008: The impact of stress and violence on children

Transcript

Jen Lumanlan 00:35

Hello and welcome to episode 8 of the Your Parenting Mojo podcast, and I’m afraid this is an episode I wish I didn’t have to do.  When I launched the podcast I asked anyone who has a question about parenting or child development that I might be able to answer through a review of the scientific literature to reach out and let me know, and someone got in touch to ask about the impact of domestic violence on children.  I was a little hesitant to do an episode on it at first because I was hoping that this would be something that wouldn’t really affect the majority of my audience.  But as I did a search of the literature I found that domestic violence is depressingly common and more children are exposed to it than we would like.  And if you’re getting ready to hit that ‘pause’ button and move on to a different episode, don’t do it yet – there’s also research linking exposure to domestic violence dragging down the test scores of everyone else in that child’s class.  So even if you’re not hitting anyone or being hit yourself, this issue probably impacts someone in your child’s class, and thus it impacts your child, and thus it impacts you.  Listen on to learn more about the effects of stress in general on children, and the effects of domestic violence in particular.

Jen Lumanlan 01:36

Let’s start with a general look at the impact of stress on the unborn baby, as well as on infants and preschool-aged children.  The developing fetus’ brain development is actually modified in response to a pregnant woman’s exposure to stress, because chemicals called glucocorticoids pass through the placenta.  These chemicals are important for normal brain maturation, and both too-high and too-low levels of glucocorticoids impair the fetus’ brain development.  Maternal stress and anxiety are linked to low birth weight and smaller size for gestational age of the baby, and with problems like unsociable and inconsiderate behaviors, ADHD, some psychiatric disorders, drug abuse, and mood and anxiety disorders developing as these children grow older.  Luckily it seems as though some of the effects of prenatal stress can be moderated by high-quality postnatal care, because the brain continues to develop at a rapid rate after the baby is born.

Jen Lumanlan 02:26

Children also experience maternal stress after they’re born.  Most research seems to focus on the effects of maternal depression on the infant, because depression can make it harder to bond with the baby and provide high quality care.  Some researchers looked at the brain activity of children with depressed mothers and found differences in frontal lobe activity from children with mothers who weren’t depressed, and that activity was correlated with diminished empathy and other behavioral problems.  Children of mothers who were clinically depressed in the child’s early years are also at a greater risk of developing depression in their own adolescence.

Jen Lumanlan 02:55

Many studies look at stress from a moment-in-time perspective, but I found one that examined the impact of maternal stress on babies and children over a period of 4 ½ years.  It turns out that stress is actually quite an easy thing to objectively measure: when someone is stressed their hypothalamic-pituitary-adrenal system releases the steroid hormone called cortisol from the adrenal gland, and cortisol can be measured using a simple saliva test.  The study found that children whose mothers had (diagnosed) depression both in infancy AND at age 4 ½ years had higher levels of cortisol than children whose mothers weren’t depressed at one of those times.  The researchers also found that children with high levels of cortisol at age 4 ½ are at greater risk for emotional and social difficulties in the transition to preschool and then for mental health symptoms at the end of the first grade of school.

Jen Lumanlan 04:41

It’s not only maternal stress that causes stress in young children, of course.  Children can be stressed by being in daycare for long periods of time; one study found that children had higher levels of cortisol in the afternoons than the mornings, although this can be mitigated with more supportive care.  High cortisol levels have been linked to impulsivity, lack of self-control, and aggression.  More extraverted children seem to cope better – their cortisol levels might be higher at the beginning of the school year as new relationships are formed but decline to normal later in the year.  Children who still have high levels of cortisol later in the year show more introverted tendencies.  I’m actually planning a future episode on supporting introverted children because I seem to have one, so stay tuned for that, but in the meantime I wanted to point out that there isn’t a direct line from stress to reaction; it’s mitigated by the child’s adaptation strategies and might be better thought of as a biological sensitivity to stressful situations.  In turn, it’s possible that children who are exposed to high levels of early stress may develop a high biological sensitivity to stress.  Other children might develop low biological sensitivity to stress and become more resilient than we might expect them to be given their exposure to stress and other adversity.   And I should say that so far there isn’t any evidence that elevated cortisol levels impact a child’s development, although children who are in poor daycare conditions early in their lives have an increased risk of behavioral problems later on.

Jen Lumanlan 05:00

So, on to domestic violence.  Every year, approximately 4.8 million acts of physical or sexual aggression are perpetrated against women in the United States, and many of these incidents take place in the presence of children. Researchers have estimated that between 3 and 18 million children in the U.S. are exposed to adult domestic violence each year.  The variation occurs due to differences in what, exactly you decide constitutes “violence” and even what counts as “exposure” – whether it’s actual beatings, or a broader group of behaviors like slaps and shoves, or a pattern of physically abusive acts.  “Exposure” is normally defined as being within sight or sound of the violence, but in some studies it also includes hitting or threatening a child while in his mother’s arms, taking the child hostage to force the mother’s return to the home, or forcing the child to watch assaults against the mother or to participate in the abuse.  Some mothers and children report that the aftermath of abuse is just as traumatic – an injured mother, a father who is loving one minute and violent the next, and the police being called to remove someone from the home.  I do want to acknowledge that while virtually all the studies describe father-on-mother violence that mother-on-father violence does exist, and even mother-on-mother violence in households with two mothers present.

Jen Lumanlan 06:07

Many studies have shown that children exposed to domestic violence have significantly greater behavioral, emotional, and cognitive functioning problems, depressive symptoms, anxiety, and worry, as well as difficulties adjusting to young adulthood than children who have not been exposed to violence.  The enormous variety of different types of behaviors and consequences found implies that the relationship between exposure and impacts is complex.  But not all children show these problems – at least two studies have found no greater problems in children exposed to violence than children who weren’t.  Some researchers have suggested that the number and type of risk factors are important, as well as the level of both risk AND protective factors.  A child’s gender and age, the frequency and severity of the violence as well as how long it has been happening, and the child’s relationship with his mother and the person who batters her may all influence the outcomes of the exposure to violence on the child.  While younger children may be most affected by exposure to domestic violence, they may experience a decrease in symptoms as they mature, although there are relatively few studies that have attempted to follow children for long enough to test this properly.  Young boys may demonstrate more externalizing behaviors while girls may display more internalizing behaviors, although not all studies have found this to be the case.  The development of problem behavior symptoms may be related to the amount of control the child feels over the situation – one study found that children who felt as though they had more control over a violent situation, either by attempting to calm the situation or just calming themselves, exhibited fewer problem behavior symptoms than children who felt they had less control.  Infants and toddlers, of course, are totally dependent on others for care – they can’t even control their own emotions, never mind attempt to control someone else’s.  Children who have higher self-esteem may develop more successful coping strategies, which in turn makes them more resilient, because children who feel more in control of their life circumstances may be less affected by the violence they witness.  Distress in very young children may manifest itself behaviorally in regressive behavior around language and toilet training, sleep disturbances, emotional distress, and a fear of being alone, as well as headaches, stomach aches, asthma, insomnia, nightmares, and sleepwalking.

Jen Lumanlan 08:08

Children who witness violence are often victims of violence as well – review studies find an average of 41% of children who witness violence are also victims of violent behavior, with estimates ranging from 30-70%.  And the ending of a relationship doesn’t necessarily equate with an end to violence exposure: one researcher commented that “separation is not a vaccination against domestic violence.”  A broad range of research studies using a variety of methodologies have found that violence tends to continue after separation and may actually increase in severity and lethality. Empirical evidence clearly shows that the quality of parenting and ability of both parents to meet the child’s needs are compromised in households where domestic violence is present.  Mothers who have experienced violence may find it more difficult to create an attachment with their child, and this type of stress and depression can result in an emotionally distant, unavailable, or even abusive mother.  One to two-thirds of abused women experience post-traumatic stress disorder, low self-esteem, depression, and anxiety, and this can limit the woman’s ability to develop authority over her children – all of which may compound the behavioral problems of the child and increase the impact of the original violence for the child.  Certainly not all abused women are deficient parents, but the research indicates that as a result of living in constant fear, abused women may deny their children the sense of basic trust and security that is the foundation of healthy emotional development.  Battered women are also more likely to hit their children than women who were not in abusive relationships.

Jen Lumanlan 09:30

Early stressors have impacts not only in children’s lives while they’re young, but these effects can continue for the rest of the children’s lives.  Many researchers look at one relatively small aspect of an issue in some depth, but one paper I read looked across the studies on neurobiological effects of childhood abuse on brain structure and function, and integrated that with epidemiologic data from a quiz that uses data on 17,000 adults’ adverse child experiences – the study was conducted by Kaiser Permanente, so I guess they used data from their patients.  The researchers were able to predict negative health outcomes in the adult’s lives based on their answers to the Adverse Child Experiences, or ACE quiz, which you can actually take yourself if you’re interested – it’s only 10 questions.  Look for the link to the ACE Quiz in the references for this episode.  Higher scores on the ACE quiz are linked to unexplained periods of panic, history of hallucinations, substance abuse, early sexuality and sexual dissatisfaction and intra-abdominal fat, which itself carries a mortality risk.  But overweight parents with substance abuse problems don’t normally go to the doctor and say “I need help because I saw my mother being abused when I was a child,” so doctors end up trying to treat the middle-aged person’s symptoms without a full understanding of the origins of those symptoms.

Jen Lumanlan 10:37

It’s encouraging to remember, though, that while a child’s experience with violence can be correlated with later violent behavior, the initial experience is not the sole determining factor.  Despite all of the results of negative outcomes that we’ve seen, some children are remarkably resilient and emerge mostly unscathed.  One review study found that 67% of child witnesses to violence fared more poorly than the average child, the other 37% experienced outcomes similar to or better than children who hadn’t experienced violence.  A resilient attachment to a non-violent parent or other caregiver has been shown in a variety of studies as a protective factor in mitigating trauma and distress.  The mother often emerges as the most important source of support in these children’s lives, but other adults, including grandparents can also provide important support.

Jen Lumanlan 11:20

What are some other protective factors that can help children cope with exposure to violence? Positive parenting, support, and high maternal authority are associated with more positive and less antisocial behaviors, and less externalizing behaviors.  A child with an easy temperament, who generally has a positive mood, high adaptability, and low reactivity show fewer behavior problems than children with what researchers would call “difficult” temperaments.  Children with easy temperaments are less reactive to stressors and more likely to use flexible coping strategies to deal with stress, and can better regulate their feelings.  High intelligence has also been associated with positive adaptation and is predictive of lower levels of psychiatric disorders, lower rates of behavioral problems, and higher overall functioning.  This may be because IQ is linked to verbal skills, giving children a larger range of coping strategies.

Jen Lumanlan 12:10

So, by now, perhaps you’ve already intuited the way in which this issue can impact you even if you’re not directly involved in a violent relationship – and it’s because the kinds of behavioral problems that children who witness domestic violence exhibit are the kinds of problems that disrupt a classroom.  A unique study among the ones that I’ve found, at least, measured the impact of the behavior of children who have been exposed to violence on the learning outcomes of the other children.  The study looked at children in the third through fifth grade classes in 22 elementary schools from the 1995-96 through the 2002-3 school year, so a seven year timespan, which a pretty large sample size and long timeframe for these kinds of studies.  The researchers got data from public records at the county courthouse about requests for injunctions against another family member.  The names and addresses are public in these cases so researchers could link the people who got injunctions to the students in the same school district, and the researchers found that  4.6% of the children in the sample were linked to a domestic violence case filed by a parent.  61% of the children were Black, and 85% were eligible for subsidized school lunches.  The children from troubled homes committed 55% more disciplinary infractions than children who weren’t exposed to violence.  Domestic violence is associated with a large decrease in the test scores of students who weren’t exposed to violence – adding one more troubled student to a class of 20 is associated with a decline of 10.4 percentile points for each of his classmates.  The effect is about 18% of the effect of being directly exposed to domestic violence in the child’s own home.  And this isn’t just a problem for poor families – when the researchers looked at the effect of children who are from lower-income families and are exposed to domestic violence on the reading and math achievement scores of children from higher-income families they found that adding one additional low-income troubled child to a class of 20 decreases the test scores of higher-income students by 1 ½ percentage points.  The researchers note that they believe their estimate is a lower boundary because they were only looking at effects within the classroom, and troubled children likely interact with children from other classes both in school and in neighborhoods and may negatively impact those children’s learning as well, so the overall effect that the troubled children have on other children’s learning might be much higher than this study found.

Jen Lumanlan 14:20

So what can parents do to protect their children?  It’s not my place to offer relationship advice but the scientific literature clearly shows that if your child witnesses physical abuse, it’s going to have some kind of impact on them both now and for the rest of their lives, and whether they cope with that impact better or worse than average depends a lot on your child’s personality.  Leaving an abusive relationship is incredibly difficult, and while the conventional wisdom says your quality of life will be higher if you leave than if you stay, when scientists try to test this they find that other stressors take the place of the abuse, like finding housing, poverty, and fighting for custody.  This study only followed women for a year, though, and it’s possible that two years down the line as these immediate issues became resolved, the overall quality of life began to increase in a way that it wouldn’t have if the women had stayed in the relationship.  The National Domestic Violence Hotline says that violence can escalate when someone tries to leave, so if you do choose to leave, figure out where you can go to get help.  Try to set aside some money or ask a friend or relative to hold money for you.  If you’re injured, go to a doctor or emergency room.  Look up the number for your local shelter so you have it if you need it.  Let someone know what’s going on.  If you don’t have someone else to talk with, email me at jen@yourparentingmojo.com.  I’m not a professional advice line, but I will try to help you if I can.

Jen Lumanlan 15:36

And if there’s a kid acting out in your child’s daycare or preschool, keep an eye on him.  Keep an eye on his parents.  Obviously not all acting out is driven by violence, but if you think it might be, ask the parent if everything is OK.  Even if they say ‘yes,’ the tone of their ‘yes’ will often tell you what you need to know.  Try to offer support by suggesting a playdate or a coffee.  Ask if the person has somewhere to turn – you don’t have to be everyone’s ‘safe space,’ but it’s good to know that everyone has one, even if it’s not you.  Believe me, it could make more of a difference than you know. I hope nobody listening to this ever needs it, but just in case, the number for the National Domestic Violence hotline is in the show notes for this episode on YourParentingMojo.com; look for episode 8, the impact of stress and violence on everyone’s kids.