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

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Abstract

The objective of this study was to examine the association between externalizing behaviors and indirect violence exposure, assessed both within the household and at the community level, as well as the interaction effect of indirect and direct violence exposure. A sample of parents of children ages 4–15 who have not been referred or enrolled in child welfare (n = 82) were recruited from the greater New Orleans community. Externalizing behavior was assessed with the Child Behavior Checklist (CBCL). The child’s indirect exposure to violence included witnessing community violence, witnessing physical assault, and witnessing fighting or domestic violence at home. Direct exposure to violence included the child experiencing physical aggression from a caregiver. All assessments were based on caregiver reports. To decrease potential for confounding, children were matched for analysis based on age, Hurricane Katrina exposure, and their propensity to be exposed to high indirect violence. Cumulative indirect exposure to violence was significantly positively correlated with CBCL scores. After controlling for key covariates, CBCL externalizing T score increased significantly by approximately 1.25 points for each level increase in indirect violence exposure (β = 1.25, SE = 0.57, p = 0.027). There also was a significant interaction between indirect and direct exposure to violence in the association with CBCL score (β = −0.08, SE = 0.03, p = 0.002). These findings extend previous research by demonstrating that exposure to both direct and cross-contextual indirect violence influences externalizing behaviors in children. Additionally, the findings suggest that community and household social environments are both important targets for interventions designed to decrease externalizing behaviors and improve long-term outcomes for youth at risk of exposure to violence.

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References

  1. Ştefan CA, Miclea M. A preliminary efficiency study of a multifocused prevention program for children with deficient emotional and social competencies. Procedia - Soc Behav Sci. 2010; 5: 127–139.

    Article  Google Scholar 

  2. Achenbach TM, Edelbrock CS. The classification of child psychopathology: a review and analysis of empirical efforts. Psychol Bull. 1978; 85(6): 1275–1301.

    Article  CAS  PubMed  Google Scholar 

  3. Hinshaw SP. Externalizing behavior problems and academic underachievement in childhood and adolescence: causal relationships and underlying mechanisms. Psychol Bull. 1992; 111(1): 127–155.

    Article  CAS  PubMed  Google Scholar 

  4. Murray K, Kochanska G. Effortful control: factor structure and relation to externalizing and internalizing behaviors. J Abnorm Child Psychol. 2002; 30(5): 503–514.

    Article  PubMed  Google Scholar 

  5. Wood JJ, Cowan PA, Baker BL. Behavior problems and peer rejection in preschool boys and girls. J Genet Psychol. 2002; 163(1): 72–88.

    Article  PubMed  Google Scholar 

  6. Barker E, Maughan B. Differentiating early-onset persistent versus childhood-limited conduct problem youth. Am J Psychiatr. 2009; 166(8): 900–908.

    Article  PubMed  Google Scholar 

  7. McLeod JD, Kaiser K. Childhood emotional and behavioral problems and educational attainment. Am Sociol Rev. 2004; 69(5): 636–658.

    Article  Google Scholar 

  8. Farrington DP. Childhood aggression and adult violence: early precursors and later life outcomes. In: Pepler DJ, Rubin RH, eds. The development and treatment of childhood aggression. Hillsdale, NJ: Lawrence Erlbaum Associates; 1991.

    Google Scholar 

  9. King SM, Iacono WG, McGue M. Childhood externalizing and internalizing psychopathology in the prediction of early substance use. Addiction. 2004; 99(12): 1548–1559.

    Article  PubMed  Google Scholar 

  10. Sroufe LA, Carlson EA, Levy AK, Egeland B. Implications of attachment theory for developmental psychopathology. Dev Psychopathol. 1999; 11(1): 1–13.

    Article  CAS  PubMed  Google Scholar 

  11. Appleyard K, Egeland B, van Dulmen MH, Sroufe LA. When more is not better: the role of cumulative risk in child behavior outcomes. J Child Psychol Psychiatry. 2005; 46(3): 235–245.

    Article  PubMed  Google Scholar 

  12. Finklehor D, Ormrod RK, Turner HA. Poly-victimization: a neglected component in child victimization. Child Abuse Negl. 2007; 31(1): 7–26.

    Article  Google Scholar 

  13. Manly JT, Oshri A, Lynch M, Herzog M, Wortel S. Child neglect and the development of externalizing behavior problems: associations with maternal drug dependence and neighborhood crime. Child Maltreat. 2013; 18(1): 17–29.

    Article  PubMed  Google Scholar 

  14. Kim J, Cicchetti D. Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. J Child Psychol Psychiatry. 2010; 51(6): 706–716.

    Article  PubMed  Google Scholar 

  15. English DJ, Thompson R, Graham JC, Briggs EC. Toward a definition of neglect in young children. Child Maltreat. 2005; 10(2): 190–206.

    Article  PubMed  Google Scholar 

  16. Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S. Burden and consequences of child maltreatment in high-income countries. Lancet. 2009; 373(9657): 68–81.

    Article  PubMed  Google Scholar 

  17. Hughes HM, Parkinson D, Vargo M. Witnessing spouse abuse and experiencing physical abuse: a “double whammy”? J Fam Violence. 1989; 4(2): 197–209.

    Article  Google Scholar 

  18. Gershoff ET. Corporal punishment by parents and associated child behaviors and experiences: a meta-analytic and theoretical review. Psychol Bull. 2002; 128(4): 539–579.

    Article  PubMed  Google Scholar 

  19. Day RD, Peterson GW, McCracken C. Predicting spanking of younger and older children by mothers and fathers. J Marriage Fam. 1998; 60(1): 79–94.

    Article  Google Scholar 

  20. Belsky J. The determinants of parenting: a process model. Child Dev. 1984; 55(1): 83–96.

    Article  CAS  PubMed  Google Scholar 

  21. Beauchaine TP, Webster-Stratton C, Reid MJ. Mediators, moderators, and predictors of 1-year outcomes among children treated for early-onset conduct problems: a latent growth curve analysis. J Consult Clin Psychol. 2005; 73(3): 371–388.

    Article  PubMed  Google Scholar 

  22. Taylor CA, Manganello JA, Lee SJ, Rice JC. Mothers’ spanking of 3-year-old children and subsequent risk of children’s aggressive behavior. Pediatrics. 2010; 125(5): e1057–e1065.

    Article  PubMed  Google Scholar 

  23. Berlin LJ, Ispa JM, Fine MA, et al. Correlates and consequences of spanking and verbal punishment for low-income white, African American, and Mexican American toddlers. Child Dev. 2009; 80(5): 1403–1420.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Grogan-Kaylor A. Corporal punishment and the growth trajectory of children’s antisocial behavior. Child Maltreat. 2005; 10(3): 283–292.

    Article  PubMed  Google Scholar 

  25. Lee SJ, Taylor CA, Altschul I, Rice JC. Parental spanking and subsequent risk for child aggression in father-involved families of young children. Child Youth Serv Rev. 2013; 35(9): 1476–1485.

    Article  PubMed  PubMed Central  Google Scholar 

  26. MacKenzie MJ, Nicklas E, Brooks-Gunn J, Waldfogel J. Spanking and children’s externalizing behavior across the first decade of life: evidence for transactional processes. J Youth Adolesc. 2015; 44(3): 658–669.

    Article  PubMed  Google Scholar 

  27. Edleson JL. Children’s witnessing of adult domestic violence. J Interpersonal Violence. 1999; 14(8): 839–870.

    Article  Google Scholar 

  28. Fantuzzo JW, DePaola LM, Lambert L, Martino T, Anderson G, Sutton S. Effects of interparental violence on the psychological adjustment and competencies of young children. J Consult Clin Psychol. 1991; 59(2): 258.

    Article  CAS  PubMed  Google Scholar 

  29. Holt S, Buckley H, Whelan S. The impact of exposure to domestic violence on children and young people: a review of the literature. Child Abuse Negl. 2008; 32(8): 797–810.

    Article  PubMed  Google Scholar 

  30. Wolfe DA, Crooks CV, Lee V, McIntyre-Smith A, Jaffe PG. The effects of children’s exposure to domestic violence: a meta-analysis and critique. Clin Child Fam Psychol Rev. 2003; 6(3): 171–187.

    Article  PubMed  Google Scholar 

  31. Evans SE, Davies C, DiLillo D. Exposure to domestic violence: a meta-analysis of child and adolescent outcomes. Aggress Violent Behav. 2008; 13(2): 131–140.

    Article  Google Scholar 

  32. Ehrensaft MK, Cohen P, Brown J, Smailes E, Chen H, Johnson JG. Intergenerational transmission of partner violence: a 20-year prospective study. J Consult Clin Psychol. 2003; 71(4): 741–753.

    Article  PubMed  Google Scholar 

  33. Margolin G. Effects of witnessing violence on children. In: Trickett PK, Schellenbach CJ, eds. Violence against children in the family and in the community. Washington DC: American Psychological Association; 1998: 57–101.

    Chapter  Google Scholar 

  34. Moylan CA, Herrenkohl TI, Sousa C, Tajima EA, Herrenkohl RC, Russo MJ. The effects of child abuse and exposure to domestic violence on adolescent internalizing and externalizing behavior problems. J Fam Violence. 2010; 25(1): 53–63.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Gustafsson HC, Cox MJ, Blair C. Maternal parenting as a mediator of the relationship between intimate partner violence and effortful control. J Fam Psychol. 2012; 26(1): 115–123.

    Article  PubMed  Google Scholar 

  36. Shalev I, Moffitt TE, Sugden K, et al. Exposure to violence during childhood is associated with telomere erosion from 5 to 10 years of age: a longitudinal study. Mol Psychiatry. 2013; 18(5): 576–581.

    Article  CAS  PubMed  Google Scholar 

  37. Drury SS, Mabile E, Brett ZH, et al. The association of telomere length with family violence and disruption. Pediatrics. 2014; 134(1): e128–137.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Schwab-Stone ME, Ayers TS, Kasprow W, et al. No safe haven: a study of violence exposure in an urban community. J Am Acad Child Adolesc Psychiatry. 1995; 34(10): 1343–1352.

    Article  CAS  PubMed  Google Scholar 

  39. Schwab-Stone M, Chen C, Greenberger E, Silver D, Lichtman J, Voyce C. No safe haven. II: the effects of violence exposure on urban youth. J Am Acad Child Adolesc Psychiatry. 1999; 38(4): 359–367.

    Article  CAS  PubMed  Google Scholar 

  40. Margolin G, Gordis EB. Children’s exposure to violence in the family and community. Curr Dir Psychol Sci. 2004; 13(4): 152–155.

    Article  Google Scholar 

  41. Linares LO, Heeren T, Bronfman E, Zuckerman B, Augustyn M, Tronick E. A mediational model for the impact of exposure to community violence on early child behavior problems. Child Dev. 2001; 72(2): 639.

    Article  CAS  PubMed  Google Scholar 

  42. Downey G, Coyne JC. Children of depressed parents: an integrative review. Psychol Bull. 1990; 108(1): 50–76.

    Article  CAS  PubMed  Google Scholar 

  43. Conger RD, Patterson GR, Ge X. It takes two to replicate: a mediational model for the impact of parents’ stress on adolescent adjustment. Child Dev. 1995; 66(1): 80–97.

    Article  CAS  PubMed  Google Scholar 

  44. Fauber RL, Long N. Children in context: the role of the family in child psychotherapy. J Consult Clin Psychol. 1991; 59(6): 813–820.

    Article  CAS  PubMed  Google Scholar 

  45. Turner HA, Finkelhor D, Ormrod R, et al. Family context, victimization, and child trauma symptoms: variations in safe, stable, and nurturing relationships during early and middle childhood. Am J Orthopsychiatry. 2012; 82(2): 209–219.

    Article  PubMed  Google Scholar 

  46. Dong M, Anda RF, Felitti VJ, et al. The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse Negl. 2004; 28(7): 771–784.

    Article  PubMed  Google Scholar 

  47. Finkelhor D, Turner, H., Ormrod, R., Hamby, S., & Kracke, K. Polyvictimization: children’s exposure to multiple types of violence, crime, and abuse. Juvenile Justic Bulletin: US Department of Justice, Office of Justice Programs, Office of Juvenile Justic and Delinquency Prevention. 2011; 1-11.

  48. Taylor CA, Guterman NB, Lee SJ, Rathouz PJ. Intimate partner violence, maternal stress, nativity, and risk for maternal maltreatment of young children. Am J Public Health. 2009; 99(1): 175–183.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Kelleher KJ, Hazen AL, Coben JH, et al. Self-reported disciplinary practices among women in the child welfare system: association with domestic violence victimization. Child Abuse Negl. 2008; 32(8): 811–818.

    Article  PubMed  Google Scholar 

  50. Taylor CA, Lee SJ, Guterman NB, Rice JC. Use of spanking for 3-year-old children and associated intimate partner aggression or violence. Pediatrics. 2010; 126(3): 415–424.

    Article  PubMed  Google Scholar 

  51. Lynch M, Cicchetti D. An ecological-transactional analysis of children and contexts: the longitudinal interplay among child maltreatment, community violence, and children’s symptomatology. Dev Psychopathol. 1998; 10(2): 235–257.

    Article  CAS  PubMed  Google Scholar 

  52. Hartley CC. The co-occurrence of child maltreatment and domestic violence: examining both neglect and child physical abuse. Child Maltreat. 2002; 7(4): 349–358.

    Article  PubMed  Google Scholar 

  53. Appel AE, Holden GW. The co-occurrence of spouse and physical child abuse: a review and appraisal. J Fam Psychol. 1998; 12(4): 578.

    Article  Google Scholar 

  54. King KE, Morenoff JD, House JS. Neighborhood context and social disparities in cumulative biological risk factors. Psychosom Med. 2011; 73(7): 572–579.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Evans GW, Kim P, Ting AH, Tesher HB, Shannis D. Cumulative risk, maternal responsiveness, and allostatic load among young adolescents. Dev Psychol. 2007; 43(2): 341–351.

    Article  PubMed  Google Scholar 

  56. Morales JR, Guerra NG. Effects of multiple context and cumulative stress on urban children’s adjustment in elementary school. Child Dev. 2006; 77(4): 907–923.

    Article  PubMed  Google Scholar 

  57. Rutter M, Garmezy N, Rutter M. Stress, coping and development in children. In: Garmezy N, Rutter M, eds. Stress, coping and development: some issues. New York, NY: McGraw-Hill; 1983.

    Google Scholar 

  58. Plybon LE, Kliewer W. Neighborhood types and externalizing behavior in urban school-age children: tests of direct, mediated, and moderated effects. J Child Fam Stud. 2001; 10(4): 419–437.

    Article  Google Scholar 

  59. Mrug S, Windle M. Prospective effects of violence exposure across multiple contexts on early adolescents’ internalizing and externalizing problems. J Child Psychol Psychiatry. 2010; 51(8): 953–961.

    Article  PubMed  Google Scholar 

  60. Mrug S, Loosier PS, Windle M. Violence exposure across multiple contexts: individual and joint effects on adjustment. Am J Orthopsychiatry. 2008; 78(1): 70–84.

    Article  PubMed  Google Scholar 

  61. Hickman LJ, Jaycox LH, Setodji CM, et al. How much does “how much” matter? Assessing the relationship between children’s lifetime exposure to violence and trauma symptoms, behavior problems, and parenting stress. J Interpersonal Violence. 2013; 28(6): 1338–1362.

    Article  Google Scholar 

  62. Evans GW, Li D, Whipple SS. Cumulative risk and child development. Psychol Bull. 2013; 139(6): 1342–1396.

    Article  PubMed  Google Scholar 

  63. Watters JK, Biernacki P. Targeted sampling: options for the study of hidden populations. Soc Probl. 1989; 36(4): 416–430.

    Article  Google Scholar 

  64. Tashima N, Crain C, O’Reilly K, Elifson CS. The community identification (CID) process: a discovery model. Qual Health Res. 1996; 6(1): 23–48.

    Article  Google Scholar 

  65. Kawachi I, Daniels N, Robinson DE. Health disparities by race and class: why both matter. Health Aff. 2005; 24(2): 343–352.

    Article  Google Scholar 

  66. Oaks J, Kaufman J. Methods in social epidemiology. San Francisco, CA: Jossey-Bass; 2006.

    Google Scholar 

  67. Achenbach TM, Rescorla L. Manual for the ASEBA school-age forms & profiles: an integrated system of multi-informant assessment. Burlington, VT: ASEBA; 2001.

    Google Scholar 

  68. Egger HL, Erkanli A, Keeler G, Potts E, Walter BK, Angold A. Test-retest reliability of the Preschool Age Psychiatric Assessment (PAPA). J Am Acad Child Adolesc Psychiatry. 2006; 45(5): 538–549.

    Article  PubMed  Google Scholar 

  69. Straus MA, Hamby SL. Measuring physical & psychological maltreatment of children with the conflict tactics scales. In: Kantor GK, Jasinski JL, eds. Out of the darkness: contemporary research perspectives on family violence. Thousand Oaks, CA: Sage; 1997.

    Google Scholar 

  70. Aiken LS, West SG, & Reno RR. Multiple regression: testing and interpreting interactions. Thousand Oaks, CA: Sage; 1991.

  71. Latimer K, Wilson P, Kemp J, et al. Disruptive behaviour disorders: a systematic review of environmental antenatal and early years risk factors. Child Care Health Dev. 2012; 38(5): 611–628.

    Article  CAS  PubMed  Google Scholar 

  72. Beauchaine TP, Webster-Stratton C, Reid MJ. Mediators, moderators, and predictors of 1-year outcomes among children treated for early-onset conduct problems: a latent growth curve analysis. J Consult Clin Psychol. 2005; 73(3): 371.

    Article  PubMed  Google Scholar 

  73. Herrenkohl TI, Lee J, Hawkins JD. Risk versus direct protective factors and youth violence: seattle social development project. Am J Prev Med. 2012; 43(2): S41–S56.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Farrell AD, Mehari KR, Kramer-Kuhn A, Goncy EA. The impact of victimization and witnessing violence on physical aggression among high-risk adolescents. Child Dev. 2014; 85(4): 1694–1710.

    Article  PubMed  Google Scholar 

  75. Salzinger S, Feldman RS, Stockhammer T, Hood J. An ecological framework for understanding risk for exposure to community violence and the effects of exposure on children and adolescents. Aggress Violent Behav. 2002; 7(5): 423–451.

    Article  Google Scholar 

  76. Ng-Mak DS, Salzinger S, Feldman RS, Stueve C. Pathologic adaptation to community violence among inner-city youth. Am J Orthopsychiatry. 2004; 74(2): 196.

    Article  PubMed  Google Scholar 

  77. Fitzpatrick KM. Exposure to violence and presence of depression among low-income, African-American youth. J Consult Clin Psychol. 1993; 61(3): 528–531.

    Article  CAS  PubMed  Google Scholar 

  78. LeDoux J. Rethinking the emotional brain. Neuron. 2012; 73(4): 653–676.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Gaylord-Harden NK, Cunningham JA, Zelencik B. Effects of exposure to community violence on internalizing symptoms: does desensitization to violence occur in African American youth? J Abnorm Child Psychol. 2011; 39(5): 711–719.

    Article  PubMed  Google Scholar 

  80. Leventhal T, Brooks-Gunn J. Children and youth in neighborhood contexts. Curr Dir Psychol Sci. 2003; 12(1): 27–31.

    Article  Google Scholar 

  81. Leventhal T, Brooks-Gunn J. The neighborhoods they live in: the effects of neighborhood residence on child and adolescent outcomes. Psychol Bull. 2000; 126(2): 309–337.

    Article  CAS  PubMed  Google Scholar 

  82. Selner-O’Hagan MB, Kindlon DJ, Buka SL, Raudenbush SW, Earls FJ. Assessing exposure to violence in urban youth. J Child Psychol Psychiatry Allied Discip. 1998; 39(2): 215–224.

    Article  Google Scholar 

  83. Litrownik A, Newton R, Hunter W, English D, Everson M. Exposure to family violence in young at-risk children: a longitudinal look at the effects of victimization and witnessed physical and psychological aggression. J Fam Violence. 2003; 18(1): 59–73.

    Article  Google Scholar 

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Acknowledgments

This study was supported by grants from the National Institutes of Health (NIH; R01ES020447 and P60AA009803-RC5 to Dr. Theall, and R21MH094688 and R01MH101533 to Dr. Drury) and Centers for Disease Control and Prevention (CDC, R01CE002327 to Dr. Taylor).

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Authors and Affiliations

  1. Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, 1440 Canal St., Suite 2300, New Orleans, LA, 70112, USA

    Julia M. Fleckman, Catherine A. Taylor & Katherine P. Theall

  2. Department of Psychiatry and Behavioral Sciences, Tulane School of Medicine, 1440 Canal St., Suite 1000, New Orleans, LA, 70112, USA

    Stacy S. Drury

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  1. Julia M. Fleckman
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  2. Stacy S. Drury
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  4. Katherine P. Theall
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Correspondence to Julia M. Fleckman.

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This study was approved by the Tulane University Health Sciences Center Institutional Review Board.

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Fleckman, J.M., Drury, S.S., Taylor, C.A. et al. Role of Direct and Indirect Violence Exposure on Externalizing Behavior in Children. J Urban Health 93, 479–492 (2016). https://doi.org/10.1007/s11524-016-0052-y

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