Richard Thompson Richard Thompson Juvenile Protective AssociationJuvenile Protective Association

Jonathan Kotch, Terri Lewis, Des Runyan, Jonathan Kotch, Terri Lewis, Des Runyan, Jamie SmithJamie Smith

University of North CarolinaUniversity of North Carolina at Chapel Hillat Chapel Hill

Richard Thompson Richard Thompson Juvenile Protective AssociationJuvenile Protective Association

Jonathan Kotch, Terri Lewis, Des Runyan, Jonathan Kotch, Terri Lewis, Des Runyan, Jamie SmithJamie Smith

University of North CarolinaUniversity of North Carolina at Chapel Hillat Chapel Hill

Listening to children from Listening to children from LONGSCAN: What 12-year LONGSCAN: What 12-year

olds tell us about witnessing olds tell us about witnessing violenceviolence

Listening to children from Listening to children from LONGSCAN: What 12-year LONGSCAN: What 12-year

olds tell us about witnessing olds tell us about witnessing violenceviolence

AcknowledgementsAcknowledgementsAcknowledgementsAcknowledgements

• U.S. Department of Health and Human U.S. Department of Health and Human Services Services Administration for Children, Youth, and Administration for Children, Youth, and Families Families Children's Bureau Children's Bureau Office on Child Abuse and Neglect Office on Child Abuse and Neglect

• U.S. Department of Health and Human U.S. Department of Health and Human Services Services National Institutes of Health National Institutes of Health National Institute of Child Health and Human National Institute of Child Health and Human Development   Development  

The Prevalence of The Prevalence of Witnessed ViolenceWitnessed ViolenceThe Prevalence of The Prevalence of Witnessed ViolenceWitnessed Violence

• Nearly 40% of American teenagers Nearly 40% of American teenagers witness violence every year witness violence every year (Kilpatrick (Kilpatrick et al., 2000).et al., 2000).

• 15% witness violence using a weapon, 15% witness violence using a weapon, and 30% witness violence without a and 30% witness violence without a weapon weapon (Finkelhor et al., 2005)(Finkelhor et al., 2005). .

• In areas dealing with war or high In areas dealing with war or high rates of violence, child exposure to rates of violence, child exposure to violence is likely to be much higher.violence is likely to be much higher.

Impact of Witnessed Impact of Witnessed ViolenceViolence

Impact of Witnessed Impact of Witnessed ViolenceViolence

• Mental health problems: depression, Mental health problems: depression, PTSDPTSD

• Social problems: poor peer Social problems: poor peer relationships, school failurerelationships, school failure

• Risk-taking/aggression: juvenile justice Risk-taking/aggression: juvenile justice involvement, substance useinvolvement, substance use

• WHO:WHO: Witnessing violence predisposes Witnessing violence predisposes youth to engage in violence, and to be youth to engage in violence, and to be victims of violence later on victims of violence later on (Krug et al., (Krug et al., 2002).2002).

Child Report vs. Parent Child Report vs. Parent ReportReport

Child Report vs. Parent Child Report vs. Parent ReportReport

• Problems with reliability of child Problems with reliability of child report in very young (age 6) report in very young (age 6) children children ((Thompson et al. 2006).Thompson et al. 2006).

• Parents underestimate child Parents underestimate child exposure to violence, relative to exposure to violence, relative to child report child report (Litrownik et al., 2003).(Litrownik et al., 2003).

• Child reports of witnessed violence Child reports of witnessed violence better than parent reports of child better than parent reports of child witnessing in prediction of child witnessing in prediction of child outcomes: aggression, depression, outcomes: aggression, depression, anger, anxiety anger, anxiety (Johnson et al., 2002).(Johnson et al., 2002).

Main HypothesesMain HypothesesMain HypothesesMain Hypotheses

• Modest agreement between children Modest agreement between children and parents on child exposure to and parents on child exposure to violence.violence.

• Child reports of exposure willChild reports of exposure will predictpredict child outcomes, even after controlling child outcomes, even after controlling for parent reports and for other risk for parent reports and for other risk factors (demographics and factors (demographics and maltreatment history).maltreatment history).

• Effects will be present for both family Effects will be present for both family and non-family violence.and non-family violence.

Measures: OverviewMeasures: OverviewMeasures: OverviewMeasures: Overview• Independent variablesIndependent variables

Demographic informationDemographic information• RaceRace• GenderGender• Adult male in homeAdult male in home

Other control variablesOther control variables• Caregiver Depression: CES-DCaregiver Depression: CES-D• Child Maltreatment history: Official recordsChild Maltreatment history: Official records

Child exposure to violenceChild exposure to violence• Caregiver reportCaregiver report• Child reportChild report

• Dependent variables: Child behavioral outcomes: Dependent variables: Child behavioral outcomes: YSR: Child report (internalizing and YSR: Child report (internalizing and

externalizing)externalizing) CBCL: parent report (internalizing and CBCL: parent report (internalizing and

externalizing)externalizing) TSC-C: Trauma Symptom Checklist for ChildrenTSC-C: Trauma Symptom Checklist for Children

Independent Variables: Independent Variables: DemographicsDemographics

Independent Variables: Independent Variables: DemographicsDemographics

Race/Ethnicity African American

54%

White 27% Hispanic 6% Other 13%Child’s Gender Male 49% Female 51%Adult male in home 59%

Independent Variables: Independent Variables: Other Control VariablesOther Control VariablesIndependent Variables: Independent Variables: Other Control VariablesOther Control Variables

Maltreatment 67%

Caregiver Depression M Score (SD)

11.0 (9.9)

Independent Variables: Independent Variables: Exposure to ViolenceExposure to Violence

Independent Variables: Independent Variables: Exposure to ViolenceExposure to Violence

• Child Report: History of Witnessed Child Report: History of Witnessed Violence ScaleViolence Scale 8 items assessing witnessed violence8 items assessing witnessed violence Clarified whether violence included Clarified whether violence included

family or non-familyfamily or non-family Frequency ever witnessed: Likert Frequency ever witnessed: Likert

scale from none (0) to 4 or more scale from none (0) to 4 or more times (3). times (3).

Independent Variables: Independent Variables: Exposure to Violence Exposure to Violence

(cont.)(cont.)

Independent Variables: Independent Variables: Exposure to Violence Exposure to Violence

(cont.)(cont.)• Caregiver Report: Child Life Caregiver Report: Child Life

EventsEvents 6 items focused on witnessed 6 items focused on witnessed

violence from longer scale violence from longer scale Clarified whether violence Clarified whether violence

included family or non-familyincluded family or non-family Frequency witnessed in last year: Frequency witnessed in last year:

Likert scale from none (0) to 4 or Likert scale from none (0) to 4 or more times (3).more times (3).

Dependent Variables: Dependent Variables: Child Behavioral Child Behavioral

OutcomesOutcomes

Dependent Variables: Dependent Variables: Child Behavioral Child Behavioral

OutcomesOutcomes M (SD)

YSR: Internalizing 48.4 (9.6)

YSR: Externalizing

47.8 (10.5)

CBCL: Internalizing

51.3 (10.9)

CBCL: Externalizing

55.2 (11.1)

TSC: PTSD 41.1 (8.4)TSC: Anxiety 41.0 (9.4)TSC: Depression 39.8 (8.6)

Method: AnalysisMethod: AnalysisMethod: AnalysisMethod: Analysis• All subjects with age 12 interviewAll subjects with age 12 interview• Subjects with incomplete data droppedSubjects with incomplete data dropped• CorrelationsCorrelations• Series of hierarchical regression Series of hierarchical regression

analysesanalyses Step 1: Models with caregiver reportsStep 1: Models with caregiver reports

•Family violenceFamily violence•Non-family violenceNon-family violence

Step 2: Child reports addedStep 2: Child reports added•Family violenceFamily violence•Non-family violenceNon-family violence

Subjects: Subjects: Complete vs. Incomplete Complete vs. Incomplete

DataData

Subjects: Subjects: Complete vs. Incomplete Complete vs. Incomplete

DataData• LONGSCAN sample with age 12 data: 949LONGSCAN sample with age 12 data: 949• Analysis sample (complete data): 781 Analysis sample (complete data): 781 • Analysis sample less likely to be Hispanic Analysis sample less likely to be Hispanic

(6% vs. 12% in sample with missing (6% vs. 12% in sample with missing data)data)

• Analysis sample lower mother depression Analysis sample lower mother depression (11.0 vs. 13.9)(11.0 vs. 13.9)

• Analysis sample less internalizing (YSR): Analysis sample less internalizing (YSR): (48.4 vs. 51.5)(48.4 vs. 51.5)

• Site DifferencesSite Differences• No differences on other factors.No differences on other factors.

Child Exposure to Family Child Exposure to Family Violence: Parent-Child Violence: Parent-Child

AgreementAgreement

Child Exposure to Family Child Exposure to Family Violence: Parent-Child Violence: Parent-Child

AgreementAgreement

• Agreement significant BUT very modestAgreement significant BUT very modest

Parent-Child

CorrelationFamily Violence .14Non-Family Violence

.15

Violence Exposure as a Violence Exposure as a Predictor of Child Predictor of Child

Outcome (YSR)Outcome (YSR)

Violence Exposure as a Violence Exposure as a Predictor of Child Predictor of Child

Outcome (YSR)Outcome (YSR)Internalizi

ngExternaliz

ing

Std B Std B

Maltreatment .00 -.02

Caregiver Depression .14 .09

Caregiver Report: Non-Family

.02 .04

Caregiver Report: Family

-.02 .00

Child Report: Non-Family

.12 .22

Child Report: Family .13 .14

Violence Exposure as a Violence Exposure as a Predictor of Child Predictor of Child Outcome (CBCL)Outcome (CBCL)

Violence Exposure as a Violence Exposure as a Predictor of Child Predictor of Child Outcome (CBCL)Outcome (CBCL)

Internalizing

Externalizing

Std B Std B

Maltreatment .06 .10

Caregiver Depression .23 .21

Caregiver Report: Non-Family

.02 .05

Caregiver Report: Family

.21 .18

Child Report: Non-Family

.07 .13

Child Report: Family .01 .01

Violence Exposure as a Violence Exposure as a Predictor of Child Predictor of Child

Outcome (TSC)Outcome (TSC)

Violence Exposure as a Violence Exposure as a Predictor of Child Predictor of Child

Outcome (TSC)Outcome (TSC)PTSD Anxiet

yDepressi

on

Std B Std B Std B

Maltreatment .05 .04 .07

Caregiver Depression

.05 .07 .09

Caregiver Report: Non-Family

-.02 .02 -.00

Caregiver Report: Family

.00 -.05 -.01

Child Report: Non-Family

.18 .14 .14

Child Report: Family

.18 .16 .19

Summary of ResultsSummary of ResultsSummary of ResultsSummary of Results• Child reports of both family and non-Child reports of both family and non-

family violence predict child reports of family violence predict child reports of internalizing and externalizing behaviors internalizing and externalizing behaviors and trauma symptoms.and trauma symptoms.

• Neither caregiver reports of family or Neither caregiver reports of family or non-family violence predict child reports non-family violence predict child reports of internalizing or externalizing of internalizing or externalizing behaviors, or trauma symptoms.behaviors, or trauma symptoms.

• Caregiver report only of family violence Caregiver report only of family violence predicts caregiver report of internalizing predicts caregiver report of internalizing and externalizing behaviors.and externalizing behaviors.

• child report only of non-family violence child report only of non-family violence predicts caregiver report of internalizing predicts caregiver report of internalizing and externalizing behaviors.and externalizing behaviors.

Summary of Results Summary of Results (cont.)(cont.)

Summary of Results Summary of Results (cont.)(cont.)

• There is a significant but modest There is a significant but modest correlation between child and correlation between child and caregiver report of both family and caregiver report of both family and non-family witnessed violence.non-family witnessed violence.

• Caregiver depression predicts five of Caregiver depression predicts five of seven adverse child behavioral seven adverse child behavioral outcomes and depression.outcomes and depression.

• Child maltreatment predicts only two Child maltreatment predicts only two (caregiver report of externalizing (caregiver report of externalizing behavior and child report of behavior and child report of depression) of the seven outcomes.depression) of the seven outcomes.

LimitationsLimitationsLimitationsLimitations• Systematic, not representative, Systematic, not representative,

samplesample• Cross-sectional, not longitudinalCross-sectional, not longitudinal• Some differences between total Some differences between total

sample and sample used in analysis sample and sample used in analysis (differences controlled for)(differences controlled for)

• Site differences (controlled for)Site differences (controlled for)• Difference measures used for Difference measures used for

caregiver witnessing and child caregiver witnessing and child witnessingwitnessing

Implications for Implications for Research and Clinical Research and Clinical

PracticePractice

Implications for Implications for Research and Clinical Research and Clinical

PracticePractice• Pay attention to child reports of Pay attention to child reports of

witnessing violence witnessing violence Child report is a better predictor of Child report is a better predictor of

child’s self-reported behaviors than child’s self-reported behaviors than caregiver report.caregiver report.

Caregiver may be a valid source of Caregiver may be a valid source of child-witnessed family violence, but child-witnessed family violence, but not of child-witnessed non-family not of child-witnessed non-family violence, especially as the child violence, especially as the child grows older.grows older.

Implications for Implications for Research and Clinical Research and Clinical

Practice (cont.)Practice (cont.)

Implications for Implications for Research and Clinical Research and Clinical

Practice (cont.)Practice (cont.)• Among children at risk of Among children at risk of

maltreatment, witnessed violence maltreatment, witnessed violence happening to others in the family and happening to others in the family and the community may be associated with the community may be associated with adverse outcomes.adverse outcomes.

• Researchers should include children’s Researchers should include children’s reports of witnessing violence in reports of witnessing violence in studies of maltreatment outcomes.studies of maltreatment outcomes.

• For more information, visit our website For more information, visit our website at at http://www.iprc.unc.edu/longscan/http://www.iprc.unc.edu/longscan/

ReferencesReferencesReferencesReferences1.1. Finkelhor et al. 2005. The victimization of children Finkelhor et al. 2005. The victimization of children

and youth: A comprehensive, national survey. and youth: A comprehensive, national survey. Child Child Maltreatment Maltreatment 10:10: 5-25. 5-25.

2.2. Johnson et al. 2002. Adverse behavioral and Johnson et al. 2002. Adverse behavioral and emotional outcomes from childhood exposure to emotional outcomes from childhood exposure to violence. violence. Child MaltreatmentChild Maltreatment 77:179-186.:179-186.

3.3. Kilpatrick et al. 2000. Risk factors for adolescent Kilpatrick et al. 2000. Risk factors for adolescent substance abuse and dependence: Data from a substance abuse and dependence: Data from a national sample. national sample. Journal of Consulting and Clinical Journal of Consulting and Clinical PsychologyPsychology 68: 19-30 68: 19-30

4.4. Krug et al., eds. Krug et al., eds. World report on violence and health.World report on violence and health. Geneva : World Health Organization, 2002.Geneva : World Health Organization, 2002.

5.5. Litrownik et al. 2003. Exposure to family violence in Litrownik et al. 2003. Exposure to family violence in young at-risk children: A longitudinal look at the young at-risk children: A longitudinal look at the effects of victimization and witnessed physical and effects of victimization and witnessed physical and psychological aggression. psychological aggression. Journal of Family Violence Journal of Family Violence 18: 59-73.18: 59-73.

6.6. Thompson et al., 2006. Children’s self-reports about Thompson et al., 2006. Children’s self-reports about violence exposure: An examination of the Things I violence exposure: An examination of the Things I Have Seen and Heard scale. Have Seen and Heard scale. Manuscript under Manuscript under review.review.