How Much Does “How Much” Matter? Assessing the Relationship Between Children’s Lifetime Exposure to Violence and Trauma Symptoms, Behavior Problems, and Parenting Stress

Abstract

The study explores whether and how lifetime violence exposure is related to a set of negative symptoms: child internalizing and externalizing behavior problems, child trauma symptoms, and parenting stress. Using a large sample of violence-exposed children recruited to participate in intervention research, the study employs different methods of measuring that exposure. These include total frequency of all lifetime exposure, total frequency of lifetime exposure by broad category (i.e., assault, maltreatment, sexual abuse, and witnessing violence), and polyvictimization defined as exposure to multiple violence categories. The results indicate that only polyvictimization, constructed as a dichotomous variable indicating two or more categories of lifetime exposure, emerged as a consistent predictor of negative symptoms. The total lifetime frequency of all violence exposure was not associated with negative symptoms, after controlling for the influence of polyvictimization. Likewise, in the presence of a dichotomous polyvictimization indicator the total lifetime frequency of exposure to a particular violence category was unrelated to symptoms overall, with the exception of trauma symptoms and experiences of sexual abuse. Taken together, these findings suggest that total lifetime exposure is not particularly important to negative symptoms, nor is any particular category of exposure after controlling for polyvictimization, with the single exception of sexual abuse and trauma symptoms. Instead, it is the mix of exposure experiences that predict negative impacts on children in this sample. Further research is needed to continue to explore and test these issues.

Role of Direct and Indirect Violence Exposure on Externalizing Behavior in Children

“…Hickman and colleagues suggest that it may be the mix of the type of exposure experiences that has the greatest negative effect on children. 61 Although we did not have longitudinal data, our results suggest there may be a strong impact of cumulative indirect violence exposure on externalizing behavior in children, as well as a significant effect of direct violence exposure (e.g., physical aggression). Findings are consistent with past research indicating that multiple types of violence exposure, experienced both within the family and in the neighborhood 80, 81 both co-occur and multiplicatively contribute to behavior.…”

“…As few studies have addressed the risk for externalizing behaviors due to cumulative violence exposure, it is an important next research step to expand our understanding of the reciprocal relation between cumulative violence exposure and externalizing behaviors. 59,61 Further, an individual's temperament or personality traits, as well as social support and a variety of other factors including age and gender, are also likely moderators of the relationship between both acute and chronic stressors, such as exposure to violence and externalizing behaviors, and should be examined. Finally, there should be an emphasis on identification of potential sources of buffering for the effects of exposure to violence.…”

“…Finally, there should be an emphasis on identification of potential sources of buffering for the effects of exposure to violence. 61 Early detection and prevention of violence exposure and interventions to mitigate its impact on child development are essential to minimize the long-term psychological, socio-emotional, biological, and economic impacts of violence.…”

“…12 Although it is likely that both direct and indirect violence exposures across multiple contexts may contribute both independently and interactively to behavioral outcomes specifically in youth, particularly externalizing behaviors, few studies have directly tested this theory. [58][59][60][61] Incorporation of such a cumulative risk approach 62 into our understanding of the impact of violence exposure on children's health is paramount. The present analysis builds upon the existing literature linking independent violence exposures to externalizing and examines instead the combined impact of indirect violence exposures across individual, family, and neighborhood contexts.…”

Improving Outcomes for Children Exposed to Violence: Safe Start Promising Approaches

“…Children exposed to domestic violence (DV) have increased risk for externalizing behavior problems, internalizing behavior problems, and trauma symptoms (Evans, Davies, and DiLillo, 2008), while childhood exposure to community violence has been shown to be strongly related to both externalizing behavior problems and posttraumatic stress disorder (PTSD) (Fowler et al, 2009). In our own work examining violence exposure among a sample of families engaged with community-based service organizations, we found that exposure to multiple forms of violence strongly predicted child internalizing and externalizing behavior problems and trauma symptoms among the subsample of children with any victimization history (Hickman et al, 2013).…”