The impact of exposure to domestic violence on children and young people: A review of the literature☆
Introduction
The past three decades have witnessed unprecedented interest in the scope and consequences of children's exposure to domestic violence, resulting in a depth of empirical knowledge about its prevalence and impact on its youngest victims (Hague & Mullender, 2006; Hazen, Connolly, Kelleher, Barth, & Landsverk, 2006). While the focus of this interest and understanding has largely been achieved by eliciting the views of women, shelter workers and other professionals, more recent inquiry has sought to explore directly children and young people's experience of exposure to domestic violence (Buckley, Whelan, & Holt, 2006; Hague & Mullender, 2006; McGee, 2000, Mullender et al., 2002). Influencing this shift has been a changing perception and understanding of children's position within this abusive context. Where previously children were thought of as being tangential and disconnected to the violence between their parents, and commonly labeled “silent witnesses” (McIntosh, 2003), more recent qualitative research has disputed this opinion, finding children dynamic in their efforts to make sense of their experiences, while navigating their way around the complexity and terror intrinsic to domestic violence (McIntosh, 2002, Mullender et al., 2002).
The term “domestic violence” broadly refers to the intimate context within which one partner is abused by another, involving both men and women as victims and same sex partner violence. This term, while worn “smooth with use” (McIntosh, 2002) as the most frequently used and widely accepted term, is nonetheless criticised for, among other things, its gender-neutrality, and the primary emphasis on physical assaults and exclusion of other abuse (Stark & Flitcraft, 1996). While some research proposes equivalent prevalence rates of male and female perpetrated violence (Mirrlees-Black, 1999, Morse, 1995), other research rejects the symmetry of men's and women's experience of intimate partner violence, for a number of reasons. First, the numeric extent of violence against women exceeds that of violence against men (Tjaden & Thoennes, 2000; Walby & Allen, 2004; Watson & Parsons, 2005). Second, the impact of the abuse is likely to be greater for women than men, both emotionally and injuriously (Walby & Allen, 2004; Watson & Parsons, 2005; Women's Aid & and the Child and Women Abuse Studies Unit, London, 2001). Third, women are at far greater risk of serious and lethal abuse at the hands of their male partner than men are at risk from their female partner (Campbell, Sharps, & Glass, 2001; Jaffe, Lemon, & Poisson, 2003; Walby & Myhill, 2001; World Health Organization, 2002). Cognisant of these dilemmas regarding definition and terminology, the term “domestic violence” is nonetheless used in this paper, primarily because it is in everyday and professional use and would easily alert people to its content. The terms inter-parental violence and intimate partner violence will also be applied interchangeably in this paper, which is concerned only with the intimate context within which women are abused by men.
Studies on the impact of children's exposure to domestic violence have been beset with methodological concerns and complications. First, exposure to domestic violence is not a “homogeneous uni-dimensional phenomenon” (Jouriles et al., 1998, p. 178), whose impact can be neatly examined in isolation from the potential impact of other stressors or traumas in a child's life. With the co-occurrence of domestic violence and other forms of abuse and adversity clearly established in the literature, failure to differentiate abused children who also witness violence from those who witness domestic violence only, may inaccurately attribute a child's difficulties to the impact of witnessing, without considering the impact that being a direct victim of abuse may have on outcomes for the child (Connolly et al., 2006, Edleson, 1999). Similarly, comparing children exposed to domestic violence with children who are not exposed, without regard for the variability in the level and type of abuses those children are exposed to, both ignores and obscures the potential differential impact on child adjustment from exposure to different types of spousal violence (Jouriles et al., 1998).
Second, while recent studies have been more inclusive of broader populations to reflect the perceptions and experiences of multiple stakeholders in multiple settings (Levendosky & Graham-Bermann, 2001), prior research has been critisised for an over-sampling of research participants from shelters (Kashani & Allan, 1998). While representing a unique and highly visible sub-population of those exposed to domestic violence, shelter populations may constitute those most recently and severely affected (Edleson, 1999, McIntosh, 2003) and who may be disproportionately representative of lower socio-economic populations (Kerig, 1998). In addition, shelter life may have a stressful and unique influence on children, which may be independent of their experience of family violence and not necessarily an accurate representation of their mental health in the long term (Edleson, 1999). Kerig (1998) also highlights concerns about research relying on children drawn from clinical populations, as they may be over representative of boys and dominated by externalizing problems.
On a parallel vein, researchers comment on the paucity of reports of domestic violence from multiple family members or professionals, citing evidence that when such reports are sought, agreement is surprisingly low (Holden, 2003), and cautioning that studies which predominantly or solely reflects mothers’ reports of their children's problems will by their nature have limited accuracy as they lack the converging information necessary to ensure reliability and validity (Appel & Holden, 1998; Edleson, 1999). Appel and Holden (1998) suggest that as mothers are the sole informants in the majority of cases, the potential for both under and over-reporting needs to be considered. In partial agreement McIntosh (2003) warns only of widespread underreporting of domestic abuse by women.
A third methodological issue is raised in Appel and Holden (1998) concerning the inconsistent use of a common criterion for defining child abuse, finding upward of 15 different definitions applied to the 31 studies they reviewed. Holden's later (2003) reflections on terminology considered the range and dramatically different types of exposure mentioned in the literature, with assessment of this exposure inclusive of both mothers’ reports about what their child saw or heard and children's own reports as witnesses.
Fourth, criticisms of the measures employed to gather data include what Edleson considers to be an over-reliance on the child behavior checklist, on the grounds that it is a “rough gauge of general functioning,” and not developed to tap the distinctive impacts of witnessing violence (1999, p. 860). Echoing this point, McIntosh (2003) highlights the limited usefulness of measures across both cultural and socio-economically diverse populations, while Fantuzzo and Mohr (1999) go so far as to say that checklists are biased against those diverse populations. Fantuzzo and Mohr (1999) also point out that while the majority of research controls for the child's age and gender and the family's socio-economic status, less than half of the studies they reviewed controlled for variables such as marital status, mother's age and family size, with less again controlling for family stress, child's health or ethnicity (Fantuzzo & Mohr, 1999). Finally, Appel and Holden draw attention to the inconsistent referent period applied, with some studies reviewing lifetime experiences, while others focus only on more recent experiences (Appel & Holden, 1998).
Despite these methodological complexities, research has gone some way to indicate the prevalence of children's exposure to domestic violence, to establish the impact of this exposure for children and to distinguish between the unique and universal impacts of this traumatic exposure to other forms of trauma in a child's life. Remaining mindful of the methodological criticisms outlined above and of the dearth of scientifically established estimates of the exact numbers of children exposed to domestic violence, existing data drawn from a variety of sources does, however, suggest that large numbers of children are involved. Fantuzzo and Mohr's (1999) review of the existing databases in the US established that children are present in households where intimate partner violence is occurring, at more than twice the rate they are present in comparable homes in the general population. McDonald, Jouriles, Norwood, Shine Ware, and Ezell's (2000) research with children referred to a child mental health clinic for behavioral difficulties, found that domestic violence occurred in 48% of clinic families, most commonly with 1–2 episodes of domestic violence per year.
A substantial accumulation of reliable empirical data regarding the short- and long-term developmental implications for children who live with domestic violence has highlighted a differential yet potentially deleterious impact for children (Cleaver, Unell, & Aldgate, 1999; Edleson, 1999; Hester, Pearson, & Harwin, 2000; McGee, 2000, Mullender et al., 2002, Saunders, 2003). This article attempts to contribute to the understanding of this complex phenomenon, by exploring the impact from the child's perspective, in so far as that is possible. To this end, four separate yet inter-related domains of enquiry are identified, with impact explored within and across these domains, as follows: (1) the co-occurrence of domestic violence and child abuse; (2) the impact on parental capacity; (3) the impact on child development; and (4) exposure to additional adversities.
While there is undoubtedly a certain level of commonality in children's experience of domestic violence, it would be erroneous to assume that either impact or outcomes are predictably similar for all children. Masten and Coatsworth's (1998) work on resilient development identifies the different influences on children's development, and that children are protected “not only by the self-righting nature of development, but also by the actions of adults, by their own actions, by the nurturing of their assets, by opportunities to succeed and by the experience of success” (p. 216). Holding this resilient focus, this paper concludes with an overview of the potential outcomes for children exposed to domestic violence and a summary of the key messages for professionals concerning best practice responses to children's needs in the context of domestic violence.
Section snippets
Methods
A comprehensive search of identified databases (Arts & Humanities Citation Index; BMJ Journals Online; CINAHL; Internurse; ISI Web of Knowledge; JSTOR; Psychological and Behavioral Sciences Collection; PsycINFO; PubMed; Social Science Citation Index) was conducted using the key words “domestic,” “intimate partner violence” “child,” “exposure,” “witness.” This search was augmented with a review of the bibliographies of related articles. This yielded a vast literature of over 1000 articles in the
Findings
The findings of the data search will be presented according to the four domains outlined above, with a view to understanding both impact and outcomes for children and young people exposed to domestic violence.
Responding to the needs of children exposed to domestic violence
The past two decades have witnessed children occupying greater centrality and visibility within the literature and research on domestic violence, with emergent awareness and understanding of the impact of exposure to domestic violence on the growing child and of their needs within that context. Despite this burgeoning appreciation, the research systematically highlights how the key health, social, legal and educational professionals have struggled to identify the signs, understand the dynamics
Conclusion
This paper concludes that children may be significantly affected by the experience of domestic violence in their lives, the impact of which may resonate intergenerationally with their own involvement in adult violence (Markowitz, 2001). It also cautions however that there is rarely a direct causal pathway leading to a particular outcome (Wolfe et al., 2003) and that children are not passive participants but are active in constructing their own social world. Given the potential negative
Acknowledgements
The authors would like to acknowledge the valued support of Nicola Carr (Research Fellow, Children's Research Centre, Trinity College Dublin) and Matt Bowden (Part-time lecturer in Social Policy, School of Social Work & Social Policy, Trinity College Dublin) for their feedback on earlier drafts.
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We would also like to acknowledge the Health Research Board for funding Stephanie Holt's research fellowship.