تاثیر مواجهه با خشونت خانگی در کودکان و نوجوانان: بررسی متون

Objective This article reviews the literature concerning the impact of exposure to domestic violence on the health and developmental well-being of children and young people. Impact is explored across four separate yet inter-related domains (domestic violence exposure and child abuse; impact on parental capacity; impact on child and adolescent development; and exposure to additional adversities), with potential outcomes and key messages concerning best practice responses to children's needs highlighted. Method A comprehensive search of identified databases was conducted within an 11-year framework (1995–2006). This yielded a vast literature which was selectively organized and analyzed according to the four domains identified above. Results This review finds that children and adolescents living with domestic violence are at increased risk of experiencing emotional, physical and sexual abuse, of developing emotional and behavioral problems and of increased exposure to the presence of other adversities in their lives. It also highlights a range of protective factors that can mitigate against this impact, in particular a strong relationship with and attachment to a caring adult, usually the mother. Conclusion Children and young people may be significantly affected by living with domestic violence, and impact can endure even after measures have been taken to secure their safety. It also concludes that there is rarely a direct causal pathway leading to a particular outcome and that children are active in constructing their own social world. Implications for interventions suggest that timely, appropriate and individually tailored responses need to build on the resilient blocks in the child's life. Practice implications This study illustrate the links between exposure to domestic violence, various forms of child abuse and other related adversities, concluding that such exposure may have a differential yet potentially deleterious impact for children and young people. From a resilient perspective this review also highlights range of protective factors that influence the extent of the impact of exposure and the subsequent outcomes for the child. This review advocates for a holistic and child-centered approach to service delivery, derived from an informed assessment, designed to capture a picture of the individual child's experience, and responsive to their individual needs.

The past three decades have witnessed unprecedented interest in the scope and consequences of children's exposure to domestic violence, resulting in a depth of empirical knowledge about its prevalence and impact on its youngest victims (Hague & Mullender, 2006; Hazen, Connolly, Kelleher, Barth, & Landsverk, 2006). While the focus of this interest and understanding has largely been achieved by eliciting the views of women, shelter workers and other professionals, more recent inquiry has sought to explore directly children and young people's experience of exposure to domestic violence (Buckley, Whelan, & Holt, 2006; Hague & Mullender, 2006; McGee, 2000 and Mullender et al., 2002). Influencing this shift has been a changing perception and understanding of children's position within this abusive context. Where previously children were thought of as being tangential and disconnected to the violence between their parents, and commonly labeled “silent witnesses” (McIntosh, 2003), more recent qualitative research has disputed this opinion, finding children dynamic in their efforts to make sense of their experiences, while navigating their way around the complexity and terror intrinsic to domestic violence (McIntosh, 2002 and Mullender et al., 2002). The term “domestic violence” broadly refers to the intimate context within which one partner is abused by another, involving both men and women as victims and same sex partner violence. This term, while worn “smooth with use” (McIntosh, 2002) as the most frequently used and widely accepted term, is nonetheless criticised for, among other things, its gender-neutrality, and the primary emphasis on physical assaults and exclusion of other abuse (Stark & Flitcraft, 1996). While some research proposes equivalent prevalence rates of male and female perpetrated violence (Mirrlees-Black, 1999 and Morse, 1995), other research rejects the symmetry of men's and women's experience of intimate partner violence, for a number of reasons. First, the numeric extent of violence against women exceeds that of violence against men (Tjaden & Thoennes, 2000; Walby & Allen, 2004; Watson & Parsons, 2005). Second, the impact of the abuse is likely to be greater for women than men, both emotionally and injuriously (Walby & Allen, 2004; Watson & Parsons, 2005; Women's Aid & and the Child and Women Abuse Studies Unit, London, 2001). Third, women are at far greater risk of serious and lethal abuse at the hands of their male partner than men are at risk from their female partner (Campbell, Sharps, & Glass, 2001; Jaffe, Lemon, & Poisson, 2003; Walby & Myhill, 2001; World Health Organization, 2002). Cognisant of these dilemmas regarding definition and terminology, the term “domestic violence” is nonetheless used in this paper, primarily because it is in everyday and professional use and would easily alert people to its content. The terms inter-parental violence and intimate partner violence will also be applied interchangeably in this paper, which is concerned only with the intimate context within which women are abused by men. Studies on the impact of children's exposure to domestic violence have been beset with methodological concerns and complications. First, exposure to domestic violence is not a “homogeneous uni-dimensional phenomenon” (Jouriles et al., 1998, p. 178), whose impact can be neatly examined in isolation from the potential impact of other stressors or traumas in a child's life. With the co-occurrence of domestic violence and other forms of abuse and adversity clearly established in the literature, failure to differentiate abused children who also witness violence from those who witness domestic violence only, may inaccurately attribute a child's difficulties to the impact of witnessing, without considering the impact that being a direct victim of abuse may have on outcomes for the child (Connolly et al., 2006 and Edleson, 1999). Similarly, comparing children exposed to domestic violence with children who are not exposed, without regard for the variability in the level and type of abuses those children are exposed to, both ignores and obscures the potential differential impact on child adjustment from exposure to different types of spousal violence (Jouriles et al., 1998). Second, while recent studies have been more inclusive of broader populations to reflect the perceptions and experiences of multiple stakeholders in multiple settings (Levendosky & Graham-Bermann, 2001), prior research has been critisised for an over-sampling of research participants from shelters (Kashani & Allan, 1998). While representing a unique and highly visible sub-population of those exposed to domestic violence, shelter populations may constitute those most recently and severely affected (Edleson, 1999 and McIntosh, 2003) and who may be disproportionately representative of lower socio-economic populations (Kerig, 1998). In addition, shelter life may have a stressful and unique influence on children, which may be independent of their experience of family violence and not necessarily an accurate representation of their mental health in the long term (Edleson, 1999). Kerig (1998) also highlights concerns about research relying on children drawn from clinical populations, as they may be over representative of boys and dominated by externalizing problems. On a parallel vein, researchers comment on the paucity of reports of domestic violence from multiple family members or professionals, citing evidence that when such reports are sought, agreement is surprisingly low (Holden, 2003), and cautioning that studies which predominantly or solely reflects mothers’ reports of their children's problems will by their nature have limited accuracy as they lack the converging information necessary to ensure reliability and validity (Appel & Holden, 1998; Edleson, 1999). Appel and Holden (1998) suggest that as mothers are the sole informants in the majority of cases, the potential for both under and over-reporting needs to be considered. In partial agreement McIntosh (2003) warns only of widespread underreporting of domestic abuse by women. A third methodological issue is raised in Appel and Holden (1998) concerning the inconsistent use of a common criterion for defining child abuse, finding upward of 15 different definitions applied to the 31 studies they reviewed. Holden's later (2003) reflections on terminology considered the range and dramatically different types of exposure mentioned in the literature, with assessment of this exposure inclusive of both mothers’ reports about what their child saw or heard and children's own reports as witnesses. Fourth, criticisms of the measures employed to gather data include what Edleson considers to be an over-reliance on the child behavior checklist, on the grounds that it is a “rough gauge of general functioning,” and not developed to tap the distinctive impacts of witnessing violence (1999, p. 860). Echoing this point, McIntosh (2003) highlights the limited usefulness of measures across both cultural and socio-economically diverse populations, while Fantuzzo and Mohr (1999) go so far as to say that checklists are biased against those diverse populations. Fantuzzo and Mohr (1999) also point out that while the majority of research controls for the child's age and gender and the family's socio-economic status, less than half of the studies they reviewed controlled for variables such as marital status, mother's age and family size, with less again controlling for family stress, child's health or ethnicity (Fantuzzo & Mohr, 1999). Finally, Appel and Holden draw attention to the inconsistent referent period applied, with some studies reviewing lifetime experiences, while others focus only on more recent experiences (Appel & Holden, 1998). Despite these methodological complexities, research has gone some way to indicate the prevalence of children's exposure to domestic violence, to establish the impact of this exposure for children and to distinguish between the unique and universal impacts of this traumatic exposure to other forms of trauma in a child's life. Remaining mindful of the methodological criticisms outlined above and of the dearth of scientifically established estimates of the exact numbers of children exposed to domestic violence, existing data drawn from a variety of sources does, however, suggest that large numbers of children are involved. Fantuzzo and Mohr's (1999) review of the existing databases in the US established that children are present in households where intimate partner violence is occurring, at more than twice the rate they are present in comparable homes in the general population. McDonald, Jouriles, Norwood, Shine Ware, and Ezell's (2000) research with children referred to a child mental health clinic for behavioral difficulties, found that domestic violence occurred in 48% of clinic families, most commonly with 1–2 episodes of domestic violence per year. A substantial accumulation of reliable empirical data regarding the short- and long-term developmental implications for children who live with domestic violence has highlighted a differential yet potentially deleterious impact for children (Cleaver, Unell, & Aldgate, 1999; Edleson, 1999; Hester, Pearson, & Harwin, 2000; McGee, 2000, Mullender et al., 2002 and Saunders, 2003). This article attempts to contribute to the understanding of this complex phenomenon, by exploring the impact from the child's perspective, in so far as that is possible. To this end, four separate yet inter-related domains of enquiry are identified, with impact explored within and across these domains, as follows: (1) the co-occurrence of domestic violence and child abuse; (2) the impact on parental capacity; (3) the impact on child development; and (4) exposure to additional adversities. While there is undoubtedly a certain level of commonality in children's experience of domestic violence, it would be erroneous to assume that either impact or outcomes are predictably similar for all children. Masten and Coatsworth's (1998) work on resilient development identifies the different influences on children's development, and that children are protected “not only by the self-righting nature of development, but also by the actions of adults, by their own actions, by the nurturing of their assets, by opportunities to succeed and by the experience of success” (p. 216). Holding this resilient focus, this paper concludes with an overview of the potential outcomes for children exposed to domestic violence and a summary of the key messages for professionals concerning best practice responses to children's needs in the context of domestic violence.

This paper concludes that children may be significantly affected by the experience of domestic violence in their lives, the impact of which may resonate intergenerationally with their own involvement in adult violence (Markowitz, 2001). It also cautions however that there is rarely a direct causal pathway leading to a particular outcome (Wolfe et al., 2003) and that children are not passive participants but are active in constructing their own social world. Given the potential negative repercussions of children's exposure to domestic violence, in particular the intergenerational transmission of such violence (Ehrensaft, Cohen, & Brown, 2003), there exists a need for a wide range of programs that can intervene to improve their potential for healthy adjustment (McAlister-Groves, 1999). The literature reviewed advocates for a holistic and child-centered approach to service delivery, derived from an informed assessment of all of the issues outlined above and designed to capture a picture of the individual child's experience (Calder & Hackett, 2003; Hester et al., 2000; Kelly & Humphreys, 2001). Finally, interventions should be grounded in a clear philosophical and value base, beginning with an affirmation that the child's welfare is paramount and in many situations is intrinsically aligned to the protection and empowerment of their mother (Hendry, 1998 and Kelly, 1996).