Kathryn H. Howell

Factors discriminating among profiles of resilience and psychopathology in children exposed to intimate partner violence (IPV)

OBJECTIVE To evaluate the social and emotional adjustment of 219 children in families with varying levels of intimate partner violence (IPV) using a model of risk and protection. To explore factors that differentiate children with poor adjustment from those with resilience. METHODOLOGY Mothers who experienced IPV in the past year and their children ages 6-12 were interviewed. Standardized measures assessed family violence, parenting, family functioning, maternal mental health, and childrens adjustment and beliefs. RESULTS Using cluster analysis, all cases with valid data on the Child Behavior Checklist, Child Depression Inventory, General Self-Worth and Social Self-Competence measures were described by four profiles of childrens adjustment: Severe Adjustment Problems (24%); children who were Struggling (45%); those with Depression Only (11%); and Resilient (20%) with high competence and low adjustment problems. Multinomial logistic regression analyses showed children in the Severe Problems cluster witnessed more family violence and had mothers higher in depression and trauma symptoms than other children. Resilient and Struggling children had mothers with better parenting, more family strengths and no past violent partner. Parents of children with Severe Problems were lacking these attributes. The Depressed profile children witnessed less violence but had greater fears and worries about mothers safety. CONCLUSION Factors related to the child, to the mother and to the family distinguish different profiles of adjustment for children exposed to IPV who are living in the community. Resilient children have less violence exposure, fewer fears and worries, and mothers with better mental health and parenting skills, suggesting avenues for intervention with this population. PRACTICE IMPLICATIONS Findings suggest that child adjustment is largely influenced by parent functioning. Thus, services should be targeted at both the child and the parent. Clinical interventions shaped to the unique needs of the child might also be tested with this population.

Assessing resilience in preschool children exposed to intimate partner violence.

This study examined why some preschool-age children exposed to intimate partner violence (IPV) showed deleterious outcomes and others appeared more resilient. Resilience, conceptualized as strengths in emotion regulation and prosocial skills, was evaluated using the Social Competence Scale developed by the Conduct Problem Prevention Research Group. The sample consisted of 56 mothers and their 4- to 6-year-old children exposed to IPV within the past 2 years. After controlling for relevant demographic factors, hierarchical regression analyses indicated that better parenting performance, fewer maternal mental health problems, and less severe violence exposure predicted better emotion regulation and prosocial skill scores, which in turn were negatively correlated with maladaptive child behaviors. These findings can be used to inform and enhance clinical services for children exposed to IPV.

The impact of intimate partner violence and additional traumatic events on trauma symptoms and PTSD in preschool-aged children

Children exposed to intimate partner violence (IPV) are at increased risk for developing traumatic stress symptoms and posttraumatic stress disorder (PTSD). Unfortunately, children who witness IPV are often exposed to additional traumatic events. Previous research has indicated that approximately one third of children experience 2 or more direct victimizations each year, and that exposure to one type of victimization places children at risk for exposure to additional types of victimization. Yet little is known about the impact of these additional traumas on childrens functioning. For a sample of 120 preschool children (age 4-6 years) exposed to IPV in the past 2 years, 38% were exposed to additional traumatic events, including sexual assaults by family members, physical assaults, serious accidents, and/or life-threatening illnesses. Those exposed to both IPV and additional traumatic events had higher rates of PTSD diagnoses, traumatic stress symptoms (d = 0.96), and internalizing (d = 0.86) and externalizing behavior (d = 0.47) problems, than those exposed to IPV alone. We also compared DSM-IV diagnostic criteria to proposed criteria for evaluating traumatic stress in preschool-aged children. Results revealed the importance of conducting a complete assessment of traumatic events prior to treating children exposed to IPV.

Traumatic Events and Maternal Education as Predictors of Verbal Ability for Preschool Children Exposed to Intimate Partner Violence (IPV)

Despite research on the effects of intimate partner violence (IPV) on children, little is known about its impact on cognitive development. In this study, 87 preschool-aged children and their mothers exposed to IPV within the last two years participated in interviews to ascertain verbal ability, history of violence, and exposure to trauma. When compared to a national sample of 1,700 same-age children not evaluated for exposure to traumatic events, children exposed to IPV scored significantly lower on verbal ability, as assessed with standardized measures. In order to understand variation in verbal ability, multiple regression models were tested. Both prior exposure to traumatic events and the level of mother’s education were significant predictors of verbal ability. However, level of education mediated the relationship between traumatic events and the child’s verbal ability.

Mediators and Moderators of Change in Adjustment Following Intervention for Children Exposed to Intimate Partner Violence

Children aged 6 to 12 who were exposed to intimate partner violence (IPV) within the last year participated in an intervention program found to be successful in reducing their internalizing and externalizing behavior problems. However, little is known about factors that may contribute to this efficacy. Both fixed and modifiable risk factors that predicted change in children’s adjustment after the intervention were identified and tested. There was a significant relationship between the extent of exposure to IPV, gender, change in mothers’ mental health, and change in child adjustment. Among fixed factors, length of exposure to violence was found to moderate the relationship between the amount of the child’s and mother’s participation in the intervention and change in child adjustment, specifically internalizing behavioral problems. Among the modifiable risk factors, change in mother’s mental health, specifically symptoms of posttraumatic stress, was found to mediate the relationship between the amount of intervention participation and change in child adjustment. These findings can be used to inform and enhance evidence-based clinical services for children exposed to IPV.

Toward assessing traumatic events and stress symptoms in preschool children from low-income families.

Traumatic events can seriously disrupt the development of preschool children. Yet few studies capture developmentally specific examples of traumas and the expression of distress for this age group. Mothers and teachers of 138 preschoolers from low-income families were interviewed about traumatic events and completed a new measure assessing their childs traumatic stress symptoms. They reported traumatic events as the death of a person, death of a pet, family violence, high conflict divorce, sudden family loss, accident or injury, and viewing the World Trade Center attack. Factor analysis of 17 trauma symptoms revealed three internally consistent and valid scales: Intrusions, Emotional Reactivity, and Fears, plus a Total omnibus score. Traumatic stress symptoms varied by the type of event. Scores were higher for traumatic events involving close family members than for distal events.

Predicting Shelter Residence in Women Experiencing Recent Intimate Partner Violence

This study sought to determine factors associated with shelter residence in women with recent histories of intimate partner violence (IPV). The sample included 113 women, approximately half of whom resided in a shelter over the past year. Participating women provided demographic information and completed standardized measures of IPV, trauma, and depression. Ethnicity, income, housing stability, and mental health, but not violence exposure, differentiated the shelter and community groups. Trauma symptoms, housing instability, and ethnicity best predicted shelter residence. Future research should focus on determining what types of services and interventions will best address the unique needs of each population.

Fostering Social Competence in Preschool Children Exposed to Intimate Partner Violence: Evaluating the Preschool Kids' Club Intervention

This study assessed whether participation in an intervention program enhanced social competence in 113 preschool-aged children who were exposed to intimate partner violence. Change in competence was evaluated from baseline to approximately five weeks postbaseline and compared preschool children who did and did not receive intervention services. Protective factors, such as exposure to less severe violence, were identified that predicted change in competence scores. Results indicated that children with the highest social competence pre-intervention exhibited a significant increase in their postintervention scores, if they participated in the program. The extent of this change was predicted by a higher preintervention score and exposure to less severe violence. This study indicates that even short-term intervention could result in meaningful change in key aspects of child functioning.

Potential mediators of adjustment for preschool children exposed to intimate partner violence

Roughly 15.5 million children live in a home where intimate partner violence (IPV) has occurred at least once in the past ear (McDonald, Jouriles, Ramisetty-Mikler, Caetano, & Green, 2006). Epidemiological research indicates that preschoolged children are disproportionately exposed to this form of violence as compared to older children (Fusco & Fantuzzo, 009). Living in a home where IPV is present places children at increased risk for exposure to other potentially traumatic vents, such as child abuse and neglect (Zolotor, Theodore, Coyne-Beasley, & Runyan, 2007). Research shows that children ho witness IPV in the home are 15 times more likely to be abused, as compared to the national average (Osofsky, 2003). In study of Head Start preschoolers, 50% of families experiencing IPV also experienced child abuse (Graham-Bermann et al., 012). Further, exposure to IPV may fall under the broader category of emotional child abuse, defined as the chronic attack of a hild by an adult that negatively affects the child’s self-worth (Trocme & Wolfe, 2001). Such emotional abuse may lead the hild to become terrified by the constant use of threats or intimidating behavior. Evidence suggests that exposure to family iolence accounts for the majority (58%) of all substantiated cases of child emotional maltreatment (Trocme & Wolfe, 2001). Children who have to cope with such emotional abuse may develop feelings of inadequacy and helplessness (author eference; Wekerle & Wolfe, 2003). Exposure to IPV has been systematically and directly linked to a wide variety of adjustent problems in children, including health problems, emotional suppression, behavior problems, and posttraumatic stress ymptoms (Bogat, DeJonghe, Levendosky, Davidson, & von Eye, 2006; Graham-Bermann & Seng, 2005; Wolfe, Crooks, Lee, cIntyre-Smith, & Jaffe, 2003). Over time, research has broadened its focus to examine possible mediating and moderating factors that could more ully explain the relationship between exposure to violence and poor child adjustment. For example, there is evidence hat exposure to both violence and maternal depression places children at compound risk for poor school functioning and

Physical Health in Preschool Children Exposed to Intimate Partner Violence

Exposure to violence and traumatic events during childhood has long been associated with poor physical and psychological health during adulthood. Very few studies, however, have taken steps to understand the immediate relationship between exposure to intimate partner violence (IPV) and physical health problems in young children. In this study, we examined the mother-reported physical health problems of 102 preschool-age children who have been exposed to IPV. We found that children exhibiting more traumatic stress symptoms displayed fewer total health problems; however, gastrointestinal problems and asthma were related to poor psychological adjustment. We also found that preschool-age girls were more likely to display health problems than boys. Future studies of the physical health consequences of exposure to IPV in young children would benefit from examinations of specific changes in physiological processes to draw conclusions about the effects of violence on immune system functioning and physical health.