Intimate Partner and Pediatric Violence

Children Exposed to Violence Within Families

    Given
the magnitude of this problem, there is a growing awareness of the potential
harm to children exposed to violence within families. 

    Following a 2-year
analysis of violence and children, the American Academy of Pediatrics issued a
policy statement indicating that the US is experiencing an epidemic of children
exposed to violence. 

    Despite recognition that domestic violence seriously
threatens the health and emotional well-being of children, only recently
researchers have focused on children affected by domestic violence. 

    There has
been intense advocacy and legislative action to combat violence against women;
however serious concerns about their children did not appear in the research
literature until recently (Mohr, Lutz, Fantuzzi, & Perry, 2000).

Risk Factors For Violence 

    Children
who live in homes where partner violence occurs are at risk for developing a
range of emotional, physical, and behavioral symptoms. 

    Research suggested that
they are at serious risk of developing a host of aggressive, antisocial, or
fearful and inhibited behaviors and deficits in social skills (Farrell &
Bruce, 1997). 

    They are reported to have impaired concentration and difficulties
in school performance (Schwab-Stone et al., 1999; Delaney-Black et al., 2002)
and higher levels of alcohol abuse as adults (Dube, Anda, Felitti, Edwards,
& Croft, 2002). 

    They perform overall at lower levels than nonexposed
children on a variety of measures of cognitive and motor development (Jaycox et
al., 2002). 

    Children who witness domestic violence demonstrated higher levels of
depression and anxiety than counterparts in nonviolent homes (Berman et al.;
Hurt, Malmud, Brodsky, & Giannetta, 2001; Cuffe et al., 1998; Jaycox et
al.). 

    They see violence as an acceptable form of resolving interpersonal
conflicts and they are at risk for potential deviance in future social
relationships (Hurt et al.). Children from families with domestic violence are
at risk of suffering physical violence themselves.

     The link between marital
conflict and child maltreatment has received much attention in the past 10 to
15 years. 

    It has been observed that children of battered women are at an
increased risk of being abused themselves, with estimates of an overlap between
spousal abuse and child abuse ranging from 30% to 60% (Hartley, 2002; Dong et
al., 2003 ).

Child Exposure to Family Violence

    In
addition, child exposure to family violence can be deadly. Dube et al. (2001)
examined the relationship between the risk of suicide attempts and adverse
childhood experiences and the number of such experiences. 

    The researchers
conducted a retrospective cohort study of 17,337 adult health maintenance
organization members who attended at primary care clinic in San Diego within a
3-year period (1995-1997). 

    Subjects completed a survey about childhood abuse
and household dysfunction, suicide attempts (including age at first attempt),
and multiple other health-related issues. 

    The researchers discovered a powerful
relationship between adverse childhood experiences and risk of attempted
suicide throughout the life span. 

    Alcoholism, depressed affect, and illicit
drug use, which are strongly associated with such experiences, appeared to
partially mediate this relationship ship.

Study Interventions 

    Finally,
in a landmark intervention study, Stein and a multidisciplinary group of
colleagues (2003) evaluated the effectiveness of a collaboratively designed
school-based cognitive behavioral group therapy intervention. 

    The 10-session
intervention significantly de- creased symptoms of posttraumatic stress
disorder (PTSD) in students who were exposed to violence and experiencing
distress.

    There
is a dearth of research conducted by nursing scholars on children exposed to
violence. Some recent work has been published on the issue of children’s
reactions to exposure to family homicide, which may be considered within the
context of family or intimate partner violence. 

    Clements and Burgess (2002)
conducted interviews with 131 children ages 9 to 11 years during the initial 1
to 3 months after a family homicide and provided insight into themes of
bereavement. 

    A major finding in the study was that the witnessing or hearing
the news of a family member homicide was a powerful associative factor for
childhood PTSD and for complicated bereavement.

    In
sum, nursing research concerned with victims’ children is scanned when compared
to what is being studied by psychologists, physicians, and social workers. 

    Findings in all cases comparing children exposed to domestic violence with
children from nonviolent homes indicate that this exposure 

(a) has an adverse
impact across a range of child functioning

(b) produces different adverse
effects at different ages

(c) increases the risk of child abuse

(d) is
associated with other risk factors such as poverty and parental substance
abuse 

    However, comprehensive reviews of this literature indicate no reliable
information about the impact of particular types or frequencies of domestic
violence on children or the impact of various degrees of exposure on children’s
functioning and across time. 

    Close inspection of the child impact research
indicates that it does not provide a substantial basis to inform strategic
national policies and systemwide action due to many gaps and inadequacies. 

    Some
of these include retrospective analysis, no longitudinal studies
unsubstantiated reports of child exposure or the violent episode itself,
exclusive use of the CBCL as opposed to instruments that are more domain
specific, and others (for more in-depth discussion on shortcomings of this
literature , see Mohr, Lutz, Fantuzzo, & Perry, 2000).

     Yet, without
accurate, reliable information about the prevalence and nature of children’s
exposure to domestic violence, prevention and intervention efforts cannot be
designed for, and public and private resources cannot be appropriately targeted
to the affected children.

Effective Responses and Effective Interventions

Effective
responses and effective interventions depend on responses to several questions. 

    First, how many children are exposed to domestic violence, and what is the
nature of these children’s exposure? Second, how do these traumatic events
uniquely affect the course of healthy development for child victims? 

    Third,
what factors increase risk for, or provide protection against, the potentially
deleterious effects of child exposure to domestic violence? Fourth, what types
of interventions can mitigate these specific negative effects? Responses to
these critical questions require a scientifically rigorous research agenda,
leading to the development of a trustworthy database.

    Nurses
are often the first care providers identifying and assessing not only adult
victims but their children. Their presence in the area of adult victimology is
laudable, but nurse scholars are relatively absent in the discussion
surrounding the child victims-as invisible as the children themselves a scant 2
decades ago.