anxiety, and behavior and peer problems. Before examining how each of these effects can interfere with children's adaptation to school and academic competence, it is important to consider three issues related to children's violence exposure.

First, violence exposure rarely occurs only once or only in one form. That is, most children who are exposed to violence are rarely exposed to only one incident or one type of violence. Researchers have determined that there are high rates of cooccurrence between exposure to community violence and intrafamilial violence, and within the family, high rates of co-occurrence have been detected between interparental violence and parent-to-child violence. Moreover, it also has become clear that these different forms of violence are frequently recurring events.

A second central issue is that violence exposure often goes hand in hand with numerous other adverse life experiences. Children living with violence typically experience other stressors such as poverty, neglect, poor nutrition, overcrowding, substance abuse, lack of adequate medical care, parents' unemployment, and parents' psychopathology. These factors can exacerbate and extend the negative effects of violence exposure in children. For example, children whose parents suffer from psychopathology or struggle with substance abuse problems may not have had the opportunity or guidance to develop pro-social coping skills with which to deal with violence exposure in their community. Although children exposed to violence may have a greater need for nurturance and protection than children without such stressors, they may actually have less access to social support from their caretakers. Therefore, efforts to grasp the effects of violence exposure on children also must evaluate the context in which the child is embedded.

A third issue is that the effects of violence exposure are developmentally contingent. Children face specific challenges at different points in development. Thus, the impact of violence exposure will vary according to the child's developmental level. Children's abilities to appraise and understand violence, to respond to and cope with danger, and to garner environmental resources that offer protection and support change become refined over the course of development. Moreover, theorists assert that as children mature, the skills required to master current life challenges rest on competencies acquired earlier in development. Accordingly, exposure to violence early rather than later in development may be more detrimental, particularly if the violence exposure compromises the foundations required to develop future competencies. In a related vein, however, if early violence exposure is terminated, the plasticity in children's developmental processes may promote recovery for any lost or delayed functioning. The implications of length and timing of violence exposure are complicated and require future empirical investigation.

The review that follows examines the cognitive, emotional, behavioral and social effects of violence exposure, and highlights the ways in which these effects can disrupt children's adaptation to school and academic competence. Although the effects of violence exposure are presented here as distinct, in reality the cognitive, emotional, behavioral and social effects of violence are interrelated and contribute to one another. For example, if children who are exposed to violence are less flexible and resourceful in their reasoning, these cognitive processes may be associated with problems with peers and school work, which may then lead to depression and anxiety.

Cognitive Effects

Exposure to violence, particularly parent-to-child violence, has been associated with problems in children's cognitive processes and poor academic functioning. Researchers have linked exposure to chronic abuse and violence with lower IQ scores, poorer language skills, decrements in visual-motor integration skills and problems with attention and memory. Cognitive problems associated with exposure to violence and abuse comprise one of the most direct threats to the developmental task of school adaptation and academic achievement. Deficits in attention regulation, language skills, and memory undermine the child's ability to accomplish the central requirements of academic achievement and school adaptation, namely to encode, organize, recall, and express understanding of new information. Accordingly, physically abused school-age children have been found to score lower than non-abused comparison children on tests of verbal ability and comprehension, reading and math skills, and overall achievement on standardized tests. Similarly, children exposed to community violence tend to show lower school achievement.

The cognitive effects of violence exposure affect more than children's academic performance. Children who have difficulty with attention and memory may not be sensitive to important social cues and expectations, and thus find themselves struggling with school rules, peer relationships, and classroom instructions. Thus, the cognitive effects of violence exposure may disrupt children's successful functioning in the school environment in addition to hindering academic competence.

Emotional Effects

Exposure to violence almost always carries emotional consequences for children. Children's exposure to intrafamilial violence has been linked to depression and more negative self-concept. Studies have shown that both witnessing and/or being a victim of community violence may put children at risk for increased anxiety and depressive symptoms. Violence exposure can be interpreted by the child to mean not only that the world is unsafe but also that the child is unworthy of being kept safe. Whether related to violence in the home or in the community, these attitudes can undermine children's school adjustment and academic achievement by contributing to negative self-perceptions and problems with depression and anxiety.

Another emotional consequence for children exposed to violence is posttraumatic stress disorder (PTSD). Researchers have determined that both chronic and acute exposure to violence is linked to heightened levels of PTSD symptoms, including diminished concentration, sleep disturbance, sudden startling, and intrusive thoughts. These symptoms, as well as the symptoms of anxiety and depression, interfere with children's academic achievement by making it more difficult to attend to school lessons, and by lowering the motivation and disrupting the concentration necessary to complete academic tasks. Similarly, children's adaptation to the school environment may be undermined by the emotional consequences of violence exposure. Violence-exposed children have been rated by teachers and parents as less "ready to learn," less competent in school, and more likely to repeat grades.

In addition, children's efforts to manage the emotional consequences of violence exposure may interfere with school adaptation and academic achievement. Research has shown that children use both behavioral distraction and attentional disengagement to cope with uncontrollable stress and reduce anxiety. Children's efforts to cope with the symptoms of depression, anxiety, and PTSD may have a deleterious effect on their social awareness, social engagement, ability to problem solve, and their attentional resources. Whereas some children will cope with the emotional toll of violence exposure by isolating themselves and withdrawing from the environment, other children will use behavioral distraction to cope with overwhelming negative emotions. Both coping strategies can create problems in the classroom and on the playground.

Behavioral and Social Effects

Childhood exposure to violence is associated with a variety of aggressive and otherwise maladaptive behaviors that can disrupt children's school adaptation and academic competence. Such behavior problems not only interfere with classroom learning, they also hamper children's efforts to make friends, another essential task of childhood and an important dimension of school adaptation. Exposure to intrafamilial violence has been linked with increased aggression, fighting, "meanness," and generally disruptive behavior. Children exposed to intrafamilial violence are reported to have more disciplinary problems at school than their non-exposed peers, and are more likely to be suspended. Likewise, exposure to community violence has been associated with increases in antisocial behavior and aggression, as reported by teachers and parents.

Behavior problems that emerge following exposure to violence can be thought of as stemming from a lack of appropriate role models, difficulties with emotion regulation skills, and aberrant information processing. Children exposed to adult violence, particularly intrafamilial adult violence, may learn from these adults that aggressive behavior is a viable problem-solving option, and that physical aggression in close relationships is normal. Clearly, such lessons could create problems for children on the playground and later in life.

Researchers have observed that exposure to violence is related to difficulties regulating anger, frustration, and other negative feelings, as well as deficits in understanding and experiencing empathy for the feelings of others. These difficulties can lead to significant behavioral and social problems for children. As noted above, one way in which children deal with overwhelming negative feelings is through behavioral distraction. Performance in academic settings will suffer if violence-exposed children attempt to cope with anger towards other children or frustration with academic material by behaving disruptively. Moreover, children with deficits in emotion regulation, empathy, and understanding emotions tend to be rated as less popular and more rejected by their peers.

Another source of behavior and social problems for violence-exposed children involves aberrant processing of social information. Researchers have observed relations between exposure to violence, problems in the way children think about social relationships, and children's social adjustment in the school peer group. Violence-exposed children have been found to be less interpersonally sensitive and attentive to social cues, less competent at social perspective taking, less able to identify others' emotional expressions and to understand complex social roles, and more likely to ascribe hostile intentions to the neutral behavior of others. The suboptimal processing of social information may contribute to the problem behaviors seen in children exposed to violence.

Long-Term Consequences of Violence Exposure

The impact of violence exposure can go beyond the period of exposure and the immediate aftermath, affecting some individuals into adulthood. Although little is known concerning the effects of exposure to community violence, researchers have examined the adult lives of individuals exposed in childhood to intrafamilial aggression. Adults exposed to such violence as children have been found to have completed significantly fewer years of school and reported more episodes of truancy during their time in school compared to non-exposed peers. In addition, and perhaps related to their lack of schooling, adults exposed to intrafamilial violence in childhood also are at greater risk for arrest for a violent crime, and for earlier and more chronic involvement in criminal behavior.

It is important to recognize, however, that the damaging effects of violence exposure are not inevitable. Researchers have identified a host of protective factors that can buffer the detrimental effects of adverse life events, such as violence exposure. Among these factors are the presence of supportive adults in children's lives, scholastic competence, and realistic educational and vocational plans.

Conclusion

The effects of violence exposure, problematic in their own right, also have a detrimental impact on two key developmental challenges, namely, children's school adaptation and academic achievement. Both the effects of violence exposure and consequent poor mastery of important developmental challenges set violence-exposed children on a trajectory towards maladaptive outcomes. Much remains to be learned about how violence exposure brings about these effects and how the cognitive, emotional, behavioral and social systems of a child are interconnected. It is important for social scientists and professionals working with children to continue to search for ways to reduce violence exposure and to intervene effectively to keep violence-exposed children on a pro-social track.

Although different types of violence exposure can hold unique effects for children, there are common symptom patterns among children exposed to violence. Difficulties with attention and other cognitive processes, troubling emotional aftereffects, and problems with behavioral and social adaptations are frequent outcomes for children exposed to diverse types of violence. Because children's reactions to violence exposure may be present as common emotional or behavioral symptoms, violence exposure may be overlooked as the underlying problem. From treatment and policy perspectives, it is critical that the assessment of children routinely evaluates for both family and community violence.

See also: Affect and Emotional Development; Aggressive Behavior; Attention; Juvenile Justice System, subentry on Juvenile Crime and Justice.

bibliography

Bolger, Kerry E.; Patterson, Charlotte J.; and Kupersmidt, Janis B. 1998. "Peer Relationships and Self Esteem Among Children Who Have Been Maltreated." Child Development 69:1171–1197.

Buka, Stephen L.; Stichik, Theresa L.; Birdthistle, Isolde; and Earls, Felton J. 2001. "Youth Exposure to Violence: Prevalence, Risks, and Consequences." American Journal of Ortho-psychiatry 71 (3):298–310.

Garbarino, James; Dubrow, Nancy; Kostelny, Kathleen; and Pardo, Carole. 1992. Children in Danger. San Francisco: Jossey-Bass.

Garmezy, Norman, and Masten, Ann S. 1994. "Chronic Adversities." In Child and Adolescent Psychiatry, ed. Michael Rutter, Lionel Hersov, and Eric Taylor. Oxford: Blackwell.

Lynch, Michael, and Cicchetti, Dante. 1998. "An Ecological-transactional Analysis of Children and Contexts: The Longitudinal Interplay Among Child Maltreatment, Community Violence, and Children's Symptomatology." Development and Psychopathology 10 (2): 235–257.

Margolin, Gayla, and Gordis, Elana B. 2000. "The Effects of Family and Community Violence on Children." Annual Review of Psychology 51:445–479.

Osofsky, Joy D.; Wewers, Sarah; Hann, Della M.; and Fick, Ana C. 1993. "Chronic Community Violence: What Is Happening to Our Children?" In Children and Violence, ed. David Reiss, John E. Richters, Marian Radke-Yarrow, and David Scharff. New York: Guilford.

Perez, Cynthia M., and Widom, Cathy Spatz. 1994. "Childhood Victimization and Long-Term Intellectual and Academic Outcomes." Child Abuse and Neglect 18:617–633.

Schwab-Stone, Mary E.; Ayers, Tim S.; Kaprow, Wesley; Voyce, Charlene; Barone, Charles; Shriver, Timothy; and Weissberg, Roger P. 1995. "No Safe Haven: A Study of Violence Exposure in an Urban Community." Journal of the American Academy of Child and Adolescent Psychiatry 34:1343–1352.

Schwartz, David, and Proctor, Laura. 2000. "Community Violence Exposure and Children's Social Adjustment in the School Peer Group: The Mediating Roles of Emotion Regulation and Social Cognition." Journal of Consulting and Clinical Psychology 68:670–682.

Shields, Ann, and Cicchetti, Dante. 1998. "Reactive Aggression Among Maltreated Children: The Contributions of Attention and Emotion Dysregulation." Journal of Consulting and Clinical Psychology 27:381–395.

Sroufe, L. Alan, and Rutter, Michael. 1984. "The Domain of Developmental Psychopathology." Child Development 55:17–29.

Straus, Murray A. 1992. "Children as Witnesses to Marital Violence: A Risk Factor of Lifelong Problems Among a Nationally Representative Sample of American Men and Women." In Children and Violence: Report of the Twenty-Third Ross Roundtable on Critical Approaches to Common Pediatric Problems, ed. Donald F. Schwarz. Columbus, OH: Ross Lab.

Trickett, Penelope K., and McBride-Chang, Catherine. 1995. "The Developmental Impact of Different Forms of Child Abuse and Neglect." Developmental Review 15:311–337.

Werner, Emmy. 1993. "Risk, Resilience, and Recovery: Perspectives from the Kauai Longitudinal Study." Development and Psychopathology 5:503–515.

Widom, Cathy Spatz. 1998. "Childhood Victimization: Early Adversity and Subsequent Psychopathology." In Adversity, Stress, Psycho-pathology, ed. Bruce P. Dohrenwend. New York: Oxford University Press.

internet resource

U.S. Department of Health and Human Services. 1999. "Child Maltreatment 1999: Reports from the States to the National Child Abuse and Neglect Data System." <www.acf.dhhs.gov/programs/cb/publications/cm99/index.htm>.

Anna Marie Medina

Gayla Margolin

Elana B. Gordis

COMMUNITY VIOLENCE

Many children in the United States are exposed to so much violence that the problem has been characterized as a "public health epidemic." Related in part to transient age-related demographic changes (that is, in the percentage of youth who are at highest risk for violence), children's violence exposure has declined slightly since the early 1990s. The homicide rate, however, is still more than double that reported in 1950 according to the National Summary of Injury Mortality Data, with the 1996 rate being 22 per 100,000 for young people fifteen to twenty-four years old. Further, the United States has the highest level of violence exposure of any developed country in the world. Homicide is the third-leading cause of death for children five to fourteen years of age, the second-leading cause of death for those aged fifteen to twenty-four, and has been the leading cause of death for African-American youth from the early 1980s into the early twenty-first century. It is crucial to understand what such levels of exposure may mean for children in the United States.

In addition to community violence exposure, some estimates, such as those reported by Murray Straus and Richard Gelles in 1990, indicate that between 8.5 and 11.3 women per 100 are abused by husbands or boyfriends in the United States. Dating violence–that is, the perpetration of an act of violence by at least one member of an unmarried couple on the other member (which can include sexual assault, physical violence, or verbal or emotional abuse)–appears to range from 9 to 65 percent depending on whether threats and emotional or verbal aggression are included in the definition.

While exposure to community violence occurs less frequently for children who do not live in lower socioeconomic neighborhoods, children are also often exposed to violence in their homes and in the media. Exposure to media and family violence crosses socioeconomic and cultural boundaries, occurring in all groups in U.S. society. The effects are often less visible in higher socioeconomic groups, but, nonetheless, such violence impacts significantly on children during their development and influences their later relationship experiences.

Levels of Exposure to Community Violence

Community violence exposure, whether it be isolated, frequent, or unfortunately at times almost continuous, includes frequent and continual exposure to random violence and the use of guns, knives, and drugs. In the early twenty-first century it is rare in urban elementary schools not to find children who have been exposed to such negative events. Children who have been interviewed in several different studies lucidly tell their stories of witnessing violence, including shootings and beatings, as if they were ordinary, everyday events.

In Steven Maran and Donald Cohen's survey of sixth, eighth, and tenth graders in New Haven, Connecticut, in 1992, 40 percent reported witnessing at least one violent crime in the previous year. Very few of these inner-city children were able to avoid being exposed to violence, and almost all eighth graders knew someone who had been killed in a violent incident. In a study by Carl C. Bell and Esther J. Jenkins involving 500 children at three elementary schools on the South Side of Chicago in 1993, one in four had witnessed a shooting and one-third had seen a stabbing. In another study by Jenkins and Bell (published in 1997) surveying 200 Chicago high school students in 1993, almost two-thirds had seen a shooting and close to one-half had seen a stabbing. Three in five of those who witnessed a shooting or stabbing indicated that the incident had resulted in a death. More than one-fourth of these high school students reported that they had themselves been victims of severe violence.

Even very young children are exposed to high levels of violence. Betsy Groves and colleagues' 1993 survey of parents whose children attended a pediatric clinic at a public hospital in Boston in 1993 found that one of every ten children under the age of six had witnessed a shooting or stabbing. In Marva Lewis, Joy Osofsky, and Mary Sue Moore's 1997 study, African-American third-and fifth-grade children living in a high-violence area of New Orleans were asked to draw pictures of "what happens" in their neighborhoods. They drew in graphic detail pictures of shootings, drug deals, stabbings, fighting, and funerals and reported being scared of the violence and of something happening to them. Children living with domestic and community violence commonly draw similar pictures.

In 1993 John E. Richter and Pedro Martinez conducted an extensive interview study on the exposure to violence with 165 mothers of children, ages six to ten, living in a low-income neighborhood in Washington, DC. According to police statistics, this neighborhood was characterized as having a moderate level of violence; there might be an occasional murder or violent incident, but violence was not a regular event. Concurrently, another study by Joy Osofsky and colleagues gathered similar interview data on fifty-three African-American mothers of children, ages nine to twelve, in a low-income neighborhood in New Orleans, Louisiana. According to police statistics, this neighborhood was characterized as having a high level of violence; a murder or more than one violent incident occurred on a regular basis. Some differences in violence exposure were noted, likely due, to a considerable extent, to differences in the levels of violence in the two neighborhoods being sampled. The data from both studies, however, clearly showed that children frequently are victims of and witnesses to significant amounts of violence. Fifty-one percent of the New Orleans fifth graders and 32 percent of the Washington, D.C., children had been victims of violence, ranging from being chased or beaten to having a gun held to their head.

Xiaoming Li and colleagues, in a 1998 study of 349 low-income black urban children (ages nine to fifteen), found that those who witnessed or were victims of violence showed symptoms of posttraumatic stress disorder similar to those of soldiers coming back from war. The symptoms increased according to the number of violent acts the child had witnessed or experienced. In a 1996 report, Hope Hill and colleagues focused on some of the sociopolitical issues related to violence exposure as well as the importance of support for children by the family, teachers, and community in effective prevention and intervention efforts. This work is consistent with the findings of the Violence Intervention Program, which have indicated the importance of a broad base of support for violence prevention. Deborah Gorman-Smith and Patrick Tolan found that exposure to community violence was related to subsequent symptoms of depression and anxiety as well as to aggressive behaviors as reported by the children, their parents, and teachers. In this 1998 study, having a mother present in the home seemed to be a major factor in mitigating the relationship between community violence exposure and subsequent depressive symptoms in the children.

While specific rates of exposure to community violence vary depending on the definition of exposure and the nature of the sample, children of all ages are being exposed to community violence at an alarming rate. As noted, such exposure has been linked to higher rates of post-traumatic stress symptoms, as well as to depressive symptoms, antisocial behavior, and decreased school performance. In a 2000 article, Stacey Overstreet suggested that repeated exposure to community violence may influence children to become numbed, demonstrating uncaring behavior toward others and desensitization to aggression. Such children may themselves show increased aggression, acting out, and subsequent antisocial behavior.

Impact on Children in School

Exposure to violence is not limited to homes and neighborhoods. For many youth, schools, which should be safe havens, are also places where they can be exposed to violence, which can impact on a student's concentration and ability to be successful in school. Exposure to violence and trauma can lead to feelings of helplessness, hopelessness, and vulnerability in children. Some may react with anger and aggression, which can lead to behavior and discipline problems in school. Others may withdraw and become depressed, which while not drawing as much attention can have a great affect on their ability to concentrate, their self-esteem, and, consequently, their performance. Beyond the psychological and behavioral consequences of exposure to violence that may impact on a child in school, children may learn that violence is an acceptable behavior. They learn violence from what they observe and may believe that fighting and violent behavior is all right either in or outside of the classroom. They do not learn to negotiate to solve problems; rather, they may more quickly lose control of their emotions. Children exposed to violence often do not learn to communicate feelings and may be more easily pressured by peers. They may believe that aggressive behaviors lead to attention and respect. Bullying and intimidating behaviors may be another consequence.

The Centers for Disease Control and Prevention in Atlanta, in their 1998 "Surveillance Summaries," reported survey results from a nationally representative sample of students in grades nine through twelve for selected risk behaviors both at school and outside of school. The survey focused on categories, including students who had carried a weapon, had carried a gun, were in a physical fight, were injured in a physical fight, were threatened or injured on school property, were in a physical fight on school property, and had property stolen or deliberately damaged on school property. The study found alarmingly high incidents of these disturbing behaviors in schools throughout the country.

Children suffer with enormous short-term and long-term consequences from such violence exposure. Students living in urban inner-city environments commonly provide vivid descriptions of the violence they see and experience in their environment, sometimes on a daily basis. Susan Chira's 1994 poll of high school students indicated that 30 percent of white students and 70 percent of African-American students knew someone who had been shot within the previous five years; 19 percent of white students and 37 percent of African-American students identified violence as the biggest problem at school; and 5 percent of white students and 27 percent of African-American students reported worrying about shootings at school. A Harris poll of 2,000 teenagers from around the country indicated that one in eight overall, and almost two in five from inner cities, said that they carried a weapon to protect themselves. In addition, one in nine overall, and one in three in high violence areas, said they had stayed away from school for fear of violence. This 1996 poll was carried out before the many school shootings that later occurred. Despite the previously noted data indicating that the overall incidence of violence exposure has been decreasing slightly (although this may be transient), national surveys demonstrate increased concern and fears about violence in school, especially among older children.

The problem of children's exposure to community violence is significant. Without intervention efforts, it may increase with age shifts in coming years. It is clear that major efforts need to be undertaken to decrease violence exposure and to mitigate the effects of this exposure when it occurs.

See also: Aggressive Behavior; Juvenile Justice System, subentry on Juvenile Crime and Justice; Neighborhoods; Parenting, subentry on High-Risk Neighborhoods; Urban Education.

bibliography

Appelbone, Paul. 1996. "Crime Fear Is Seen Forcing Change in Youth Behavior." New York Times January 12.

Bell, Carl C., and Jenkins, Esther J. 1991. "Traumatic Stress and Children." Journal of Health Care for the Poor and Underserved 2:175–185.

Bell, Carl C., and Jenkins, Esther J. 1993. "Community Violence and Children on Chicago's Southside." Psychiatry 56:46–54.

Centers for Disease Control and Prevention. 1998. "CDC Surveillance Summaries" 47 (SS-3).

Centers for Disease Control and Prevention. Division of Violence Prevention, Family and Intimate Violence. 1998. National Center for Injury Control, 1998. Atlanta, GA: Centers for Disease Control and Prevention, Division of Violence Prevention, Family and Intimate Violence.

Centers for Disease Control and Prevention. National Center for Injury Prevention and Control. 1996. National Summary of Injury Mortality Data, 1987–1994. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.

Chira, Susan. 1994. "Teenagers in a Poll Report Worry and Distrust of Adults." New York Times July 10.

Fingerhut, Lois A.; Ingram, Deborah D.; and Feldman, Jacob J. 1992. "Firearm Homicide among Black Teenage Males in Metropolitan Counties." Journal of the American Medical Association 267:3054–3058.

Finkelhor, David, and Dziuba-Leatherman, Jennifer. 1994. "Victimization of Children." American Psychologist 49:173–183.

Flannery, Daniel, and Huff, C. Ronald. 1998. Youth Violence: Prevention, Intervention, and Social Policy. Washington, DC: American Psychiatric Press.

Gorman-Smith, Diane, and Tolan, Patrick. 1998. "The Role of Exposure to Community Violence and Developmental Problems among Inner City Youth." Development and Psychopathology 10:99–114.

Groves, Betsy M., and Zuckerman, Barry. 1997. "Interventions with Parents and Caregivers of Children Who Are Exposed to Violence." In Children in a Violent Society, ed. Joy D. Osofsky. New York: Guilford.

Groves, Betsy M.; Zuckerman, Barry; Marans, Stephen; and Cohen, Donald. 1993. "Silent Victims: Children Who Witness Violence." Journal of the American Medical Association 269:262–264.

Hill, Hope M.; Levermore, Monique; Twaite, James; and Jones, L. P. 1996. "Exposure to Community Violence and Social Support as Predictors of Anxiety and Social and Emotional Behavior among African-American Children." Journal of Child and Family Studies 5:399–414.

Huessman, L. Rowell, and Eron, Leonard D., eds. 1986. Television and the Aggressive Child: A Cross National Comparison. Hillsdale, NJ: Erlbaum.

Jaffe, Peter; Wilson, Susan; and Wolfe, David. 1986. "Promoting Changes in Attitudes and Understanding of Conflict Resolution among Child Victims of Family Violence." Canadian Journal of Behavior Sciences 18:356–366.

Jenkins, Esther J., and Bell, Carl C. 1997. "Exposure and Response to Community Violence among Children and Adolescents." In Children in a Violent Society, ed. Joy D. Osofsky. New York: Guilford.

Lewis, Marva.; Osofsky, Joy D.; and Moore, Mary Sue. 1997. "Violent Cities, Violent Streets: Children Draw Their Neighborhoods." In Children in a Violent Society, ed. Joy D. Osofsky. New York: Guilford.

Li, Xiaoming; Howard, Donna; Stanton, Bonita; Rachuba, Laura; and Cross, Shelia.1998. "Distress Symptoms among Urban African-American Children and Adolescents: A Psychometric Evaluation of the Checklist of Children's Distress Symptoms." Archives of Pediatrics and Adolescent Medicine 152:569–577.

Marans, Stephen, and Cohen, Donald. 1993. "Children and Inner-City Violence: Strategies for Intervention." In Psychological Effects of War and Violence on Children, ed. Lewis Leavitt and Nathan Fox. Hillsdale, NJ: Erlbaum.

Morse, Jodie. 2000. "The Perception Gap: School Violence." Time April 24.

Murray, John. 1997. "Media Violence and Youth." In Children in a Violent Society, ed. Joy D. Osofsky. New York: Guilford.

National Commission on Children. 1991. Speaking of Kids. Washington, DC: National Commission on Children.

Osofsky, Joy D., ed. 1997. Children in a Violent Society. New York: Guilford.

Osofsky, Joy D.; Wewers, Sarah; Hann, Della M.; and Fick, Ann C. 1993. "Chronic Community Violence: What Is Happening to Our Children?" Psychiatry 56:36–45.

Overstreet, Stacey. 2000. "Exposure to Community Violence: Defining the Problem and Understanding the Consequences." Journal of Child and Family Studies 9 (1):7–25.

Richters, John E. 1993. "Community Violence and Children's Development: Toward a Research Agenda for the 1990's." Psychiatry 56:3–6.

Richters, John E., and Martinez, Pedro. 1993. "The NIMH Community Violence Project: I. Children as Victims of and Witnesses to Violence." Psychiatry 56:7–21.

Rosenberg, Mark L., and Fenley, Mary A. 1991. Violence in America: A Public Health Approach. New York: Oxford University Press.

Rosenberg, Mark L.; O'Carroll, Patrick W.; and Powell, Kenneth E. 1992. "Let's Be Clear: Violence Is a Public Health Problem." Journal of the American Medical Association 267:3,071–3,072.

Schwab-Stone, Mary E.; Ayers, Tim S.; Kasprow, Wesley; Voyce, Charlene; Barone, Charles; Shriver, Timothy; and Weissberg, Robert P. 1995. "No Safe Haven: A Study of Violence Exposure in a Urban Community." Journal of the American Academy of Child and Adolescent Psychiatry 34:1343–1352.

Straus, Murray. 1979. "Measuring Intrafamilial Conflict and Violence: The Conflict Tactics Scales." Journal of Marriage and Family 41:75–88.

Straus, Murray, and Gelles, Richard. 1990. Physical Violence in American Families: Risk Factors and Adaptations to Violence in 8,145 Families. New Brunswick, NJ: Transaction.

U.S. Federal Bureau of Investigation. 1992. Uniform Crime Statistics Report. Washington, DC: U.S. Federal Bureau of Investigation.

Joy D. Osofsky

Howard J. Osofsky

DOMESTIC VIOLENCE

Domestic violence is the greatest public health issue confronting women and children in the United States today. Information from the American Medical Association indicates that:

• Battering is the primary cause of injury to women in the United States.
• The average victim of domestic violence will be physically abused three times per year.
• The total annual health care cost of domestic violence is estimated at over $40 million.
• 20 to 45 percent of all injuries seen in emergency rooms are the result of domestic violence.
• Two-thirds of all women who are murdered die as a result of domestic violence.

Domestic violence is defined as a pattern of behavior that may include physical and sexual violence, threats, insults, and economic deprivation aimed at gaining and maintaining power and control over the mind, body, behavior, and lifestyle of a partner. Under this definition, domestic violence is not limited to married couples or even heterogeneous relationships. Domestic violence can and often does occur within families and across generations.

One of the problems that social scientists, researchers, doctors, and advocates have in documenting the numbers of victims of domestic violence is the stigma attached to an act of violence between family members and intimate partners. One's home is considered a place of safety and refuge, so when violence occurs in that sanctuary, the perpetrators and victims are often reluctant and even fearful to report the incident to outside persons or agencies. When the violence is reported, women and children are overwhelmingly reported as the victims.

In the United States, researchers estimate that one in four women will experience domestic violence at some point in their lifetime. Women who seem most vulnerable to domestic violence are ages sixteen to twenty-four. Data from a 1998 study by the National Violence Against Women Survey indicate that 8 million women are physically, sexually, or emotionally abused every year and 1.9 percent of the women in the United States, which represents 1.9 million women, were physically assaulted in the 12 months prior to the survey.

But physical assault is only a small part of the overall cycle that constitutes domestic violence. The cycle frequently begins with forms of emotional abuse including humiliation, name calling, and making the victim feel guilty. The perpetrator may also use economic abuse, such as preventing the victim from getting a job or taking all the money away and controlling every expenditure. The perpetrator may isolate the victim, limiting the victim's contacts with other family members, friends, and social contacts. As the cycle escalates the perpetrator may use threats of violence against the victim or against children in the home or actual violence such as abusing pets, breaking things, and displaying weapons. Eventually the threats will lead to physical violence causing injury and sometimes death. Physical violence includes beatings, rape, and mutilation.

When the violence is over there may be a period of peace in which the perpetrator asks for forgiveness, apologizes, presents gifts, and blames others, including the victim, for causing the violence. Most often the victim will forgive the perpetrator due to emotional and financial dependence. Victims may also, because of past humiliations and intimidations, feel that they share the blame for causing the violence and the cycle will repeat itself. By definition, domestic violence is a pattern of behavior and not a single act of violence. This pattern or cycle repeats itself many times and it is the repetition that classifies the behavior as domestic violence.

Domestic violence cuts across all areas of culture, class, income, education, profession, race, and age. Internationally an estimated 20 to 50 percent of women have experienced physical violence from an intimate partner or family member. But the true magnitude of domestic violence is hard to assess. In some cultures sexual abuse or rape by an intimate partner is not considered a crime and many incidents of domestic violence are ultimately reported as child injury or abuse when a child is intentionally or unintentionally injured during a violent episode. Even when the situation is made known to legal or social service agencies, treatment or prosecution may be difficult because the victim will not press charges or leave the home.

The Effect of Domestic Violence on Children

Police reports indicate that children are present in the home in 40 to 50 percent of cases involving domestic violence calls. Research indicates that between 3.3 and 10 million children are exposed to domestic violence in the United States every year. Children are significantly affected by this exposure to domestic violence in a number of ways. The most common are that they observe violent acts, they incur injury to themselves, and they suffer neglect by their caretakers.

Children who observe domestic violence react in many ways. External behaviors may include aggressive behavior and conduct problems in home and in school, fighting, cursing, and name calling. Internal behaviors that may also occur include anxiety, depression, low self esteem, guilt, crying; decreased intellectual and academic functioning including inability to concentrate; difficulty with school work, school truancy and failure; and developmental delay. Domestic violence can also affect children's social development, causing them to become isolated and withdrawn from friends and family and demonstrate low levels of empathy. Children affected by domestic violence may also exhibit negative physical health, developing somatic symptoms, poor sleeping and eating habits, headaches, stomach aches, and self-destructive behaviors such as suicide attempts and self-mutilation. A 1998 study indicates that between 45 and 70 per cent of children exposed to domestic violence are also victims of physical abuse. Children in homes with domestic violence are at higher risk of sexual abuse than children in nonviolent homes.

At every stage of a child's life the impact of exposure to violence in the home is evident. Infants or very young children are vulnerable to injury when adults handle them roughly in a moment of violence, but children are also subject to injury when flying objects are thrown or smashed or when weapons are used. They also may be ripped from their caretakers' arms or hurt when the person holding them falls or is knocked down. The victim of domestic violence may neglect the child in an attempt to appease the abuser or in fear that the child might be harmed further if concern is shown. Effects of this neglect can be seen in infants or young children through eating or sleeping disturbances (particularly if the abuse routinely occurs during meal times or after the child has gone to sleep), listlessness, developmental delays (due to lack of stimulation), and failure to thrive (due to lack of nurturing). Exposure to violence interferes with children's ability to develop trust in adults charged with their care. These children commonly exhibit excessive irritability, fear of being left alone, regression in toileting and language skills, and other delays in learning.

School-age children between the ages of five and twelve may exhibit more significant behaviors as a result of observing domestic violence. These children may be aggressive toward other children, exhibit low self-esteem, feel insecure, run away, use drugs, or have problems in school. As the child enters the teen years the child may exhibit more of the behaviors associated with the abuser or the victim. The child who identifies with the victim may come to accept violence as part of an intimate relationship. The child who identifies with the perpetrator learns to use violence to control relationships. Teens may also feel compelled to intervene on behalf of the victim and be injured, or be coerced into participating in the violence. Teens commonly experience shame about what is going on in their home and seek to remove themselves from the situation by running away or attempting suicide. When a victim seeks to remove herself and her children from an abusive situation, the children are frequently separated from their communities, friends, and schools. This puts additional stress on the child.

Given the serious consequence of domestic violence on children, some professionals argue that exposure to domestic violence constitutes a form of child maltreatment. But others argue that not all children are affected in the same way and that, in fact, many children learn to cope with the violence. Thus, witnessing abuse should be viewed as a potential risk factor for child maltreatment rather than conclusive evidence.

Response to Domestic Violence and Child Maltreatment

Since the late 1980s, researchers and practitioners have recognized the relationship between domestic violence and child maltreatment, yet little has been done to coordinate the delivery of services to these populations. The typical service delivery model has different points of entry into the system for adult victims and child victims. Frequently cases are heard in different court systems and those seeking help have to repeat their stories numerous times, fill out similar types of forms at each agency, and receive counseling separately from their children. In some systems the victim is required to seek counseling to receive other services, but the abuser is not required to receive any treatment at all.

As communities have focused on making families safer, new strategies have been developed to address domestic violence treatment and prevention. These strategies focus on building collaboration among law enforcement, child welfare, health care, and domestic violence prevention advocates. Cross-training is one of the most commonly implemented strategies to ensure that police officers, child protective services workers, school personnel, and mental health and medical professionals all recognize the signs of domestic violence and child abuse and know where to refer the victim. Co-location of services to facilitate access to safe housing, counseling, financial support, and legal intervention to victims and children is another effective strategy. But there is still much about prevention, identification, reporting, and treatment of domestic violence victims and abusers that is not known.

Laws on Domestic Violence

In 1984 Congress passed the Family Violence Prevention and Services Act, designed to help states in their efforts to increase public awareness about domestic violence. Ten years later the Violence Against Women Act of 1994 (VAWA) was passed. This act includes provisions to increase the number of programs available to victims of domestic violence. In addition, VAWA directly addresses the impact of domestic violence on children through treatment programs for children who are harmed by these acts.

State laws vary in approaches to domestic violence. For example, all states have provisions for restraining orders to keep the abuser away from the victim, but how long the order lasts, who is included in the order, and how specific courts process such requests vary from state to state. More than half of the states have laws that require that domestic violence be considered when a court makes an award of child custody or visitation. And while this is an improvement over the days when domestic issues were considered irrelevant to the welfare of the child, the laws still leave much discretion to the court.

Societal costs of the effects of domestic violence are enormous. Some costs, such as the cost of mental health and medical treatment, loss of work time for victims and abusers, court proceedings, and law enforcement response, can be estimated. But society cannot begin to estimate the worth of a lost childhood, broken homes, death of a parent, and fear caused by domestic violence.

See also: Aggressive Behavior; Attention; Child Abuse and Neglect; Dropouts, School; Parenting; Stress and Depression.

bibliography

Fantuzzo, John W., and Mohr, Wanda K. 1999. "Prevalence and Effect of Child Exposure to Domestic Violence." The Future of Children: Domestic Violence and Children 9 (3):21–32.

Matthews, Martha A. 1999. "The Impact of Federal and State Laws on Children Exposed to Domestic Violence." The Future of Children: Domestic Violence and Children 9 (3):50–66.

Osofsky, Joy D. 1999. "The Impact of Violence on Children." The Future of Children: Domestic Violence and Children 9 (3):33–49.

Tjaden, Patricia, and Thoennes, Nancy. 1998. "Stalking in America: Findings from the National Violence against Women Survey." Research in brief prepared for the National Institute of Justice and Centers for Disease Control and Prevention. Denver, CO: Center for Policy and Research.

United Nation Children's Fund. 2000. "Domestic Violence Against Women and Girls." Innocenti Digest 6:2–17.

internet resources

American Medical Association Council on Scientific Affairs. 2001. "AMA Data on Violence Between Intimates." <www.ama-assn.org/ama/pub/article/2036-5298.html>.

Family Refuge Center. 2001. "Domestic Violence and Children: The Effects of Domestic Violence on Children." <www.familyrefugecenter.com/effecton.html>.

National Clearinghouse on Child Abuse and Neglect Information. 2001. "In Harm's Way: Domestic Violence and Child Maltreatment." <www.calib.com/nccanch/pubs/otherpubs/harmsway.cfm>.

Peace at Home. 1995. "Domestic Violence: The Facts–A Handbook to STOP Violence." <www.cybergrrl.com/views/dv/book/def.html>.

Debbie Miller