Children Exposed to Violence

A study of a national sample of American children found that over the past year 60 percent were exposed to violence, crime, or abuse in their homes, schools, and communities. Almost 40 percent of American children were direct victims of 2 or more violent acts, and 1 in 10 were victims of violence 5 or more times. Children are more likely to be exposed to violence and crime than adults. Almost 1 in 10 American children saw one family member assault another family member, and more than 25 percent had been exposed to family violence during their life (Finkelhor et al., 2009).

Poly-victimization
The term poly-victimization describes individuals who have experienced multiple victimizations of different kinds, such as sexual assault and bullying, or witnessing intimate partner violence and physical abuse. Nearly half of a national sample of children had experienced at least 2 different kinds of victimizations in the past year (Finkelhor et al., 2007). Over the course of their lifetimes, 66 percent experienced 2 or more types of violence, 30 percent experienced 5 or more types and 10 percent experienced more than 10 different types of violence (Turner et al., 2010). Over the course of their lifetimes, 57 percent of the children who had witnessed intimate partner violence were also direct victims of child maltreatment (Hamby et al., in press).

Factors that increase children's risk of being exposed to violence include:

• Age: Older children are exposed to more serious forms of violence and are more likely to be victims of multiple kinds of violence (Finkelhor et al., 2009; Finkelhor et al., 2007a; Baum, 2005).
• Gender: Boys are exposed to higher rates of physical assault than girls (Finkelhor et al., 2009; Kilpatrick et al., 2003; Stein et al., 2003; Woodward & Fergusson, 2000). Girls are exposed to higher rates of sexual victimization than boys (CDC, 2010; Finkelhor et al., 2009; Finkelhor et al., 2007a; Kilpatrick et al., 2003; Small & Zweig, 2007; Theodore et al., 2005).
• Race and ethnicity: Overall lifetime rates of exposure to violence are higher among black and Native American adolescents (Kilpatrick et al., 2003).
• Family structure: Children who do not live with both biological parents are at increased risk of exposure to violence, especially for experiencing physical and sexual assault perpetrated by a family member and witnessing domestic and community violence (Hanson et al., 2006).
• Family alcohol problems/drug use: Risk for exposure to violence and risk of experiencing multiple victimization episodes was higher when family alcohol problems or drug use were present (Stevens et al., 2005; Hanson et al., 2006).
• Intimate partner violence: Children from families where intimate partner violence was present had an increased risk of subsequent child maltreatment victimization (McGuigan & Pratt, 2001; Rumm et al., 2000).
• Peer delinquency: Children who associate with more deviant or delinquent peers in one year are at higher risk for exposure to community violence in the next year (Salzinger et al., 2006; Lambert et al., 2005).
• Prior Victimization: Children who experienced one type of victimization in the past year had double or even triple the risk of other types of victimization. These risks held true for lifetime exposure as well (Finkelhor et al., 2009).

Outcomes of Children Exposed to Violence

Outcomes for children exposed to violence are often overlapping, with children experiencing multiple problems. Any one of the identified outcomes has multiple risk factors other than exposure to violence which makes establishing a causal link between exposure to violence and any specific outcome extremely challenging (Saunders, 2003).

Psychological health outcomes
These include problems associated with depression, anxiety, post-traumatic stress disorder, isolation, shame, fear, guilt, and low self-esteem (Bourassa, 2007; Finkelhor et al., 2009; Johnson et al., 2002; Moylan et al., 2010; Kilpatrick et al., 2003).

Physical health outcomes
Children exposed to violence are at risk for physical injury and are also more likely than others to have poor overall health, have illnesses requiring medical attention, attempt suicide, or be involved in self-injury (Duke et al., 2010; Finkelhor et al., 2009; Flaherty et al., 2009). There is evidence that exposure to child abuse and neglect has profound effects on brain development and cognition (Child Welfare Information Gateway, 2009).

Academic difficulties and failure
Exposure to violence increases the risk that children will drop out of school or do more poorly in school (Herrenkohl et al., 2008; Holt et al., 2007).

Behavioral problems
Behavioral outcomes may include substance abuse or dependence, teen pregnancy, aggression, conduct disorder, delinquency, and violence, including dating violence and intimate partner violence (Bourassa, 2007; Duke et al., 2010; Ehrensaft et al., 2003; Finkelhor et al., 2009; Herrenkohl et al., 2008; Johnson et al., 2002; Kilpatrick et al., 2003; McCabe et al., 2005; Moylan et al., 2010; Nofzinger & Kurtz, 2005).

Delinquency and offending
High rates of victimization are seen in juvenile justice samples. Seventy percent of youth in residential placement had some type of past traumatic experience, with 30 percent having experienced frequent and/or injurious physical and/or sexual abuse (Sedlak & McPherson, 2010). Some types of victimizations are more strongly associated with violent offending than others (Nofzinger & Kurtz, 2005). Sexual victimization is not predictive of violent offending, whereas victims of child physical abuse are approximately 1.7 times more likely than others to be involved in perpetrating violent offenses. Being the victim of a physical assault increases the likelihood of violent juvenile offending by 3.3 times (Nofzinger & Kurtz, 2005).

Poly-victimization
A number of studies have found that exposure to multiple kinds of violence predicts negative outcomes beyond the effects of any specific type of exposure. The range of outcomes includes psychological distress, adjustment in adult relationships, college adjustment, school grades, physical health, teen pregnancy, delinquency, bullying, self-directed violence, physical fighting, teen dating violence perpetration, and adult intimate partner violence victimization and perpetration (Duke et al., 2010; Richmond et al., 2009; Elliott et al., 2009; Holt et al., 2007; Flaherty et al., 2009; Sternberg et al., 2006; Finkelhor et al., 2007a; Turner et al., 2010; Anda et al., 2001; Whitfield et al., 2003; Spriggs et al., 2009).

Practice Recommendations

CrimeSolutions.ojp.gov includes information about evidence-based programs that are promising and effective at addressing issues related to CEV. Beyond evidence about specific programs, this review identified principles and characteristics associated with successful practices. These include:

• Engaging and intervening with both the parent and child
• Combined home-based and center-based approaches
• Multi-modal approaches (combining individual, group, family, advocacy, case-management and/or combining treatment approaches)
• Parent training as prevention and intervention
• Psycho-educational roles for all providers across all aspects of the continuum
• System partners that interact with children and families from prevention to response

To advance practice, there is a need for:

• Common measures and definitions for both research and practice so that research findings can be compared, analyzed, and applied.
• Further development of screening and risk assessment tools using poly-victimization indicators.
• More focused attention to poly-victims in delivering and distributing resources and services.
• Further training and cross-training for multiple disciplines on CEV.

References

Anda, R., Felitti, V., Chapman, D., & Croft, J. 2001. "Abused boys, battered mothers, and male involvement in teen pregnancy." Pediatrics, 107(2).

Baum, K. 2005. Juvenile Victimization and Offending, 1993-2003. Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.

Bourassa, C. 2007. "Co-occurrence of interparental violence and child physical abuse and its effect on the adolescents' behavior." Journal of Family Violence, 22(8), 691-701.

Child Welfare Information Gateway. 2009. Understanding the Effects of Maltreatment on Brain Development. Washington, D.C.: United States Department of Health and Human Services, Administration for Children and Families.

Duke, N.N., Pettingell, S. L., McMorris, B.J. & Borowsky, I.W. 2010. "Adolescent violence perpetration: Associations with multiple types of adverse childhood experiences." Pediatrics, 125, 778-786.

Ehrensaft, M.K., Cohen, P., Brown, J., Smailes, E., Chen, H., & Johnson, J.G. 2003. "Intergenerational transmission of partner violence: A 20-year prospective study." Journal of Consulting and Clinical Psychology, 71, 741-753.

Elliott, A.N., Alexander, A.A., Pierce, T.W., Aspelmeier, J.E., & Richmond, J.M. 2009. "Childhood victimization, poly-victimization, and adjustment to college in women." Child Maltreatment, 14(4), 330-343.

Finkelhor, D., Ormrod, R. K., & Turner, H. A. 2007a. "Poly-Victimization: A neglected component in child victimization." Child Abuse & Neglect, 31(1), 7-26.

Finkelhor, D., Ormrod, R. K., & Turner, H. A. 2007b. "Re-victimization patterns in a national longitudinal sample of children and youth." Child Abuse and Neglect, 31(5), 479-502.

Finkelhor, D., Turner, H., Ormrod, R., & Hamby, S. 2009. "Violence, abuse, and crime exposure in a national sample of children and youth." Pediatrics, 125(5), 1-13.

Finkelhor, D., Turner, H., Ormrod, R., & Hamby, S.L. 2010. "Trends in childhood violence and abuse: Evidence from 2 national surveys." Archives of Pediatrics & Adolescent Medicine, 164(3), 238-242.

Flaherty, E.G., Thompson, R., Litrownik, A.J., Zolotor, A.J., Dubowitz, H., Runyan, D.K., English, D.J. & Everson, M.D. 2009. "Adverse childhood exposures and reported child health at Age 12." Academic Pediatrics, 9(3), 150-156.

Hamby, S., Finkelhor, D., Turner, H., & Ormrod, R. (in press). Exposure to intimate partner violence and other family violence: Nationally representative rates among U.S. youth. Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.

Hanson, R.F., Self-Brown, S., Fricker-Elhai, A.E., Kilpatrick, D.G., Saunders, B.E., & Resnick, H.S. 2006. "The relations between family environment and violence exposure among youth: findings from the national survey of adolescents." Child Maltreatment, 11, 3-15.

Herrenkohl, T.I., Sousa, C., Tajima, E.A., Herrenkohl, R.C., & Moylan, C.A. 2008. "Intersection of child abuse and children's exposure to domestic violence." Trauma, Violence & Abuse, 9, 84-99.

Holt, M.K., Finkelhor, D., & Kaufman Kantor, G. 2007. "Multiple victimization experiences of urban elementary school students: Associations with psychosocial functioning and academic performance." Child Abuse and Neglect, 31, 503-515.

Johnson, R.M., Kotch, J.B., Catellier, D.J., & Winsor, J. 2002. "Adverse behavioral and emotional outcomes from child abuse and witnessed violence." Child Maltreatment, 7(3),179-186.

Kilpatrick, D.G., Saunders, B.E., & Smith, D W. 2003. Youth Victimization: Prevalence and Implications, Research in Brief. Washington, D.C.: National Institute of Justice.

Lambert, S.F., Lalongo, N.S., & Boyd, R.C. 2005. "Risk factors for community violence exposure in adolescence." American Journal of Community Psychology, 36(1), 29-40.

McCabe, K.M., Lucchini, S.E., Hough, R.L., Yeh, M., & Hazen, A. 2005. "The relation between violence exposure and conduct problems among adolescents: A prospective study." American Journal of Orthopsychiatry, 75, 575-584.

McGuigan, W.M., & Pratt, C.C. 2001. "Predictive impact of domestic violence on three types of child maltreatment." Neglect: The International Journal, 25(7), 869-883.

Moylan, C.A., Herrenkohl, T.I., Sousa, C., Tajima, E.A., & Herrenkohl, R. 2010. "The effects of child abuse and exposure to domestic violence on adolescent internalizing and externalizing behavior problems." Journal of Family Violence, 25(1), 53-63.

Nofzinger, S., & Kurtz, D. 2005. "Violent lives: A lifestyle model linking exposure to violence to juvenile violent offending." Journal of Research in Crime and Delinquency, 42, 3-26.

Richmond, J.M., Elliott, A.N., Pierce, T.W., & Aspelmeier, J.E. 2009. "Polyvictimization, Childhood Victimization, and Psychological Distress in College Women." Child Maltreatment, 14(2), 127-147.

Rumm, P., Cummings, P., Krauss, M., Bell, M., & Rivara, F. 2000. "Identified spouse abuse as a risk factor for child abuse." Child Abuse and Neglect, 24, 1375-1381.

Salzinger, S., Ng-Mak, D.S., Feldman, R.S., Kam, C., & Rosario, M. 2006. "Exposure to community violence: Processes that increase the risk for inner-city middle school children." Journal of Early Adolescence, 26, 232-266.

Saunders, B.E. 2003. "Understanding children exposed to violence: Toward an integration of overlapping fields." Journal of Interpersonal Violence, 18, 356-376.

Sedlak, A.J., & McPherson, K. 2010. Nature of risk and victimization: Findings from the Survey of Youth in Residential Placement. Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.

Spriggs, A.L., Halpern, C.T., & Martin, S.L. 2009. "Continuity of adolescent and early adult partner violence victimisation: Association with witnessing violent crime in adolescence." Journal of Epidemiology & Community Health, 63(9), 741-748.

Small, K., & Zweig, J.M. 2007. "Sexual victimization of youth." Prevention Researcher, 14(2), 3-5.

Stein, B.D., Jaycox, L.H., Kataoka, S.H., Rhodes, H.J., & Vestal, K.D. 2003. "Prevalence of child and adolescent exposure to community violence." Clinical Child and Family Psychology Review, 6(4), 247-264.

Sternberg, K.J., Baradaran, L.P., Abbott, C.B., Lamb, M.E., & Guterman, E. 2006. "Type of violence, age, and gender differences in the effects of family violence on children's behavior problems: A mega-analysis." Developmental Review, 26(1), 89-112.

Stevens, T.N., Ruggiero, K.J., Kilpatrick, D.G., Resnick, H.S., & Suanders, BE. 2005. "Variables differentiating singly and multiply victimized youth: Results from the National Survey of Adolescents and implications for secondary prevention." Child Maltreatment, 10, 211-223.

Theodore, A.D., Chang, J.J., Runyan, D.K., Hunter, W.M., & Bangdiwala, S.I. 2005. "Epidemiologic features of the physical and sexual maltreatment of children in the Carolinas." Pediatrics, 115(3), 331-337.

Turner, H.A., Finkelhor, D., & Ormrod, R. 2010. "Poly-Victimization in a National Sample of Children and Youth." American Journal of Preventive Medicine, 38(3), 323-330.

Whitfield, C.L., Anda, R.F., Dube, S.R., & Felitti, V.J. 2003. "Violent childhood experiences and the risk of intimate partner violence in adults: Assessment in a large health maintenance organization." Journal of Interpersonal Violence, 18, 166-185.

Woodward, L.J. & Fergusson, D.M. 2000. "Childhood and adolescent predictors of physical assault: A prospective longitudinal study." Criminology, 38(1), 233.