Journal Issue: Domestic Violence and Children Volume 9 Number 3 Winter 1999
Behavioral and Emotional Effects of Exposure
The number of studies on the impact of children's exposure to violence is still relatively limited due to various difficulties in conducting research on behavioral and emotional effects. For example, such research often poses ethical difficulties if it is to include a comparison or control group of children who are exposed to violence and not provided services to help mitigate this exposure. Also, research in this area often includes the collection of qualitative data through focus groups and interviews to augment the quantitative data on child outcomes and help gauge the impact of community-based interventions. While the qualitative accounting of feelings and events may be the most meaningful way to assess change, the collection of such data from many individuals in the child's world (parents, caregivers, teachers, police officers) takes more time than collecting quantitative measures on children at one time period, and may be difficult to conduct systematically and yet with sensitivity to the children, families, and the community. In addition, unless researchers are experienced in collecting such data, it may be difficult for them to listen to the children's stories, which are often horrendous.
Despite the limited research in this area, however, much can still be gleaned from existing studies about the effects of children's exposure to violence. The literature on family violence identifies adverse effects on children's physical, cognitive, emotional, and social development. Studies on the effects of exposure to media violence also indicate an increase in negative behaviors. More recently, there has been increasing interest in the effects of violence on children living in urban areas who are exposed to chronic community violence.15 Parallels have been drawn between children growing up in inner cities in the United States and those living in war zones.16 In fact, findings from several studies show posttraumatic stress disorder symptoms of children living in "urban war zones" to be similar to the symptoms of children living in actual war zones.17 As discussed further below, these symptoms vary by age, but include nightmares, clinginess to parents or caregivers, fear of natural exploring beyond their immediate environment, a numbing of affect, distractibility, intrusive thoughts, and feelings of not belonging. Whether a child's exposure to violence leads to withdrawal or to increased aggression and violence is likely to depend on a variety of factors, including the age at which the trauma occurred, the supports in the environment, and the characteristics of the child.18Developmental Differences in the Effects of Exposure
While children are affected by violence exposure at all ages, less is known about the consequences of exposure at younger ages, especially any long-term consequences. Many people assume that very young children are not affected at all, erroneously believing that they are too young to know or remember what has happened. In fact, however, studies indicate that there are links between exposure to violence and negative behaviors in children across all age ranges.
Infants and Toddlers
Even in the earliest phases of infant and toddler development, existing research indicates there are clear associations between exposure to violence, and emotional and behavioral problems. Infants and toddlers who witness violence either in their homes or in their community show excessive irritability, immature behavior, sleep disturbances, emotional distress, fears of being alone, and regression in toileting and language. 19 Exposure to trauma, especially violence in the family, interferes with a child's normal development of trust and later exploratory behaviors, which lead to the development of autonomy.20 Recent reports have noted the presence of symptoms in these young children very similar to posttraumatic stress disorder in adults, including repeated reexperiencing of the traumatic event, avoidance, numbing of responsiveness, and increased arousal.21 For example, in one study, young children were afraid to be near the scene of the violent event they had witnessed, often were afraid to go to sleep or woke up with nightmares, and showed a limited range of emotion in their play.
Several studies support a link between exposure to community violence and symptoms of anxiety, depression, and aggressive behaviors in school-age children living in violent urban neighborhoods.22 As with preschoolers, school-age children exposed to violence are more likely to show increases in sleep disturbances, and less likely to explore and play freely and to show motivation to master their environment.23 They often have difficulty paying attention and concentrating because they are distracted by intrusive thoughts. In addition, school-age children are likely to understand more about the intentionality of the violence and worry about what they could have done to prevent or stop it.24
In extreme cases of exposure to chronic community violence, school-age children may also exhibit symptoms akin to posttraumatic stress disorder, similar to the symptoms described for infants and toddlers above. In both the study of children ages 6 to 10 in Washington, D.C., and the study of children ages 9 to 12 in New Orleans (see Box 1), children's reports indicated a significant link between the witnessing of violence and such symptoms as nightmares, fears of leaving their homes, anxiety, and a numbing of affect.25 Forty percent of the mothers in the New Orleans sample and 20% in the Washington, D.C., sample said their children were worried about being safe. Similar proportions of the children reported feeling "jumpy" and "scared."
Other studies have reported that school-age children who are exposed to family violence are affected similarly to those exposed to community violence.26 Such children often show a greater frequency of internalizing (withdrawal, anxiety) and externalizing (aggressiveness, delinquency) behavior problems in comparison to children from nonviolent families. Overall functioning, attitudes, social competence, and school performance are often affected negatively. In addition, studies show that as children get older, those who have been abused and neglected are more likely to perform poorly in school; to commit crimes; and to experience emotional problems, sexual problems, and alcohol/substance abuse.27
Studies of school-age children exposed to media violence have also identified adverse effects over time. For example, a longitudinal study of eight-year-old boys that tracked viewing habits and behavior patterns found that those who viewed the most violent programs growing up were the most likely to engage in aggressive and delinquent behavior by the time they were age 18 and serious criminal behavior by age 30.28 Reports indicate that exposure to media violence may increase negative behaviors because of the potential for social learning and modeling of inappropriate behaviors by youths.29 Even when fictionalized, violence that is dramatically portrayed and glamorized is likely to have negative impacts on children and increase their propensity for violence. Despite the differences between fictionalized portrayals of violence and the reality of experiencing violence, researchers have found that real-life events shown in a sensationalized manner may overwhelm or numb the senses.5
In contrast to the relatively limited amount of research on younger children, considerable research has been done on adolescent youth violence.30 Such research indicates that adolescents exposed to violence, particularly those exposed to chronic community violence throughout their lives, tend to show high levels of aggression and acting out, accompanied by anxiety, behavioral problems, school problems, truancy, and revenge seeking.31
The more severe effects of violence exposure on adolescents may be related to the fact that they are exposed to much more violence than younger children. In 1995, the U.S. Department of Justice reported that teenagers between the ages of 12 and 15 are victims of crime more than any other age group, and that adolescents of all ages are victims at twice the national average.32 Although some adolescents who witness community violence may be able to overcome the experience, many others are deeply scarred. For example, some report giving up hope, expecting that they may not live through adolescence or early adulthood.33 Such chronically traumatized youths often appear deadened to feelings and pain, and show restricted emotional development over time. Alternatively, such youths may attach themselves to peer groups and gangs as substitute family and incorporate violence as a method of dealing with disputes or frustration.34
For example, one study of low-income black urban preteens and teens (children ages 9 to 15) found that those who witnessed or were victims of violence showed symptoms of posttraumatic stress disorder similar to those of soldiers coming back from war, with the distress symptoms increasing according to the number of violent acts witnessed or experienced. Symptoms included distractibility, intrusive and unwanted fears and thoughts, and feelings of not belonging.35
Studies of children exposed to war consistently show that separation from family and destruction of important early relationships is one of the most potentially damaging consequences of war for children, but that the children in war zones who are cared for by their own parents or familiar adults suffered far fewer negative effects. Similar findings have been shown in studies of children exposed to other types of violence. In the following section, research identifying the key protective factors that can help children cope with various types of violence in their lives is discussed.Key Factors Contributing to Resilience
An important, but little understood, area concerns the issue of invulnerability or resilience—that is, the ability to determine which children will experience fewer negative effects in response to exposure to violence. Results from several studies of resilient infants, young children, and youths exposed to community violence consistently identify a small number of crucial protective factors for development: a caring adult, a community safe haven, and a child's own internal resources.36
The Crucial Role of Parents
The most important protective resource to enable a child to cope with exposure to violence is a strong relationship with a competent, caring, positive adult, most often a parent.37 As shown in studies of children exposed to war (and other catastrophic stressors such as premature birth, trauma, and loss), such events can threaten the development of a child's ability to think and solve problems. But with the support of good parenting by either a parent or other significant adult, a child's cognitive and social development can proceed positively even with adversity.
For example, a study from 1943, which provided some of the earliest reports on children exposed to trauma during World War II, found that despite the potential for severe traumatization for children living in the midst of bombardment, far fewer negative effects occurred among those who were cared for by their own parents or familiar adults where some semblance of order was maintained in their lives.38 More recently, in 1986, researchers reported that while children who had been exposed to the stress of extreme violence during the war in Cambodia revealed mental health disturbances years after the immediate experience was over, those who did not reside with a family member were most likely to show posttraumatic stress symptoms and other psychiatric symptoms.39 A similar finding was reported by a psychiatrist working in Uganda during times of conflict.40
Similarly, studies of children exposed to chronic community violence have also identified parenting as a key protective factor. For example, one 1996 study of school-age children living in Washington, D.C., neighborhoods with varying levels of violence found that the children who perceived greater support from their families showed less anxiety, even when living in more violent neighborhoods.41 Case stories of young children exposed to violence reinforce this finding. For example, researchers assessing the stories of children involved in a therapeutic project at Boston City Hospital concluded that parents are the first-line buffers and protectors of children, and that children restabilized most successfully when parents communicate that they understand their children's fears and are establishing a plan of action to deal with the problem.42
Benefits of Community Safe Havens
Children living in high-violence areas can benefit from having a protected place in the neighborhood. Such "safe havens" can shield children from exposure to violence and can aid in their resilience.43 Traditional protected areas for children have included schools, community centers, and churches. Most children spend as much waking time at schools as at home; therefore, schools and teachers have an enormous potential for providing emotional support and nurturing for children exposed to violence. Several studies have shown the positive effects gained when a favorable school climate is provided despite its location in a violent neighborhood.44 In addition, both schools and community centers can provide opportunities for children to benefit from the support of peers, which has been shown to be instrumental in reducing anxiety among children exposed to violence.41 Churches not only provide safe meeting places, but also provide belief systems that have been shown to help children cope with trauma.42
Characteristics of the Child
Finally, various individual characteristics have been associated with increased resilience among vulnerable children, enabling them to use their own internal resources effectively as well as reach out to others for support when needed. The child's most important personal quality is average or above-average intellectual development with good attention and interpersonal skills.45 Additional protective factors cited in studies include feelings of self-esteem and self-efficacy, attractiveness to others in both personality and appearance, individual talents, religious affiliations, socioeconomic advantage, opportunities for good schooling and employment, and contact with people and environments that are positive for development. To a large extent, however, the ability of a child to realize the value of such protective factors is linked to the family and institutional supports discussed above.