J Fam Viol (2007) 22:3342 DOI 10.

1007/s10896-006-9054-y

ORIGINAL ARTICLE

The Inuence of Domestic Violence on Preschooler Behavior and Functioning

Gabriel J. Ybarra Susan L. Wilkens Alicia F. Lieberman

Published online: 5 January 2007 C Springer Science+Business Media, LLC 2006

Abstract Enhancing current explanations of domestic violence exposure effects on child cognitive and behavioral functioning was the purpose of this investigation. Participants were 31 domestic violence exposed and 31 nonexposed children ages 3 to 5 years and their single-parent household mothers. Child-mother pairs were matched for childs age, gender, and ethnicity, mothers age and education, and annual family income. Child cognitive and behavioral functioning was assessed via psychological assessment and parent report. The presence of mental health difculties in mothers was assessed using self-report and clinicianadministered instruments. Exposed children showed lower verbal functioning and higher internalizing behaviors than did their non-exposed peers. Exposed mothers displayed greater psychological difculties than did their counterparts. Keywords Domestic violence . Preschoolers . Intelligence . Psychopathology Having at least one parent who enacts physical violence, psychological aggression, or high levels of other conictual behaviors toward their adult partner has been established
G. J. Ybarra ( ) Department of Psychology, University of North Florida, 4567 St. Johns Bluff Rd., South, Jacksonville, FL 32224-2645, USA e-mail: gybarra@unf.edu S. L. Wilkens Alliant University, Alameda, CA, USA A. F. Lieberman Department of Psychiatry, School of Medicine, University of California San Francisco, San Francisco, CA, USA

as a positive correlate of child behavioral difculties (e.g., English, Marshall, & Stewart, 2003). Despite the results provided by outstanding investigations and reviews of this topic (e.g., Jouriles, Murphy, & OLeary, 1988; McCloskey, Figueredo, & Koss, 1995), the existing literature has yet to fully delineate and describe the extent of child difculties directly related to domestic violence (DV). A more thorough understanding of these relations is necessary for effective prevention and remediation efforts for children witnesses of such experiences. Childhood witnessing of DV is neither uncommon nor uneventful. Parent reports from community samples suggest that as many as 3043% of children in the United States of America have witnessed some form of physical violence between their parents (Huth-Bocks, Levendosky, & Semel, 2001; Straus, 1979). In households with spousal abuse, young children are more likely to witness incidents of violence than are older children (Fantuzzo, Boruch, Beriama, Atkins, & Marcus, 1997). Such exposure has been negatively associated with child development, hindering childrens accomplishment of key developmental milestones, such as toilet-training or walking (Osofsky, 1995; Pynoos, 1993; Pynoos & Eth, 1986). DV exposure also may negatively affect current cognitive functioning (Koenen, Moftt, Caspi, Taylor, & Purcell, 2003) and, more specically, language skills development (Huth-Bocks, Levendosky, & Semel, 2001). Early verbal decits may be especially problematic, as the start of formal education calls for a substantial reliance on language as a main foundation for academic functioning. Indeed, child witnesses display academic decits, including weaker academic performance, impaired concentration, poorer school attendance, and lower school and social activity interest than do their non-witness classmates (Carlson, 1984; Hughes, 1988; Wolfe, Jaffe, Wilson, & Zak, 1985).
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Studies also have found a positive relation between DV and externalizing (e.g., aggression) and internalizing behaviors (e.g., lowered self-esteem, anxiety, and depression) (Cummings & Davies, 1994; Dadds, Atkinson, Turner, Blums, & Lendich, 1999; Thormaehlen & Bass-Feld, 1994; Wolfe, Jaffe, Wilson, & Zak, 1985). Child witnesses of DV may meet criteria for psychological disorders, especially posttraumatic stress disorder (Ackerman & Pickering, 1989; Kilpatrick & Williams, 1998; Osofsky, 1995; Rossman & Ho, 2000) more often than do their non-exposed peers. Child relational correlates of DV exposure include reduced empathy and prosocial behaviors, poorer communication skills, and increased behaviors that undermine the development of a social network (e.g., aggression toward peers) (Dadds et al., 1999; Thormaehlen & Bass-Feld, 1994). The negative effects of child exposure to violence or conict within the home have been attributed to a variety of interactive mechanisms, with child externalizing behaviors positively related to more severe DV (e.g., higher levels of violence, more intense psychological aggression), direct behavior modeling, an impaired child-parent relationship, social information processing and impaired emotion regulation, while child internalizing behavioral difculties appear to be better explained by the presence of distorted cognitions by children, including attributional errors (Greenberg, Speltz, & DeKlyen, 1993; Grych & Fincham, 1990; Grych, Fincham, Jouriles, & McDonald, 2000; Rutter, 1994; Weiss, Dodge, Bates, & Pettit, 1992). Indeed, such cognitive errors have been positively related to internalizing behaviors in community-based and shelter-residing children exposed to parental conict, but not to externalizing behaviors (Grych et al., 2000). Unfortunately, much of the current literature on DV effects on children is limited by the lack of control for the variable of child abuse within many studies (e.g., Huth-Bocks, Levendosky, & Semel, 2001), making it difcult to separate effects of child abuse from those of more severe DV. The current investigation controls for this confound by using child abuse as an exclusionary criterion. Child age is an important factor that must be considered when attempting to explain differential outcome following DV exposure. Much of the DV literature addressing children focuses on latency-aged children (e.g., Levendosky & Graham-Bermann, 1998; Kerig, Fedorowicz, Brown, Patenaude, & Warren, 1998) or includes a wide age range within childhood (e.g., Graham-Bermann, 1996). Use of a wide age range in childhood inhibits ones ability to identify effects or processes more unique to a particular developmental period. For example, in parental conict literature, younger children often display more intense internalizing and externalizing behavioral responses to parental conict than do older children and adolescents (Cummings, ZahnWaxler, & Radke-Yarrow, 1984), in part due to younger
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childrens greater parental contact and smaller social support networks than that of their older counterparts (Porter & OLeary, 1980). The possession of less mature cognitive skills also may increase younger childrens likelihood of expressing psychological vulnerabilities following conict due to more frequent aforementioned cognitive errors, such as, I made him hit Mommy. The current study addresses the age range and early childhood weaknesses in the literature by focusing on pre-schoolers ages 3 to 5 years. Child outcome following exposure to DV appears to be inuenced by factors presented by mothers. Following physical battery by male partners, samples of women treated at shelters (Kemp, Rawlings, & Green, 1991; Presty, 1996) or outpatient facilities (Cascardi, OLeary, Lawrence, & Schlee, 1995) meet criteria for PTSD at a rate that exceeds that of the general population. A womans experience of PTSD or other psychological difculties may impede her parenting behaviors and her ability to cope with her childs negative behaviors (Emery & Laumann-Billings, 1992; Presty, 1996). For example, psychopathology might decrease a mothers ability to appropriately address common child-rearing situations involving crying, comforting, or limit-setting (see Levendosky & Graham-Bermann, 1998). Parenting appears to be an avenue of child-parent interaction that is disrupted by DV, with such exposure associated with elevated parental stress, poorer behavioral control of children, reduced parental availability, and a more authoritarian parenting style (Erel & Burman, 1995; Levendosky & GrahamBermann, 1998; Levendosky, Huth-Bocks, Shapiro, & Semel, 2003). Specic risk factors may increase a womans vulnerability to PTSD following DV exposure, including early major life stressors (van der Kolk, McFarlane, & Weiseth, 1996; Wilson & Keane, 1997). The disruption by DV on the child-parent relationship also might help to explain observed decits in cognitive functioning in early childhood. Huth-Bocks, Levendosky, and Semel (2001) found 35 year old children exposed to DV to display lower verbal abilities than non-exposed peers, while no difference was observed in non-verbal abilities. However, this study used the Peabody Picture Vocabulary TestRevised (Dunn & Dunn, 1981), a measure of expressive rather than receptive language, and the Block Design subtest from the Wechsler Preschool and Primary Scale of IntelligenceRevised (WPPSI-R; Wechsler, 1989), suggesting that these estimates of cognitive abilities may be more limited than would be estimates based on fuller assessments of cognitive functioning. Koenen et al. (2003) assessed a sizable sample of 1116 sets of twins in England and discovered that domestic violence exposure accounts for 4% of variation on young childrens intelligence quotient (IQ) points, with an average reduction of 8 IQ points. However, this investigation failed to assess for the presence of maternal psychopathology. It may be that resultant maternal

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psychopathology leaves a child with an impaired partner or coach with whom to practice foundational verbal skills, while non-verbal skills are more easily pursued in a solitary or sibling-led manner. The current study improves upon the most recent literature on cognitive affects of DV exposure through the use of a full WPPSI-R battery (Wechsler, 1989) to more rigorously evaluate both verbal and performance skills in DV-exposed and non-exposed children, and through the assessment for maternal psychopathology via the Clinician Administered PTSD Scale (CAPS; Blake et al., 1990) and the Symptom Checklist 90-Revised (SCL-90-R; Derogatis, 1983). Confounding variables that must be considered within an investigation on children exposed to domestic violence include socioeconomic status, race/ethnicity, and extrafamilial community violence. Socioeconomic status is relevant because recently dissolved violent relationships often result in signicant economic strain for a mother and her child. The role of race and ethnicity can be controlled within such an investigation without sacricing unduly the generalizability of a projects results. Also, as literature shows that community violence can negatively impact a childs functioning (Richters, 1990; Richters & Martinez, 1993), assessing community violence in addition to DV exposure allows one to separate the former from the latters effects. The current study exceeds the great majority of investigations on these issues by matching exposed and non-exposed parent child-dyads on socioeconomic status and race/ethnicity, and by assessing and controlling for community violence exposure. To systematically evaluate the role of domestic violence, we recruited a sample of children and mothers not exposed to DV matched on key demographic variables and single mother head of household status to another sample of mother and child DV victims referred for clinical services. The purpose of the present study was to determine whether exposure to DV leads to decits in functioning in children and their mothers that exceed the effects of other contextual variables often associated with DV, including lower socioeconomic status, community violence, and early maternal history of stressful life events. Four main hypotheses were made, predicting that: (1) child witnesses of DV would display lower verbal cognitive functioning than would their non-exposed peers, with no differences in non-verbal functioning; (2) child witnesses would have greater internalizing and externalizing behavioral difculties than would non-witness children; (3) exposed children of mothers with greater psychopathology would display lower cognitive abilities and greater behavioral difculties than would their exposed counterparts of less symptomatic mothers, and (4) children exposed to higher levels of DV would exhibit greater externalizing behaviors than would their peers exposed to lower levels of DV.

Method Participants Participants were 62 preschoolers aged 3 to 5 years (M age = 52.8 months) and their mothers invited to a laboratory located on a large urban hospital campus. Out of a potential pool of 82 mother- child dyads referred by mental health professionals, caseworkers, the local legal system, community outreach, or word-of-mouth following exposure to DV and separation from the mothers violent partner (Exposed group) as part of an initial assessment for an ongoing empirically-based intervention program, thirty-one pairs were matched on demographic information to dyads from a community sample. To create a community sample pool, a separate group of 52 mother-child pairs from single parent households with no DV exposure was recruited and asked to provide permission to be considered for participation in the current investigation. The community sample was recruited from various local sources, including preschools, community centers, Head Start programs, and pediatric clinics (Non-Exposed group). In an effort to minimize the inuence of confounding variables, Exposed and Non-Exposed dyads were matched in a stepwise fashion on child age (within 6 months), child gender, and child ethnicity (matched with one parents ethnicity if no full match was possible), mothers age (within 5 years), mothers educational attainment, and annual family income, while the researchers were blind to other target variables, with random selection used to choose among more than one match. To control for the inuence of fathers, mothers in both groups were single heads of households. Exclusionary criteria for both mother and child were mental retardation or autism, substance abuse, chronic or severe mental illness, active suicidal or homicidal ideation, life-threatening medical illness, inability to speak English, or a conrmed report of child physical or sexual abuse. Of these initial pools, 33 pairs were created for comparison (63.4% of the community sample, 40.2% of the clinical sample) and agreed to participate with their child in the study. Data from two NonExposed children were not included in the analysis due to the discovery of insufcient English language prociency, necessitating eliminating two dyads from analyses. Setting and researcher personnel Assessment of the child participants took place in a 16-foot2 playroom that included two child-sized chairs and an examination table. Mothers were assessed in a nearby interview room. The child and adult assessments were conducted by Ph.D.-level postdoctoral fellows, and pre-doctoral interns in clinical psychology. Licensed clinical psychologists supervised all assessments.

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Procedure Each mother who agreed to participate with her child was scheduled for an appointment. Mothers were instructed to prepare their child for the appointment by telling them that they would be asked to play, tell stories, and answer questions. Following arrival, participating pairs were welcomed, with the mother provided verbal and written explanations prior to providing consent for herself and her child. The child and mother participants were shown the location of the two experimental rooms, then invited to begin their simultaneous participation with their respective assessor. Child participants were administered the Wechsler Preschool and Primary Scales of Intelligence-Revised (WPSSI-R; Wechsler, 1989). The adult assessor interviewed the mother in a semi-structured manner to gather demographic information and to evaluate the presence of trauma-related symptoms (CAPS; Blake et al., 1990), and presented the mother with a series of self-report and parent report questionnaires. During their assessment, children and mothers were encouraged to take a 10-min break and to enjoy a snack of juice and cookies to minimize fatigue and maintain rapport. Following completion of their participation, mothers and children were debriefed and thanked, paid $30.00 for their participation, and reimbursed for participation-related child-care or transportation costs. Child participants were offered a small toy worth approximately $3.00. Measures Childrens exposure to community violence Mothers reported on their childs exposure to violence from the larger social context by completing the parent report version of the Screening Survey of Childrens Exposure to Community Violence (CECV; Richters & Martinez, 1993) parent-report questionnaire. The CECV is a 51-item parent report questionnaire that assesses the extent to which a child or someone who the child knows has been exposed to violent events, such as being chased by gangs, experiencing a serious accident, being slapped, punched, or hit. In the present study, the CECV showed moderate internal consistency with a coefcient alpha of .79. Child behavior The Child Behavior Checklist 2/3 or 4/18 (CBCL 2/3 or 4/18; Achenbach, 1991; Achenbach & Edelbrock, 1983) was used to assess the mothers perception of their childs general behavioral functioning. Two summary index scores of the CBCL were analyzed in the present study: mothers report of their childs internalizing behaviors (Internalizing T score) and externalizing behaviors (Externalizing T score).
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Achenbach (1991; Achenbach & Edelbrock, 1983) reports high to moderate reliability and construct validity. Child cognitive functioning The Wechsler Preschool and Primary Scales of IntelligenceRevised (WPSSI-R; Wechsler, 1989) is a widely used, wellestablished cognitive assessment instrument for children aged 3 years to 7 years, 3months. The current study used the full battery of subscales, summarizing childrens cognitive functioning using three IQ scores - Performance, Verbal, and Full Scaleas directed in the WPSSI-R manual (Wechsler, 1989). Wechsler reports strong reliability and validity for the measure. Incidence of domestic violence The Conict Tactics Scales (CTS; Straus, 1979; Straus, Hamby, Boney-McCoy, & Sugarman, 1996) were completed by participating mothers to assess the frequency of different conict-related behaviors enacted by the participating mother and her partner toward each other during last 12 months of their relationship. The original Conict Tactics Scales (CTS1; Straus, 1979) were used to assess 27 of the 31 subjects in the clinical, exposed sample. The Revised Conict Tactics Scales (CTS2; Straus et al., 1996) was used to assess exposure to DV in the remaining exposed subjects and for all of the non-exposed subjects. Only responses to items common to both CTS versions were selected for analyses, with the items contributing to constructs related to conict: violence/physical assault, verbal/psychological aggression, and reasoning/negotiation (Straus, 1979; Straus et al., 1996). Mothers responses were scored in the manner specied by the instruments authors (Straus et al., 1996). Straus provides data indicating strong interparent reliability, with numerous studies of conict between parents of children suggesting at least moderate validity (e.g., Cummings et al., 1984; El-Sheikh, 1994). Maternal life events The Life Stressor Checklist (LSC; Wolfe, Kimerling, & Brown, 1993; Wolfe, Kimerling, Brown, Chrestman, & Levin, 1996) was used to assess participating mothers experience of very distressing events in their lifetimes. Mothers completed the LSC to validate claimed experiences of a traumatic event (Criterion A; Wolfe, Kimerling, Brown, Chrestman, & Levin, 1996). Mothers indicated each stressors subjective impact at the time of occurrence and the degree of the events inuence on their lives. Mothers responded to a series of 22 potentially traumatic life events, including: accidents and natural disasters: personal events such as illness, separation and loss, and physical and sexual

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violence and assault. In the current study, the LSC showed high internal consistency on the occurrence of traumatic events within a persons lifetime with a coefcient alpha of .79. Life stressors endorsed by mothers were further assessed using the Clinician Administered PTSD Scale (Blake et al., 1990). Maternal psychological functioning The Clinician Administered PTSD Scale (CAPS; Blake et al., 1990) is a structured clinical interview that assesses consequences of possibly traumatic events. Participating mothers were interviewed with the CAPS by the adult assessor to further pursue events reported on the LSC and to assess whether any resultant difculties t the established symptom clusters of posttraumatic stress disorder (PTSD), including the frequency and intensity of symptoms involving persistent reexperiencing of a traumatic event, persistent avoidance of stimuli associated with the event, and persistent increased emotional or physiological arousal not present prior to the traumatic event. Mothers current PTSD symptoms were assessed for the current investigation (Blake et al., 1990). Symptoms endorsement was dened using the 12 rule, with a symptoms presence indicated by a minimal frequency of at least once a month and a symptom intensity of at least a 2 (moderate intensity or distress; Blake et al., 1995). Mothers experience of PTSD symptoms was summarized by adding the products of a frequency by intensity calculation for each of the three symptom clusters (Blake et al., 1995). The CAPS has been reported to have at least moderate reliability and validity (Blake et al., 1990, 1995; Foa & Tolin, 2000; King, Leskin, King, & Weathers, 1998; Mueser et al., 2001). In the current study, high internal consistency for frequency by intensity scores for the separate reexperiencing, avoidance, and arousal symptom clusters and overall frequency by intensity score was observed with coefcient alphas of ranging from .86 to .93. The Symptom Checklist 90-Revised (SCL-90-R; Derogatis, 1983), self-report questionnaire composed of 90 briey described psychological and somatic symptoms, was completed by mothers to provide a more general assessment of difculties present at the time of assessment. Individual responses were compared to normative nonpatient data to derive a global distress index, the Global Severity Index (GSI). Moderate reliability and validity for the GSI have been reported by Derogatis and Lazarus (1994). Statistical analyses Validation of the matching process and the DV Exposed and Non-Exposed group assignment were conducted using t-tests, univariate analyses of variance (ANOVA), and Chisquare analyses on demographic and CTS scores. Analy-

ses of main hypotheses were conducted in the following manner. First, separate independent sample t-tests were conducted to investigate the inuence of domestic violence on child cognitive and behavioral functioning. Separate t-tests also were used to explore group differences for maternal functioning. A median split on a composite score of maternal psychopathology was conducted for the evaluation of behavioral and cognitive functioning of Exposed children of mothers with high versus low levels of symptomology. A median split on level of DV exposure was used to categorize Exposed children as having high versus low DV exposure, followed by independent sample t-tests on child behavioral and cognitive functioning. Finally, although the child participants were gender-matched, the inuence of gender was evaluated to explore its relation to child functioning within this sample. Data were analyzed using SPSS for Windows v. 11.5, with result levels with p < .05 dened as signicant. Results As a validity check for the matching process, comparisons between the Exposed and Non-Exposed groups on childrens gender, age, and ethnicity, mothers age and education, and annual family income were conducted, and revealed no group differences (see Table 1). Using separate two (gender) by two (Condition: Exposed, Non-Exposed) univariate analyses of variance (ANOVA), more specic evaluation of possible gender differences were explored. No differences were by According to maternal report on the CECV, children from violent homes experienced marginally more community violence (9.6 violent events) than did children na ve to DV (6.3 events), t(59) = 1.7, p = .094. To remove possible overlap with DV events, twenty-two items of the original 51 CECV items were removed for a more conservative comparison, resulting in no difference between Exposed (3.2 events) and Non-Exposed groups (2.6 events), p > .40. As validation for the membership of Exposed versus Non-Exposed group identication, mothers who experienced DV during their childs lifetime reported on the Conict Tactics Scales (CTS; Straus, 1979; Straus et al., 1996) a signicantly higher number of physically violent actions directed at them by their male partners during the last 12 months of their relationship than did their counterparts not exposed to DV, t(58) = 6.91, p < .001 (See Table 1). Psychological aggression and sexual violence were enacted more often by male partners of Exposed mothers than by partners of Non-Exposed mothers, ps < .01. Also contributing to childrens DV exposure, Exposed mothers reported enacting a greater number of physically violent and psychologically aggressive behaviors toward their male partner than did Non-Exposed mothers, ps < .05. No overlap was observed between groups on physical violence, with little
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38 Table 1 Summary of means, standard deviations, and analyses of demographic characteristics for exposed and non-exposed groups

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Age Child (months) Mother (years) Annual family income Child gender Male Female Child ethnicity Asian Black Latino White Mixed Mother education High school or less Some college College graduate CTS Score Physical violence Mother Partner Psychological aggression Mother Partner Sexual violence Mother Partner

Exposed (n = 31) M (SD) 52.6 32.6 $22,412 f 18 13 3 5 4 7 12 9 10 12 Ma 22.9 56.8 55.6 57.6 55.6 57.6 Rangeb 0 to 204 7 to 184 0 to 184 18 to 200 0 to 25 5 to 175 (8.8) (6.3) ($19,800)

Non-exposed (n = 31) M (SD) 53.9 34.1 $28480 f 18 13 2 11 4 5 9 0.11 10 9 12 Ma 0.30 48.5 52.8 48.5 52.8 48.5 Rangeb 0 to 4 0 to 2 0 to 90 4 to 80 0 to 25 0 to 25 (9.5) (7.3) ($27,200)

t 0.28 0.39 2 0.00 4.01

df 60 60

t 2.22 6.33 3.03 6.91 0.41 2.73 60 60 60 60 60 60

Mean number of behaviors enacted in last 12 months reported on Conict Tactics Scales;
b Range of number of behaviors reported; p < .05; p < .01; p < .001.

overlap between groups on psychological aggression and sexual violence. On the WPPSI-R(Wechsler, 1989), DV-exposed children achieved lower Verbal IQs (M = 89.8) than did Non-Exposed children (M = 100.7), t(58) = 2.36, p < .05 (see Table 2). A similar pattern was seen on the Full Scale IQ, with NonTable 2 Cognitive functioning and behavioral problems means and standard deviations for exposed and non-exposed children

Exposed children achieving higher scores (M = 101.1) than their Exposed counterparts (M = 92.2), t(58) = 2.01, p < .05. No differences were found between groups on Performance IQ, p > .20. All IQ means for the Exposed and Non-Exposed groups were within the Average range for cognitive functioning (Wechsler, 1989).
Non-exposed (n = 31) Ma (SD)b 101.1 100.7 93.8 109.2 101.1 96.1 107.3 (n = 31) Mc 56.0 55.1 57.4 51.0 52.8 48.5 (17.2) (18.9) (15.5) (19.9) (16.3) (17.0) (13.3) (SD)d (8.5) (8.0) (9.4) (9.7) (8.9) (10.5) 0.15 60 0.05

WPPSI-R Full scale IQ Verbal scale IQ Males Females Performance IQ Males Females CBCL T-scores Externalizing Males Females Internalizing Males Females

Exposed (n = 29) Ma (SD)b 92.2 89.8 85.8 95.4 96.1 94.4 98.3 (n = 31) Mc 56.4 55.8 57.2 56.5 55.6 57.6 (17.0) (16.6) (15.5) (17.1) (15.0) (17.7) (12.0) (SD)d (9.8) (11.3) (7.8) (10.6) (9.7) (12.5)

t 2.01 2.36

df 58 58

Powere 0.59 0.80

Normative WPPSI-R Full Scale, Verbal, & Performance Intelligence Quotient M = 100.
b Normative WPPSI-R Full Scale, Verbal, & Performance Intelligence Quotient SD = 15. c

1.25

58

0.26

Normative CBCL Scale T-score M = 50.

Normative CBCL Scale T-score SD = 10. Power as a function of and signicance level ( = .05). p < .05. Springer

2.11

60

0.58

J Fam Viol (2007) 22:3342 Table 3 Life stress events and current psychological functioning means and standard deviations or percentages for exposed and non-exposed mothers LSC Eventsa Current distressb SCL-90-R GSI scorec CAPS Frequency by Intensity Score
a b c

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Exposed (n = 31) M (SD) 9.33 1.11 62.3 (n = 31) Mb 41.8 (3.7) (0.7) (10.9) (SD) (23.2)

Non-exposed (n = 31) M (SD) 6.87 0.89 52.8 (n = 31) Mb 18.1 (3.0) (1.1) (11.3) (SD) (14.1)

t 2.83 0.92 3.34

df 60 60 60

4.77

60

Number of self-reported negative life events. Level of current distress related to experienced negative events. Global Severity Index T-Score Normative M = 50. p < .01; p < .001.

Children exposed to DV displayed higher levels of internalizing behaviors (M T-score = 56.5) than did their NonExposed counterparts (M = 51.0) on the CBCL, t(60) = 2.11, p < .05 (Achenbach, 1991; Achenbach & Edelbrock, 1983; see Table 2). However, no group differences were observed on externalizing behaviors. It is important to note that both groups were within the normal range for severity level (Tscore < 70) of behavioral difculties. Review of mothers exposure to life stressors revealed that Non-Exposed mothers experienced fewer negative nondomestic violence life events (M = 6.87) than did Exposed mothers (M = 9.33), t(60) = 2.83, p < .01. However, the two groups of mothers did not differ in their report of current difculties related to these negative events, p > .362. Investigation of maternal psychological functioning revealed that Exposed mothers reported higher psychological distress (M = 62.3), as indicated by the SCL-90-R Global Severity Index (GSI) T-Score, than did their Non-Exposed counterparts (M = 52.8), t(60) = 3.34, p < .001 (see Table 3). In addition, Exposed mothers reported a higher frequency and intensity of their symptoms (M = 41.8) during the CAPS interview than did Non-Exposed mothers (M = 18.1), t(60) = 4.77, p < .001. To evaluate the role of maternal psychopathology within the DV-Exposed group, a composite score of psychopathology was calculated by adding the CAPS summary score and the SCL-90-Rs GSI index score. A median split was used to divide Exposed mothers into high and low categories of psychopathology. Using the Exposure group median of 104.1 for maternal psychopathology, mothers were divided into high and low categories. Exposed children of mothers with high levels of psychopathology displayed higher Internalizing difculties (M = 56.5) than did their peers of mothers with low psychopathology (M = 51.0), t(28) = 2.05, p < .05. No group differences were found between Exposed children from high and low maternal psy-

chopathology categories for externalizing behavioral difculties, or for Verbal, Performance, or Full Scale IQs. To further explore the inuence of DV on childrens behavioral functioning, Exposed children were divided into high and low DV exposure categories using a median split. First, summary CTS scores of physical violence, psychological aggression, and sexual violence were combined to calculate a DV-Exposure summary score. Using the Exposed group median of 122 DV-related events, children were divided into high and low categories. Children exposed to higher levels of DV displayed marginally more externalizing behaviors (M T-score = 59.8) than did their low-DV peers (M = 53.1), t (28) = 1.91, p = .067. The potential inuence of gender on intellectual functioning was evaluated using separate two (Condition: Exposed, Non-Exposed) by 2 (Gender: Male, Female) univariate analysis of variance (ANOVA) on Full Scale IQ, Verbal IQ, and Performance, all resulting in non-signicant interactions, ps > .360. To evaluate the inuence of gender on parentreported child behavior, similar ANOVA were run on CBCL Internalizing and Externalizing T-scores, also resulting in non-signicant interactions, ps > .230.

Discussion This study is one of the few to follow the methodologically rigorous standards of: (1) using more than one reporter (both mother and child) and more than one outcome variable (mother psychopathology, child behavior, and child cognitive functioning), (2) focusing on a narrow child age range to avoid developmental change as a confound, and (3) evaluating both clinical and non-clinical range families for enhanced understanding of the role of DV (OBrien, Margolin, & John, 1995). Further, through a matching process and
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statistical methods, the study controlled for other factors, such as socioeconomic status, ethnicity, community violence, and other maternal life stressors to better isolate and evaluate the effect of witnessing DV on young children. The resultant ndings clearly indict DV as a negative inuence on young children that exceeds the effects of other risk factors. Replicating ndings from a large twin-study of a reduction of approximately 8 overall IQ points (Koenen et al., 2003), children in the current study with DV experience scored 8.9 Full Scale IQ points lower than did their non-exposed peers on the Wechsler Preschool and Primary Scale of IntelligenceRevised (Wechsler, 1989). Further, the nding of lower verbal skills children exposed to DV experiences is similar to an earlier investigation (Huth-Bocks, Levendosky, & Semel, 2001). The current ndings of exposed children displaying lower verbal scores (M IQ = 89.8) than their non-exposed counterparts (M = 100.7) should be received with greater condence than earlier investigations in that a full WPPSI-R battery, rather than brief inventories or individual subtests, was used to estimate cognitive ability. As displayed by the analyses targeting gender, the inuence of domestic violence on verbal IQ within this sample appears to exist outside of any gender effects. The absence of an interaction between domestic violence exposure and gender likely reects the success of the matching processincluding genderto quiet such confounds so that conict exposure could be evaluated in a more independent fashion. The current ndings further our understanding of the relation between child cognitive functioning and DV exposure by demonstrating that severity of maternal psychopathology did not help to differentiate exposed childrens cognitive functioning. This relationship should be further explored, as a larger sample size may have detected such an inuence. As the participating children were preschoolers, the lower prediction in cognitive functioning is particularly troublesome, as the near-immediate start of formal educations language-based requirements provides little to no delay time prior to appropriate intervention. Indeed, the 11-point IQ difference between the exposed and non-exposed children might be interpreted as a setback for a childs readiness to learn. The group difference nearly equals the standard deviation for normative verbal IQ scores on the WPPSI. A general implication might be that other developmental challenges involving social interaction, academic tasks, and adequate recruitment of social support from others also may be impeded by such a language decit. Given reduced receptive language ability in her child, an exposed mother also might experience greater frustration when attempting to understand her childs upset or distress. In terms of a relational effect, a childs verbal difculties might feed into other relational difculties with a symptomatic mother, further exacerbating their interacSpringer

tions. No Performance IQ difference between the Exposed and Non-Exposed groups suggests that nonverbal cognitive abilities may be developmentally less affected by conict exposure. The signicantly lower level in cognitive functioning in the exposed children, as compared to their non-exposed peers, is alarming. Similar to the ndings of a larger twin study, this study suggests that young children are severely impacted by violence within their families. One explanation is that the psychopathology present in a mother following a violent relationship directly impedes her ability to stimulate cognitive development that maximizes a childs genetic potential. However, due in part to the size of the current sample, comparisons between levels of maternal psychopathology did not provide evidence for such an explanation among the exposed children. Another possibility is that mothers intellectual functioning is diminished following such experiences, either through organic brain injury or via the distracting presence of psychological symptoms, leaving their children in less stimulating, learning environments. More research focusing on the relations between mother psychopathology and maternal cognitive functioning with child cognitive functioning using larger sample sizes while maintaining much of the rigor of the current study is required to explain this result. The predicted higher level of internalizing behaviors reportedly enacted by children exposed to DV (M T-score of 56.5) compared to non-exposed children (M = 51.0) was found, a pattern that agrees with the literature (e.g., Cummings & Davies, 1994). Further, this relation appears to be unexplained by gender differences. However, no effect for maternal psychopathology severity level on child externalizing behavior difculties was found. Perhaps symptomatic mothers were more attentive to the presence of similar difculties in their child. It may be that internalizing and externalizing behavior problems are experienced in different manners by mothers, especially following excessive externalizing behaviors enacted by mothers adult partners toward them. Further research is needed to further explore this distinction. The lack of group differences for externalizing behavioral difculties is contrary to other reported investigations of child behavior following DV events (e.g., Wolfe, Jaffe, Wilson, & Zak, 1985). It is possible that the steps taken to control for confounding variables, such as socioeconomic status, community violence, and maternal life stressors contributed to this lack of effect. Rather than being seen as a weakness, the improved methodology of the current study may have allowed the current authors to distinguish between parent reports on these two categories of problematic child behaviors. Alternatively, earlier studies were more often focused on older, latency-age children for whom externalizing behaviors are more easily recognized (e.g. teachers contacting ones parent, peer ghts at school). A

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direct comparison of the sampling differences among similar studies might help to illuminate the reasons for this disparity. Differences in the number of life stressors experienced by the sets of mothers was noted, although mothers reported no difference in current distress related to those non-domestic violence events. As Exposed mothers reported both higher levels of general psychological difculties as well as greater symptoms related to trauma, it may be that this harsher early experience made mothers more vulnerable to the subsequent experience of being victimized by domestic violence. Further, this vulnerability may extend to a reduction in parenting effectiveness, perhaps explaining the higher rate of internalizing behavioral difculties in the Exposed children. Limits of the current study include the small sample size, the lack of direct behavioral observations of mother-child interactions, and the absence of an assessment of maternal cognitive functioning. Power analysis revelation of moderate to high effect sizes for the Full Scale IQ, Verbal IQ, and Internalizing behavioral difculties suggest condence in these ndings, while the low power observed in a post-hoc manner for Performance IQ and Externalizing difculties imply that the current sample was not sufcient to uncover possibly present difculties. Although the exclusion of children who had been directly abused will limit the generalizability of the current ndings, the benet of a clearer focus on the effects of DV on children outweighs this cost. The current ndings are a clear demonstration of the uniquely detrimental effects that DV events inict on children and their mothers. Exposure to family violence appears to exacerbate often already difcult parent-child situations by undermining the supportive, sensitive, and appropriately responsive nature of this dyad. These data indicate that DV exposure should be followed by an evaluation of the childparent relationship, and, if recommended, the timely administration of interventions that redress likely socioemotional wounds wreaked on children and their mothers, with the primary goal of reinvigorating and balancing the child-mother relationship and with the secondary goals of improving adult psychological functioning and child verbal abilities and selfdirected behaviors and cognitions.
Acknowledgments This research was supported by NIMH Grant R21 MH59661, P.I. Alicia F. Lieberman, and by the generous contribution of the Irving B. Harris Foundation to the Child Trauma Research Project. The authors wish to express their gratitude to the administration, physicians, and staff of the San Francisco General Hospital Pediatric Clinic, the San Francisco Head Start Program, Friends of St. Francis Child Care, the Family School at Visitacion Valley Community Center, and Good Samaritan Family Resource Center, Inc., for their gracious permission and assistance in the recruitment of mother and child participants. Thanks also are due to Lori Lange, Patricia Van Horn, and Chandra Ghosh-Ippen for their thoughtful comments on earlier versions of the manuscript.

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