PTSD symptoms in young children exposed to intimate partner violence

Examination of protective factors that promote prosocial skill development among children exposed to intimate partner violence

This retrospective cohort study examined prosocial skills development in child welfare-involved children, how intimate partner violence (IPV) exposure explained heterogeneity in children's trajectories of prosocial skill development, and the degree to which protective factors across children's ecologies promoted prosocial skill development. Data were from 1,678 children from the National Survey of Child and Adolescent Well-being I, collected between 1999 and 2007. Cohort-sequential growth mixture models were estimated to identify patterns of prosocial skill development between the ages of 3 to 10 years. Four diverse pathways were identified, including two groups that started high (high subtle-decreasing; high decreasing-to-increasing) and two groups that started low (low stable; low increasing-to-decreasing). Children with prior history of child welfare involvement, preschool-age IPV exposure, school-age IPV exposure, or family income below the federal poverty level had higher odds of being in the high decreasing-to-increasing group compared with the high subtle-decreasing group. Children with a mother with greater than high school education or higher maternal responsiveness had higher odds of being in the low increasing-to-decreasing group compared with the low stable group. The importance of maternal responsiveness in fostering prosocial skill development underlines the need for further assessment and intervention. Recommendations for clinical assessment and parenting programs are provided.

Co-occurrence of Intimate Partner Violence and Suicide Mortality Among Adolescents and Young Adults in the United States

PURPOSE

Suicide is the second leading cause of death among people ages 10-24 in the United States (US). Intimate partner violence (IPV) is also prevalent, and studies suggest that IPV is associated with youth suicide risk. However, limited research has investigated such associations. We conducted an in-depth analysis of youth suicides that were preceded by or coincided with IPV (i.e., IPV-related) to characterize how decedents were involved in IPV, IPV types experienced, and prior legal systems involvement.

METHODS

Using US National Violent Death Reporting System (2014-2018) data for suicide decedents aged 7-24 (n = 15,430 deaths), we manually reviewed case narratives for IPV-related suicides (n = 882) and coded details concerning IPV circumstances. We conducted bivariate analyses to compare IPV-related suicides to other (non-IPV) youth suicides and examined differences in antecedent circumstances between IPV perpetrators (n = 651) and victims (n = 81) using multivariable logistic regression.

RESULTS

Among IPV-related suicides, most decedents were male and were described as IPV perpetrators. Physical IPV was most frequently reported. Compared to decedents with a history of IPV perpetration, decedents with a history of IPV victimization were more often female and younger. Narratives of IPV victim decedents had higher odds of reporting physical IPV; narratives of IPV perpetrator decedents had higher odds of reporting psychological IPV.

DISCUSSION

Future research should explore the relationship between IPV perpetration and suicide and potential impacts on surviving partners. Research and practice should seek to develop effective assessments and interventions for young people that address IPV and suicide risk simultaneously.

Pediatricians' Practices and Desired Resources for Addressing Intimate Partner Violence

To explore pediatricians' perspectives on supporting intimate partner violence (IPV) survivors, including (a) clinical practices and resource use, (b) ideal resources, and (c) barriers to the use of existing resources, we conducted dyadic and individual virtual interviews with pediatricians recruited through Twitter and the American Academy of Pediatrics Council, section, and chapter listservs. The interviews were approximately 60 minutes in length, audio recorded, and transcribed verbatim. We used a thematic analysis approach and hybrid deductive-inductive coding. Twenty-three pediatricians participated in 14 interviews. We identified four themes. Participants' current practices primarily focused on IPV screening and response to disclosure. They described strategies for IPV resource provision and decision-making involving child protective services. They identified multilevel barriers to addressing IPV, including barriers, such as time, identified in previous studies as well as barriers related to the COVID-19 pandemic, telehealth, the electronic health record, and disclosure-focused approaches. The participants desired provider-facing and caregiver-facing resources to strengthen the capacity to address IPV; some were unaware of currently available resources. They noted the need for continued attention to optimizing systems to enhance their capacity to support IPV survivors. Pediatricians report varying practices to address IPV and identify several surmountable barriers to supporting IPV survivors. Our study suggests that disclosure-driven clinical practices, confidentiality concerns, and lack of resources limit pediatricians' capacity to address IPV. Additional resource development and dissemination efforts are needed to improve the awareness of IPV resources currently available to pediatricians and families.

Improving posttraumatic stress disorder assessment in young children: comparing measures and identifying clinically-relevant symptoms in children ages six and under

Young children exposed to trauma are vulnerable to developing posttraumatic stress disorder (PTSD). Although experts agree on the importance of tailoring PTSD assessments to be developmentally-appropriate for young children, there is little research on which assessment methods best identify clinically significant symptomatology in this difficult-to-assess population. Two competing models for assessing PTSD have been proposed by the DSM-5 and ICD-11. This study compared a DSM-5 measure to an ICD-11 measure in young children (ages 1-6) exposed to a natural disaster. The measures identified similar rates of PTSD in children; however, diagnostic agreement between the measures was low (31-36%). Both PTSD measures were associated with actual and perceived life threat, functional impairment, and comorbid psychopathology. PTSD symptom and cluster endorsement rates were also binned by age and compared to functional impairment to identify commonly-reported and highly impairing symptoms in trauma-exposed young children, as potential candidates for inclusion in future revisions of diagnostic criteria. Across age ranges, increased clinginess post-trauma was the most commonly reported symptom and was associated with functional impairment. Arousal symptoms (startle, hypervigilance) and Re-experiencing symptoms (nightmares) also emerged as relevant for young children. Findings may contribute to efforts to improve assessment for PTSD in young children.

"I Have to Make Sure She Is Not Sad": Children's Perceptions of Their Mothers' Experiences in Shelters for Battered Women

A qualitative study examined children's subjective perception of their mother's situation during their stay in shelters for battered women (SBW). Thirty-two children, aged 7-12 years, who were staying with their mothers in SBWs participated in this study. Thematic analysis revealed the following two core themes: children's perceptions and insights, and feelings that were related to their perceptions. The findings are discussed in light of the concepts of exposure to IPV as a lived trauma, and re-exposure to violence in new contexts, and the role of the relationship with the abused mother in shaping the child's well-being.

A Social Network Analysis of a Multi-sector Service System for Intimate Partner Violence in a Large US City

About one in four women in the US report having experienced some form of intimate partner violence (IPV) during their lifetime and an estimated 15.5 million children live in families in which IPV occurred in the past year. Families of young children with IPV experiences often face complex needs and require well-coordinated efforts among service providers across social and health sectors. One promising partnership aims to support pregnant and parenting IPV survivors through coordination between IPV agencies and community-based maternal and early childhood home visiting programs. This study used social network analysis (SNA) to understand the interconnectedness of the system of IPV prevention and intervention for families with young children in a large US city. The SNA included 43 agencies serving this population across various service domains spanning IPV, legal, maternal and child health, and public benefit programs. An SNA survey collected data on four forms of collaboration between agencies, including formal administrative relationship, referral reciprocity, case consultation, and shared activities in community committees/organizing bodies. Density and centrality were the primary outcomes of interest. A community detection analysis was performed as a secondary analysis. The overall level of interconnectedness between the 43 responding agencies was low. Making referrals to each other was the most common form of collaboration, with a network density of 30%. IPV agencies had the highest average number of connections in the networks. There was a high level of variation in external collaborations among home visiting agencies, with several home visiting agencies having very few connections in the community but one home visiting program endorsing collaborative relationships with upwards of 38 partner agencies in the network. In serving families at risk for IPV, home visiting agencies were most likely to have referral relationships with mental health provider agencies and substance use disorder service agencies. A community detection analysis identified distinct communities within the network and demonstrated that certain agency types were more connected to one another while others were typically siloed within the network. Notably, the IPV and home visiting communities infrequently overlapped. Sensitivity analyses showed that survey participants' knowledge of their agencies' external collaborations varied by their work roles and agencies overall had low levels of consensus about their connectedness to one another. We identified a heterogeneous service system available to families of young children at-risk for or experiencing IPV. Overall inter-agency connectedness was low, with many siloed agencies and a lack of shared knowledge of community resources. Understanding current collaborations, silos, and centrality of agencies is an effective public health tool for allocating scarce resources across diverse service sectors to efficiently improve the system serving families experiencing IPV.

Post-traumatic Stress Disorder in School-age Children: A Nationwide Prospective Birth Cohort Study

Traumatic childhood events are some of the few identifiable and to some extent preventable causes of psychiatric illness. Children exposed to severely stressful events may react with post-traumatic stress disorder (PTSD) and this may impact their level of function in daily life, their future development and mental health. The traumatic stress model suggests that traumatic stress in the family, community violence, and other traumas are regarded as additive environmental factors that can outweigh protective compensatory factors and thus interact with individual vulnerabilities. This study is based on prospective panel data including the whole population of children born in Denmark from 1984 to 1994, who are followed from age 7 to age 18 (N = 679,000) in the window between 2001 and 2012. Risk factors for first-time diagnose with PTSD are analyzed by the discrete time log-odd model. We found a lifetime prevalence of 2.3% PTSD in school-age children (n = 15,636). In accordance with the model, indicators of traumatic stress in the family, family disintegration, community violence, and individual vulnerabilities predicted later diagnose with PTSD. Individual neurodevelopmental disorder - especially autism (adjusted Odds Ratio (OR 7.1) and ADHD (OR 10.7) - were predicative of PTSD. The results cooperated the traumatic stress model. Some results were inconsistent with the traumatic stress model e.g., parental substance abuse were associated with less than expected PTSD in school-age children when adjusted for other risk factors. This indicates that PTSD may be underestimated in these groups. PTSD diagnoses in administrative records underestimate the prevalence, systematically. Efforts to increase PTSD screening may allow for better management.

Stress biomarkers and child development in young children in Bangladesh

BACKGROUND

Hundreds of millions of children in low- and middle-income countries are exposed to chronic stressors, such as poverty, poor sanitation and hygiene, and sub-optimal nutrition. These stressors can have physiological consequences for children and may ultimately have detrimental effects on child development. This study explores associations between biological measures of chronic stress in early life and developmental outcomes in a large cohort of young children living in rural Bangladesh.

METHODS

We assessed physiologic measures of stress in the first two years of life using measures of the hypothalamic-pituitary-adrenal (HPA) axis (salivary cortisol and glucocorticoid receptor gene methylation), the sympathetic-adrenal-medullary (SAM) system (salivary alpha-amylase, heart rate, and blood pressure), and oxidative status (F2-isoprostanes). We assessed child development in the first two years of life with the MacArthur-Bates Communicative Development Inventories (CDI), the WHO gross motor milestones, and the Extended Ages and Stages Questionnaire (EASQ). We compared development outcomes of children at the 75th and 25th percentiles of stress biomarker distributions while adjusting for potential confounders using generalized additive models, which are statistical models where the outcome is predicted by a potentially non-linear function of predictor variables.

RESULTS

We analyzed data from 684 children (49% female) at both 14 and 28 months of age; we included an additional 765 children at 28 months of age. We detected a significant relationship between HPA axis activity and child development, where increased HPA axis activity was associated with poor development outcomes. Specifically, we found that cortisol reactivity (coefficient -0.15, 95% CI (-0.29, -0.01)) and post-stressor levels (coefficient -0.12, 95% CI (-0.24, -0.01)) were associated with CDI comprehension score, post-stressor cortisol was associated with combined EASQ score (coefficient -0.22, 95% CI (-0.41, -0.04), and overall glucocorticoid receptor methylation was associated with CDI expression score (coefficient -0.09, 95% CI (-0.17, -0.01)). We did not detect a significant relationship between SAM activity or oxidative status and child development.

CONCLUSIONS

Our observations reveal associations between the physiological evidence of stress in the HPA axis with developmental status in early childhood. These findings add to the existing evidence exploring the developmental consequences of early life stress.

The Moderating and Mediating Role of Responsive Parenting Behavior in Explaining the Link between Intimate Partner Violence and Posttraumatic Stress Symptoms in Young Children

Responsive parenting serves an influential role in explaining the link between children's exposure to intimate partner violence (IPV) and children's mental health impairment, but how this occurs is not well elucidated. In some cases, researchers examine parenting as a mediator to explain how IPV leads to maladaptive outcomes (i.e., IPV negatively impacts one's capacity for responsive parenting, which in turn impacts children), whereas others examine moderation in which either the absence of responsive parenting exacerbates adverse outcomes or increased responsive parenting buffers risk. Mediation addresses theoretical questions about how or why IPV leads to maladaptive outcomes, whereas moderation addresses who might be most impacted. However, responsive parenting has rarely, if ever, been tested as both a mediator and moderator of the link between IPV and posttraumatic stress symptoms (PTSS) within the same sample. The current study examined the mediating and moderating role of responsive parenting on physical IPV exposure and child PTSS in a longitudinal sample of 391 children ages 3 to 5 years (M = 4.74, SD = 0.89). Self-report measures of physical IPV exposure, parenting practices, and PTSS were completed by mothers. We found that responsive parenting significantly moderated and mediated the association between physical IPV exposure and child PTSS over time. Studies that include tests of both moderation and mediation are critical for advancing mechanistic insight into the role of parenting in the etiology of mental health impairment in children exposed to IPV.

Could children exposed to intimate partner violence against their mother have more functional gastrointestinal disorders?

OBJECTIVE

To analyze the association between child exposure to intimate partner violence (CEIPV) committed against their mother and functional gastrointestinal disorders (FGIDs) in school-age children.

METHODS

A prospective cohort study was carried out that evaluated 626 mother-child pairs living in a poor urban area in the Northeast of Brazil. The mothers were asked about their children's exposure to intimate partner violence. Holden's classification was used, which investigates ten types of CEIPV from prenatal care. The number of exposures, age of onset, and the perpetrator of the exposure were also verified. The FGIDs in children were identified from the mother's responses to the questionnaire about pediatric gastrointestinal symptoms, Roma III version parent-report, translated and cross-culturally adapted into Brazilian Portuguese.

RESULTS

FGIDs were more frequent among children exposed to violence than those not exposed (OR: 1.64; 95% CI: 1.04-2.58; p = 0.03). Likewise, in children who suffered four or more types of exposure (OR: 1.81; 95% CI: 1.10-2.96; p  = 0.01), in which the exposure started in the first two years of life (OR: 1.93; 95% CI: 1.08-3.47; p = 0.02) and in those whose biological father was the perpetrator of the violence (OR; 1.62; 95% CI: 1, 05-2.48; p = 0.02).

CONCLUSION

Corroborating the proposal of the biopsychosocial model, CEIPV increases the chance of occurrence of FGIDs in school-age children. Therefore, early identification and proposals for appropriate interventions are suggested both for the prevention of CEIPV and for the prevention and follow-up of FGIDs.

Stress Biomarkers and Child Development in Young Children in Bangladesh

Background

Hundreds of millions of children in low- and middle-income countries are exposed to chronic stressors, such as poverty, poor sanitation and hygiene, and sub-optimal nutrition. These stressors can have physiological consequences for children and may ultimately have detrimental effects on child development. This study explores associations between biological measures of chronic stress in early life and developmental outcomes in a large cohort of young children living in rural Bangladesh.

Methods

We assessed physiologic measures of stress in the first two years of life using measures of the hypothalamic-pituitary-adrenal (HPA) axis (salivary cortisol and glucocorticoid receptor gene methylation), the sympathetic-adrenal-medullary (SAM) system (salivary alpha-amylase, heart rate, and blood pressure), and oxidative status (F2-isoprostanes). We assessed child development in the first two years of life with the MacArthur-Bates Communicative Development Inventories (CDI), the WHO gross motor milestones, and the Extended Ages and Stages Questionnaire (EASQ). We compared development outcomes of children at the 75th and 25th percentiles of stress biomarker distributions while adjusting for potential confounders (hereafter referred to as contrasts) using generalized additive models, which are statistical models where the outcome is predicted by a potentially non-linear function of predictor variables.

Results

We analyzed data from 684 children (49% female) at both 14 and 28 months of age; we included an additional 765 children at 28 months of age. We observed 135 primary contrasts of the differences in child development outcomes at the 75th and 25th percentiles of stress biomarkers, where we detected significant relationships in 5 out of 30 contrasts (17%) of HPA axis activity, 1 out of 30 contrasts (3%) of SAM activity, and 3 out of 75 contrasts (4%) of oxidative status. These findings revealed that measures of HPA axis activity were associated with poor development outcomes. We did not find consistent evidence that markers of SAM system activity or oxidative status were associated with developmental status.

Conclusions

Our observations reveal associations between the physiological evidence of stress in the HPA axis with developmental status in early childhood. These findings add to the existing evidence exploring the developmental consequences of early life stress.

Epidemiology of Childhood Witnessing Domestic Violence and Exploration of Its Relationships With Affective Lability and Suicide Attempts in Chinese Young Adults

Childhood witnessing domestic violence (CWDV) exerts short- and long-term negative impacts on emotional and behavioral health. The present study investigated the epidemiological features of CWDV, and its negative impact on psychological outcomes in a sample of Chinese college students. The mediating role of emotion regulation strategies on CWDV associations with psychological outcomes and gender differences in these relationships were examined. A total of 3,126 respondents (1,034 males; 2,086 females; 6 missing data in gender) completed the study questionnaire, which included demographic characteristics, CWDV, and suicide attempt history items as well as the Emotion Regulation Questionnaire (ERQ) and Affect Lability Scale-18 (ALS-18). Overall, 43.03% of the respondents reported CWDV, including 44.87% of males and 42.09% of females. Higher frequencies of CWDV were found to be related to the following factors: unstable marital status of parents; not being an only child; being a left-behind child, family financial difficulties, consumption of alcohol in the past year, and being in relatively poor physical condition. Among males, ERQ suppression scores were significantly higher for those men who experienced "often or every day" CWDV than for men who indicated that they did not have any history of CWDV (Bonferroni-corrected p = 0.047). More frequent CWDV was associated with higher ALS-18 scores and increased risk of suicide attempts in males and females (p < 0.05), and emotion regulation (suppression) was found to mediate the association between CWDV and affective lability among males. This study revealed high rates of CWDV, and serious impacts of CWDV on mental health in male and female Chinese college students. In males, but not females, emotion regulation strategy use, use of suppression, was found to act as a mediator in the association of CWDV with affective lability. Our findings suggest that interventions for individuals with CWDV should focus on the emotional regulation, which may help them improve mental health, especially in males.

The Psychosocial Impacts of Intimate Partner Violence against Women in LMIC Contexts: Toward a Holistic Approach

Work on the mental health impacts of intimate partner violence in low-and middle-income countries has focused primarily on clinical disorders such as post-traumatic stress disorder, depression, and substance abuse. This paper analyzes how non-clinical, psychosocial impacts from everyday stressors, particularly economic hardships and concern over one's children, cause extensive suffering and damage women survivors' well-being, influencing the development and expression of clinical disorders. Using a social ecological framework, the paper analyzes how psychosocial impacts arise at multiple levels, including societal levels where social norms often devalue women and privilege men, and how the stressor accumulation increases the harm caused by intimate partner violence (IPV) against women (IPVAW). Drawing on survivors' narratives and studies from diverse low and middle income country (LMIC) settings, including armed conflict and natural disaster settings, the paper underscores the importance of understanding both clinical impacts and the non-clinical, psychosocial impacts, which interact with and complement one another. Recognizing the interplay also between IPVAW and other forms of violence against girls and women, the paper calls for a more comprehensive approach to understanding and addressing the impacts of IPVAW. Recognizing the enormous variety within and across countries that are considered to be LMIC settings, the paper cautions against universalized approaches to understanding the effects of IPVAW and helping to support survivors.

Role of Psychologists in Child Abuse Pediatrics

This article describes the extent of the problem and the medical evaluation of child maltreatment, focusing on the outpatient interdisciplinary assessment of suspected child physical and sexual abuse. Separate from their role as clinicians, the roles of the child psychologist before, during, and after the medical assessment are highlighted. The child psychologist is an important member of the interdisciplinary team who helps the team prepare for the evaluation (before), assists in screening and determining immediate psychological safety during the medical evaluation (during), and communicating the need for further treatment and follow-up (after).

Posttraumatic Stress Symptoms and Correlates in Women and Children From Backgrounds of Domestic Violence

Ongoing research has continued to inform our understanding of the effects of living with domestic violence on both women and children. The majority of this research, however, has tended to focus on each population separately, with only a relatively few studies to date assessing the relationship between maternal and child emotional functioning, particularly for symptoms of posttraumatic stress (PTSS). This study was designed to investigate trauma symptomatology in mother-child dyads from backgrounds of domestic violence, where the children are able to self-report on their own symptoms. In addition, the study examined anxiety and depression as important correlates of PTSD in children. Participants were recruited by staff at two metropolitan Domestic Violence Services and interviewed by the first author using standardised PTSD scales and trauma inventories. Results found no significant relationship between trauma symptoms in the mother and those in her child. With respect to children who met the criteria for a diagnosis of posttraumatic stress disorder (PTSD), they were more likely to have higher levels of anxiety and depression when compared to children who did not meet PTSD criteria. Results suggest that the emotional responses of older children may tend to reflect their own experiences rather than being a reflection of maternal distress as seems more likely with younger children. Implications of these findings include the importance of independent assessments of older children, and that older children may profit from early therapeutic interventions in their own right.

Conflict Appraisals and Trauma Symptoms in Children Exposed to Intimate Partner Violence

Children exposed to intimate partner violence (IPV) are at risk for posttraumatic stress symptoms (PTSS) and alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning. The current study investigated children's threat and self-blame appraisals about parental conflict as potential mechanisms leading to these adverse outcomes. Parent-child relationships were also examined. The sample consisted of 119 10-year-olds and their mothers who were recruited from the community as part of a larger study of IPV. Children's reports of IPV directed at their mother in the past year were not associated with PTSS; however, IPV exposure was associated with attenuated cortisol output in response to a social stressor. IPV exposure was also associated with greater threat appraisals and poorer quality parent-child relationships. These results provide further evidence that witnessing IPV is threatening for children, has negative consequences for parent-child relationships, and can impact children's HPA axis functioning.

Interparental Violence and Early Adolescents' Adjustment Problems in China: Testing a Moderated Mediation Model of Parental Warmth and Emotional Insecurity

This study analyzed the relationships between exposure to interparental violence and adolescents' adjustment problems. It also explored the mediating role of emotional insecurity and the moderating role of parental warmth in these relationships. Five hundred and seventy-eight early adolescents from three migrant primary schools and one public school in Beijing participated in this survey, reporting on their perceived interparental violence, emotional insecurity, post-traumatic stress symptoms (PTSS), and internalizing and externalizing behavioral problems. The results revealed that emotional insecurity partially mediated the association between interparental violence and all three indicators of adjustment problems, with stronger mediating effects on PTSS and internalizing problems than on externalizing problems; parental warmth buffered the association between emotional insecurity and internalizing/externalizing problems. This study adds insights to present literature on how interparental violence contributes to different aspects of adolescents' adjustment problems in the Chinese context.

Suffering and Care of 0-12 Year-Old Children Exposed to Intimate Partner Violence: Making Clinical Forensic Data Talk

Children's exposure to intimate partner violence (IPV) is a widespread phenomenon that can have detrimental consequences on their health and well-being. This study examined how clinical forensic consultation data of adult victims of IPV might provide information on the potential suffering of children exposed to IPV, the duration of exposure and the knowledge of the situation by the professionals with whom those children were in contact. Data were collected from the consultation files of 112 adult victims of IPV who consulted the Violence Medical Unit at the Lausanne University Hospital (Switzerland) in 2014, and who were parents of children aged 0 through 12. Descriptive quantitative and qualitative analyses were performed. Symptoms of suffering, such as dysregulation of instinctual functions and developmental, behavioral or emotional difficulties, were reported for nearly one-third of the victims' children. Children's exposure to IPV often started around their birth and about four in 10 children had been exposed for three years or more. Health and childhood professionals were unaware of the exposure for the vast majority of the children. Clinical forensic data can be useful in providing information on the suffering and care of children exposed to IPV. Their suffering took the form of a non-specific posttraumatic symptomatology and therefore might be difficult to detect. It is necessary to make professionals and parents aware of the fact that IPV can have a harmful impact on children's health and well-being, and to encourage health professionals to consider the possibility of IPV when facing such symptoms.

Association between maternal intimate partner violence and health-related quality of life in their preschool children: The mediating role of maternal parenting styles

BACKGROUND

Although intimate partner violence (IPV) against women is a public health issue around the world, there is a lack of evidence regarding the impact of maternal IPV on preschool children's health-related quality of life (HRQOL). Therefore, the aim of this study was to investigate the association between maternal IPV and HRQOL among Chinese preschool children, as well as the mediating role of maternal parenting styles.

METHODS

A cross-sectional study was conducted with 4,243 mother-child dyads who attended preschools. Mothers self-reported their parenting styles and experience of IPV. Children's HRQOL was collected through mother-proxy report with the Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0). Multivariate linear regression analysis was conducted to evaluate the association between maternal IPV and children's HRQOL. Mediation models were further applied to explore the possible mediating role of maternal parenting styles.

RESULTS

Of the included mothers, 7.4% had experience of IPV. Compared to children of mothers without any IPV exposure, those of mothers with experience of IPV had significantly lower scores in all HRQOL dimensions and summary scales. After adjustment for covariates, maternal IPV was significantly associated with children's lower physical health summary score, psychosocial health summary score, and total scale score. Mediation analysis showed that both rejection and overprotection mediated such associations, but not for the emotional warmth.

CONCLUSION

Our findings indicated the need to screen maternal IPV supplemented with targeted interventions focusing on parenting styles, in order to mitigate the negative impact of maternal IPV on children's HRQOL.

Children's perceptions of their parents in the context of domestic violence: A qualitative synthesis

BACKGROUND

Children who are impacted by domestic violence [DV] hold multifaceted views regarding their perpetrating and non-perpetrating parents. Despite a need to better understand the complexity of these children's experiences, no attempts have yet been made to integrate the outcomes of previous studies.

OBJECTIVE

The present study synthesized existing qualitative evidence regarding children's perceptions of their parents and the parent-child relationship in the context of DV. This was undertaken to gain further insight into the ways in which children understand and relate to both parents, and to aid clinicians who support impacted families.

METHODS

Following a systematic search and quality appraisal, ten eligible studies were included for data analysis, using a thematic synthesis approach.

RESULTS

Five analytical themes were identified, consisting of children's descriptions of their parent as someone who does not meet their physical or emotional needs, the perpetrating parent as someone who is overpowering and controlling, experiences of one's own parents being unlike other parents, the perpetrating parent as being either inherently bad and unchanging or varying in their character, and the non-perpetrating parent as a protective figure in the children's lives.

CONCLUSIONS

Findings highlighted children's acute awareness of the power dynamics of DV, the wide-ranging impacts that DV can have on the perceived quality of the parent-child bond and the diverse ways in which children manage their ongoing relationships with both parents. Understanding these varied perspectives will enable clinicians to tailor interventions, assist children in processing their relationships and enhance existing supports.

How Adolescents, Mothers, and Fathers Qualitatively Describe Their Experiences of Co-Occurrent Problems: Intimate Partner Violence, Mental Health, and Substance Use

This qualitative study examines the perceptions of mothers, fathers, and adolescents on the relations they see between intimate partner violence, mental health and substances use parental problems that co-occur in their family, and the mothers' and fathers' associated parenting challenges. The sample was composed of 43 people (15 mothers, 16 fathers, and 12 adolescents) who were directly affected by the co-occurrence of intimate partner violence and mental health or substances use parental problems. The participants were recruited with the collaboration of public and community organizations in the Province of Québec (Canada). The data were collected through semi-structured interviews and combined with a table detailing the specific problems identified by the participants. A thematic content analysis method was employed to do the coding, and a summary of the results was returned to some participants who agreed to collaborate with the validation of the results. The analysis revealed numerous and diverse relations between the interviewees' co-occurring problems, but two principal patterns emerged. The first one was chiefly observed in the comments made by mothers and adolescents who saw the co-occurring problems as being the consequence of the intimate partner violence on the mother. The second pattern was largely observed in the fathers' comments, who explained that the substance use problems came before the intimate partner violence and acted as an aggravating factor. The co-occurrence of intimate partner violence with other parental problems strongly affected the mothers' and fathers' parenting, making it more difficult to meet the children's needs. Considering the complexity and diversity of the experiences and needs of the mothers, fathers, and children in co-occurring situations, future studies should evaluate the services provided to these families and the coordination between the different concerned organizations.

Self-compassion and resilience mediate the relationship between childhood exposure to domestic violence and posttraumatic growth/stress disorder during COVID-19 pandemic

BACKGROUND

Studies have indicated that childhood exposure to domestic violence is a common factor in posttraumatic growth (PTG) and posttraumatic stress disorder (PTSD), but it is unclear whether PTG and PTSD share a common/different underlying mechanism.

AIM

To explore the common/different underlying mechanism of PTG and PTSD.

METHODS

Between February 12 and 17, 2020, a nationwide cross-sectional online survey was conducted in China among 2038 university students, and a self-administered questionnaire was used for the data collection. The data included demographic characteristics, such as age, gender, and subjective social economic status, and childhood exposure to domestic violence scale that was selected from the Chinese version of revised Adverse Childhood Experiences Question, Self-compassion Scale, Connor–Davidson Resilience Scale, Posttraumatic Growth Inventory, and the Abbreviated PTSD Checklist-Civilian version. A structural equation model was used to test the hypotheses.

RESULTS

Exposure to domestic violence was significantly associated with PTG and PTSD via a 1-step indirect path of self-compassion (PTG: β = -0.023, 95%CI: -0.44 to -0.007; PTSD: β = 0.008, 95%CI: 0.002, 0.014) and via a 2-step indirect path from self-compassion to resilience (PTG: β = -0.008, 95%CI: -0.018 to -0.002; PTSD: β = 0.013, 95%CI: 0.004-0.024). However, resilience did not mediate the relationship between exposure to domestic violence and PTG and PTSD.

CONCLUSION

PTG and PTSD are common results of childhood exposure to domestic violence, which may be influenced by self-compassion and resilience.

Survivors' Social Construction of Intimate Partner Violence in Cebu City, Philippines

Intimate partner violence (IPV) is a worldwide social issue perpetrated by intimate male partners against their wives. Studies on IPV have generated accurate comparative information since the 1993 World Conference on Human Rights and the Declaration on the Elimination of Violence Against Women to guide strategy and track progress in attempts to comprehend the IPV issues. In many attempts to understand violence against women, the social construction of IPV was not well documented in the literature. This article aims to explore IPV survivors' social construction of IPV by analyzing the experiential narratives of IPV survivors. To address the objective, this article used the phenomenological approach by examining the lived experiences of 15 IPV survivors. Our study finds that IPV made IPV survivors empowered, and with this social construction, survivors were able to overcome violence perpetrated by their intimate partners. The findings further proved that giving preferential attention to the needs of IPV victims could lead to victim empowerment, a factor needed in the elimination of violence against women and children in all forms. It is suggested for any intervention activities to (a) ultimately address the empowerment of individuals and (b) respond to the needs of individuals because what may work for one victim may not work for another.

The Trauma Symptom Checklist for Young Children: A Psychometric Review

The Trauma Symptom Checklist for Young Children (TSCYC) is a 90-item caregiver-report measure of childhood traumatic stress and abuse-related experiences in children, ages three to twelve years old.

PURPOSE

The objective of this review is to examine the current empirical evidence (n = 22) regarding the psychometric properties of the TSCYC.

METHOD

A variety of study designs were reviewed for psychometric evidence supporting the reliability and validity of the TSCYC.

RESULTS

The psychometric evidence for the TSCYC indicates it is a reliable scale. However, evidence of validity is moderate and focuses on older children.

DISCUSSION

Clinicians may utilize the TSCYC to support a PTSD diagnosis in children. Further psychometric exploration would strengthen the body of evidence for younger children (ages 3-5) who have had traumatic experiences.

Age-related similarities and differences in networks of acute trauma-related stress symptoms in younger and older preschool children

BACKGROUND

Prior research on trauma-exposed preschool children has found various levels of trauma-related stress symptoms depending on age, which might be explained by developmental factors.

OBJECTIVE

This study uses network analysis to extend prior research and compare symptom presentation in younger and older preschoolers in the acute phase (first 4 weeks) following a potentially traumatic event.

METHOD

Parent-reported trauma-related acute stress symptoms were assessed using the Pediatric Emotional Distress Scale - Early Screener via www.kidtrauma.com. First, the overall symptom severity and symptom levels were compared between younger (1-3 years) and older (4-6 years) preschoolers. Further, two Gaussian graphical models of stress symptoms in younger (n = 242; M_age = 2.3 years; SD_age = 0.6 years) and older preschoolers (n = 299; M_age = 4.8 years; SD_age = 0.7 years) were modelled and compared.

RESULTS

Overall symptom severity did not differ between the groups. Symptom levels for developmental regression and avoidance of talking about the event were higher in older preschoolers. The network structures of the younger and the older preschoolers were largely similar. Highly central symptoms in both networks were trauma-unrelated fear and anger. The connections between fear of reminders and clinginess and trauma-unrelated fear and clinginess were stronger in the older preschoolers' network. The connections between worry and sadness and withdrawal; fear of reminders and creation of games, stories, and pictures; and whininess and clinginess were all stronger in the younger preschoolers' network.

CONCLUSIONS

Trauma-related stress symptomatology of younger and older preschoolers may not differ greatly in the acute phase. Trauma-unrelated fear and anger seem to be central symptoms in both groups. However, examining symptom-level associations across age groups revealed differential connections that might arise from developmental differences. If replicated in longitudinal and within-subject studies, these findings could help tailor interventions for trauma-exposed preschoolers in the acute phase.

Dyadic Profiles of Posttraumatic Stress Symptoms in Mothers and Children Experiencing Intimate Partner Violence

Children who witness intimate partner violence (IPV) develop posttraumatic stress disorder at alarmingly high rates. Research suggests that caregivers' symptoms of posttraumatic stress (PTSS) often co-occur alongside children's PTSS, a phenomenon termed "relational posttraumatic stress." The goal of this study is to use dyad-centered analyses to examine heterogeneity in relational PTSS presentations in mother-child dyads, and to determine factors differentiating relational PTSS profiles. Data were drawn from a sample of 231 IPV-exposed, ethno-racially diverse mother-child dyads, with children ranging from ages 4 to 12. The results of a latent profile analysis indicated that a two-profile model was the best fit with the data. Both profiles indicated similar levels of PTSS across the dyad; however, they differed in overall symptom severity. Parenting and IPV severity significantly predicted profile membership; however, age did not. Results suggest that similarities in PTSS presentation should be expected in mother-child dyads, at least in families who experience IPV.

The Experience of the Infant Entering Refuge (Shelter) Setting with Their Mothers After Fleeing Family Violence

Almost nothing is known about how the infant may experience being in a women's Refuge (Shelter) setting with their mother after fleeing family violence, despite the high numbers of infants and young children in Refuges or Shelters. This research was concerned with exploring how the infant experienced refuge within a Refuge setting post family violence. Using a non-intrusive, ethically informed, 'infant led' approach, this research involved ten infants (aged 3 weeks to 16 months), ten mothers, and 13 staff in eight Refuges from three countries: Australia, Scotland and England. Data was collected through infant observation, interviews with mothers and then staff. Presented is a synthesis of a research methodology which was led by the infant, drew on concepts of 'inter-subjectivity' and used a constructivist grounded theory method. Infants were often lost from view within the Refuge setting. The mother, herself traumatised, was expected to be the refuge for her infant. Only the obviously distressed infant was assisted, and where available, from outside specialist workers. It was often too painful for the adults, both mothers and staff, to see or reflect on the infant's possible trauma. Significantly, in all cases the motivation for each mother to enter Refuge was ensuring their infant's safety. Concern for their infant or young child can be a powerful catalyst for women leaving a violent relationship. Refuges (Shelters) are in a unique position to respond to the infant in their own right whilst helping to heal and grow the infant/mother relationship.

A latent class analysis to identify how patterns of Intimate Partner Violence influence Early Childhood Development outcomes in Honduras

BACKGROUND

Intimate Partner Violence (IPV) against women is a complex phenomenon with long-term consequences for victims and their families.

OBJECTIVE

The goals of this study are two-fold: to identify common patterns of co-occurring and/or successive experiences with IPV; and to study the association between these IPV patterns and outcomes of Early Childhood Development (ECD) among the victim's children.

DATA AND PARTICIPANTS

Data was obtained from the 2011-12 Honduras Demographic Health Survey (DHS).

METHODS

A Latent Class Analysis (LCA) was conducted to define homogeneous patterns of experiences with IPV in terms of the type, severity, timing of the last event, and perpetrator of the violence. Outcomes of interest were binary variables indicating if a child is developmentally on track according to the ECD index and its four domains. LCA with distal outcomes and multivariate logistic regressions were used to measure the association between IPV patterns and ECD outcomes.

RESULTS

Five patterns of lifetime experiences with IPV were identified: (1)"no violence"; (2)"physical and sexual violence by an ex-partner"; (3)"current emotional violence"; (4)"current controlling, emotional and physical violence"; and (5)"past controlling, emotional and physical violence". Multivariate results show that children were less likely to be developmentally on track if their mothers were exposed to patterns of "physical and sexual violence by an ex-partner" or "current controlling, emotional and physical violence", relative to children whose mothers had not experienced violence. Further analysis of specific ECDI domains suggested that IPV hampers children's socioemotional development, but it is not associated with other domains of ECD.

CONCLUSION

Experiencing a pattern of co-occurrent forms of IPV negatively influences ECD and the socio-emotional development of the victim's children in low and middle-income countries. This study provides initial evidence about the complexity of this phenomenon and its long-lasting sequels.

Assisting clients experiencing family violence: Clinician and client survey responses in a child and family health service

AIMS AND OBJECTIVES

To determine the baseline levels of training, knowledge and confidence working in the area of family violence in staff at a public child and maternal health service in Melbourne, Australia, as well as perceived staff barriers to working effectively in this area. This study also aimed to explore the client perception of existing screening practices.

BACKGROUND

Family violence is a global concern with pregnancy and the postnatal period times of particularly high risk. Child and maternal health services are well placed to screen for violence, yet clinician and client perceptions of screening remain poorly characterised.

DESIGN

Thirty-five staff and 15 mothers participated in this cross-sectional, mixed-method study, via an online survey. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross-sectional guidelines were used.

RESULTS

The majority of staff screened clients for family violence, at least some of the time, with over 50% often or always screening. However, only half of staff respondents indicated that they believed they knew how to screen appropriately. Screening occurred most often over the phone or at the first service visit. The most commonly reported barriers to screening were suspected perpetrators being present during consultations and language barriers. Most clients reported being screened for physical violence and safety in the home with few being asking about financial and sexual abuse, or psychological violence and coercive control. Clients who disclosed violence reported being well supported.

CONCLUSION

While some baseline staff knowledge and skills have been identified, further support for clinicians is needed to ensure best practice and improve services and outcomes, particularly in regard to screening for different types of violence across the spectrum.

RELEVANCE TO CLINICAL PRACTICE

This study helps to inform clinical screening practices in maternal health services through an exploration of facilitators and barriers in the screening process.

Intimate partner violence indirectly dysregulates child diurnal adrenocortical functioning through positive parenting

Data were drawn from an ongoing study of preschoolers (N = 221). Mothers self-reported experiences of intimate partner violence (IPV) and parenting practices, and collected three saliva samples (waking, midday, and bedtime) on themselves and their child on two consecutive days. Saliva samples were later assayed for cortisol. Bootstrapped mediation analyses revealed IPV to indirectly impact child diurnal cortisol through positive parenting. Specifically, greater exposure to IPV was associated with reduced positive parenting and subsequently heightened child waking cortisol levels. IPV did not indirectly impact child diurnal cortisol via autonomy supporting parenting or maternal diurnal cortisol. These findings suggest a possible pathway by which mother's experience of IPV indirectly influences child physiological regulation via maternal positive parenting.

The epidemiology of domestic violence in Saudi Arabia: a systematic review

OBJECTIVES

The aim of this study is to review the prevalence, risk factors, and outcomes of domestic violence (DV) in Saudi Arabia.

METHODS

Systematic review utilizing PRISMA guidelines conducted on articles focusing on research related to the epidemiology of domestic violence in Saudi Arabia between 2009 and 2017 were identified through electronic databases (PubMed and Embase) and supplemented by cross-referencing and local journal searches.

RESULTS

Eleven studies were conducted in six cities (Riyadh, Jeddah, Madina, Taif, Arar, and Al-Ahsa). Several screening questionnaires were utilized; four studies used the WHO multi-country study questionnaire and found that the lifetime prevalence of DV ranged between 39.3 and 44.5%. The most frequently reported risk factors for DV were the level of education of both the victim and the spouse and alcohol or drug addiction of the spouse.

CONCLUSIONS

One in every three women in Saudi Arabia is a victim of domestic violence. Strategies to reduce risk factors, prevent DV, care for victims, and mitigate the effects of DV must be adopted by health care agencies in Saudi Arabia.

Examination of a New Brief Screener to Measure Trauma Symptoms and Violence Exposure Among Young Children

The purpose of this study was to create a reliable, quick and easy to administer screening measure of violence exposure and trauma for children from infancy through age 7. In a sample of 6,676 children, caregivers completing a 22-item screener reported nearly one out of five youth had been exposed as witness or victim to at least one kind of violence. For trauma, caregivers reported that their children had trouble going to sleep at least sometimes (15.83%), had cried or had a tantrum to exhaustion (15.61%) and had difficulty concentrating or focusing (15.55%). Analyses showed reliable internal consistency for violence exposure (.74) and trauma (.85) scales. Factor analyses revealed a single trauma factor and two violence exposure factors, witnessing and victimization. These data provide support for a brief screening measure for trauma and violence exposure in children from birth through age seven that can be administered by minimally trained staff in public systems and community-based agencies who can then refer children and families to necessary assessment and treatment services.

Risk and protective factors for child development: An observational South African birth cohort

BACKGROUND

Approximately 250 million (43%) children under the age of 5 years in low- and middle-income countries (LMICs) are failing to meet their developmental potential. Risk factors are recognised to contribute to this loss of human potential. Expanding understanding of the risks that lead to poor outcomes and which protective factors contribute to resilience in children may be critical to improving disparities.

METHODS AND FINDINGS

The Drakenstein Child Health Study is a population-based birth cohort in the Western Cape, South Africa. Pregnant women were enrolled between 20 and 28 weeks' gestation from two community clinics from 2012 to 2015; sociodemographic and psychosocial data were collected antenatally. Mothers and children were followed through birth until 2 years of age. Developmental assessments were conducted by trained assessors blinded to background, using the Bayley-III Scales of Infant and Toddler Development (BSID-III), validated for use in South Africa, at 24 months of age. The study assessed all available children at 24 months; however, some children were not able to attend, because of loss to follow-up or unavailability of a caregiver or child at the correct age. Of 1,143 live births, 1,002 were in follow-up at 24 months, and a total of 734 children (73%) had developmental assessments, of which 354 (48.2%) were girls. This sample was characterised by low household employment (n = 183; 24.9%) and household income (n = 287; 39.1% earning <R1,000 per month), and high prevalence of maternal psychosocial risk factors including alcohol use in pregnancy (n = 95; 14.5%), smoking (n = 241; 34.7%), depression (n = 156; 23.7%), lifetime intimate partner violence (n = 310; 47.3%), and history of maternal childhood trauma (n = 228; 34.7%). A high proportion of children were categorised as delayed (defined by scoring < -1 standard deviation below the mean scaled score calculated using the BSID-III norms from a United States population) in different domains (369 [50.5%] cognition, 402 [55.6%] receptive language, 389 [55.4%] expressive language, 169 [23.2%] fine motor, and 267 [38.4%] gross motor). Four hundred five (55.3%) children had >1 domain affected, and 75 (10.2%) had delay in all domains. Bivariate and multivariable analyses revealed several factors that were associated with developmental outcomes. These included protective factors (maternal education, higher birth weight, and socioeconomic status) and risk factors (maternal anaemia in pregnancy, depression or lifetime intimate partner violence, and maternal HIV infection). Boys consistently performed worse than girls (in cognition [β = -0.74; 95% CI -1.46 to -0.03, p = 0.042], receptive language [β = -1.10; 95% CI -1.70 to -0.49, p < 0.001], expressive language [β = -1.65; 95% CI -2.46 to -0.84, p < 0.001], and fine motor [β = -0.70; 95% CI -1.20 to -0.20, p = 0.006] scales). There was evidence that child sex interacted with risk and protective factors including birth weight, maternal anaemia in pregnancy, and socioeconomic factors. Important limitations of the study include attrition of sample from birth to assessment age and missing data in some exposure areas from those assessed.

CONCLUSIONS

This study provides reliable developmental data from a sub-Saharan African setting in a well-characterised sample of mother-child dyads. Our findings highlight not only the important protective effects of maternal education, birth weight, and socioeconomic status for developmental outcomes but also sex differences in developmental outcomes and key risk and protective factors for each group.

Thai women's experiences of and responses to domestic violence

Purpose

Domestic violence has been linked to many health consequences. It can impact women’s mental, physical, sexual, and reproductive health, and all of these effects can be long lasting. Despite the growing awareness of the deleterious effects of domestic violence in Thailand, there have been few nation-wide studies that have examined the issue and its consequences. In fact, Thailand has not examined intimate partner violence incidence for the past 20 years. This study aimed to investigate the consequences of domestic violence across the country.

Subjects and methods

A cross-sectional study was conducted in four areas of Thailand: central, southern, northern, and northeastern. One province in each area was selected by simple random sampling techniques. One thousand four hundred and forty-four married or cohabiting females in a heterosexual union, aged 20–59 years, were included in the sample and were interviewed about their experiences of psychological, physical, and sexual violence by their male partners.

Results

One thousand four hundred and forty-four women completed the interviews. Sixteen percent of respondents encountered domestic violence in its various psychological, physical, or sexual forms. In the majority of cases, all forms of domestic violence were exerted repeatedly. Four-fifths of women who faced domestic violence reported that it had an impact on their physical and mental health as well as employment. This study also found that half of the domestic violence survivors reported their children had witnessed violent situations. These women exercised four coping strategies to deal with their domestic violence: 1) counseling; 2) requesting help from others; 3) fighting back; and 4) running away from home.

Conclusion

The findings confirm that domestic violence has implications that extend beyond health and result in the deterioration of the quality of women’s lives. These results underscore that domestic violence is a serious problem that must be addressed in Thai society.

PTSD in Children Below the Age of 6 Years

PURPOSE OF REVIEW

This review summarizes the latest evidence and developments in the validation of PTSD diagnostic criteria for children 6 years and under (PTSD<6Y), discusses the limitations of the current diagnostic criteria, and highlights areas for future research.

RECENT FINDINGS

Research has found that the DSM-5 PTSD<6Y, and a similar version in the DC:0-5, currently provides the most developmentally sensitive classification of PTSD for young children. In contrast, preliminary evidence suggests that the ICD-11 criteria might not appropriately capture PTSD in young children. The inclusion of PTSD<6Y, the first developmental subtype in the DSM-5, represents an important step towards having a diagnostic system that is developmentally sensitive and relevant across the life span. However, further validation work and research with regard to the definition of trauma and functional impairment as well as with the age-appropriate description of symptoms is needed, especially in the youngest age group (0-3 years).

Adolescents at Serious Psychosocial Risk: What Is the Role of Additional Exposure to Violence in the Home?

Research into the effects of interpartner violence on the psychosocial development of the children of maltreated mothers is a relatively new field. This work examines the impact of exposure to interpartner violence (EIPV) on minors in middle and late adolescence, where this vicarious maltreatment is in addition to other situations of severe psychosocial risk. A group of adolescents who had suffered various types of direct maltreatment were compared with another group who, in addition to experiencing direct maltreatment, had mothers who had also been the victims of interpartner violence. There were 276 participants in total (138 adolescents and their mothers) reporting via questionnaires about their experiences related to maltreatment and about maladaptation and psychological dysfunction. The results demonstrate significant dysfunction in the adolescents, especially as indicated in the mothers' reports. In addition, the results make it clear that the adolescents are actively and directly involved in the episodes of interpartner violence and that the additional negative impact of vicarious maltreatment is evident in almost every aspect of their lives. Only the attitude toward teachers scored worse in the no-EIPV group. EIPV minors scored higher on personal and social maladjustment and worse on adaptive skills, and showed a more marked tendency to internalize problems. This study emphasizes the importance of considering EIPV as a form of child maltreatment and including it in programs of protection and intervention.

The association between child exposure to intimate partner violence (IPV) and perpetration of IPV in adulthood-A systematic review

Increasingly recognized as a distinct form of childhood maltreatment, children's exposure to intimate partner violence (IPV) has been shown to be associated with an array of negative psychosocial outcomes, including elevated risk for additional violence over the life course. Although studies have identified child exposure to IPV as a predictor of IPV perpetration in adulthood, no review has critically evaluated the methodology of this quantitative work. The present study examines the association between childhood exposure to IPV and the perpetration of IPV in adulthood based on a systematic review of the literature from inception to January 4, 2016. Databases searched included Medline, Embase, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews, Sociological Abstracts and ERIC. Database searches were complemented with backward and forward citation chaining. Studies were critically appraised using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Of 5601 articles identified by the search, 19 studies were included for data extraction. Sixteen of these studies found that child exposure to IPV was significantly and positively associated with adult IPV perpetration; three studies reported null findings. The methodological quality of the studies was low. Work thus far has tended to focus on child exposure to physical IPV and the perpetration of physical IPV within heterosexual contexts. In addition, measures of child exposure to IPV vary in their classification of what exposure entails. We critically discuss the strengths and limitations of the existing evidence and the theoretical frameworks informing this work.

A Diagnosis of Denial: How Mental Health Classification Systems Have Struggled to Recognise Family Violence as a Serious Risk Factor in the Development of Mental Health Issues for Infants, Children, Adolescents and Adults

Child and adolescent mental health services (CAMHS) routinely overlook assessing for, and providing treatment to, infants and children living with family violence, despite family violence being declared endemic across the globe. As contemporary neuro-developmental research recognises the harm of being exposed to early relational trauma, key international diagnostic texts such as the DSM-5 and ICD-10 struggle to acknowledge or appreciate the relational complexities inherent in addressing family violence and its impacts during childhood. These key texts directly influence thinking, funding and research imperatives in adult services as well as CAMHS, however, they rarely reference family violence. Their emphasis is to pathologise conditions over exploring causality which may be attributable to relational violence. Consequently, CAMHS can miss important indicators of family violence, misdiagnose disorders and unwittingly, not address unacceptable risks in the child's caregiving environment. Notwithstanding urgent safety concerns, ongoing exposure to family violence significantly heightens the development of mental illness amongst children. CAMHS providers cannot and should not rely on current diagnostic manuals alone. They need to act now to see family violence as a significant and important risk factor to mental health and to treat its impacts on children before these develop into enduring neurological difficulties.

Posttraumatic Stress Symptoms in Preschool Children in Foster Care: The Influence of Placement and Foster Family Environment

Children in foster care often experience traumatic events which increase their risk for posttraumatic stress symptoms (PTSS). Until now, no research has investigated the developmentally sensitive PTSS criteria for preschoolers among children in foster care. The current study estimated the prevalence of potentially traumatic experiences and clinical PTSS in German foster care children aged 3 to 7 years. The foster parents of 324 children completed questionnaires about children's PTSS, foster parental stress, parenting, and family functioning. Linear regression models tested trauma-related variables, placement history, and foster family characteristics as predictors of PTSS. Approximately 45.4% of the foster children had experienced at least one traumatic event and 15.4% had clinical PTSS. Physical abuse, β = .34, p < .001; hospitalization, β = -.17, p = .026; witnessing someone being hurt, β = -.15, p = .047; and parental stress, β = .43, p < .001, were significantly associated with PTSS. Results demonstrate the impact the foster family has on children who are coping with trauma, and suggest the necessity of trauma-sensitive trainings for foster parents, with stress management as an important component.

The role of callous/unemotional traits in mediating the association between animal abuse exposure and behavior problems among children exposed to intimate partner violence

Children exposed to intimate partner violence are at increased risk for concomitant exposure to maltreatment of companion animals. There is emerging evidence that childhood exposure to maltreatment of companion animals is associated with psychopathology in childhood and adulthood. However, few studies have explored developmental factors that might help to explain pathways from animal maltreatment exposure to children's maladjustment. The present study addresses this gap in the literature by examining relations between children's exposure to animal maltreatment, callous/unemotional traits (i.e., callousness, uncaring traits, and unemotional traits), and externalizing and internalizing behavior problems. A sample of 291 ethnically diverse children (55% Latino or Hispanic) between the ages of 7 and 12 was recruited from community-based domestic violence services. A meditational path model indicated that child exposure to animal maltreatment was associated with callousness (β=0.14), which in turn was associated with greater internalizing (β=0.32) and externalizing problems (β=0.47). The effect of animal maltreatment exposure on externalizing problems was mediated through callousness. Results suggest that callous/unemotional traits are a potential mechanism through which childhood exposure to animal maltreatment influences subsequent behavior problems. Future research is needed to evaluate the extent to which exposure to animal maltreatment affects children's adjustment over time in the context of other co-occurring adverse childhood experiences.

Mother's IPV, Child Maltreatment Type and the Presence of PTSD in Children and Adolescents

This correlational cross-sectional study was designed to investigate whether the intimate partner violence (IPV) suffered by mothers (physical and psychological maltreatment), child eyewitness of psychological and physical maltreatment suffered by the mother, the neglect suffered by children, and the maltreatment (physical and psychological) directly suffered by children are statistically associated to post-traumatic stress disorder (PTSD) symptoms exhibited by the child. In addition, the prevalence of child PTSD was estimated, as well as the concordance between the PTSD symptoms assessed by the Child PTSD Symptom Scale (CPSS) and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for child PTSD. The sample consisted of 152 Spanish children aged 8 to 17 and their mothers, who were recruited from Centers of Specialized Assistance for Women Victims of IPV. PTSD prevalence was 20.4%. The results of a canonical correlation analysis showed that the two types of maltreatment with the largest contribution to the canonical variable were physical maltreatment directly suffered by the child, and child eyewitness of physical maltreatment suffered by the mother. The potential developmental pathway of PTSD when both children and mothers suffer severe maltreatment needs to be examined, and this will contribute to the choice of the most effective type of specialized intervention.

Trauma and Very Young Children

This article examines the intersection of early childhood mental health and trauma. Working definitions, incidence, and prevalence of trauma events for this population are outlined with an emphasis on children younger than age 4 years. Trauma impacts on early childhood development are reviewed, with attention to clinical consequences, protective factors, and resilience. Best practices for assessment, screening tools, and treatment methods are presented based on the current research. Future implications include clinician and researcher partnerships to increase the number of effective screening and intervention tools for addressing trauma in very young children.

The Effects of Intimate Partner Violence Exposure on the Maternal Bond and PTSD Symptoms of Children

The quality of the maternal bond can be disrupted in women exposed to intimate partner violence (IPV), causing them to be less available to their children. The aim of this study was to examine difficulties in emotional regulation in women exposed to IPV and the impact of IPV on both the maternal bond and posttraumatic symptoms among children. A cross-sectional study was carried out with two groups: IPV dyads ( n = 36) comprising mothers who had been exposed to IPV and their children, and control dyads ( n = 27) comprising non-abused mothers and their children. Information was obtained via structured interviews including scales regarding IPV, posttraumatic stress disorder (PTSD) symptoms, maternal bond, and difficulties in emotional regulation. Correlation analyses showed a positive association between the severity of IPV, PTSD symptom severity in children, and difficulties of emotional regulation in mothers. They also showed a negative association between IPV and the quality of the maternal bond. Regression models demonstrated that exposure to sexual IPV, maternal difficulties in emotion regulation, and younger age of the mother are important predictors of lower quality of the maternal bond. Difficulties in emotional regulation and sexual IPV disrupted the quality of the maternal bond among women and their children. In addition, lower quality of maternal bond was associated with higher PSTD symptoms among children.

Traumatic Life Events and Psychopathology in a High Risk, Ethnically Diverse Sample of Young Children: A Person-Centered Approach

Studies of the association between traumatic experiences and psychopathology in early childhood have primarily focused on specific types of events (e.g., sexual abuse) or aggregated different types of events without differentiating among them. We extend this body of work by investigating patterns of traumatic event exposure in a high-risk, ethnically diverse sample of children ages 3-6 (N = 211; 51 % female) and relating these different patterns to parents' reports of child externalizing, internalizing, and post-traumatic stress symptomatology. Using latent class analysis, which divides a heterogeneous population into homogenous subpopulations, we identified three patterns of traumatic events based on parents' responses to an interview-based assessment of trauma exposure in young children: (1) severe exposure, characterized by a combination of family violence and victimization; (2) witnessing family violence without victimization; and (3) moderate exposure, characterized by an absence of family violence but a moderate probability of other events. The severe exposure class exhibited elevated internalizing and post-traumatic stress symptoms relative to the witness to violence and moderate exposure classes, controlling for average number of traumatic events. Results highlight the need for differentiation between profiles of traumatic life event exposure and the potential for person-centered methods to complement the cumulative risk perspective.

Examining Patterns of Exposure to Family Violence in Preschool Children: A Latent Class Approach

Young children can experience violence directly or indirectly in the home, with some children exposed to multiple forms of violence. These polyvictims often experience violence that is severe, chronic, and multifaceted. The current study used latent class analysis to identify and examine the pattern of profiles of exposure to family violence (i.e., violence directed towards the child and between caregivers) among a sample of 474 children ages 3-6 year who were drawn from the Multidimensional Assessment of Preschoolers Study (Wakschlag et al., 2014). The data yielded 3 classes: a polyvictimized class (n = 72; 15.2%) with high probability of exposure to all forms of violence, a harsh parenting class (n = 235; 49.5%), distinguished mainly by child-directed physical discipline in the absence of more severe forms of violence, and a low-exposure class (n = 167; 35.2%). Classes were differentiated by contextual factors, maternal characteristics, and mother-reported and observational indicators of parenting and child functioning with most effect sizes between medium and large. These findings add to emerging evidence linking polyvictimization to impaired caregiving and adverse psychological outcomes for children and offer important insight for prevention and intervention for this vulnerable population.

Young Children Exposed to Intimate Partner Violence Describe their Abused Parent: A Qualitative Study

The negative impact of intimate partner violence (IPV) begins early in the child's relationship with a caregiver. Children's relationships with, and internal working models of, abused parents have rarely been documented. The aim of this study was to collect and interpret young children's accounts of their abused parent. Interviews were conducted with 17 children aged 4 to 12 years who had witnessed IPV. Thematic analysis identified three main themes and seven sub-themes: "Coherent accounts of the parent" (sub-themes of "general benevolence", "provision of support, protection, and nurture", and "parental distress"); "Deficient accounts of the parent" ("vague accounts" and "disorganized narrations"); and "The parent as a trauma trigger" ("avoidance" and "breakthrough of intrusive memories and thoughts"). The results indicate these children may hold integrated, deficient, or blocked internal representations of an abused parent, and they illustrate the benefit of including young children as informants in research.

Attention bias in the developmental unfolding of post-traumatic stress symptoms in young children at risk

BACKGROUND

Threat-related attention bias relates to anxiety and posttraumatic stress symptoms in adults and adolescents, but few longitudinal studies examine such associations in young children. This study examines prospective relations among attention bias, trauma exposure, and anxiety and trauma symptoms in a sample previously reported to manifest cross-sectional associations between attention bias and observed anxiety at preschool age.

METHODS

Young children [mean (MN) = 5.0, ±0.7 years, n = 208] from a community-based sample completed the dot-probe task to assess their attention biases in response to angry faces. At baseline (T1) and at follow-up approximately 9 months later (T2), anxiety and trauma exposure (i.e. violent and noninterpersonal events) and symptoms were assessed by maternal report.

RESULTS

Neither attention bias nor baseline or recent trauma exposure predicted later anxiety. In contrast, attention bias toward threat and recent trauma exposure significantly predicted later trauma symptoms. There was evidence of symptom specificity such that attention bias toward threat significantly predicted hyperarousal and dissociation, but not avoidance or re-experiencing symptoms. Finally, moderation analyses indicated that the relationship between attention bias and trauma symptoms may differ according to children's experiences of probable abuse.

CONCLUSIONS

Attention profiles and trauma exposure may increase the risk that young children will develop trauma symptoms. Individual differences in these attentional patterns and children's exposure history may impact outcomes among high-risk children with potential implications for intervention.

Childhood maltreatment and violence: mediation through psychiatric morbidity

Childhood maltreatment is associated with multiple adverse outcomes in adulthood including poor mental health and violence. We investigated direct and indirect pathways from childhood maltreatment to adult violence perpetration and the explanatory role of psychiatric morbidity. Analyses were based on a population survey of 2,928 young men 21-34 years in Great Britain in 2011, with boost surveys of black and minority ethnic groups and lower social grades. Respondents completed questionnaires measuring psychiatric diagnoses using standardized screening instruments, including antisocial personality disorder (ASPD), drug and alcohol dependence and psychosis. Maltreatment exposures included childhood physical abuse, neglect, witnessing domestic violence and being bullied. Adult violence outcomes included: any violence, violence toward strangers and intimate partners (IPV), victim injury and minor violence. Witnessing domestic violence showed the strongest risk for adult violence (AOR 2.70, 95% CI 2.00, 3.65) through a direct pathway, with psychotic symptoms and ASPD as partial mediators. Childhood physical abuse was associated with IPV (AOR 2.33, 95% CI 1.25, 4.35), mediated by ASPD and alcohol dependence. Neglect was associated with violence toward strangers (AOR 1.73, 95% CI 1.03, 2.91), mediated by ASPD. Prevention of violence in adulthood following childhood physical abuse and neglect requires treatment interventions for associated alcohol dependence, psychosis, and ASPD. However, witnessing family violence in childhood had strongest and direct effects on the pathway to adult violence, with important implications for primary prevention. In this context, prevention strategies should prioritize and focus on early childhood exposure to violence in the family home.