Responses and discussions related to domestic violence.

Responses

Laura McCloskey, Ph.D., Harvard University.

Dr. McCloskey commended Dr. Fantuzzo’s five-city study for its usefulness in understanding epidemiological problems that need to be investigated further and for setting future priorities. She then discussed a number of research gaps, noting that not enough research has focused on preschool children. Despite the challenges of working with this age group, this is an important area to develop. Referring to the work of her colleagues, Dr. McCloskey also talked about the impact of domestic violence on mothers. Many studies have shown that abuse over time causes maternal depression leading to child and parenting problems. In addition, if the perpetrator is the father, and he is chronically violent, children miss out on child support and paternal investment. Thus, it is important to assess the long-term economic and psychological impact on the father-child relationship and the child’s perception of the father. Conceptual models appropriate for different development stages are also needed. Children under 5 require particular attention and we need to know more about emotional regulation at this stage. Children who have been exposed to domestic violence may undergo extreme stress that can have potentially serious impacts on brain development. In one study where women were asked about their long-term history of having violent partners, it was possible to identify periods in the child’s life when they were exposed to domestic violence. Researchers found that children exposed to violence before age six were more aggressive than those exposed in middle childhood. This suggests that there is a critical period in terms of developmental psychopathology. Clinical symptoms in middle childhood could serve as potential entry points for adolescent and young adult risk for domestic violence, beginning a potential “cycle of violence.” In adolescence, behaviors such as peer aggression and dating violence may surface in response to violence. This is another critical time to intervene, considering that aggressive behavior can deteriorate into long-term intimate partner violence in adults. Referring to Dr. Wolfe’s presentation, Dr. McCloskey agreed that domestic violence affects boys and girls differently. Boys tend to exhibit aggression while girls tend to respond more with psychopathology and depression. If girls respond with low self-esteem and depression, which many do in childhood, they are more likely to enter abusive relationships. Girls have more opportunities to enter more serious, sexually intense relationships with older men. Finally, Dr. McCloskey pointed out that there is an inequity in access to services for troubled boys and girls that must be addressed. Jacquelyn Campbell, Ph.D., R.N., Johns Hopkins University Dr. Campbell began her presentation by noting that little attention has been given to the physical effects of children exposed to intimate partner violence. There have been some hints in previous clinical studies that show exacerbation of asthma, eating disorders, and other stress-related problems. There have been a few studies on the long-term adult effects of witnessing violence and child physical and sexual abuse on physical health, including mortality as well as morbidity. However, in general, there has been limited research on the physical health effects of domestic violence, such as immune system effects, stress, and depression. For instance, are colds and flu in children in shelters due to immune system suppression? Do sleep disorders in children result from being kept awake by fighting or waiting for fighting? 

There are other consequences of intimate partner violence that merit further research. There is little information on how children respond to the severest forms of violence such as homicide and suicide. We also need to know about the physiological effects of abuse during pregnancy, as well as how domestic violence affects parenting behavior. Another important question to address is how intimate partner violence affects family coping styles and seeking of mental health resources. In terms of policies, we need to determine what are the unintended consequences of legally defining exposure to violence as child abuse and how that ultimately affects the child in terms of protective services. It is also important to consider cultural issues, such as the individual effects of neighborhoods, ethnicity, culture, immigration status, and poverty on exposure to violence, and to what extent witnessing violence contributes to known health disparities. Research in this area presents a number of challenges including ascertaining the effects of violence on very young children, developing measurement instruments that are ethnically and culturally appropriate, identifying appropriate comparison groups, and separating out other traumatic influences such as marital dissolution, community violence, and other stressors. Suggestions for future research include adding intimate partner violence to parent measures in existing research programs and to other studies involving children, using school health records as a source of data, and combining the resources of researcher/practitioner teams. 

 Discussion 

There were a number of varied comments raised in response to the domestic violence presentations. For instance, Dr. Groves commented on the limitations of police data, noting that in some communities people do not see police as helpful. Dr. Fantuzzo commented that community partnerships are important for changing how cultures view police and pointed out that in Philadelphia, African Americans are more likely to call 911. Other comments focused on the need for good measures of parenting styles, particularly in families with low incomes. Others emphasized the need to consider the developmental perspective of children exposed to violence. Dr. Margolin noted that children who have problems in childhood might not have problems later, while others who are showing no effects now may have problems later. Participants also pointed to the need for strategies to intervene in the stress response in childhood. 

 Discussions during the breakout session focused on major research gaps and what needs to be done to address them, based on what participants believe most needs to be funded. A wide range of specific study topics formed the base of discussion. Participants believed that the taxonomy of domestic violence experiences should be broader and reflect a more inclusive definition of violence. The timing and patterns of domestic violence exposure, the effects of other forms of violence, and the effects of other forms of adversity (e.g., poverty, parental mental illness, parental substance abuse, displacement from home, unhealthy peer relations, natural disasters) are components of the taxonomy. It is crucial that all effects on children be assessed across age groups ranging from early childhood through the teenage years. There is a basic need to first understand children's perspectives, attributions, and the meanings they ascribe to domestic violence before looking at effects or attempting to measure outcomes. Also of importance is the need to measure a child's degree of involvement in domestic violence, the type and intensity of exposure, and the type of sensory input (e.g., directly see, hear from another room, hear about it from someone else, see evidence of domestic violence). Other measurement issues involve how the meaning of domestic violence changes across childhood development, and children’s reactions to domestic violence, particularly when they witness or hear an incident (e.g., they may try to physically intervene, call police or contact another adult, leave home, protect siblings, or hide in a closet). Of special interest are outcomes such as homicide or suicide that derive from domestic violence. In assessing the affects of domestic violence on children, participants noted two essential areas of study: The effects of domestic violence on children and the effects of domestic violence on family functioning as it relates to the well-being of children. Discussion of the effects of domestic violence on children addressed several behavioral and developmental outcomes. The cumulative effects of combined multiple, co-occurring, or sequential types of violence (e.g., school, community, and domestic violence; terrorism, etc.) are important. Examination of children’s resilience factors is a research issue. Short-term and long-term mental and physical health effects are critical issues for study, including issues such as overall physical health disparities (as measured by recognized health/medical standards), neuro-physiological effects of and reactions to domestic violence, and the impact of substance abuse. Any research on substance abuse effects should include effects relating to parental substance abuse (e.g., care or protection of children, as an adjunct to increased incidence of domestic violence, and as a factor in parenting overall) and those effects leading to a child’s substance abuse. The effects of children witnessing domestic violence on teen relationships, pregnancies, and subsequent marriages also are of interest, along with research on the parenting abilities of children who have witnessed domestic violence. The group’s discussion of the effects of domestic violence on family functioning looked at family as a system and at parenting practices of victims and perpetrators. Some of the family functioning sub-issues included: 

• The effects on family organization and structure (e.g., roles, sibling relationships, overall stability, and the ability to handle ongoing basic needs [regular meals, clean clothes, school supplies, medication, etc.]);

 • The effects on family interaction, such as a child’s perception of hostility vs. warmth and whether or not the family is thought of as a safe place;

 • The effects on relationships with extended family members (involved vs. isolated); 

• The impact on a teen's decision to leave home and/or cut-off relations with the family; 

• The impact of family violence on poverty and on other life stresses. 

Parenting issues/problems stemming from the effects of domestic violence on parenting were of great concern to the participants. Parenting should be addressed as a global issue and expanded to include the exploration of a variety of related/intervening issues. Numerous issues are a part of this broad category, so there is a need to look at the following aspects of parenting practices involving both the victims and the perpetrators of domestic violence:

 • How does domestic violence change male and female parents? Are there patterns of competent and compromised parenting styles among victims and perpetrators?

 • How does domestic violence affect/influence the protective role and other aspects of parenting?

 • How does domestic violence affect parenting children of different ages (prenatal care and protection of the fetus; parenting the preschool child -- meeting the child's high need for engagement and supervision; parenting the school-age child -- parents as the link to the outside world; monitoring activities and friendships; facilitating a child’s emerging competencies; parenting the adolescent -- continuing to keep open communication channels while tolerating adolescent's separation from family) • What are the effects of domestic violence on behavioral correction and the creation of behavioral change in children?

 • How do parental coping styles affect parenting practices? 

• How do we work with and/or enhance the parenting skills of domestic violence victims?

 • How does parenting of female vs. male children differ in families experiencing domestic violence?

 • How does domestic violence affect the perception of parents as role models for male and female behavior? 

Another important research issue is the impact of community/societal systems (relatives, neighbors, schools, child protective and other social services, criminal justice, healthcare, etc.) on domestic violence issues. Of equal importance are the intended and unintended effects of domestic violence on those community/societal systems. Areas of interest include staff training needs, giving greater attention to referral diversity and referral follow-up, increasing inter-agency collaboration, and the development of domestic violence education and intervention programs. Participants proposed that future research focus on some of the topics suggested and that more detail related to the use of qualitative and quantitative measures and uniform instrumentation should be included. Of particular concern is the need for projects to include multiple competencies, address multiple problems, serve to move the field forward, and address what other work needs to be done. As with other fields of study, cultural/ethnic practices and beliefs are known to have an immense effect on what is considered as the norm. The group believed that all projects should examine culture/ethnicity as a critical variable, an integral part of each study, and a factor that affects measurement. The group also emphasized that research in the area of children exposed to domestic violence will require expertise from a wide range of subject areas; linkages between and across disciplines will enhance study outcomes.