M.M. Visser

Adverse Childhood Experiences of Referred Children Exposed to Intimate Partner Violence: Consequences for their Wellbeing

OBJECTIVE This study investigated the relationships among Adverse Childhood Experiences (ACEs) in a high risk clinical sample of Dutch children whose mothers were abused by an intimate partner, and the severity of behavioral and emotional problems and trauma symptoms. METHODS The study population comprised 208 children (M=7.81 years, SD=2.39, range 2-12) who were referred to mental health and welfare institutions after reported Intimate Partner Violence (IPV). At intake, caregivers, children, and teachers completed questionnaires on Adverse Childhood Experiences, behavior and emotional problems, and trauma symptoms. RESULTS The results showed that child witnesses of IPV were also exposed to other adverse experiences, such as abuse, household dysfunction and neglect. The mean number of ACEs was 5.08 (range 2-9). Twenty percent of the children in this sample experienced seven ACEs or more. The number of ACEs children were exposed to was unrelated to the level of emotional and behavioral problems, except for trauma related symptoms reported by parents. CONCLUSIONS This study shows that children who witnessed Intimate Partner Violence were also exposed to other adverse experiences. The results of this study may imply that in this high-risk clinical sample of children exposed to IPV, additional adverse experiences have a limited relationship to psychological outcomes. PRACTICE IMPLICATIONS A thorough assessment and inclusion of all Adverse Childhood Experiences is necessary for a comprehensive treatment program.

The effects of parental components in a trauma-focused cognitive behavioral based therapy for children exposed to interparental violence: study protocol for a randomized controlled trial

BackgroundInterparental violence is both common and harmful and impacts children’s lives directly and indirectly. Direct effects refer to affective, behavioral, and cognitive responses to interparental violence and psychosocial adjustment. Indirect effects refer to deteriorated parental availability and parent-child interaction. Standard Trauma Focused Cognitive Behavioral Therapy may be insufficient for children traumatized by exposure to interparental violence, given the pervasive impact of interparental violence on the family system. HORIZON is a trauma focused cognitive behavioral therapy based group program with the added component of a preparatory parenting program aimed at improving parental availability; and the added component of parent-child sessions to improve parent-child interaction.Methods/designThis is a multicenter, multi-informant and multi-method randomized clinical trial study with a 2 by 2 factorial experimental design. Participants (N = 100) are children (4–12 years), and their parents, who have been exposed to interparental violence. The main aim of the study is to test the effects of two parental components as an addition to a trauma focused cognitive behavioral based group therapy for reducing children’s symptoms. Primary outcome measures are posttraumatic stress symptoms, and internalizing and externalizing problems in children. The secondary aim of the study is to test the effect of the two added components on adjustment problems in children and to test whether enhanced effects can be explained by changes in children’s responses towards experienced violence, in parental availability, and in quality of parent-child interaction. To address this secondary aim, the main parameters are observational and questionnaire measures of parental availability, parent-child relationship variables, children’s adjustment problems and children’s responses to interparental violence. Data are collected three times: before and after the program and six months later. Both intention-to-treat and completer analyses will be done.DiscussionThe current study will enhance our understanding of the efficacy interparental violence-related parental components added to trauma focused cognitive behavioral group program for children who have been exposed to IPV. It will illuminate mechanisms underlying change by considering multiple dimensions of child responses, parenting variables and identify selection criteria for participation in treatment.Trial registrationNetherlands Trial Register NTR4015. Registered 4th of June, 2013.

The Mediating Role of Secrecy in The Development of Psychopathology in Sexually Abused Children.

Although child sexual abuse (CSA) is associated with psychopathology, limited research examined mechanisms through which CSA leads to psychopathology in children. It is generally assumed that CSA is associated with secrecy among children, to our knowledge this assumption has not yet been empirically tested. This gap in our understanding of the aftermath of CSA is surprising in light of abundant evidence linking secrecy to psychopathology among children. The current study examined whether, as compared to children who have not experienced CSA, CSA victims have a greater tendency for secrecy as reported by mothers and children, and whether psychopathology in CSA victims may be explained by their tendency to keep secrets. Sixty-three non-offending mothers and their sexually abused children (68.3% female; M age=10.89) and 48 mothers and their non-abused children (62.5% female; M age=11.17) completed questionnaires on secrecy and psychopathology (i.e., internalizing and externalizing behavior problems). Mothers of abused children perceived higher levels of secrecy and psychopathology in their children as compared to mothers of non-abused children. There were no differences in child-reported secrecy between abused and non-abused children. Mediation analyses revealed that mother-reported secrecy mediated the association between CSA and psychopathology. These findings suggest that secrecy is a potential mechanism underlying psychopathology associated with CSA, which has important implications for treatment of abused children.

I’ll Never Forgive You: High Conflict Divorce, Social Network, and Co-Parenting Conflicts

The relation between divorce, co-parenting conflicts, and children’s adjustment problems has been well established. An unresolved question for research and clinical interventions, however, is how conflicts between parents are maintained and/or escalate. This cross-sectional research tested the hypothesis that co-parenting conflicts in divorced couples are associated with perceived social network disapproval and that this relation is mediated by parents’ tendency to forgive each other. In Study 1, a convenience sample of 136 divorced parents recruited via online forums, we showed that perceived social network disapproval was indeed positively related to co-parenting conflicts and that parents’ tendency to forgive the other parent—albeit partly—explained this relationship. Strength of our research is that in Study 2, 110 parents referred to children’s mental health care because the wellbeing of the children was severely compromised by the severity of the conflicts between parents, we replicated these results. In both studies perceived social network disapproval and co-parenting conflicts were positively related and this link was mediated by forgiveness: perceived social network disapproval was negatively related to forgiveness, which in turn was negatively related to more parental conflicts.

Mother–child emotion dialogues in families exposed to interparental violence

ABSTRACT This cross-sectional study examined the hypothesis that parent–child emotion dialogues among interparental violence (IPV) exposed dyads (n = 30; 4–12 years) show less quality than dialogues among nonexposed dyads (n = 30; 4–12 years). Second, we examined whether parental posttraumatic stress symptoms and parental adverse childhood experiences (ACEs) were associated with the quality of the dialogues. As expected, in the IPV-exposed group, quality of mother–child emotion dialogues was of lesser quality; dyads often showed a lack of elaboration in their dialogue; mothers showed less sensitive guidance; and children showed less cooperation and exploration, compared to dialogues, dyads, mothers, and children in the nonexposed group. Although maternal posttraumatic stress symptoms and maternal history of ACEs were significantly higher in the IPV-exposed families than in the nonexposed families, these variables were not associated with the quality of emotion dialogues. Clinical implications and study limitations are discussed.

Praten met kinderen bij (een vermoeden van) kindermishandeling.

Vaak vraagt men zich af of het wel zinvol is om met kinderen te praten bij (een vermoeden van) kindermishandeling. Sommige mensen zijn bang om een onverwerkt trauma opnieuw ter sprake te brengen en het kind overstuur te maken. Anderen vinden de informatie die kinderen geven niet zinvol, omdat kinderen geen objectieve informatie zouden geven, geen onderscheid kunnen maken tussen fantasie en werkelijkheid of niet in staat zijn om een gesprek te voeren. Deze opvattingen leiden tot een bepaalde mate van handelingsverlegenheid bij menig professional. Voor kinderen die mishandeld zijn, is het echter van groot belang dat volwassenen daar met hen over praten. Op deze manier laten volwassenen merken dat ze weten wat er met het kind is gebeurd. Daarnaast is het van belang dat tegen het kind gezegd wordt dat het niet zijn/haar schuld is wat er is gebeurd.