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Child witness to domestic abuse: baseline data analysis for a seven-year prospective study.

Children who witness the abuse of their mothers are at risk for serious behavioral problems. About 4.8 million women are assaulted by an intimate partner each year in the United States (Centers for Disease Control and Prevention [CDC], 2011). Many abused women have children who often witness the violence.

It is estimated that one child in 15 witnessed (i.e., heard or viewed) partner violence in the past year, and one child in every four will witness violence within the child's lifetime. When extrapolated to the United States population, this equates to 8.2 million children witnessing partner violence each year, and 18.8 million children witnessing partner violence at least once during their lifetime (Hamby, Finkelhor, Turner, & Ormrod, 2011). Girls and boys are equally exposed to violence in the home. Perpetrators of partner violence are overwhelmingly male (92%), and 73% of these males are fathers of the child witness or boyfriends of the mother of the child witness (Hamby etal.,2011).

Empirical evidence exists that children exposed to partner violence have more emotional and behavioral problems when compared to children who do not witness abuse (Kitzman, Gaylord, Holt, & Kenny, 2003; Moylan et al., 2010; Wolfe, Crooks, Lee, Mclntyre-Smith, &Jaffe, 2003). More specifically, children who witness partner violence show more signs of internalizing (e.g., withdrawal, anxiety, depression) and externalizing (e.g., aggression, attention disorders, rule-breaking) behaviors (Hazen, Connelly, Kelleher, Barth, & Landsverk, 2006; McFarlane, Groff, O'Brien, & Watson, 2003). There is also evidence that increasing severity of violence against the mother and frequency of witnessing the violence are associated with more externalizing and internalizing problems in children (Lemmey et al., 2001). Additionally, there is reason to believe that children who wit ness violence in the home are more likely to become abusers and victims of abuse (Osofsky, 1995; Roberts, Gilman, Fitzmaurice, Decker, & Koenen, 2010).

Many studies have explored how the child's gender may modify the internalizing and externalizing behaviors of children exposed to partner violence (Evans, Davies, & DiLillo, 2008; Kitzman et al., 2003; Wolfe et al., 2003). In a meta-analysis of 118 published and unpublished studies from 1978-2000, Kitzmam et al. (2003) found gender did not mediate (i.e., affect) the internalizing or externalizing behaviors of children who witnessed partner violence. In contrast, the meta-analysis of 41 studies from 1980-2003 found that boys who were exposed to partner violence displayed more externalizing behaviors than girls who were exposed to partner violence (Wolfe et al., 2003). However, Wolfe et al. (2003) re-examined these results by excluding studies that reported boy-only behaviors and found that the gender difference disappeared. Evans et al. (2008) conducted a meta-analysis of 61 studies published between 1999-2006 that examined the relationship between partner violence and children's internalizing and externalizing problems, and found no significant difference for boys and girls internalizing problems. However, there was a significant difference between boys and girls externalizing problems. Boys who had a history of witnessing partner violence exhibited significantly more externalizing behaviors than did girls who had similar histories. Evans et al. further excluded three studies that reported boy-only behaviors and found that, unlike Wolfe and associates (2003), there was no significant change in effect size; therefore, gender differences remained, and boys displayed more externalizing behaviors.

Kerig (1999) studied a community sample of 102 families in which both husband and wife reported some physical aggression had occurred in the past year. Children in these families were assessed for internalizing and externalizing behaviors. Boys were found to have increased symptoms of internalizing and externalizing behaviors, while girls were at risk for developing internalizing problems.

Many women are abused, and many children witness the abuse. Witnessing the abuse has negative effects on child functioning, with the literature supporting boys more likely to be affected with negative externalizing behaviors of acting out, aggression, and hostility compared to girl witnesses. If evidence-based programs are to be developed to interrupt the effects of witness to violence on children, then gender-specific evidence is needed to maximize the healing of children and prevent further abuse. To extend evidence for clinical programs and policy guidelines to promote child wellness and healthy families, a prospective study of 300 women with children was undertaken. This study on child witness to partner violence is from the entry data of the study. We found no similar data in the literature and believe this study represents a first attempt to examine the inter-generational effects of child witness to violence against the mother on behavioral functioning of the child, specific to gender.

Based on the existing body of literature, specific research questions for this article include:

* Are there differences in the proportions of girls with borderline or clinically significant behavioral functioning score across levels of hearing, witnessing, or trying to stop abuse against their mother by a male intimate?

* Are there differences in the proportions of boys with borderline or clinically significant behavioral functioning score across levels of hearing, witnessing, or trying to stop abuse against their mother by a male intimate?


This study was a part of a seven-year prospective study funded by The Houston Endowment. The Texas Woman's University Institutional Review Board approved the project prospectively. The purpose of the seven-year prospective study is to investigate the treatment efficacy of the two models most often offered to abused women: safe shelter and justice services. In addition to examining the efficacy of these two global modes of care and support for abused women, this study plans to investigate the long-term effects that the abuse has on the women's functioning. Unlike previous studies on abused women, this study also plans to examine the effects that the abuse of the woman has on her children over a seven-year span. For the purposes of this article, we will examine the cross-generational impact that abuse has on children of abused mother's. See McFarlane, Nava, Gilroy, Paulson, and Maddoux (2012) for a full review of the aim, scope, and methodology of the seven-year prospective study.


Achenback Child Behavior Checklist, age 1.5 to 5 years and age 6-18 years. This standardized instrument provides a parental report of the extent of a child's behavioral problems and social competencies (Achenback & Rescorla, 2000). The Child Behavior Checklist (CBCL) consists of a form for children 18 months to 5 years of age and a form for youth 6 to 18 years of age. The CBCL is orally administered to a parent who rates the presence and frequency of certain behaviors on a 3-point scale (0 = not true, 1 = somewhat or sometimes true, and 2 = very true or often true). The recall period for a parent is the previous two months for young children and six months for older children. Examples of behaviors for younger children include "cruel to animals," "physically attacks people," and "doesn't want to sleep alone." Older children behaviors are "bully behavior," "vandal ism," and "prefers being with older children." The CBCL consists of two broadband factors of behavioral problems: internalizing and externalizing, with mean scale scores for national normative samples, as well as clinically referred and non-referred samples of children. Extensive psychometric testing has yielded very favorable information regarding the tool's validity and reliability in English and Spanish (Achenback & Rescorla, 1991, 2000). Time to complete the CBCL is approximately 10 minutes.

Child Witness to Abuse Question. To measure the child witness to hearing, seeing, or trying to stop the abuse, the mothers were asked how often during the preceding four months the randomly chosen child had heard, seen, or tried to stop the abuse. Categories of response were "Never," "1 to 10 Times," and "Greater Than 10 Times." Time to complete the Child Witness to Abuse Questions was two minutes.


In line with the scope of the seven-year prospective study, participants were recruited through both women shelters and the District Attorney's office. Criteria for participation included first time use of either shelter services or first time applicant for a protective order and having a child between ages 18 months and 15 years of age who lived with the mother at least 50% of the time. As women reached out to use either of the services, research assistants would provide them with an overview of the study and informed consent. If women consented to participate, the research assistant would interview the woman to get demographic and outcome measurements. One child was chosen at random to which the CBCL and the Child Witness to Abuse Questions were completed. Recruitment for women in the shelters continued for 13 months. Recruitment for women at the District Attorney's office continued for five months. Interviews took approximately 45 minutes to complete.


A total of 300 women agreed to participate in this study. Half of the sample was recruited from the District Attorney's office (n = 150), and the remaining half was recruited from various shelters for abused women (n = 150). Means and standard deviations for continuous demographic variables for the full sample are outlined in Table 1. Mothers who participated in this study had ages ranging from 18 to 52 years (M = 30.65; SD = 7.64), with the age of the randomly chosen child ranging from 1.5 to 16.42 years (M = 6.88, SD = 4.23). Participants reported an average of 3.64 (SD = 1.60) people living in their household and that there was an average of 1.93 (SD = 1.09) children living in the home. The length of the relationship with the abuser ranged greatly from 0 months to 300 months (25 years) (M= 83.59, SD = 62.86).

Frequencies and percentages of categorical demographics for the full sample are shown in Table 2. The greatest percentage of the sample identified Spanish or Hispanic as their ethnic background (n = 137; 45.7%), followed by Black (n = 78, 26.0%) and White (n = 32; 10.7%). A large majority of the sample reported that they are not currently in a romantic relationship (n = 251; 83.7%). Additionally, a majority of the sample reported that they are not currently in a relationship with the abuser (n = 190, 63.3%). Most participants reported that they had completed secondary education or equivalent; however, a very slight percentage of the sample reported completing four or more years of college (n = 18, 6.0%). With regard to the randomly selected child, there were relatively equal percentages of boys and girls (50.7% and 49.3%, respectively).

Data Analysis

Data were confidentially encoded and entered into a secure database in the research office. For the purpose of this study, we analyzed the data related to children's functioning level (e.g., normative, borderline, clinically significant) and whether or not the child has heard, seen, or tried to stop abuse. The CBCL has been normed by gender; therefore, the analysis was conducted separately for boys and girls. Due to the small number of children to which mothers reported the child saw or tried to stop the abuse, data were analyzed as Yes or No. Cross-tabulations with Pearson's Chisquare were conducted to tests for differences in children's behavior problems. Cramer's V is the standardized measure of effect size for Pearson's chi-square. Cramer's V can be interpreted as 0.01 to 0.05 as no or negligible effect, 0.06 to 0.10 as a weak effect, 0.11 to 0.15 as moderate, 0.15 to 0.25 as strong, and 0.25 and greater as a very strong effect.


Tables 3 and 4 note the percentage of children whose mothers report heard abuse by CBCL subscales for boys and girls, respectively. Similarly, Tables 5 and 6 list the percentages of children whose mothers all saw the abuse by subscales for boys and girls, respectively. Finally, Tables 7 and 8 list percentages of children whose mothers tried to stop the abuse by subscales for boys and girls, respectively.

For boys only, there were significant relationships between seeing abuse and child functioning. More specifically, there was a significant effect on internalizing behaviors ([chi square] [2] = 6.89, p = 0.032, Cramer's V= 0.213), externalizing behaviors ([chi square] [2] = 10.18, p = 0.006, Cramer's V = 0.259), and total behavioral problems ([chi square] [2] = 8.00, p = 0.018, Cramer's V = 0.229). Across all three CBCL domains, there was a significantly greater proportion of boys in the clinically significant range compared to boys who had not seen the abuse. The effect of seeing the abuse was very strong (Cramer's V = 0.259) for externalizing behaviors and strong for both internalizing behaviors and total behavior problems. There were no other significant relationships between seeing, hearing, or trying to stop abuse for boys or girls; all statistical tests and probabilities were non-significant.


In this sample of 300 children of abused women seeking shelter or justice services for the first time, boys who had seen the abuse of their mother were significantly more likely to display externalizing and internalizing behaviors consistent with disturbed male children under clinical care when compared to boys of abused mothers who did not see the abuse. The effect of seeing the abuse to the mother and behavioral outcomes measured a strong effect statistically, especially for external behaviors, such as aggression and hostility.

The gender differential measured in this study is impressive, which is congruent with findings from the literature that also report greater externalizing behaviors of male children who witness violence in the home (Carlson, 1991; Evans et al, 2008; Hazen et al., 2006; Silverstein, Augustyn, Cabral, & Zuckerman, 2006; Yates, Dodds, Sroufe, & Egeland, 2003).

To understand why there are gender differences between boys and girls who witness partner violence against their mothers, it is important to explore how boys and girls perceive the conflict between their caregivers and their attempts to cope with it. It is well established that both boys and girls who witness partner violence exhibit behavioral problems. Manifestation of these behavior problems may vary by gender. Zahn-Waxler (1993) described a boy's response to conflict as being like a "warrior" who reacts to threats by taking action, whereas girls are "worriers" who respond to conflict by internalizing their feelings. As perception of conflict increases, boys report higher perceived threat. Boys want to take action to solve the conflict, but may realize that they are unable to resolve the problem, resulting in externalizing behaviors (e.g., bullying, threats) and internalizing feelings (i.e., anxiety, helplessness) (Kerig, 1999). Boys who witness partner violence report more approval of violent actions and believe that violence enhances one's reputation compared to boys who have not witnessed partner violence. Girls, on the other hand, report more internalizing problems (e.g., self-blame, sullen) when perception of conflict increases (Kerig, 1999; McIntosh, 2003).

Boys and girls learn patterns of gender roles from observing their caregivers (Osofsky. 2003). Boys are often socialized to be strong and stoic, with crying or showing emotion viewed as a weakness. Boys may observe the male of the family exhibiting externalizing behaviors (e.g., aggression, rule-breaking) and emulate this behavior. This may translate to aggressive behavior when faced with conflict and or anxiety when attempts fail to help their abused mother (Kerig, 1999). Boys who witness partner violence as children are more likely to perpetrate partner violence as adults (Roberts et al, 2010), thus continuing the cycle of violence into the next generation.

Girls are often socialized to be compliant and submissive. Seeing their mother being abused by a male may lead girls to believe that this behavior is acceptable and females are powerless to stop it. Girls who witness their mother's abuse may try to be "extra good" to diffuse the situation, and therefore, internalize their feelings (Kerig, 1999). Girls may also see internalizing behavior (e.g., anxiety, depression) modeled by their mothers.

Children in homes where partner violence is occurring are learning that violence is an acceptable way to resolve conflict, that violence may characterize intimate relationships, and therefore, may find violence between men and women a normal phenomenon (Osofsky, 2003). Research has shown a link between parental behavioral and physical health, with increasing internalization and externalizing problems for children living in an abusive household. Specifically abused mothers may exhibit psychosocial problems, such as depression and anxiety (internalizing behaviors), whereas male abusers in the home often exhibit aggression and hostility (externalizing behaviors) (Mitchell, Lewin, Rasmussen, Horn, & Joseph, 2011).

Mothers are often the main source of care and protection for their children, but they may be unable to meet these obligations due to their own abuse (Osofsky, 2003). Mothers of children who witness partner violence have been associated with increased psychosocial problems, such as mental health problems and general family dysfunction (Osofsky, 2003), and health problems, such as chronic pain (Symes, McFarlane, Nava, Gilroy, & Maddoux, 2013). These psychosocial and health problems experienced by the mother may have an effect of the internalizing and externalizing behaviors of their children. For example, Evans, Shipton, and Keenan (2007) reported that children who lived with mothers who experienced chronic pain had more internalizing (anxiety and depression) and externalizing (aggression and delinquency) problems than children living with mothers who were not experiencing chronic pain. Interestingly, boys were more affected than girls. Boys were reported to have an increase in anxiety and insecure attachments. The authors suggest this difference may be explained by differing socialization of boys and girls, with girls assuming a more caretaker role within the family and boys rebelling against a caretaker role. This rebellion by the boys may be manifested by an increase in aggressive behavior and anxiety. Thus, the internalizing and externalizing behaviors and gender differences reported for children who have witnessed violence may be associated with the mother's physical and psychological health. Further research is needed to determine the effect of mother's physical and psychological health on internalizing and externalizing behavior of both boys and girls who witness partner violence.

The impact on children who witness the abuse of their mother differs for boys and girls, with boys more affected and displaying clinical internalizing and externalizing behaviors comparable to boys under treatment. To effectively plan interventions to help these children, gender differences must be considered. Preventing child witness to violence against the mother can begin with screening of the mother for abuse and providing safety and referral information should violence exists. The U.S. Preventive Services Task Force (2012) recommends health care workers screen women between the ages of 14 and 46 years for intimate partner violence and provide referral services that offer support to abused women. A child health visit can provide a safe opportunity to screen mothers for abuse and discuss the possible negative effect on child behavior. The American Academy of Pediatrics (AAP) Committee on Child Abuse and Neglect (1998) identifies the importance and awareness of partner violence toward the health and wellbeing of children. The AAP provides a guideline endorsed by the Society of Pediatric Nurses (2010) for the identification, evaluation, and treatment of children exposed to partner violence (Thackeray, Hibbard, Dowd, The Committee on Child Abuse and Neglect, & The Committee on Injury, Violence, and Poison Prevention, 2010). It is essential that health care providers be aware of the impact of partner violence on the growth, development, and behavioral functioning of children.

Acknowledgment: The authors appreciate the unflagging assistance and support of the administrators and staff of the five shelters in Harris County and the Chief and staff of the Harris County District Attorney's Office, Family Criminal Law Division. The authors also acknowledge funding by The Houston Endowment.


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Faye Blair, PhD, is an Associate Clinical Professor, College of Nursing, Texas Woman's University, Denton and Houston, TX.

Judith McFarlane, DrPH, is a Parry Chair in Health Promotion & Disease Prevention, Texas Woman's University, Denton and Houston, TX.

Angeles Nava, PhD, is a Post-Doctoral Research Fellow, College of Nursing, Texas Woman's University, Denton and Houston, TX.

Heidi Gilroy, MS, is a Grant Program Manager, College of Nursing, Texas Woman's University, Denton and Houston, TX.

John Maddoux, MA, as a Research Analyst, Texas Woman's University, Denton and Houston, TX.
Table 1.
Means and Standard Deviations of Continuous Demographics
of Full Sample

                                     n       M      SD    Min    Max

Age of woman                        300   30.65    7.64    18      52
Child age (years)                   299    6.88    4.23   1.5   16.42
Children between 1.5 to 16 years    300    1.93    1.09     1       7
Months in relationship              297   83.59   62.86     0     300
People living in household          298    3.64     1.6     1       9

Table 2.
Frequencies and Percentages of Categorical
Demographics of Full Sample

                                           n      %

  White                                    32    10.7
  Black                                    78    26.0
  Asian                                    4     1.3
  American Indian/Native Alaskan           1     0.3
  Spanish or Hispanic                     137    45.7
  Bi-/Multi-Racial                         15     5
  White, Hispanic                          33     11

Currently in an intimate relationship
  No                                      251    83.7
  Yes                                      49    16.3

Currently in relationship with abuser
  No                                      190    63.3
  Yes                                     110    36.7

Attended school as child?
  No                                       3      1
  Yes                                     297     99

Completed grades 1 to 8?
  No                                       10    3.3
  Yes                                     290    96.7

Completed grades 9 to 11?
  No                                       43    14.3
  Yes                                     257    85.7

Graduate from high school or GED?
  No                                      101    33.7
  Yes                                     199    66.3

Completed 1 to 3 years of college?
  No                                      148    49.3
  Yes                                     152    50.7

Completed 4 or more years of college?
  No                                      282     94
  Yes                                      18     6

Randomly chosen child's gender
  Boy                                     152    50.7
  Girl                                    148    49.3

Child's relationship with abuser
  Biological child                        184    61.3
  Not biological child                    116    38.7

Does child have illness or disability?
  Yes                                      68    22.7
  No                                      232    77.3

Table 3.
Frequencies and Percentages of Child Hearing
Abuse by CBCL Subscales for Boys

Child Heard Abuse

                                  1 to 10      More than
                     Never        Times        10 Times

Internalizing      n     %      n     %      n     %     5.99   0.2

  Normative       20    62.5   33    55.9   25    41.0
  Borderline       2    6.3     9    15.3    9    14.8
  Clinical        10    31.3   17    28.8   27    44.3

Externalizing                                            6.59   0.16
  Normative       22    68.8   38    64.4   28    45.9
  Borderline       3    9.4     9    15.3   12    19.7
  Clinical         7    21.9   12    20.3   21    34.4

Total Problems                                           5.24   0.26
  Normative       20    62.5   37    62.7   27    44.3
  Borderline       2    6.3     5    8.5     6    9.8
  Clinical        10    31.3   17    28.8   28    45.9

Table 4.
Frequencies and Percentages of Child Hearing
Abuse by CBCL Subscales for Girls

Child Heard Abuse

                                 1 to 10     More than
                    Never        Times       10 Times
Internalizing     n            n           n     --      2]        p

  Normative       21   77.8   46    69.7   33    60     5.27     0.26
  Borderline      0     0      3    4.5    6    10.9
  Clinical        0    22.2   17    25.8   16   29.1
Externalizing                                           1.36     0.851
  Normative       18   66.7   48    72.7   36   65.5
  Borderline      1    3.7     4    6.1    4    7.4
  Clinical        8    29.6   14    21.2   15   27.3
Total Problems                                          2.82     0.589
  Normative       19   70.4   46    69.7   36   65.5
  Borderline      0     0      2     3     4    7.3
  Clinical        8    29.6   18    27.3   15   27.3

Table 5.
Frequencies and Percentages of Child Seeing Abuse by CBCL
Subscales for Boys

Child Saw Physical Abuse

                            No                  Yes

Internalizing         n         %         n         %

  Normative         47 (a)      61     31 (b)     41.3
  Borderline        10 (a)      13     10 (a)     13.3
  Clinical          20 (a)      26     34 (b)     45.3

  Normative         49 (a)     63.6    39 (a)      52
  Borderline        16 (a)     20.8     8 (a)     10.7
  Clinical          12 (a)     15.6    28 (b)     37.3

Total Problems
  Normative         51 (a)     66.2    33 (b)      44
  Borderline         6 (a)      7.8     7 (a)      9.3
  Clinical          20 (a)      26     35 (b)     46.7

Child Saw Physical Abuse

Internalizing     [X.sup.2]   0.032


Externalizing       10.18     0.006

Total Problems        8       0.018

Note: Differing subscripts indicates
significant differences p < 0.05.

Table 6.
Frequencies and Percentages of Child Seeing Abuse by CBCL
Subscales for Girls

Child Saw Physical Abuse

                    No          Yes

                  n     %     n     %     [X.sup.2]     p

Internalizing                               0.05      0.974

  Normative       44   66.7   56   68.3
  Borderline      4    6.1    5    6.1
  Clinical        18   27.3   21   25.6

Externalizing                               2.05      0.359
  Normative       43   65.2   59    72
  Borderline      3    4.5    6    7.3
  Clinical        20   30.3   17   20.7

Total Problems                              2.19      0.335
  Normative       45   68.2   56   68.3
  Borderline      1    1.5    5    6.1
  Clinical        20   30.3   21   25.6

Table 7.
Frequencies and Percentages of Trying to
Stop Abuse by CBCL Subscales for Boys

                            Child Tried to Stop Abuse

                     Yes         No

                   n     %     n     %     [X.sup.2]     P

Internalizing                                3.47      0.117
  Normative       46    58.2   32   43.8
  Borderline      10    12.7   10   13.7
  Clinical        23    29.1   31   42.5

Externalizing                                1.97      0.374
  Normative       49    62.0   39   53.4
  Borderline      13    16.5   11   15.1
  Clinical        17    21.5   23   31.5

Total Problems                               5.00      0.082
  Normative       49    62.0   35   47.9
  Borderline       8    10.1   5    6.8
  Clinical        22    27.8   33   45.2

Table 8.
Frequencies and Percentages of Trying to Stop Abuse by CBCL
Subscales for Girls

                            Child Tried to Stop Abuse

                     No           Yes

                   n     %      n     %     [X.sup.2]     P

Internalizing                                 2.87      0.238
Normative         62    69.7   38    64.4
Borderline         3    3.4     6    10.2
Clinical          24    27.0   15    25.4
Externalizing                                 3.00      0.223
Normative         66    74.2   36    61.0
Borderline         5    5.6     4    6.8
Clinical          18    20.2   19    32.2
Total Problems                                1.91      0.386
Normative         64    71.9   37    62.7
Borderline         4    4.5     2    3.4
Clinical          21    23.6   20    33.9
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Title Annotation:Continuing Nursing Education
Author:Blair, Faye; McFarlane, Judith; Nava, Angeles; Gilroy, Heidi; Maddoux, John
Publication:Pediatric Nursing
Article Type:Report
Date:Jan 1, 2015
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