Family Violence Carrying Over ‘Intergenerationally’

Introduction

Statement of The Problem

Having read through several research articles and other materials this researcher has discovered that witnessing violence in the family leads to several psychological problems in later life and adulthood. A pattern is seen whereby children who grow up in abusive homes turn out to be abusers themselves. This pattern whereby the cycle of abuse is taken over by the next generation contributes to the intergenerational transmission of domestic violence. The question arises as to how this cycle could be broken or stopped. The literature on the subject has delved into the relevant variations seen. Possible predictors of family violence carrying over ‘intergenerationally’ into the children have been suggested by many researchers. Pertinent questions about the effects, risks, and interventions have been researched in an attempt to find an answer to the current pattern. The problem of how we are going to change the pattern of the cycle of abuse is the question.

Statement of Purpose

The purpose of this clinical research project is to offer a comprehensive literature review on major components of ‘domestic violence’ which disturbs the life of children. There are five separate entities involved in this research: Family Violence; Intergenerational effect; Resiliency, Attachment, and Interventions. The collection of research on these matters is intended to be an exploratory study of first the separate factors involved and second this writer’s proposal that a healthy attachment to a role model is the key to resiliency. If we can establish what creates resiliency in the cycle of violence then this can provide the basis for new prevention work to be utilized in the area of working with victims of domestic violence. If we know that a healthy attachment and positive role model can potentially break the intergenerational transmission pattern, then we can encourage this type of relationship to take place with those who are at risk for continuing the cycle. Given that many women who are in abusive relationships will remain so, often throughout their child’s life; this has implications for domestic violence programs across the country. If these programs implement psycho-educationally modeled groups with curricula that emphasize the importance of a healthy attachment, this can empower mothers to protect their children and therefore break the intergenerational pattern of violence. Domestic violence and its effects on children are considerable problems in the field and despite the lack of specification training most, if not all professionals/therapists are likely to encounter this phenomenon in all lines of work and thus this information is relevant in all clinical and therapeutic functions.

Significance of the study

Statistics tell that the problem of child abuse is a growing and significant health problem. Many children are unable to face the difficulties and become abusers themselves or become psychiatric patients. Society needs to aim at finding methods of eliminating the possibility of children having domestic violence.

Research Hypotheses

A healthy attachment to a child maltreated through witnessing domestic violence or experiencing physical abuse can break the cycle of abuse and prevent the child from proceeding to a life of behavioral, cognitive, and school maladjustment problems, socialization deficits, and adaptive behavior deficits through interventions which strengthen resilience.

Children will be negatively affected by their exposure to domestic violence against women or physical abuse as reflected on a variety of measures assessing emotional adjustment, school-related risk, and delinquency.

The combined effects of both domestic violence through witnessing it and being victimized through direct physical abuse will have more negative outcomes than with anyone experience.

Among maltreated children, children exposed to domestic violence are more likely to repeat a grade and have school adjustment problems than physically abused children.

The intergenerational transmission process allows for the correlation of the degree of exposure to domestic violence in childhood to the extent of current behavior.

The attachment theory increases the field of risks and protective factors and thereby the predictability of intergenerational transmission of domestic violence.

The attachment has a positive relationship with affect regulation which is a mediator in the intergenerational transmission of domestic violence.

Intergenerational transmission of domestic violence leads to externalizing behaviors of poor school performance, delinquency, drug abuse, and alcohol abuse and internalizing behaviors of depression and suicidal thoughts.

Intergenerational transmission of domestic violence is moderated by some factors which break the cycle of abuse leading to a favorable change in outcomes.

Resilience helps children facing adversity to break the cycle of abuse and adapt positively towards an outcome much different from that expected under their circumstances.

A healthy attachment is a basic requirement in any intervention to change the attitudes, behaviors, and outlooks of a maltreated child who is to be guided into becoming a personality academically inclined with good social disposition and equipped to face the challenges of the world and contributing positively to it.

Interventions incorporating a healthy attachment help break the cycle of abuse and build resilience in a maltreated child.

Domestic violence precipitates emotional abuse.

This researcher has outlined the main hypothesis completely relevant to the dissertation (numbered one) and several other hypotheses related to the literature review done. These facts have been new to this researcher and could be to others too.

Definitions

Domestic violence

1. The World Report on Violence and Health (WRVH), released by the World Health Organization (WHO) in October 2002, defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either result in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.”(Dahlberg and Krug, 2002).
2. Domestic violence is defined as the “physical, sexual or psychological violence directed toward children, women, men, or elders that occurs or has occurred within familial or intimate relationships” (Centers for Disease Control & Prevention [CDC], 1997).
3. Domestic or intimate partner violence typically refers to violence perpetrated against adolescent and adult females within the context of family or intimate relationships. (Lu, 2007, Pg. 1)

The first two definitions have been taken from exalted organizations and the third from a researcher’s point of view. Domestic violence is also termed spousal violence, partner violence, intimate partner violence, marital conflict, or parental conflict.

Child maltreatment

Child maltreatment is the abuse of children by the witnessing of domestic violence against women or experiencing physical abuse which could be exacerbated by the influence of an unhealthy attachment leading to psychological, behavioral, and social negative outcomes which cause the child to experience illness and maladjustment problems in school and adulthood, in intimate relationships and to be prone to delinquency and crime.

Emotional abuse

Emotional abuse and neglect are ‘persistent hostility, persistent failure to respond to the child’s physical, emotional, intellectual and social needs, seriously unrealistic expectations, inappropriate stimulation of a child’s aggression and/or sexuality, exploitation of a child for the gratification of another’s needs and grossly inconsistent care’ (Mitchell, 2005). This is another form of child maltreatment.

A Healthy Attachment

A healthy attachment is a natural phenomenon of the seeking, attaining, and retaining close proximity of a child to a preferred caregiver, the mother or mother-like figure, through a process of bonding and other processes which permit the development of a child with psychosocial resilience and competent personality.

Intergenerational transmission

Intergenerational transmission is the process by which the experiences of a child in infancy and childhood are carried over to its adulthood through a social learning process of imitating modeled behavior by a peer personality, usually the father, and attachment to a caregiver who is usually the mother or a mother-like figure.

Resilience

Resilience is the dynamic process involved in building the capacity of a child to resist adversity and be protected against the expression of problems arising out of exposure to domestic violence at an impressionable infant or young age and leads to positive adaptation and evolution of a normal competent personality towards adulthood.

Academic Resilience

Academic resilience can be defined as the development and maintenance of average or above-average levels of academic attainment despite the experience of socio-economic adversity or other adversities in childhood. (Schoon, 2006, Pg.8)

Research Design

Research Questions

1. What is a healthy attachment?
2. How are children affected through exposure to domestic violence?
3. Are the outcomes of experiencing both domestic violence witnessing and being physically abused the same as experiencing either one?
4. What are the differences in children who witnessed domestic violence or experienced physical abuse where school adjustment problems are concerned?
5. What is the reason for current violent behavior in people who were exposed to domestic violence in childhood?
6. What are the theories behind the intergenerational transmission of domestic violence?
7. How does ‘affect regulation’ influence the intergenerational transmission of domestic violence?
8. What are the behavioral outcomes possible due to intergenerational transmission of domestic violence?
9. Can intergenerational transmission be modified into positive outcomes?
10. What is the role of resilience in the intergenerational transmission of domestic violence?
11. What is the role of healthy attachment in the intergenerational transmission of domestic violence?
12. How can the cycle of abuse be broken to prevent the intergenerational transmission of domestic violence?
13. Is emotional abuse part of domestic violence?

Data Sources and Methodology

In order to obtain the existing literature in the key areas that comprise this project, this researcher had to conduct a thorough search that would enable the gathering of such information. Literature was gathered from published, peer-reviewed, psychological articles and books from two libraries online. Some of the journals selected were the Journal of Family Violence, Child and Family Behavior Therapy, Journal of Nurses in Staff Development, Developmental Psychology, Monitor on Psychology, Children and Youth Services Review, Cognitive and Behavioral Practice, Child Development, Contemporary Family Therapy, Journal of Women’s Health and Psychosomatic Medicine. Most of the matter was selected from recent studies and books. The new books that this researcher has used are Kaplan & Sadock’s Comprehensive Textbook of Psychiatry (2005), Resilience to Childhood Adversity (Fergusson and Horwood, 2003), 5 minutes Consult Clinical Companion to Women’s Health (Amy Gottlieb, 2007), Current Diagnosis & Treatment Obstetrics & Gynecology, 10th Edition (2008), Basic Concepts Of Psychiatric-Mental Health Nursing (Rebraca, 2005) and Resilience in Children, Families and Communities: Linking Context to practice and policy (2005). The Google the search engine also contributed to some material. Though this researcher planned only 100 references, he has in the course of his search reached around 200.

The matter obtained was broken up into five key areas: (1) Family Violence (2), Intergenerational effect (3); Resiliency (4), and Attachment (5) Interventions. All five areas were initially used separately to determine the amount of literature available. For example, a generic search was conducted on the area of family violence by plugging in all the terms that may apply (such as family violence, domestic violence, spousal abuse, etc). When terms were used to search they were truncated in order to capture all possible relevant research available. When these results were found, this researcher then narrowed the playing field by plugging in existing saved searches (i.e., 1-4) and matching up different aspects of the literature. For example, the search for family violence, (1), was then matched with the search for intergenerational effect (3) and so on until all five elements had been searched with each of the five elements and all possible scenarios exhausted. This type of methodology was employed in all the data sources mentioned above.

Limitations and Delimitations

No qualitative research was conducted in this study to provide any evidence for the hypothesis, thus findings are limited to information already provided in the existing literature. Careful consideration was given to the focus of this study to establish the boundaries of the scope of the work and to provide the most relevant material to the reader. For example, it was necessary to tease out the difference between those who witness DV and those who were abused; however due to the lack of research that makes these delineations studies that involved both were included. It was also necessary to explore and limit the type of abuse.

Literary Review

History

Many people think that family violence was discovered in the 1960s. It is true that the scale of effort on behalf of victims has been greater since that period than ever before. But in fact, reports of DV date back to Colonial times where one eighteenth-century judge is reported as suggesting that the size of the beating instrument a husband could legally use should be no thicker than a man’s thumb (incidentally this is where the saying rule of thumb is derived from) (Pleck, 2004). From 1640 to 1680, the puritans of colonial Massachusetts enacted the first laws anywhere in the world against wife-beating and “unnatural severity” to children. A second reform epoch lasted from 1874 to about 1890; when societies for the prevention of cruelty to children (SPCCs) were founded and smaller efforts on behalf of battered women were initiated (Pleck, 2004). According to Kashani (1998) in contrast to child abuse, public policy in the United States has been relatively slow and hesitant to recognize spousal abuse as a major problem, and consequently, women have traditionally not been protected adequately from abuse by legislation.

Domestic Violence: A Public Health Problem

Violence was first recognized as a public health problem of priority in 1996 by the WHO. A major report was ready by 2002 (WHO, 1996, 2002). The U.S. Department of Health and Human Services [USDHHS], 1998) aims at nationwide reduction of violence in its national health plan, Healthy People 2010.

Though the home is considered as a safe haven, it is the place where the most common violence manifestations are seen (Lu, 2007, Pg.1). Domestic or intimate partner violence refers to the violence perpetrated against an adult or adolescent female within the family. 95% of victims of domestic violence are women (Lu, 2007, Pg.1). The abuser aims to dominate and control the victim and keep things that way. A behavior pattern is seen whereby the abuser resorts to physical, sexual, psychological, and economic coercion. The victim, feeling ashamed and guilty does not report the abuse. The violence would be in the form of threats, throwing objects, pushing, kicking, hitting, beating, sexual assault, and threatening with or using a weapon (Lu, 2007, Pg.1). Verbal abuse, social isolation, deprivation of food, money, transportation, and denial of health access are some of the other methods.

Phases of Domestic Violence

The violence is in the progression of a cycle and can be predicted. 3 phases have been recognized in DV: the phase of tension building, the battering phase, and the honeymoon phase.

Tension building phase

The tension-building phase is wrought with arguments and blaming. The battered person withdraws without protests or any display of her anger. The batterer fully senses the partner’s anger, becomes possessive, jealous, and fearful ( Rebraca, 2005, Pg.526). An emotional distance is created. The batterer gives vent to his anger, rationalizing that the battered person did not assert her stance and thereby accepted what he says. Minor abuse is coped with by the battered person. She is depressed. The batterer has his tension relieved through drugs or alcohol.

Acute Battering phase

These may incite the battering phase where the batterer loses control of his behavior ( Rebraca, 2005, Pg.526). The battered person also loses control and is unable to stop the physical abuse. The actual violence is perpetrated in the battering phase and includes verbal threats, sexual abuse, physical hitting or slapping, and the use of weapons. Immediately after, both are in a state of shock. They cannot remember the details of what happened.

Loving phase

In the loving phase, the abuser denies the violence. Both become calm. He makes excuses, apologizes, buys gifts, and promises never to repeat it again. He claims that he cannot live without her. The battered person believes and forgives him as she feels helpless. The batterer also takes her response as a show of her love and thinks that she has excused his misbehavior (Rebraca, 2005, Pg.526). However, this lasts only till the next cycle.

Factors favoring domestic violence

Unemployment, poverty, alcohol and drug abuse increase domestic violence. Domestic violence is rampant across all ethnicities, races, religions, educational levels, and socioeconomic strata. Within the framework of domestic violence, child abuse, elder abuse and abuse of disabled people occur.

Why women do not leave a violent relationship

Women in spite of being battered opt to remain in the relationship. The reasons could be that they lack resources, institutional responses, and traditional ideology (Rebraca, 2005, Pg.526).

Lack of resources

The woman may be having a child and may not be able to maintain proper living standards for the children (Rebraca, 2005, Pg.527). She may not be able to access cash or bank accounts. The existence of her and the children become dependent on the perpetrator. If she leaves home, a charge of desertion may prevent her from having custody of the children. She may also lose any joint assets with the spouse.

Lack of institutional responses

Reporting violence to the police and clergy usually produces negative responses.

The situation may worsen if the batterer gets information about her complaints. The police believe in considering domestic violence as just a dispute wherein the woman is discouraged from filing the complaint (Rebraca, 2005, Pg.527). Restraining orders do not prevent the batterer from returning to his old pursuits. Prosecutors are unwilling to prosecute these batterers. Clergy and counselors believe in ‘saving the marriage’. The woman does not have her complaint justified. Her condition becomes worse and the domestic violence continues (Rebraca, 2005, Pg.527).

Traditional ideology

Tradition has taught her that divorce is not an acceptable option. The children need the father. A single-parent family is unacceptable to society. She even explains away her husband’s behavior as due to stress factors. Not strong enough to take positive action and stop the abuse, she hopefully waits till her husband changes himself and stops the abuse. She lacks self-confidence and feels ashamed, embarrassed, and powerless. Her argument that life is like this and not so bad keeps her going ( Rebraca, 2005, pg.527).

Clinical Presentation of Domestic Violence

Sexual abuse presents as chronic pelvic pain, decreased interest or arousal, dyspareunia (painful intercourse), or chronic vaginitis (Lu, 2007, Pg.2). The women become anxious during the pelvic examination. Spousal abuse may be seen as persistent multiple body aches, chronic headaches, palpitations, abdominal complaints, and sleep disturbances. Eating disorders are also common (Lu, 2007, Pg.2). They may also present with complaints that do not point to any organic illness or physiological mechanisms. Symptoms may be found linking to psychological problems. Some present with post-traumatic stress disorder due to their frequent experiences and others develop full-fledged psychosis (Lu, 2007, Pg.2).

Diagnosis Of Domestic violence

Diagnosis is a problem unless the situation is looked out for. The barriers are the practitioner’s lack of knowledge, lack of understanding about the widespread prevalence of domestic violence, lack of time to rule out the abuse, fear of offending the patient, and feeling powerless where treatment is concerned (Lu, 2007, Pg.3). The screening assessment should include questions about violence which every patient can answer. Direct questioning would give a picture. Questions asked to the face of the patients would produce more results. It is important to keep the perpetrator out of the examination room and ask the questions in complete privacy without using anyone in the family for even interpretation.

Assistance to the abused in Domestic Violence

The disclosed abuse must be acknowledged and the trauma documented (Lu, 2007 Pg. 3). Immediate safety must be assessed and if necessary, a safety plan must be established. The victim must be given education and referred to community support services. Direct quotations may be recorded. The recording must be completely confidential, giving no inkling to the perpetrator. The shelter must be offered if she cannot go back. Educational materials may be left where the victims can just pick them up while in the hospital (Lu, 2007, Pg.4). Referral sources for police departments, emergency departments, shelters for battered women, rape crisis centers, counseling services, self-help programs, and agencies for legal, financial, and emotional support may be provided. Referral services for psychiatric treatment also may have to be done.

Domestic Violence in pregnancy

‘The prevalence of domestic violence during pregnancy ranges from 0.9% to 20.1%, with most studies identifying rates between 3.9% and 8.3%.’ (Tjaden and Thonnes, 1998). Whereas violence in nonpregnant women is directed at the head, neck, breasts, and abdomen are frequent targets during pregnancy. Physical abuse during pregnancy is a significant risk factor for low birth weight and maternal complications of low weight gain, infections, anemia, smoking, and alcohol or drug usage {Tjaden and Thoennes, 1998).

Domestic violence in pregnancy is harmful to the mother and child (Lu, 2007, Pg.2). Domestic violence appears to be a greater problem for pregnant women than pre-eclampsia, gestational diabetes, and other complications of pregnancy. The extent of violence may increase during the pregnancy period especially into the postpartum period. The physical and psychological stress would be increased. The victim would not be able to avail of adequate antenatal care (Lu, 2007, Pg.2). There would be poor nutrition and weight gain expected in pregnancy. Subsequently, the victim resorts to alcohol, cigarettes, and substance abuse. Physical trauma can give rise to abruptio placentae, preterm labor, preterm premature rupture of membranes, and maternal and fetal injuries and demise, all very serious consequences (Lu, 2007, Pg.2).

Domestic violence includes physical or sexual abuse and psychological menace.

Spousal abuse is the deliberate, severe, and repeated injury to a domestic partner by the other (Jeanjot, 2008). Abuse is found in all people of different ethnicities, socio-economic situations, levels of education, of the aggressor or battered women. It is a major public health problem. Pregnancy is a situation where the pregnant woman is more highly vulnerable to body changes. Increased economic pressures and less frequent sexual relationships trigger abuse more frequently (Jeanjot, 2008). The violence could induce obstetric complications due to direct trauma, or indirectly through stress, depression or poor obstetric health. Various surveys showed that many women have been subject to violence, 17% in the current pregnancy. This figure was obtained from frequent systematic screening during each trimester (Jeanjot, 2008). Intimidation could explain why women did not leave.

Jeanjot’s Study

Jeanjot’s study estimated the prevalence of pregnant women with violence and tried to identify the risk factors involved. 3 groups were used for the study. The first group of women experienced violence during their current pregnancy. The second group had a history of violence but not during this pregnancy. The third group never had any experience of violence. Obstetric complications were noted and health care providers’ attitudes were evaluated (Jeanjot, 2008). 44 women (22%) reported violence, at least once. 22 (11%) experienced violence in the current pregnancy. In 70% of cases, the aggressor was a relative, the husband or the companion or ex-husband or ex-companion, or rarely some other woman. Some had different aggressors. 3 women had verbal and psychological abuse. 5 had physical violence added upon the verbal and psychological abuse. 4 had sexual violence. The present pregnancy was due to rape by their husbands for 3 women. 45.5 % of women had only psychological abuse. Physical and sexual violence constituted 6% (Jeanjot, 2008). For 13 women, violence began or increased with pregnancy. 1 woman reported alcohol abuse by the aggressor. Violence was detected in 41% (9) women by the staff. Half of these had already left the aggressor. 13 women never complained of abuse. 2 women who had not left the aggressor asked for help (Jeanjot, 2008)

Sexual abuse

It occurs through using force or threat or due to an inability of the victim to protest (Lu, 2007, Pg.4). The majority of cases often go unreported. Sexual abuse is the sexual act performed by one person on another without her consent. It includes genital or oral or anal penetration. Marital rape is the abuse forced on a non-consenting partner in a marital alliance. Acquaintance rape, date rape, and incest are the various sexual offenses done on a non-consenting person. Statutory rape is sexual intercourse with a girl between the ages of 14-18 as specified by law (Lu, 2007, Pg.5). Child sexual abuse is the contact between a child and an adult, solely for the gratification of the adult. All states of the US have made it mandatory to report these abuses. In half of the states, physicians are required to report incidents coming to their notice. Society has a tendency to blame the victims for which reason, the victims hesitate to report to the authorities. The motivation for most sexual assaults is the degradation and humiliation of the victim rather than the sexual gratification (Lu, 2007, Pg.5).

The victims do not usually reveal that they have been abused sexually. Mental symptoms or other symptoms which do not have any connection with the abuse would be presented. A rape trauma syndrome results from abuse (Lu, 2007, Pg.5). The first response is seen in the acute phase which lasts for hours or days. There will be a complete loss of emotional control and the victim cannot cope with the situation. Crying incessantly or excessive anger may be seen. Sometimes an unnatural calm may be the presenting feature. This is probably due to the attempt of the victim to assume control over her. The initial reactions of denial, shock, numbness, and withdrawal may subside after 2 weeks (Lu, 2007, Pg.5). For two weeks after the abuse till several months later, the symptomatology returns and can become intensified. At this time, the victim seeks treatment for symptoms. The next phase which is the delayed phase occurs months or years afterward. It is characterized by anxiety, vulnerability, loss of control, and self-blame. Plenty of mental problems like nightmares, catastrophic fantasies, sexual dysfunction, distress, and mistrust could be seen (Lu, 2007, Pg.5)

Elder abuse

Research, education, intervention, and overall funding have all been done in association with spousal abuse and child abuse. However, elder abuse which has been existing for centuries has merited attention only recently. There is a paucity of research in this field even now. State and Federal Laws now exist to protect elders (Geroff, 2007). Elder maltreatment is seen across all races, ethnicity, and socio-economic groups. Their abusers would be a close family member like a spouse or adult child. It could also be a professional caregiver. It is really hard to reach these elders as they are isolated, impaired, or dependent (Geroff, 2007). Greek mythology and literature reveal stories of patricide to gain power. Some tribes have encouraged the ritual suicide of the less productive leader. Early American history has incidents of witch-hunting where elderly postmenopausal women have been tortured and burnt at the stake. It was only in 1975 that granny battering began to be spoken about.

Child maltreatment

Experiencing physical maltreatment or witnessing domestic violence as a child is associated with a variety of negative outcomes that go beyond immediate physical injuries. Victims report numerous physical, psychological, and behavioral sequelae. The negative effects of maltreatment experienced as a child are continued well into adulthood (Chiodo, 2008).

Chiodo’s study

Child protection services are increasingly in demand. Childhood trauma from witnessing domestic violence in the family of origin is increasing in number. This awareness has bolstered the services. Chiodo’s study of 2008 investigated 3 groups of maltreated children. The groups included those children who witnessed domestic violence against women, the physically abused children, and the children who had experienced both. The outcomes that were noticed for the maltreatment were behavioral problems, school-related ones, delinquency, and an overall risk (Chiodo, 2008). Other research has identified the poorer outcomes as problem behaviors, socialization deficits, and adaptive behavior deficits (Kaplow and Widom, 2007). Cognitive functioning and language development may be affected (Pears and Fisher, 2005). The extent of the outcome differed in the children. The trauma experienced by children by witnessing domestic violence against women or experiencing physical trauma themselves are seen in 30-60% of families (Edleson, 1999).

Negative Effects OF Maltreatment

Experiencing physical abuse produces many physical, psychological, and behavioral sequelae. These reflect internalizing behaviors of depression and suicidal thoughts and externalizing or aggressive behaviors of poor school performance, delinquency, drug, and alcohol abuse (Trickett, 1997). Maltreated children have more adjustment problems and difficulty maintaining peer relationships (Pelcovitz, Kaplan, DeRosa, Mandel, & Salzinger, 2000). The negative effects of maltreatment in childhood are carried into adulthood. Witnessing domestic violence has been declared as a form of criminal child abuse (Kantor & Little, 2003). 75-100% of domestic violence is witnessed by children. 45% -70% of the exposed children have experienced physical abuse themselves (Fantuzzo and Mohr, 1999). Emotional and behavioral dysregulation and psychopathology are associated with witnessing domestic violence (Cummings, Davies, & Campbell, 2000). Children from violent homes are more associated with the destruction of public property, depression, and aggression than children from non-violent homes. Academic problems due to impaired concentration and achievement occur in these affected children. Verbal, motor, and cognitive skills are affected. The battered parent may not be able to handle the child emotionally as she is unavailable, being preoccupied with her own problem. The children exhibit various problems depending on the age they are in when exposed. Younger children may see most of it and be really vulnerable. Pre-school-age children are likely to have physical ailments, emotional problems, and aggressive behavior. Older children exhibit poor academic performance and have difficulty identifying with their peers. One method adopted in child welfare policies is to take the child away from the mother which is a drastic procedure. A less drastic method would be to combine the child protection services and the domestic violence network services together and keep the child with the mother and put them in programs to lessen the trauma (Magan et al, 2000). The data in Chiodo’s study confirmed the prediction of earlier studies that child victims of abuse and witnesses to domestic violence experienced higher rates of psychopathology (the double whammy of Hughes, Parkinson, and Vargo, 1989). The result was also in accordance with studies that reported patterns of insecure attachment (Morton & Brown, 1998).

The Plight of the female Care-giver

This study indicated that female caregivers who were victims of domestic violence were compromised people who could not perform their parenting capacity to the maximum. They had severe physical and mental disorders. The study also found that abused children behave in such a manner as to reject interventions of inconsistent parenting styles. This leads to a compromise of the secure attachment. Community interventions become important to improve parent-child interactions. Academic performance was found to be poor and conforming to earlier studies. Resilience may be cultivated if the maltreated children are provided the facility of a ‘structured and predictable school environment’. The children become stable and participate in extra-curricular activities (Egeland, Carlson & Sroufe, 1993).

Differences Between the Domestic violence and the physical abuse groups

Children who are exposed to domestic violence are different in two aspects from the children who are physically abused. Physically abused children have a greater behavioral risk than children exposed to domestic violence against women (Chiodo, 2008). Children who have experiences of both types of maltreatment have the highest behavioral risk, very similar to the children with physical abuse alone. Both these kinds of children learn to use aggression or deviant behavior to solve their problems. Experiencing partner violence does produce effects in some parts of the psychosocial development but may not affect behavioral risks (Chiodo, 2008).

The second difference between the 2 groups is that younger children are more exposed to domestic violence and the children who undergo physical abuse are older. A study has indicated that children who are exposed to domestic violence are more prone to being physically abused (McCloskey et al, 1995). Exposure to domestic violence must be taken as a warning for the possibility of future abuse.

Symptomatology is not very different in both groups. When comparing the outcomes, the children who are exposed to domestic violence and are physically abused also are the ones with maximum changes in psychological, behavioral, and academic concerns (Chiodo, 2008). Co-occurrence of victimization and exposure produces greater trauma than the groups with anyone kind of abuse.

Co-existence of the two problems together

It is essential to rule out domestic violence when investigating children of physical abuse. The battering could be an underlying problem. Counseling of these children should assume a family systems approach, especially in children with a disrupted attachment where they are taken away from the mother. The most intensive interventions must be given to the children who experience both fits of abuse (Chiodo, 2008).

The Plight of the Maltreated Children

Interventions are aimed at general behavior patterns, regulation of affect, and support for the disrupted attachment. Children who are put into foster homes need support from counselors. Their feeling of loss needs to be attended to, healthy interactions with the foster parents must be encouraged and the child’s mental development must be assisted. Separation of the child and mother could be prevented by combining the domestic violence networks and the child protection services as earlier mentioned (Kirk and Griffith, 2004). Chiodo’s study highlights the significance of family violence in the lives of children. Vulnerable children have effects far more than the actual abuse. Neglect of these childhood issues could produce further harm by producing adults who would repeat what they have experienced. Necessary interventions would prevent such adults from coming up in this world (Chiodo, 2008).

Summary of the significant outcomes of maltreated children after Child’s Study

Children exposed to domestic violence against women were much younger than children who were physically abused and children experiencing two forms of maltreatment. There was no gender difference. Both male and female children had the same outcome. Physically abused children were more likely to have ADHD than those witnessing DV. Children who experienced both types of maltreatment had more chances of developing ADHD than when exposed to DV alone. In the evaluation of ADHD, the proportion which had the DV and the physically abused were similar. The result was similar in conduct disorder. Maltreated children compared to children exposed to violence were more likely to have repeated a grade than the physically abused. The children with both experiences had the biggest chances of repeating a grade when compared to either of the other 2 groups taken alone. The variable of chronic absenteeism did not have a significant difference between the 2 groups of single abuse. Children physically abused were older than those exposed to DV. The combined abuses also occurred in older children. A three-way analysis of covariance ANCOVA showed a significant difference in the groups of differently maltreated children. The children who experienced both types of maltreatment scored higher on the cumulative risk assessment scale than either of the other 2 groups. In the groups experiencing either the physical abuse or the exposure to DV, both had similar cumulative risk assessment scores.. In the overall risk assessment score, surprisingly there were no differences. The behavioral risk scores measured the variables of external behavior patterns of aggression or withdrawal, use of alcohol or drugs, or violence towards others showed the highest score for the combined experience group, the higher for the physically abused, and the least for the group exposed to DV.

The Child Abuse and Prevention Treatment Act (CAPTA)

This act of the United States was amended in 2003. It accorded intervention services to maltreated infants and toddlers. Funding for this comes under Part C of the Individuals With Disabilities Education Act (IDEA). IDEA 2004 provides intervention services for children under 3 who have been involved in a substantiated case of neglect or abuse. Part C is expected to reduce developmental delays. CAPTA says child abuse and neglect is “Any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act which presents an imminent risk of serious harm”. (USDHHS, 2006)

‘Substantiated maltreatment’ is the investigation disposition that is used to refer to cases where the allegation of maltreatment or risk of maltreatment was supported or founded by state law or state policy (USDHHS, 2006). The Act does prevent some maltreated children who are referred but do not avail of the intervention services due to some obstacles like the establishment of eligibility. Children who need timely interventions for developmental progress are denied a favorable outcome for apparently flimsy reasons. Delay in the provision of intervention services is of particular concern as maltreatment is known to be related to education problems later, requiring special education services (Jonson-Reid et al, 2004). There is also concern over the underutilization of Part C services (Rosenberg, Smith, and Levinson, 2007).

Eligibility for Part C services

Developmental delay is the primary criterion for eligibility for Part C services. The degree of delay varies with the states (Shackleford, 2006). A diagnosed risk condition which would delay development is another accepted criterion. Chromosomal anomalies are included here. The third category is left to the discretion of the states.

Infants and toddlers who are exposed to biochemical or environmental conditions that place them at risk are eligible if the state laws permit. Only 5 states permit this (Shackleford, 2006). As only few states recognize the risk, maltreated infants may still experience delay in getting the services.

National Study of Child and Adolescent Well-Being. (NSCAW)

Purpose of study

The purpose of this study was to obtain answers about the crucial program, its policy and issues of concern to the Federal government, State and Local governments

and Child Welfare Agencies (Scarborough, 2008). The characteristics of maltreated infants, their care-givers, maltreatment experiences, factors related to the Individualized Family Service Plan which decides the eligibility for Part C services are all covered in the study. The characteristics of the children or care-givers or the maltreatment could change over 5 4 months, the time till the next assessment (Scarborough, 2008). The goal of the study was to inform the providers of Part C, the educators and child welfare service providers about the features of maltreated infants who are covered under the IFSP and the relationship to the special education services at the kindergarten age (Scarborough, 2008). 5501 children covered under the Welfare Agency were selected first for the study.

Procedure adopted and Instruments used

Children, the primary care-giver, the welfare worker and teacher if present were interviewed about the children’s health, development, behavior and family experiences with the child welfare services (Scarborough, 2008). Baseline data were first collected and then updated at 12, 18, 36 and 54 months afterwards. 49% were male children. 44 % white, 30% black, 27% Hispanic or otherwise was the ethnicity noted. 45% were below 6 months of age. 55% were between 7 months and 12 months at baseline. 92 County Child Welfare Agencies participated from 36 states. Oversampling was chosen so that enough children were still available for the study. Retention rate at 54 months was 85%. The development status was assessed with the Bayley Infant Neurodeveloper Screener. Potential impairments or delays in the basic neurological functions, receptive functions (sensation and perception), expressive functions (fine, oral and gross motor skills) and the cognitive processes of memory, learning and thinking were evaluated. The scale was marked as risk levels of low, moderate and high (Scarborough, 2008). For assessing cognitive development in children below 3, the Batelle Development Inventory was used. BDI measures the perceptual discriminations skills, memory, reasoning, academic performance and conceptual development. The Kaufman Brief Intelligence Test was used to measure children from 4 years upwards. This measured verbal and non verbal intelligence, tested vocabulary and the ability to perceive relationships. Children with scores lower than 1.5SDs below the mean had poor cognitive development. Auditory and expressive communication skills were examined using the Pre-School Language Scale 3

(Scarborough, 2008).. This scale distinguished language disorders 66 -80 % of the times. A score 1.5SDs below the mean of above signified a language development problem. The Child Behavior Checklist and the Teachers Report Form measured the emotional and behavioral problems. Total problem scores greater than 63 were considered significant. The Loneliness and Social Dissatisfaction Scale was used to measure loneliness, social adequacy, peer status and relationship quality. 1 SD above the mean or greater was comsidered as depicting a high level of loneliness and social dissatisfaction. Health was rated by welfare workers as excellent, very good, good, fair or poor (Scarborough, 2008).

Care-Givers

Caregivers were described according to age, education level, poverty level and whether they had cognitive impairment, mental illness, substance abuse and domestic violence (as history or active) (Scarborough, 2008). The Composite International

Diagnostic Interview Schedule-Short-Form was used to test for substance dependence. Interpersonal violence was tested using the Strauss Conflict-Tactics scale. Self reports also were collected from the care-givers. The Home Observation Measure of the Environment Short Form gave an idea of the emotional nurturing, cognitive /verbal responsiveness and stimulation in the home. Those environments having a score of lower than 10% were considered of low quality. A modified Maltreatment Classification system was used (Scarborough, 2008). Workers decided whether the maltreatment was substantiated, indicated or unsubstantiated; whether there were earlier reports on the child; and the level of harm perceived at the first instance. Following the investigation by the workers, it was decided whether to give it the IFSP, which says that the child is eligible for early services under Part C. If the child was not selected, it would still be observed for 12 months to check for developmental disability. The report from the teachers confirmed whether the child was getting special education services.

Findings

31% children had IFSP. 53% of maltreated infants were high neurodevelopmental risks at baseline (Scarborough, 2008). 19% had poor cognitive scores. 12% scored low on languages. 14 % had behavior problems as seen by the welfare workers. 22 % had poor physical health. 68% care-givers were less than 35 years at baseline. 37% did not complete high school and 45 % lived below the poverty line. 56 % had current or past history of domestic violence. 34 % had mental illness and 33 % had substance problems. 13 % had cognitive problems and 12 % had low quality homes. Children with the IFSP were more likely to have been reported for substantiated maltreatment and were more likely to have had the experience of severe or moderate harm. At the age of five and a half, 25% had a low level language score, 13 % had a low cognitive score and 13 % had loneliness and social dissatisfaction (Scarborough, 2008).

We notice that the cognitive score has reduced from 19% at baseline age to 13% at 5.5 years of age. 12 % score for low level languages rose to 25% at the higher age. Parents reported internalizing problems in 7% children, externalizing problems in 20 % and total clinical level problems in 20%. Teachers reported internalizing problems in 9%, externalizing problems in 13% and total clinical level problems at 9%. At 5.5 years of age, 18% could not do regular school work as they had emotional, physical or some mental problems which interfered with their regular school work. Among the maltreated infants with an IEP (Individualised Education Plan), 66% had speech and language impairments. A developmental disability was seen in 26% and Attention Deficit Hyperactivity Disorder was seen in 25%. Learning disability was seen in 24% and emotional disturbance was seen in 22% (Scarborough, 2008).

The services available

Boys were found to require IEP twice as many times and special education services three times as many times. Children with a care-giver having cognitive impairment were more than 9 times as likely to have IEP due to poor parenting. Surprisingly characteristics of maltreatment did not have any relationship with the IEP 54 months later. Policies allow maltreated children receive special services like IEP, IFSP and special education services provided they are substantiated cases. In the study 31% of cases were reported for IFSP whereas the incidence reported for Part C services is 2.3%. A vast difference existed. Under-utilisation of Part C services is true and needs a change (Scarborough, 2008).

National Incidence

Researchers in the United States have estimated that spousal abuse or partner abuse comes to approximately 5.3 million women each year (Tjaden & Thoennes, 2000). Rapes are estimated to be at 300,000 women and 93,000 men in a single year and minority groups are victimized more (Tjaden & Thoennes, 2000). One in three women, physically assaulted or raped by an intimate partner, is injured. More than 500,000 women injured because of domestic violence need medical treatment (Tjaden & Thoennes, 2002). 3% of emergency treatment women are victims of spousal abuse. Thirty percent of women who seek emergency room treatment have experienced abuse at some time in their life (Dearwater et al., 1998). 324,000 women experience domestic violence during pregnancy in a year (Gazmararian et al., 2000). A child witnessing domestic violence is at risk for physical and mental health problems of long term duration. Alcohol and substance abuse, becoming a victim of abuse, or abusing others are some of the outcomes (Felitti et al., 1998). The health-related costs of rape, physical assault, stalking, and homicide by intimate partners exceed $5.8 billion each year Brackeley, 2008). Of this total, nearly $4.1 billion are for direct medical and mental healthcare services. Productivity losses account for nearly $1.8 billion, according to a report by the Centers for Disease Control and Prevention (CDC, 2003).

Findings of the US Census, 2005

Based on the July 2005 U.S Census estimate released January 2006 (223,000,000 total U.S adults aged 18 or over), approximately 33 million or 15% of all U.S. adults, admitted that they were victims of domestic violence. Furthermore, 6 in 10 adults claimed that they knew someone personally who had experienced domestic violence. Among all adults, 39% said that they had experienced at least one of the following, with 54% saying that they hadn’t experienced any: called bad names (31%); pushing, slapping, choking or hitting (21%); public humiliation (19%); keeping away from friends or family (13%); threatening the family (10%); forcing you to have sexual intercourse without consent (9%) (All State national Poll, 2004). It is unfortunate that indications of abuse and family violence are significantly under-reported due to the very nature of the “private problem.” Many women do not come forward for fear of retribution and shame. Especially likely to go unreported is abuse of women and children of color and of others outside the majority culture. Social and economic barriers and inequalities are often the greatest barriers to reporting and limit access to help (All State National Poll, 2004).

More recent statistics

More recent statistics give a worse picture. 4-5 million women are believed to be abused by their partners. 21% of the crimes experienced by women are caused by their intimate partners (Lu, 2007). 40% of murdered women are done to death by their husbands, boyfriends or ex boyfriends. One fifth of all American women are predicted to be physically assaulted by their partners at some time in their life. Child abuse occurs in 33-77% of families where adults are abused (Lu, 2007). The prevalence of domestic violence in ambulatory care settings is between 20 and 30%. Prevalence of assault in pregnancy is between 1 and 20%, most studies showing a range between 4 and 8%. Estimates show that every year 700000 and 10000000 American women are sexually assaulted. One estimate states that 30% report to the police and 50% do not tell anyone (Lu, 2007). It seems that 20% of adult women, 15% of college-going-age young girls and 12% of adolescent girls have had experiences of abuse. The very young and the disabled, physically or mentally, are vulnerable. 75% of adolescent assaults are from acquaintances and can be termed acquaintance rape. Incest and date rapes also come under the group of sexual assault. Date rapes are associated with alcohol and drugs like flunitrazepam which reduce the female’s ability to refuse consent or remember the incident. Statutory rape is when girls between 14 and 18 years of age are assaulted (Lu, 2007). Child sexual abuse is when a child is being used for the stimulation of an adult. Marital rape is the term used when the violence is perpetrated within the sanctity of a marriage but without the consent of the partner.

Annual Child Injury Mortality

Recent assessments show that the Annual child-injury mortality of 8.6/100 000 is seen in high-income countries compared with 41.8/100 000 in low- and middle income countries (Global Burden of Disease Database, 2002) in the statistics of violence to children. The problem is obviously yet to be solved.

USDHHS statistics

Statistics in the Children’s Bureau of the Department of Health and Human Services show that in 2002, 3 million victims were recorded as requiring child protective services. 896000 of these were found to be correct reports. This came to 12.3 per 1000 children. 60% came under the protective services due to neglect, 20% due to physical abuse, 10% due to sexual abuse and 7% due to emotional abuse. The Bureau found that 1400 children died due to maltreatment (Kaplan, 2005). Of these, 41% were within the first year of age.

The Elder Population

Life expectancy has risen greatly in the last century. There is an elder boom in America (Geroff, 2007). The fastest growing age segment is the ‘over 75’ group. The number of centenarians has doubled in the last 10 years. In 1980, 25.5 million people were above 65 years of age and represented 11.3% of the population. In 2000, the Census showed 35 million people in this group, constituting 12.4 % of the population (Geroff, 2007). At this time, 4.2 million were 85 and above. More interactions would be seen between the over-85s and the health care system. The senior outpatient visits are in the ratio 2:1 when compared to the general population. Elder abuse will obviously increase.

The Health Policy in the United Kingdom

The United Kingdom government policy has broadened its concept of child protection to one of safeguarding (DfES, 2007). Vulnerable children could be abused, neglected or go in for mental and physical ill health. They could also face educational failure, indulge in crime and anti-social behavior. They should be protected from all these (McDougall, 2004). The Change for Children Programme with its theme “Every Child Matters” is targeted at safeguarding and improving life chances for children

(DfES 2003). The children particularly requiring these services are the ‘looked after’ children (in local authority care), disabled children, those in custody and those exposed to domestic violence. The safeguarding duty lies with the directors of the childrens’ services and Council members (DH, 2006). The health profession has been adapted to meet the demands of modernization. Accountability and increased responsibility now rest with the nursing profession. The Public Health White Paper (DH, 2004) is enabling all people including children to make ‘informed and healthy lifestyle choices’. It recognized that children needed more protection and that school nursing helped children to make positive healthy lifestyle choices (DH, 2004). Children in custody are a particularly vulnerable group being subjected to ‘high rates of bullying and intimidation, extensive self-harm, high rates of mental health problems, and an alarming rate of suicides’ (Lambert, 2005). Nurses and other professionals are working with children in custody, assessing vulnerability, self-harm and suicide. Safeguarding a child affected by domestic violence is also a priority. 90% of all registered domestic violence is witnessed by children (DH, 2006). This amounts to 750000 children per year as registered. The problem is expected to be much higher and the registered figure could only be the tip of the iceberg. Safeguarding children should become a part of everyday nursing.

Risk Factors

As already mentioned DV can happen to anybody but research suggests there are a constellation of risk factors that can influence a person’s likelihood of being in an abusive relationship. All racial, socioeconomic, religious, and ethnic groups have a record of domestic violence (Gottlieb, 2007).

Age factor

A young age below 36, single, separated or divorced female, are additional risk factors for domestic violence (Gottlieb, 2007). In America, 61% of rape victims are below 18 years and one third below 11 years. The rates of violence among the blacks between 15 and 17 years especially have risen, far outpacing violence in other groups (Bernet, 2005, Pg. 3416). In 1995, one third who indulged in violence was between the ages of 12 and 19 and one half of all victims were below 25. It was found that 94% of men had to seek medical care at least once in a span of 4 years (Bernet, 2005,). 41% of these cases were due to violent incidents. However it is heartening to note that there has been a decline in the violent crime (Bernet, 2005).

The Sex Factor

The main social problems are domestic violence and sexual abuse against women.

It is surprising that assaults perpetrated by both men and women are similar by Carol Zlotnick et al’s study. She found that 5% men and 4% women assault their partner (Kaplan, 2005, Pg. 2395). Murray Strauss reported that more women who exercised severe violence by kicking and punching had the same rates for exercising minor assaults of slapping and throwing things at the partner. Strauss tallied 39 studies of family violence (Kaplan, 2005, Pg 2395). David Sugarman and Gerald Hotaling also found a higher rate of assault by females in dating relationships (Kaplan, 2005, Pg 2395). Witnessing violent behaviors brings out different traumatic consequences in male and female children. Males are afraid of being violated but they exhibit behaviors which seem to identify with the abusers. The females become afraid of being attacked.

Violence in pregnancy

Women originating from Africa appeared to be more abused than other socio-cultural groups when compared to the non-abused. The women who had been abused were usually unmarried or in an unstable relationship (Jeanjot, 2008). Substance use did not show a difference between abused and non-abused women. Abused women had more

anxiety and insomnia than non-abused women. This anxiety was especially pronounced during pregnancy. The women who suffered violence in pregnancy had depression and accepted less social support. They had more of induced abortions than the non-abused group. They had less pre-natal follow-up (Jeanjot, 2008). Complications of pregnancy were not different in the abused and non abused groups. Abuse in pregnancy can cause abruption placenta, abortion, premature rupture of membranes, premature labor, premature delivery, uterine rupture, fetal-maternal shock and death. However Jeanjot’s study did not find any difference of incidence of these in the abused group. Violence in pregnancy may induce the woman to resort to smoking or alcohol abuse.

Drug Abuse

5.9 to 6.9 million women in America are found to have a substance use disorder.

Both perpetrator and victim are affected by drug abuse. Both groups contribute to domestic violence. Increased risk of victimization is seen in active drug abuse. Again, assault has been known to lead to drug abuse. Females using drugs have a tendency to associate with people who are assault prone. Also they tend to become involved in taking grave risks.

Socio-economic factors

Poverty is a significant risk factor. Poor females, simply by being in the company of a partner, are at greater risk.

Risk factors in domestic violence reaching criminal proportions.

The following factors have been considered as risk factors for criminal domestic violence: ‘antisocial attitudes, drug dependency, low level education, poor vocational and cognitive and interpersonal skills’ (Vennard and Hedderman, 1998). These risk factors can be targeted when aiming for a reduction in further offences, (Andrew, Bonta and Hart, 1985).

Domestic violence tended to be of the younger age group, unmarried, having unstable lifestyles, of low verbal intelligence with a tendency to place responsibility for their circumstances on others. A criminal record is usually associated (Cunningham, 1998). Some criminal offenders had a borderline personality problem (Dutton, 1998).

Witnessing domestic violence when young, disrupted attachment patterns, high levels of interpersonal dependency and jealousy, attitudes condoning domestic violence and lack of empathy are some of the risk factors identified in a study of 336 offenders in UK (Gilchrist, 2003). The offences that were committed by the 336 were as follows: 38% of assault causing bodily harm, 37% of common assault, 11% criminal damage, 6% harassment, 6% threats to kill, 5% affray and 2% grievous bodily harm. In 73% of offences, alcohol had been consumed prior to the offences. In 23% of cases, a weapon was involved. 43% of offenders were staying with their parents till the age of 16. 36% claim to have been witness to domestic violence between their parents and 36% had no such history. 23% said that they were abused as children. 6% had been sexually abused. 48% of the group was alcohol dependent (Gilchrist, 2003).

Risk factors in children

The rates of maltreatment were similar for both sexes but the sexual abuse was greater for the females. The highest victimization was seen in the 0-3 age group. The rate decreased with the increase in the age. The rate for infants was 16 per 100 in the age group 0-3 and 16 per 1000 for adolescents of the age group 16-17. 58% of the perpetrators were found to be females and 42% males. These figures are all approximations as the actual amount of abuse is still vague (Bernet, 2005, Pg 3416). The victimization rate which was high in 1993 (15.2 per 1000 children) came down to 11.8 per 1000. The higher rate in 1993 was attributed to three factors; ‘greater public awareness and willingness to report, improved data collection methods and local economic conditions which reduced many families to stressful conditions (Bernet, 2005, Pg 3416). The children who are high risks for sexual abuse belong to the age group below 3 years (Rebraca, 2005). Children with a developmental delay are highly prone to the abuse. Those living in homes where substance abuse occurs are another prone group.

Children whose parents are mere adolescents or who have only a single parent or who are in foster care are also highly likely to be abused. Those who had primary caretakers who were themselves sexually abused or had mental illness or had a developmental delay are considered prone to abuse (Rebraca, 2005).

Risk factors in Elder abuse

Physical abuse, physical neglect, psychological abuse, psychological neglect, financial or material abuse, financial or material neglect and violation of personal rights are the different kinds of elder abuse. Potent predictors of elder abuse are age, race, poverty, functional impairment, cognitive impairment and living with someone. Poverty in the black races can be considered a predictor of elder abuse. Functional status is the most conspicuous factor. ADL components, higher functional impairment and cognitive impairment were risk factors. Worsening cognitive factor was important as a predictor (Lachs et al, 1997). Some believe that functional impairments are directly causative of mistreatment. Others believe that functional impairment prevents the victimized elder from protecting himself permitting the perpetration of abuse. Elders who live with someone are the ones subject to abuse.

Youth violence

Children may suffer devastating after-effects at the sight of domestic cruelties, including ‘‘negative behavioral, cognitive, social, and emotional outcomes’’ (Osofsky 2003, p. 162). Osofsky also asserted that parents do not bother to tend to their children in the period of recovery from the trauma leading to the children continuing the cycle of abuse. In many cases of femicide, long, ongoing, domestic violence before the murders is traumatic to the children (Smith, 1998).

Intergenerational Effect

The Social Learning Theory

The intergenerational transmission of family violence is considered as arising from the witnessing of a domestic or family violence as a child (van der Kolk, 2005).

It explains that observing another person’s behavior generates ideas which lead to development of similar behavior patterns. Modeled behavior is imitated if the outcome is seen to be desirable. Observing DV at home gives vulnerable children ideas on how, when and to whom the violence must be directed. Original studies found plenty of DV men had a history of DV at home. Similarly a history of victimization in childhood, physically or sexually, is a risk factor for later assault. Victims of partner and stranger assault in adulthood are likely to have had experiences of childhood abuse twice over non-victims. A survey of 4000 adults indicated that being witness to marital aggression between their parents was the single most important risk factor for adolescent girls who later became victims of marital assault. Men who experienced their fathers’ violent behavior at home were 10 times as likely to become perpetrators of abuse (van der Kolk, 2005).

Domestic violence in adulthood is believed to be the influence of the intergenerational transmission of violence. Research has framed this concept in the context of social learning theory (Corvo, 2006). ‘Modeling’ is the term used to describe the mechanism of intergenerational transmission. The social learning theory says that ideas of new behaviors generate from the observation of people who matter or influential persons (Bandura, 1986). Modeled behavior is adopted if the perceived behavior appears to have desirable outcomes. Ideas about how, when and towards whom aggression is appropriate and violence is to be perpetrated will be formed from the time of witnessing of domestic violence in childhood.

Cognitive and self-reflective functions mediate the violence (Corvo, 2006). Many researchers found that domestically violent men originated from families with a high level of violence. Other researchers like Carroll (1980) found that child abuse was associated with current domestic violence for both men and women. Kalmus (1984) indicated that both child abuse and inter-parental or spousal abuse contributed to present family aggression and violence in men and women. The effect of social learning derived intergenerational transmission was small but significant. (Holtzworth Munroe et al, 1997). Holtzworth suggested that other variables could exist in the transmission. A wider range of ‘family of origin’ variables has been explored (Corvo, 1997).

Corvo’s study

The study confirmed that the intergenerational transmission model asserts that the early childhood in a home with domestic violence predicts that one will be violent in his new family or in any intimate relationship (Corvo, 2007). Separation was measured in months. The number of months that the father was away from home, the mother away from home, number of times the respondent was away, the number of months he was away from home, the number of times the father was ill, the number of times the mother was ill, deaths in the family and the number of times the participant was ill were the measurements for separation or loss.

Of the 74 men being treated for domestic violence selected for the study, 14% had no separation or loss events. 52% had 3 or more events (Corvo, 2007). The number of times the respondent lived away from home was the biggest predictor of current violence. The number of times respondent was hospitalized and paternal illness followed just behind as predictors. The variables that did not predict the current violence were parental divorce, number of caregiver changes, death of family members, institutional or foster placement, and number of times father lived away. Whether it is the type of separation or loss that is important or whether it is the disturbed attachment that is important as predictor has yet to be studied. Comparable effects are seen in child abuse by either parent and the witnessing of domestic violence. Child abuse is a stronger predictor of current violence than the observation of intimate partner violence. The best predictor regression model using a set of combined variables of father abuse, mother abuse, separation and loss had the same variance as the family of origin violence taken alone. However separation and loss appear the better predictors of current violence.

One more theory

Possibly 2 methods could be surmised for current violence: disrupted attachments and child abuse. A multi-thoeretical model starting with the social learning process and going onto disrupted attachments probably explains the current violence better. Application of this model should produce better laws, policies, regulations, treatment programs and interventions for batterers (Corvo, 2007).

The following section of ‘Attachment’ deals with the expansion of the original social learning process of intergenerational transmission into the attachment theory or the adoption of a multi-theoretical approach.

Attachment

“Attachment is an enduring emotional bond, uniting one person with another, manifested by various efforts to seek proximity and contact to the attachment figure, particularly when under stress (emotional or physical distress or illness)”. (Gough and Perlman, 2006).

Holtzworth, Munroe et al (1997) found that the violence in the family of origin was not much associated to the present partner violence. Other variables could be providing a better relationship. Literature has investigated many family of origin variables like neglect, erratic care-giving and separation from care-givers all of which happen to be attachment variables. Zeanah and Zeanah (1989) suggested an attachment theory which redefined intergenerational transmission of DV to a theme of parent-child relationships. John Bowlby’s trilogy of Attachment and Loss (1980) says that attachment behavior is the seeking, attaining or retaining of proximity to a preferred person. This is an instinct which has evolved through experience with the primary function of saving the young from predators. Attachment behavior is ‘activated by separation or loss or by the caregiver not responding adequately’. The established attachment is long lasting. Any threat to this bond causes anger, anxiety and loss and can lead to sorrow. Erratic care-givers can cause the child to be always anxious and dreading the moments of separation. The ability to respond appropriately in intimate relationships would be disturbed. Analysis showed greater effects for physical abuse rather than exposure to domestic violence. Child abuse regardless of the gender of the parent has a greater consequence in the current behavior rather than spousal violence which the child witnessed.

The Healthy attachment

Children are emotionally and psychologically attached to their care provider who is usually their mother. A healthy or positive attachment is one of trust and security. This occurs as a result of the care-provider consistently and satisfactorily responding to the child’s physical and emotional needs (Gough and Perlman, 2006). The harmonious sequence of interactions between the child and care-provider forms the basis of the child’s internal working model for forming and maintaining relationships with others. A healthy and secure attachment helps the child to develop good emotional balance and resilience to stress. Mood regulation and impulse control are achieved

From the attachment disorder site

A child who has developed a secure attachment will have the confidence to explore further relationships and the environment he is in. Ongoing support and availability of the primary attachment figure helps him develop further skills. He becomes competent and effective and moves forward with confidence for further explorations and development of physical and social skills. This soon leads to independence and autonomy (Gough and Perlman, 2006).

The child’s brain at infancy is at its most receptive stage. Experiences, good and bad, will determine the natural sculpting process of the neurons in the brain (Healthy attachment, 2001). For a child to develop a healthy attachment, the basic requirement is a good parent. A healthy attachment between at least one adult and the child ensures that the neural pathways in the brain develop in the best possible manner with sufficient connections to handle stress, anxiety and easily absorb new information and experiences.

The child has a greater self-esteem, is willing to explore widely and controls emotions better. He has lesser behavioral problems in school (Healthy attachment, 2001). His problem-solving capabilities and coping skills are greater. The communication skills are better and he attains a higher literacy level. His social skills are good and he develops more positive relationships with his friends. This child is secure and tends to trust others. He is predicted to have fulfilling relationships in later life. Several activities help to form a quality attachment. Breastfeeding helps the bonding. Holding, touching, making eye contact and soothing sounds are important. The positive responses of the care-giver add to the healthy attachment. His confidence is increased if things go according to routine. Setting limits for good and correct behavior teaches the child to keep from harm. Having more than healthy attachment helps the child to develop resilience (Healthy attachment, 2001).

Attachment Disorders

If the child is denied the opportunities to develop a healthy attachment, adverse effects occur in the ‘cognitive, social, emotional, and moral development.’ Loss of the primary attachment figure is traumatic to the child and results in heavy emotional scarring (Gough and Perlman, 2006). A previously secure child finds it easier to form new relationships which if permanent could make some allowance for recovery. However if frequent breaches of the primary attachment occur, the child would not be able to trust anyone to provide it efficient care. The ability to form attachments diminishes (Gough and Perlman, 2006). Attachment disorders include ‘eating and sleeping problems, social skill deficits, learning difficulties, attention deficits, aggressive outbursts, mood disorders, adjustment disorders, difficulties with transitions, and relationship problems.’ (Gough and Perlman, 2006). These may extend into adulthood.

The Attachment Theory by Bowlby and Ainsworth

A biological basis for understanding close protective relationships was provided by Bowlby’s attachment theory. Attachment theory is the joint work of Bowlby and Ainsworth. John Bowlby formulated the attachment theory from ‘ethology, cybernetics, information processing, developmental psychology, and psychoanalysts’ (Bretherton, 1992). Mary Ainsworth added that the attachment figure is a secure base from which the child explores the world (Bretherton, 1992). She also provided the concept of maternal sensitivity to infant signals and how it helped to develop mother-infant attachment patterns. Without her work in the Strange Situation and Mary Main’s Adult Attachment Interview, Bowlby’s theory would not have advanced so far (Bretherton, 1992).

Child Attachment

A child’s wish to remain close to his mother is a biological drive that evolved with time. Attachment behavior is understood to be a series of strategies which satisfy the primary need of proximity (Maunder, 2001). These strategies of attachment behavior include crying, smiling, making verbal sounds, approaching and any means which put the child in close proximity to its mother. Organised patterns of attachment occur in the second half of the first year (Ainsworth et al, 1978) and emerge through a learning process. The patterns of approach and withdrawal are enhanced or guided by the mother so that the child accumulates a ‘procedural memory’, a developmental learning, before it reaches a stage where it can by itself consciously remember. These developmental patterns may not be recalled later as the neurological system is not fully developed till the age of 3 (Kandel, 1999). Attachment behaviors vary with the parent-child pairs. However typical clusters can be identified.

The attachment of infants can be classified using Ainsworth’s Standardized Strange Situation where the infant is placed in various stressful situations which elicit certain behaviors. The child may be placed with a stranger or separated from his primary care-taker and then reunited with this person (Ainsworth et al, 1978).

The Four Types of Infants by Attachment Behavior

Four phenotypes have been described: secure, avoidant, angry-ambivalent and disorganized (Maunder, 2001). 50-70% of 12-18 months’ old children are securely attached (Gerwitz and Edleson, 2007, Pg 153). The study by Gerwitz and Edleson has identified the insecure attachments as avoidant –anxious, anxious-resistant and disorganised. Avoidant babies cry minimally when separated, accept the presence of the stranger as similar to the mother and avoids contact with the mother on reunion (Maunder, 2001). The secure babies are very distressed at separation, do not tolerate the stranger and are very soothened on reunion. A secure attachment allows the child to develop self-regulation. When the care-giver responds favorably to the child’s needs, it has a capacity to develop internal regulation (Gerwitz and Edleson, 2007).The angry-ambivalent babies show separation distress like the secure babies and seek the closeness to the mother but show anger in addition (Ainsworth et al, 1978). The disorganized attachment babies are a group with no organized pattern. The phenotypes are classified according to the ‘goodness of fit’ between the parent, child and environment. The needs of the infants and environmental stresses shape the parental response (Belsky, 1995). If the parental response to the infant is poor, the attachment becomes avoidant. The child realizes that his crying to catch the attention of his mother is a futile attempt. He is taught to be independent. His attachment behavior is deactivated. The angry-ambivalent attachment arises from inconsistent care by the mother. Sometimes the response is good. Proximity causes the child to be anxious about possible separation. It is not soothened by the proximity but becomes more anxious. (Bowlby, 1977)

Infants when separated from their mothers cry aloud and search for them agitatedly. If the duration of the separation becomes persistent, the response becomes less with a decreased heart rate and lowered body temperature, probably signifying despair.

Isolation rearing may be partially corrected by the entry of substitute mothers (Kraemer, 1992). ‘Mutual engagement and interaction’ are the factors which support the close proximity of mother and infant. They are the requisites of the security of the emotional attachment and physiological self-regulation.

Studies have shown that parent-child relationship and child adjustment improve when the intimate partner violence ceases and living conditions become more stable. (Holden et al, 1998). Mothers who experienced intimate partner violence showed improvement in that they used less violence on the children when they were distant from the abusive partner (Walker, 1984). Another way to put it would be that attachment relationships show improvement on cessation of domestic violence (Gerwitz and Edleson, 2007).

Self-Regulation

A secure toddler learns to ‘modulate affective, behavioral and cognitive displays through internal control’ (Gerwitz and Edleson, 2007). Multiple genetic and environmental factors affect this ability. The development of self-regulation heralds the development of social skills. The child is able to focus on issues, peer situations and also persevere in the face of challenges. Impaired self-regulation causes conduct and behavioral problems (Masten and Coastworth, 1998). This would be evident in the pre-school and school ages where adherence to rules and pro-social behavior are called for. (Gerwitz and Edleson, 2007). In the presence of risk factors, self-regulation cannot be achieved. Early efforts of interventions to correct the situation of the child in adversity should be targeted at the self-regulatory system. Childcare and pre-school programs must be focused on successful regulation of anger and negative emotions prior to the development of social and conflict resolution skills (Gerwitz and Edleson, 2007). Simultaneously parenting skills must be enhanced at home. Socialisation (learning the values, language and the behaviors for functioning in the society) and social competence begin in infancy. The baby first smiles, gazes and makes sounds.

Adult Attachment

An adult attachment relationship is one which provides a feeling of security through close proximity (West, 1994). Adult attachments start with the committed sexual partners but could include the attachment of a doctor and patient, a school teacher and a mother of a student and similar other relationships. Bowlby’s attachment theory speaks of the internal working model which explains the attachment lasting over a long time. The positive responses of self and other are resiliency of self and responsiveness of the other. The negative responses are a fragile or incompetent self and an unavailable or unreliable other. The expectations of self and other are independent of each other. So the individual’s attachment status can be one of four types.

The four types of adults by attachment behavior

A secure person has positive expectations of both self and other. The secure person considers himself worthy of care, effective in providing care and exhibits efficacy in dealing with most stressors by themselves (West, 1994). Secure people are ‘adaptable, capable, trusting, and understanding’ (Klohnen, 1998). These facts are consistent with the psychobiological model of Bowlby. Insecure attachments cope with stress in an inadequate manner but expect more of others. These people are pre-occupied, dismissing and fearful. This adult attachment is equivalent to the angry-ambivalent child. Pre-occupied attachment is associated with plenty of care-seeking, protesting strongly when separated and fearing loss (West, 1994). Although care is sought for, the smoothening from the attachment is minimal. These individuals are of an anxious nature, dependent, emotional, impulsive and seeking approval frequently. People with the dismissing attachment do not trust the effectiveness of social supports (others) but have a positive view of themselves and independence. The self-sufficient and undemanding attitude is highly appreciated but the insecurity associated with distrust and the avoidance of intimacy is evident to all. Any situation that calls for the help of others would result in a crisis. These people are usually cold to others (Bartholomew, 1991). Fearful attachment personalities consider expectations of both self and others as negative. They are seen as cautious, doubting, shy and suspicious of others. The dismissing and fearful adult attachments can be compared to the avoidant attachment in children.

The Internal Working Model

The internal working model of Bowlby helps us to understand attachment type. Attachment type can be considered the result of an internal working model that guides affects and behavior when a threat is perceived (Maunder, 2001). Attachment type can also be defined as a disposition towards some perceptions of others, some perceptions of self and certain preferred strategies that are triggered by the presence of a perceived threat. The internal working model also explains that attachment insecurity can be understood as a trait (Maunder, 2001). Insecure attachment is associated with illness and secure attachment is associated with health.

Maunder’s pathways for relating insecure attachment and illness

Maunder’s study described a model which accounted for the relationship between insecure attachment and illness. 3 pathways have been described: disturbances of stress regulation, use of external regulators of affect and non-use of protective behaviors. Individual differences are seen in all the pathways. The insecure attachment could increase perceived stress. In pre-occupied attachment, the self is vulnerable and so reduces the threshold for triggering the attachment. Avoidant attachment is accompanied by a feeling of distrust and interdependence and the need for these would be perceived as a threat. The threshold for triggering the attachment is again reduced. In another study by Mickulincer and Florian (1995), 92 male military personnel were studied for appraisal of the 4 months’ combat training. Ambi-valent or pre-occupied trainees showed the highest threat.

The first pathway – Insecure Attachment can affect the Stress

The insecure attachment could affect the duration and intensity of the physiological stress. Changes in heart rate have been noted in children who are separated from their mothers (Sroufe and Waters, 1977). A secure child whose heart rate increased during separation, returned to normal within 1 minute of reunion. The pre-occupied and the avoidant children had higher rates long after the reunion though their behavior returned to normal. The avoidant children exhibited little stress. It was also found that adreno-cortical stress reactivity at the time of the Strange Situation only in the ambi-valent children (Spangler, 1998). A picture depicting the death of a child’s mother and women with a history of childhood abuse are two other instances of increased adreno-cortical hormone and heart rates.

Attachment pattern decides the response and success to accepting social support.

Close, intimate relationships between women have been understood to have been very supportive against the psychiatric problems that could ensue from a stressful life (West, 1986). This explains the hypothesis that ‘felt’ security is effective in buffering stress. The degree of buffering would be greater seen in secure attachments. In the insecure attachments, the buffering would be more seen in the pre-occupied attachment than in the avoidant type. The secure attachment type would seek support for problems. The avoidant attachment type would prefer to keep a distance while the pre-occupied type would not seek support for fear of rejection. A study among recently widowed people and happily married elder people showed that emotional loneliness can only be replaced by another emotional relationship. Nonattachment support is insufficient (Stroebe, 1996).

An attachment figure is essential to reduce the physiological stressors.

The second pathway- Insecurity alters the use of external regulators

Insecurity influences the internal affect regulation. It is usually associated with the greater use of external regulators for soothing, distracting or exciting. Smoking, alcohol usage, over-eating, under-eating, using psychosomatic drugs, indulging in risky sexual activity are some of the techniques adopted by the insecure attachment types (Maunder, 2001). They all happen to be risks for illnesses too.

The third pathway- Insecurity changes the use of protective factors

Insecure attachment type of people has a tendency not to stick to proper treatment of any illness they have. Diabetes requires proper control. It was found that avoidant attachment types had a higher HbA1c which is a measure of diabetic control. The pre-occupied types showed a lesser value (Maunder, 2001). Though we presume that the higher levels of HbA1c in the avoidant group are due to non-adherence to treatment, they could also be due to the higher gluco-corticoids in this group. The glucocorticoids contribute to insulin resistance.

Studies have shown that the attachment types influence the symptom reporting too. The avoidant group prefer not to report symptoms and they employ emotional self-control and coping mechanisms (Kotler, 1994). The fearful and pre-occupied group has so many unexplained symptoms. Sexual abuse in childhood produces more complaints in adulthood and utilizes health care more than the non abused people (Fillingim, 1999)

Maunder’s psychobiological model

Maunder summarized that attachment insecurity does influence physical illness.

The attachment style may be a predictor of stress vulnerability and illnesses. “The attachment paradigm provides a biopsychosocial model of disease (Maunder, 2001). The significance of critical interactions between the care-giver and the infant are explained by the model. The individual thus develops his own behavior patterns and physiological responses providing the best fit between himself, the care-giver and the environment. Events of illness which can represent loss, isolation, threat and dependency are the best triggers for the initiation of attachment styles (Maunder, 2001). Studies to investigate the causal processes leading to co-related attachment types need to be done. Maunder suggests that the concept of ill-health in attachment insecurity is not universal. The high prevalence of stress and insecure attachment (35-40% of the general population) maintain that the insecurity in attachment style cannot vouch for an uncommon disease (Mickelson, 1997).

Second hit

To say that a highly specific behavioral pattern is a sufficient condition for a major illness does not make sense (Simpson, 1999). It is more relevant to think that the behavioral pattern is a ‘second hit’ on a previously existing condition like a genetic pre-disposition or an infection. Attachment security still needs to be investigated in treatment non-adherence and other health risk behaviors. Here we know that attachment insecurity could give rise to illness. We can predict how the insecure person could accept a treatment modality depending on his attachment type (Maunder, 2001). The outcome could be compared to the adherence pattern in other attachment types. Behavioral interventions could also be modified by the attachment type for various external regulators like substance abuse. Treatment adherence could be enhanced through strategies devised to increase ‘perceived personal control’. Interpersonal distance needs to be respected. A different approach has to be taken for the pre-occupied attachment type who adopts an excessive help-seeking attitude. The attitude to seek help excessively must be reduced with the intervention (Maunder, 2001).

The association of attachment insecurity with depression is another field requiring further studies (West, 1998). Depression is connected to a worse course of physical illness. The depression could be a direct consequence of severe attachment disruption distress. There is an overlap of features of attachment insecurity and depression. It can be concluded that the two cannot be separated based on the biopsychosocial concepts.

Affect Dysregulation (Dankoski study, 2006)

Affect regulation is inclusive of the processes that are inherent and learned by a child and which are responsible for his ability to observe, evaluate and change his emotional reactions to achieve his goals (Dankoski, 2006). When a child’s attachment behavior is responded to suitably, the child develops flexible behaviors for regulating affect. The parent’s internal working model and affect regulation strategies influence their children who in turn develop their own internal working model and affect regulation strategies. Early childhood abuse would cause them to expect a hostile response from the world. The negative emotional state becomes exacerbated. Psychopathology and violence develops apart from the dysregulated state (Bradley, 2000).

Attachment, affect dysregulation and family chaos

Dankoski’s study of 2006 investigated the relationships of ‘attachment, affect dysregulation and family chaos with adult violence against women. It was found that attachment and family chaos predicted affect dysregulation in the first model. In the second model, attachment and family chaos predicted later violence against women. In the third model the affect dysregulation acted as a mediator. Higher levels of family chaos predicted higher levels of affect dysregulation. More externalizing and internalizing behaviors predicted more perpetration of violence (Dankoski, 2006). This led to the realization that higher level of family chaos also predicted higher levels of externalizing and internalizing behaviors Attachment also has a positive relationship with affect dysregulation and affect dysregulation was significantly predicted by attachment. Higher levels of teacher-reported externalization and internalization were predicted by the higher scores on attachment (Dankoski, 2006).The attachment relationships in abusive and chaotic families may not be conducive to the development of adaptive affect regulation strategies. Possibly only poor strategies would develop. Shame, fear, sadness and other emotions are all depicted as aggression or anger. The dysregulated behavior leads to adult perpetration of violence.

Study Limitations

One disadvantage of Dankoski’s study was that data for the 3 models had to be collected from 3 different time periods, the first in the 1940s. The risk factor was collected at time one, the mediator at time two and outcome at time three. Even the child rearing practices would have been different in the 1940s. The various scales used were not reliable. The participants were homogenous and constituted another limitation in that generalization was not possible.

Evaluation of study

Higher Attachment levels predicted higher Logged later violence against women. Higher levels of Family chaos also predicted higher Logged later violence against women (Dankoski, 2006). Attachment and Family chaos predicted affect dysregulation which in turn predicted logged later violence against women. The relationship between the affect dysregulation and later violence against women showed that more externalizing and internalizing behaviors predicted a greater perpetration of adult violence which explains the hypothesis for the study (Dankoski, 2006).

Dankoski (2006) says that the relationship between the early experience and the later violence against women is not a direct relationship but a more complex one like many researchers thought. Researchers have not been able to tell how the intergenerational transmission actually occurs (Holtzworth-Munroe et al, 1997).

Risk and resilience model

Dankoski used the risk and resilience model which is based on the theories of risk and resilience to determine the predictors of adult violence. Risk predisposes a person to negative outcomes while the resilience provides a positive outcome despite the risk. Resilience could be understood as the result of accumulated buffering methods along with the use of internal and external resources which help to cope with stress, resolve conflicts and become experts in tasks throughout development (Dankoski, 2006).

Linking risks and outcomes

Mechanisms which link risks and outcomes are of 2 kinds: mediators and moderators. Mediators provide the observable links while the moderators increase, decrease or change the direction of the relationship between the risks and outcomes. Prolonged states of negative effect lead to the development of psychopathology and dysregulated effect. There were 438 participants of ages around 11-17 years and who were juvenile delinquents at correctional facilities (Dankoski, 2006). Physical abuse status used here was termed physical punishment by father or mother. They were followed for 18 years and approached for assessment at around 31 years. The measures of later violence against women, attachment, affect dysregulation (externalisation and internalization) and family chaos (delinquency, alcoholism, emotional disorders and parent relationship instability) were taken. Affect regulation was measured in a proxy manner. The Child Behavior list was used to determine externalization and internalization (Dankoski, 2006). Stealing, Untruthfulness, Defiance, Cruelty, Cheating, Destroying School Material, Temper Tantrums, Profanity, Impudence, Smoking, Quarrelsome, Domineering, Imaginative Lying were addressed in externalization. More externalizing behaviors were indicated by higher scores. Nervousness, Unhappy, Easily Discouraged, Sullen, Fearful, Suspiciousness, Coward, Unsocialness and Shyness were measured for internalization.

Inadequacy of Dankoski’s study

The studies of the intergenerational transmission of domestic violence are insufficient when studying child abuse (Dankoski, 2006). The broad sequelae of child abuse are yet to be studied. Dankoski suggests that affect regulation is a new area in studies. He advises that the relationship between affect dysregulation and the intergenerational transmission of violence needs to be studied using intimate relationships both within and without in adulthood. A true mediation technique may be used. Attachment to abusive members may also be studied. Studies may also be done on non-violent individuals who had child abuse in their childhood. Interventions to reduce family violence must be studied, especially those regarding affect dysregulation. (Dankoski, 2006). It has become necessary to understand factors that predict resilience and protect against the intergenerational transmission. Violence must be prevented and the cycle of abuse has to be broken.

Attachment and Loss

Variables in the attachment theory like neglect, erratic care-giving and separation from care-givers have been investigated. A suggestion that intergenerational transmission patterns of child maltreatment has to be redefined to a broader theme of parent-child relationships have been made (Corvo, 2006). The trilogy theory of Attachment and Loss deals with the classes of behavior, relationships and cognitive schemes that allow the evolving of a distinct competent or distorted personality (John Bowlby, 1980). Bonding and other related processes would be involved. Attachment behavior is the seeking, attaining and retaining close proximity to a preferred care-giver. Evolution has produced the behavior of protecting the young from predators in humans and animals alike. This behavior is a natural instinct mediated by experience (Corvo, 2006). If the relationship is healthy with positive emotional bonds between the child and parents, the resulting relationship between adults later in life would be the same. Attachments are considered homeostatic in that they become modified depending on whether the response to success and failure in the achievement of goals which are the proximity or responsiveness of the care-giver. Real or threatened loss of or separation from the care-giver activates the attachment behavior (Corvo, 2006). The relationship endures once the attachment bond is established. Extreme anger and emotions are exhibited when threats occur. Loss of the bond causes anger and sorrow. The emotional development and ability to establish bonds depends very much on the attachments processes in the early childhood.

Hypersensitivity to separation

Unavailable or erratic care-givers produce a hypersensitivity to separation. The person becomes insecure anxious and highly emotional. He will have difficulty in differentiating or responding to care-seeking or care-giving behaviors. Summarizing, disturbed attachments in childhood in the family of origin produce emotional consequences. The result is a problem in the person’s inability to respond suitably to the contemporary intimate demands (Corvo, 2006). Bowlby (1984) has made similar interpretations. He designed a protocol of family violence from the attachment theory. In the attachment theory, relationships where family violence is maximum are the central ones. These include the parent-to-child and spouse-to-spouse. Evolutionary and genetic forces influence these relationships strongly as they are concerned with reproduction and survival of the young. Family violence is not natural. It is considered to be the distorted version of attachment, probably due to an evolutionary adaptation (Corvo, 1997). Family violence from whatever cause, be it parent-child or interspousal, could be continued into the next generation.

Expanding the theory of Intergenerational transmission in men being treated for domestic violence

Corvo’s study aimed at broadening the theoretical basis of intergenerational transmission models of family violence. 74 men who were being treated for domestic violence participated in the study. Exposure to the violence in the family of origin was determined. How much the separation and loss variables had influenced the participant’s violent behavior was studied. Whether the present violent behavior was consistent with or more when compared to the original family violence was also determined (Corvo, 2006).

The assumption was that ‘the intergenerational transmission effect can predict the levels of violent behavior when the level of violence in the family of origin is known. Variables measuring separation and loss were the number of times the parent lived away from the family, the number of times the participant lived away, the number of months he lived away, whether he ever lived in an institution or foster home, the number of times the father and mother were ill, deaths in the family and the number of times he himself was in hospital.

Findings

8 (11%) men’s mothers had lived away once (Corvo, 2006). The mothers of 3 %( 2) lived away 4 times. 24 (32 %) men lived away once. 9 (14%) lived away 2 or more times. Participants were away for an average of 13.4 months. 6 (8%) of them had lived in institutions (Corvo, 2006). 10 of them had a history of serious or life threatening illness of the father.29 (39%) had at least one hospitalization in childhood. 26(35%) had parental divorce. 3 (4%) reported of having stayed in foster homes. 12(16%) reported of a death of close members in their families. 8 (11%) reported of serious maternal illness. From the study it was understood that paternal child abuse was a better predictor of present violence more than paternal spousal violence (Corvo, 2006). The current levels of violence was strongly predicted by the number of times the participant was away from home, the number of times he was hospitalized and serious paternal illness. Parental divorce, number of care-giver changes, death of family members, institutional home placement and the number of times the father was away did not have any relationship with the current violence levels. Where the violence in the family of origin was lowest, separation and loss were the strongest predictors (Corvo, 2006).

Disrupted attachment after social learning process

Violence in present day relationships may occur due to disruptions in attachment and child abuse. Corvo’ study indicated that the intergenerational transmission may not solely be explained by the social learning theory. Findings show a combination of conditions in the family of origin, especially disruptions in attachment. The psycho social processes involved in the etiology of domestic violence are better understood with Corvo’s multitheoretical model.

Corvo’s multi-theoretical model

This broader model provides a bigger, unlimited range of effective responses to the laws, regulations, therapy and education programs that could be used in family violence. It further means that one approach would not be effective for all the perpetrators of domestic violence (Corvo, 2006). A multi-pronged individualistic type of assessment and treatment plans has to be designed. Supportive behavioral change strategies planned for a long term effect must be used. More studies are indicating that the causality of domestic violence as multiple. The existing interventions, policies and programs are outdated and of limited effectiveness (Corvo, 2006)

Different mechanisms in mother’s and father’s endorsement

Physical punishment (PP) is used as a disciplinary technique by 58% of fathers and 64% of mothers (Strauss and Stewart, 1999). The various methods of PP include, slapping, throwing objects, hitting, shaking and hair pulling. Increased aggression to the siblings and peers in childhood has been traced to PP (Strassberg et al, 1994). Psychological distress is increased in adolescence and youth (Turner and Finkelhor, 1996). This also leads to a greater possibility of spousal and child abuse (Strauss, 1983). Those with harsh physical discipline in the family of origin would practice these methods on their children (Muller, Hunter, & Stollak, 1995). Direct and indirect pathways have been identified in research to demonstrate the continuity of aggressive parenting (Smith and Farrington, 2004) and constructive parenting (Chen and Kaplan, 2001). Many explanations have been given by different researchers, mainly the social learning theory. The others are hostile personality and child temperament (Muller et al, 1995).Many researches revealed that the mothers were influenced by their parent’s physical punishment but not the fathers who were more influenced by their wives’ stories of childhood (Stattin et al, 1995). Marital conflict on the other hand is more predictive of the use of physical punishment by the fathers rather than the mothers (Kanoy, Ulku-Steiner, Cox & Burchinal, 2003). A different theory is also possible. Parents who experienced PP would not repeat PP with their children (Kaufman and Zigler, 1988).

A satisfying marital relationship is one factor which positively moderates the transmission of aggressive parenting (Rutter, Quinton and Hill, 1990). This is consistent with the attachment theory which says that corrective experiences in youth or adulthood could modify parenting behaviors (Bowlby, 1988). Marital relationship is one such corrective experience (van Ijzendoorn, l992). It has been found that the intergenerational transmission of maternal rejection is modified (Belsky et al., 1989) just as ‘maternal anger and punitive control’ (Crockenberg, 1987), ‘ill-tempered parenting’ (Caspi & Elder, 1988), and ‘poor parenting among institution-reared mothers and fathers’ (Rutter et al., 1990). Strauss (1983) believes that abusive parenting could be evident along with physical punishment and the correlates are similar. This leads us to think that the factors which moderate the intergenerational transmission would work for physical punishment as well.

Moderation of Intergenerational Transmission

Lunkenheimer’s study (2006) investigated whether marital satisfaction moderated the intergenerational transmission of physical punishment. The participants were 107 fathers and 241 mothers of 3 year olds. Assessment of marital satisfaction was through the use of the Conflicts and Problems solving scale. It was that mothers were influenced by the socioeconomic status and the use of physical punishment by their mothers. The fathers were influenced by the socioeconomic status and the perceived harshness of childhood discipline (Lunkenheimer, 2006). The fathers’ behaviors were moderated by marital satisfaction but not the mothers’. It was seen that physical punishment by the same sex parent and socioeconomic status are the significant factors in the intergenerational transmission. There is no doubt about the negative impacts that heightened parental conflict can have on the children’s ‘academic, behavioral and social emotional functioning’ (Riggio, 2004). There is only a poor relationship between the abused mother and her children (McNeal and Amato 1998). Children may witness 75% of parental aggression (Kerouac et al, 1986) and these children may imitate their earlier experiences (De Voe and Smith, 2002) or simulate them in their intimate relationships (Maker et al, 1998). Children exposed to parental violence and child abuse have similar behaviors (Kitzman et al, 2003). Children exposed to family violence are likely to be aggressive (Holden and Ritchie, 1991), angry (Adamson and Thompson, 1998) and show defiance to parents (Lemmey et al, 2001). They could have a social skill impairment and may go in for depression and anxiety (Fantuzzo, 1991). Traumatization could occur. This is seen as increased crying, fear, argumentativeness, sleep problems and nightmares (Levendosky et al, 2003). Parent-child relationship is affected by domestic violence (Ybarra et al. 2007). The quality of the relationship is influenced by factors like marital satisfaction (Graham-Bermann 2003), mother’s level of psychological functioning (Holden and Ritchie, 1991) and the parent-child attachment (Davies and Cummings, 1994).

Battered mothers forget good parenting

Battered mothers may be less available emotionally in the interaction with the child (Holden et al, 1998). Being depressed, battered mothers tend to overlook the emotional impact they have on the child.(Peled and Edleson, 1992). This leads to negative parenting (Levendosky et al, 2003). Battered mothers are believed to react by punishing their children (Rossman and Rea, 2005). They are less warm to their children (Levendosky and Graham Bermann, 2000). Authoritative parenting has positive child behavior outcomes (Rossman and Rea, 2005). The risk of battered women having disorganized and insecure attachments to their children is greater (Quinlivan and Evans, 2005). Pre-school children of battered mothers had several problems. They were less focused on tasks, interacted and spoke less. They preferred to sit away from their mothers. The children may get less support in the form of affection or help from the mother (McCloskey et al, 1995). These children exhibit higher levels of aggression (Murray et al, 1999).

Attachment, Infidelity And Interparental Conflict (Platt’s study)

Bowlby says that children have a tendency to internalize their experiences from caregivers (1973). They accumulate beliefs about themselves and others within themselves and develop a ‘template’ for relationships always for the rest of their life. The working model of the adult child will depend on whether the attachment figure has provided sufficient love and responds to protecting the child in a supportive manner (Platt et al, 2008).

If constant nurturing and support are given, the child will carry a positive model of himself. He will in turn trust and love others or develop a positive model of others. If the caregiver in the family of origin was inconsistent in providing this love and support, the child also develops a negative model of self and others. Bartholomew and Horowitz (1991) expanded on Bowlby’s concept. They indicated that when an individual’s views of self and others were considered positive or negative, 4 categories of attachment could be identified. The secure group would exhibit self and others as positive (Platt et al, 2008). The preoccupied group would consider self as negative and others as positive. The dismissing group would think of self as positive but others as negative. The fearful group would have negative self and others. The secure group preserves a sense of self confidence and worthiness. They feel that other people are receptive to their needs and accept them for what they are worth. The pre-occupied group depends on others a great deal for that confidence (Platt et al, 2008). Their need is fulfilled by reaching out for help. Dismissive children avoid close contact with others and diminish the importance of others for their own confidence. The fearful group avoids closeness but still has no self confidence. These attachment styles which form during childhood seem to influence the individual in adulthood, unless a major event changes the relationship. This could be in the form of death or chronic illness (Hamilton, 2000). For the secure group relationships with parents are cherished memories of warmth and care. The groups with insecure attachment style remember their parents as conflicting and controlling. Emotional bonds in childhood influences the attachment styles exhibited in romantic relationships in later life. Mickelson, Kessler, and Shave confirmed this (1997). They found that adult romantic attachment styles were very much dependent on the child abuse, physical abuse or death of a parent. Children witnessing low quality marital relationship and violence between their parents were negatively related to the secure rating. The rating was positive when related to the anxious and avoidant rating. Hence it can be surmised that childhood traumas and insecure adult types enjoy a strong relationship (Platt et al, 2008).

Infidelity

Infidelity is a major problem for many married couples (Treas & Giesen, 2000). 26% to 70% of married women and 33% to 75% of married men are estimated to be guilty of infidelity (Shackelford & Buss, 1997). The significant and common cause is extramarital sex resulting in marital conflict and dissolution of marriage (Amato & Rogers, 1997). Research on infidelity focuses mainly on its predictors and treatment implications (Olson, Russell, Higgins-Kessler, & Miller, 2002). Research has mostly concentrated on how divorce affects children and less on the inter-parental conflict. However it is this conflict and not the divorce that has greater effect on the children (Cummings & Davies, 1994). Interparental conflict has been found to be a better predictor of the children’s functioning after the divorce. The change in the parent’s marital status and the child’s separation from one parent are not so significant predictors.

Researchers have studied infidelity. Brown linked this word to family patterns (Platt, 2008). For all children, their parents are role models. The parental infidelity is another role that could be easily emulated by children. There is also a pattern of avoidance attached. Parents who indulge in infidelity give rise to offspring who emulate their parents and engage in infidelity themselves (Carnes, 1983). This is seen as a repetition of the family pattern. (Moultrup, 1990). The child may identify with the parent who indulged in the infidelity or may adopt avoidance behaviors in relationships based on the parent’s patterns. These avoidance behaviors may result in the adult child engaging in infidelity. Another study on parental divorces and attachment styles perceived that adult children who witnessed extra-marital affairs and anger, considered as the reasons for divorce were likely to have an insecure attachment (Walker and Ehrenberg, 1998). The fear of the partner engaging in a double relationship, born out of their parents’ experience, could harm their relationship. These children develop a negative view of others because they think that all relationships are two-timing ones and not trustworthy.

Interparental conflict

Infidelity or other issues, such as finances, housework, or the children could be the reasons for arguments in the home (Platt, 2008). Children from these families where a great amount of conflict is experienced feel less social support and lower self confidence when compared to children from families with little conflict. This kind of conflict affects the parent-child relationship too. This is because interactions in one family subsystem influence the other subsystems in the family (Minuchin, 1998). Interparental conflict in the marital dyad could spill over into the parent-child dyad as ‘harsh parenting behaviors’ (Erel and Burman, 1995). Where there is interparental conflict, the support of the parents to the children would decrease. This would disrupt the child’s formation of a secure attachment.

Bowlby says that such children ‘internalise the experiences’ and the negative internal working model would guide their future behavior. The attachment style adopted in romantic relationships is influenced by the negative working model. Daughters of parents with marital conflict were likely to have a dismissive attachment style when compared to daughters from a non-conflictual family. They would have less confident interpersonal skills and take a negative view of others (Henry and Holmes, 1998). Sons in the same situation, were more likely to become secure individuals just like those from non-conflictual families. However they would have a negative view of themselves. So it was difficult to predict attachment styles for sons of parents with marital conflict.

Concepts of Platt’s study

The purpose of Platt’s study of 2008 examines 3 concepts. It investigates the impact of parental infidelity on the style of attachment of the adult child and the how he views himself and others (Platt, 2008). It then investigates the impact of interparental conflict on attachment style of the adult child and how he views himself and others. The third concept examined was the relationship between parental infidelity and the likelihood of the adult child himself indulging in infidelity. The Conflict Properties and the Threat Scales were compared to the Anxiety and Avoidance subscales (Platt, 2008).

. The children who felt ‘threatened’ in the face of marital conflict were the ones with a negative view of themselves and others. The Self-blame scale was not used here. Those who blamed themselves for the conflict tended to developing methods of coping. This reduced the impact of the conflict and allowed them to continue thinking positively about others (Platt, 2008).

The adult children with and without the fearful attachment exhibited no difference in the level of hostility or self-blame. However the children with the fearful attachment style perceived a threat while the non fearful group did not (Platt, 2008). The greater the threat, the worse is their romantic attachment which is also fearful. ‘Coping skills or the amount of distress’ were not assessed in Platt’s study and this allows scope for further study in this field. Adult children who did and did not know about parental infidelity showed no difference in the models of self and others (Platt, 2008). A similar result was seen where the fearful attachment group was concerned. Coping skills and values of the children with the knowledge of parental infidelity or of how long ago the infidelity occurred could have given better pictures of the attachment styles. However since they were not assessed here, more scope for further study remains (Platt, 2008). Carne’s (1983) study results say that infidelity has more chances to occur in adult children whose parents indulged in it. In Platt’s study, the adult children who knew the infidelity of their fathers were more inclined to repeat it. However where the knowledge of their mothers’ infidelity was concerned, there was less chance that they indulge in infidelity (Platt, 2008). This has been explained by Glass and Wright’s study of 1985: ‘Men who engage in infidelity are not as likely as women who engage in infidelity to have an emotional involvement’. Men usually get involved in a purely sexual affair without emotional attachment6 whereas the women are emotionally attached. The emotional attachment may not be perceived as infidelity by adult children, hence the chance to repeat it is less. However as they view the father’s attachment as infidelity, they may have the tendency to repeat it. Adult male children who had knowledge of the father’s infidelity had more chance of repeating it than the female children. The sons may view the fathers as role models just as daughters view their mothers.

Limitations of Study

The limitations of Platt’s study were that the study involved only a specific population; the present results may change as the views of the children change with maturity; there was no parental assessment; the responses may not have been totally correct in order to hide the infidelity from others and many may not have been aware (Platt et al, 2008). Platt’s study focused on marital conflict and the importance of assessing the children of such circumstances. The importance of therapy for these children is also highlighted. Cognitive behavioral therapy or solution focused therapy could be used to strengthen them. The effect of the father’s infidelity is recognized. The offspring of such fathers are the ones to be concentrated upon. Individual or group therapy may help them (Platt et al, 2008).

The different aspects of attachment highlight the possibility of turning around

matters so that we do not allow maltreated babies to stroll into the maladjustments in life that rule all hope out of their becoming worthy citizens of this world and who would fight against the negative outcomes possible from the intergenerational transmission of the domestic violence they have suffered. We shall now see what resilience is and how it can help in correcting the unwelcome situations created by domestic violence.

Resilience

“Resilience refers to patterns of positive adaptation in the context of past or present adversity, which is one class of adaptive phenomena observed in human lives” (Riley, 2005, Pg.13). The normal developmental processes and interacting person-environmental systems best explain the concept of resilience (Riley, 2005). It consists of the patterns of positive adaptation in the face of adversity. In a normal individual’s life, where functioning and development are alright, however significant the adversity is, the individual manages to recover through his own inbuilt ability or resilience. The evaluation about a person is made depending on the expectations of a community with regard to developmental milestones and culture. Adversity, one risk factor, is the experiences or events which disrupt the normal functioning (Riley, 2005, Pg.14).

Addition of other risk factors like homelessness, prematurity, genetic illnesses, poverty, having an uneducated mother, harsh parenting could predict negative outcomes. This cumulative risk is a point of focus now (Riley, 2005, Pg.14). Survival is the primary criterion for resilience.

Maintaining coherence as a living and developing organism requires two tasks of self-regulation and organization one side and adaptation and growth on the other (Riley, 2005, Pg.15). The individual is in continuous association and interaction with the other social and physical systems. Resilience has therefore been thought of as ‘dynamic developmental processes’. The interactions that a normal individual goes through is a combination and culmination of the following processes: genetic, cellular, hormonal, neural, cardiovascular, and other systems within the body and between the individual and the system in which he survives which consists of his interactions with his family members, peers, schools, the general community, the media and others. All these systems are interconnected (Riley, 2005, Pg.15).

What is stress?

Stress can occur in 2 manners. Physcial stress in the form of illness could affect a person and make him angry and unable to cope with regular life including school. A violent or unhappy school environment, reciprocally, could precipitate and contribute to the physical stress. In such a situation, a healthy attachment in the guise of an able, supportive and loving mother or other care-giver along with a good cognitive presence in the child would produce a better outcome than expected (Riley, 2005, Pg.15).

At what level is resilience seen?

The resilience processes could take place at the level of the person or family or school or community (Riley, 2005, Pg.16). The different levels are interconnected producing adaptations within adaptations. Greater success can be predicted if all these systems are resilient giving rise to a resourceful nation. The child also finds it easier to survive and develops resilience faster (Riley, 2005, Pg.16). However let us not lose sight of the basic adaptive processes for resilience of the child which include regular parenting, social learning and self –regulation.

The processes involved

Resilience is the capacity of a child to resist adversity and prevent the expression of problems arising out of exposure to domestic violence at an impressionable infant or young age. It is defined as the dynamic process that leads to positive adaptation within the context of significant adversity (Luthar, 2003). Children exposed to extremely adverse environments of domestic violence are found not developing later problems of adjustment (Werner and Smith, 1992). This has been explained as due to resilience which protects against or reduces the effects of exposure to the domestic violence (Rutter, 1985). Researchers have suggested two concepts which could explain the resilience: the protective processes and compensatory processes (Fergusson, 2003, pg 131).

Protective processes

Protective processes include those to which resilience occurs following exposure to the risk factor. Protective factors produce resilience at any time. Presence of some protective factors raises the likelihood of other factors emerging later (Werner, 2005, Pg 4). Protective buffers play a greater role in the course of life of the child who was faced with adverse family conditions earlier. They could be ‘good health, an easygoing, engaging temperament; intellectual and scholastic competence; an internal locus of control; a positive self-concept; the ability to plan ahead; and a strong religious faith or sense of coherence’ (Werner, 2005, Pg.5). Other protective factors include a competent and loving mother, affectionate relationship with other care-givers like grandparents, elder siblings, teachers, older mentors and a support team.

A study in Hawaii identified multiple risk factors like poverty, peri-natal trauma, parental psychopathology and adverse child rearing conditions (Werner, 2005, Pg. 5). It was also discovered that the same resilience factors worked for families in better environments but the predictability was stronger for those with more risky adverse environments.

Development of Resilience

Positive developmental outcomes in adulthood are the result of direct and indirect connections between the individual’ own protective factors and outside supportive factors during the formative years (Werner and Smith, 2001). The resilience of the individuals who faced higher adversity earlier heightened their competency and efficiency. The number of stressful events later was limited and many opportunities had opened up for them. The study opened up two points for thought; that the early childhood years are essential for developing resilience later and that there is a possibility of recovery available in the later stages of development through the many opportunities available (Werner, 2005, Pg. 6).

Competency due to resilience

The personality and competency of an individual depended very much on the number of stressful events encountered. Children who were socially mature at the age of 2 had fewer stressful events at age 10. Children who were of high scholarly competence at 10 had less stressful events in adolescence. Young men and women who had efficiency and planned their life reported less stressful events in their forties even though they had the history of an adverse childhood behind them (Werner, 2005, Pg.6). Those who reached competency sought out their own positive environments for their future prospects. The protective factors were found to influence female resilience more than the male. The outside factors or sources of support made a difference in the lives of males (Werner, 2005, Pg.6). These factors would not be acting to produce resilience when there is no risk factor. Among the protective factors, the role of care-givers and the cognitive abilities of the child stand out (Riley, 2005, Pg.17). Unique talents in sports or creative arts could help in the resilience.

However the key role for a child’s success in conditions of adversity is that of the care-giver, who could be parents, grand-parents, teachers or mentors. The healthy attachment is the answer. The cognitive adequacy for problem-solving, attention and the capacity for performing well in school when coupled with experience enhances resilience (Riley, 2005, Pg. 17). Positive adaptation in one instance helps to continue this pattern of adaptation.

Compensatory processes

Compensatory processes act to produce resilience whether exposure occurs to the risk factor or not (Fergusson, 2003, Pg.133). The compensatory factors act beneficially in people who are exposed or not to domestic violence. Both protective and compensatory factors can together be termed resilience factors. Resilience factors include intelligence and problem solving abilities, gender, external interest and affiliations, parental attachment and bonding, early temperament and behavior and peer factors (Fergusson, 2003, Pg.133) as perceived from several studies. Several studies have shown that young people of the resilient type are of higher intelligence and possess better problem-solving skills than their non resilient peers (Seifer, Sameroff, Baldwin, & Baldwin, 1992). Other studies have shown that females are less distressed by family violence or marital discord than males (Hetherington, 1989). Children from high risk families who manage to have an attachment to another adult outside their home appear to be resilient in the long run (Jenkins & Smith, 1990). A warm and nurturing relationship with at least one parent may help the child to develop resilience (Bradley et al, 1994). Individualistic temperament and behavior could be associated with resilience to adverse conditions (Wyman et al, 1991).

Fergusson’s study

Fergusson and Horwood’s study was a 21 year longitudinal study. Of those who had a high resilience and had been exposed to severe family adversity, only 18 % developed externalizing symptoms (Fergusson, 2003, Pg.145). Of those with low resilience and similarly exposed to severe family adversity, 70% developed externalization. 44% of the high-resilience group developed internalizing symptoms following high childhood adversity. Under the same conditions, 76% of the low resilience group developed them (Fergusson, 2003, Pg.145). This study showed that increasing exposure to childhood adversity caused increases in the externalising and internalizing symptoms. Those who were exposed to 6 factors produced externalization 2.4 times higher than those with low exposure and internalization 1.8 times higher (Fergusson, 2003, Pg. 146). It was also evident that all who were exposed to high levels of adversity did not develop problems in later life. Many of them developed resilience that diminished the effects of adversity.

Externalization and Internalization in the genders

Genderwise, it was found that the risk of developing externalization was reduced with females while the risk of developing internalization was reduced in males (Fergusson, 2003, pg. 146). This can be understood as resilience being exhibited by females to externalization and males exhibiting resilience to internalization and vulnerability of females to internalization and males to externalization. Where personality and related factors were concerned, a low novelty-seeking person with plenty of self-esteem would project resilience for externalizing factors while low novelty seeking and low neuroticism were the resilience factors for internalizing responses (Fergusson, 2003, Pg. 147). Avoiding attachment to delinquent care-givers reduced the effects of exposure to childhood adversity in externalization and in internalization, having a strong parental attachment reduced the effects of family adversity. In essence, a secure attachment is necessary to produce resilience to adversity (Fonagy et al, 1994). Factors that contribute to resilience for externalization are different from those for internalization. The resilience factors for externalization include females, low novelty seeking, high self esteem, low attachment to delinquent peers and only 18% exhibited externalization. In contrast, 70% of males of high novelty seeking personality, with low self-esteem and strong attachments to delinquent peers exhibited externalization (Fergusson et al, 2003, Pg. 149).

Blaming the victim

The absence of adaptation or resiliencies is as important as the building of resilience. One of the most damaging of views is ‘that the child is deficient because he does not have the right stuff’ if they do not perform. Resilience is not a trait (Riley, 2005, Pg.17). Only a person who does not understand the meaning of resilience fundamentally can make such a remark. Blaming the victim is the worst thing that can even put back a child’s development. “Resilience depends upon a complex interactions of individuals and their contexts, as well as the nature of the child, unfolding events, and the families, peer groups, schools, communities, cultures, and societies in which the interactions are embedded” ( Riley, 2005, Pg.18). It is the support that adults in the form of parents, teachers and community provide that helps the child build resilience. Exhausted or mentally ill parents, unseeing teachers and a nation impoverished by war cannot afford this support.

What Good Parenting Can Do

Development is cumulative in nature (Riley, 2005, Pg.19). Good parenting ensures the laying of a good foundation early in childhood. Even if this parenting is disrupted for some reason, the child does not revert to a status of a child with no healthy attachment. This child with the well-laid foundation is better equipped to form new healthy attachments when compared to a child who never had the good fortune to start with a healthy attachment. The child would have skills for competent functioning, has expectations for a new healthy attachment, trust and motivation to connect with a new adult. Its positive attachment history shows a resilient adaptation. A child who had a difficult starting relationship can still reach success if the later attachments were healthy (Riley, 2005, Pg.19).

Negative Attachment

A negative attachment in infancy can reduce the development of protective features. The child will not learn prosocial skills and ways of interacting with others. The child feels ineffective in facing the world and believes that relationships are cold and is afraid of being rebuffed. Maltreatment by care-givers creates great risks for innocent children who surely have not opted for this plight. Damage already done to their affect keeps them like that unless interventions and a healthy attachment are successful in changing the situation and making the child resilient (Riley, 2005, Pg.20). ‘Experience with loving consistent care-givers or mentors’ would help this child to form good, positive and healthy relationships. However some residual effect of the early unhealthy childhood attachment often remains (Riley, 2005, Pg 20).

Risk and resilience in academics

Academic achievement is an important feature of our culture. Success or failure in school has long term effects with individual and social consequences (Schoon, 2006, Pg.6). Academic qualification is essential for securing employment in adulthood and also in ensuring adult health and well being. Resilience is the term attributed to individuals who are members of high risk groups with families who had hardship and poverty, or had their childhood in violent neighborhoods, or were born with congenital defects or major disabilities or injuries or illness, or have endured stress in their childhood like marital conflict or mental illness in the family, or have suffered trauma due to physical abuse or war experiences, who have adjusted and attained positive outcomes where negative ones were expected (Schoon, 2006, Pg.9). Socio-economic risk is a major factor which influences individual adjustments across domains.

Combination of risk factors

Outcomes are not governed by individual risk factors in isolation. Many variables would usually exert a combined effect (Schoon, 2006, Pg.9). A high risk individual is one with many disadvantages. Children’s competence includes academic achievement and behavioral adjustment which are the predictors for positive adult adjustment for work, family life and health. ‘Emotional maturation, adjustment to puberty, and the formation of a coherent identity’ are the positive adjustments in the adolescent period. (Schoon, 2006, Pg.12). Positive adjustment in old age is linked to ‘mastery of daily demands and satisfaction with one’s aging process’. The identification of whether outcomes are successful or not depends on the person who experiences them.

Outcomes

What success means to one person may not be success in the eyes of another. Successful development has to be defined within a cultural context (Schoon, 2006, Pg.13). Another factor which has to be considered is the wide extent of outcomes across domains. The outcomes could be emotional, academic, behavioral or physical adjustments. All children do not respond in the same manner to adversity. A child exposed to severe hardship may turn out to be terrific academic performers. Success in one domain need not necessarily imply that success would surely be seen in another.

Protective factors to break the cycle

Protective factors like characteristics of the individual, the family environment and the wider social context modify the outcome to a certain extent. Some individuals manage to break the cycle and succeed in spite of odds. Individuals who showed early academic resilience performed well in most tests and had fewer behavioral problems. They also had more friends and cultivated hobbies (Schoon, 2006, Pg.14). Oozing confidence, they enjoyed school life and were motivated academically. Their positive attitude towards further education and career choices gave no hint of their childhood hardships. A supportive family environment with parents participating in all their activities and choices, taking them out, reading to them, having joint activities and helping each other in household chores ensures a positive adjustment. Support from teachers who have recognized the children’s abilities and the cohesion among the neighbourhood also plays a great role in shaping the positive adjustment (Schoon, 2006, Pg.14). Protective factors are considered the opposite of risk factors. A variable that is considered protective becomes a risk factor on its reverse. Marital harmony is a protective factor while marital conflict is a risk factor. Some variables are curvilinear where excess and reduction causes problems. Resilience is not a personality characteristic or trait.

Risk and resilience in emotional abuse

Research has found that 16% of children are maltreated in the United Kingdom.

6% are exposed to frequent and severe emotional abuse (Cawson et al, 2000). Legal definitions say that certain persistent and repetitive parental behaviors affect a child’s development and social needs negatively causing him to lose self worth and self esteem.

6 dimensions identified by Mitchell (2005) for emotional abuse and neglect are ‘persistent hostility, persistent failure to respond to the child’s physical, emotional, intellectual and social needs, seriously unrealistic expectations, inappropriate stimulation of a child’s aggression and/or sexuality, exploitation of a child for the gratification of another’s needs and grossly inconsistent care’. ‘Harsh discipline, conditional parenting,

insecure attachment, denigration and emotional unavailability are other dimensions added by Glaser (2002). Emotional abuse could be passive (neglect) or active. It could be deliberate and sadistic and could also be terrorizing, tormenting, humiliating, exploiting, criticizing or ignoring (Hart et al, 1987). Risk and resilience for emotional abuse consists of processes at the level of the individual, family or community. Emotional abuse is seen more in families with more stressors than supports or risks are greater than protective factors. A combination of variables rather than one could predict the emotional abuse better.

Occasionally it can occur in families which do not have obvious risks (Doyle, 1997). Some personality factors of the parents are known to increase the risk of emotional abuse. The quality of family relationships is linked to emotional abuse.

Domestic violence is a feature of most families where emotional abuse is found (Iwaniec, 2006). Exposure to domestic violence is now more thought of as emotionally abusive. Physical illness, mental illness, learning problems, parental neglect, substance abuse, early parenthood, large family and social exclusion could all be predictors of emotional abuse (Iwaniec, 2006). Children with congenital defects, premature babies, difficult children and those with disabilities are prone to getting emotional abuse. The variables of emotional abuse in children are the nature of the abuse, frequency, intensity and duration of the abuse; individual characteristics of the victim; the nature of the relationship between the child and the abuser; the response of others to the abuse; and factors associated with the abuse that might exacerbate its effects or account for some of the consequences of the abuse’ (Emery and Laumann Billings, 2002).

Detrimental outcomes In emotional abuse

Being subjected to emotional abuse can produce detrimental outcomes.

Difficulties in acquiring basic skills, deficits in reading, languages and mathematics are seen (Iwaniec, 2006). Low educational and vocational aspirations are seen in adolescents who display discipline problems and may be having a disruptive attachment. Exposure to emotional abuse could negate the person’s ability to manage emotional problems or cope with stressful conditions. Delinquent behaviors have been associated with emotional abuse. Victims of emotional abuse are prone to be smaller statured, weighing less and do not meet the developmental milestones (Iwaniec, 2006).

Resilience is possible by early, healthy care-giving experiences which is a pre-disposing condition. Frequency, intensity and duration are the precipitating factors. The working models of self and others are factors which are specific to the child. Behavioral and coping strategies, self esteem, internal or external attributions, disposition, school and availability of supportive relationships are other factors which determine risk and resilience (Iwaniec, 2006)..

Understanding a maltreated child in time

Many positive results confirm the view that appropriate assessment of children and necessary interventions at appropriate times are beneficial to changing the outcome.

The high-risk group consisting of the delinquent youth, the mentally ill adolescent and the teenage mother are continuing their education at community colleges. Acquiring vocational skills while in the Armed Forces, marriage to a stable partner, conversion to a religion that allows plenty of active participation, recovery from a critical illness or serious accident requiring a long hospitalization and even psychotherapy could all change their outcomes to ‘positive’ (Werner, 2005, Pg. 7). Changes could occur at any stage in life. The multiple levels of influence must be targeted simultaneously for inducing maximum resilience (Riley, 2005, Pg.21). It all comes to say that the early infant-care-giver relationship is the best target for intervention. The change-over produces active, sociable, affectionate, children causing less anxiety to the parents.

A look at the interventions that are now in progress will show us the significance of the healthy attachment in them which is a feature that forms the basis of shaping a resilient child out of a maltreated one. Identifying fully the circumstances of a maltreated child, understanding the context and its resilience is of utmost necessity in planning an effective strategy which would promote a positive adaptation (Riley, 2005, Pg.22). Misplaced blame, ineffective interventions, findings that cannot be replicated and mere theory that does not produce ideas would result in a failure of interventions if the full context of the situation is not understood fully. Close attention must be afforded to gauge the level of naturally occurring resilience and future plans must be based on this. Many researchers have with intellectual depth and appreciation of the complexity of lives contributed much literature on the subject of resilience to promote and protect the development of a healthy child (Riley, 2005, Pg. 22).

Competent parenting, intellectual resources, social competence, and easy temperament are considered as the core characteristics of resilient children and their environments (Gerwitz and Edleson, 2007). Resilience has been described as a dynamic developmental progression where time and changing circumstances allow the emergence of new strengths and vulnerabilities (Luthar, Cicchetti, & Becker, 2000). Let us now look at the possible interventions which can create and help resilience in maltreated children.

Interventions

Interventions or the strategies for helping maltreated children to negotiate developmental challenges are classified into three by Masten and Coatsworth (1998): risk-focused, protection-focused and process-focused. The risk-focused strategies reduce or prevent risks and their impacts. The protection-focused strategies counterbalance the risks by adding resources. The process-focused strategies focus on the parent-child relationships, social skills and self-regulation (Gerwitz and Edleson, 2007). Legal strategies like orders for protection, stringent sentences and mandatory arrest policies to discourage offenders all come under the risk-focused strategies. The protection-focused strategies include the domestic violence shelters and planning the safety of victims and children. The school development curricula in pre-schools and relationship-based interventions with battered mothers and their children come under the process-focused strategies and help to enhance the healthy attachment and effective parenting techniques (Gerwitz and Edleson, 2007). Supportive resources may be revealed to a family so that mothers and children both voluntarily participate instead of it being mandatory for them to join.

Strategies for the high risk children

For high-risk children the combination of all 3 strategies is the most effective. Head Start, nurse home visitation programmes, and parent-child interactions are the interventions available (Gerwitz and Edleson, 2007. The Head Start includes an educational component which equips the child with structured social skills development and educational opportunities outside the home. Family support activities and home-based interventions are used. Guidance with healthcare, nutrition, housing and other ‘concrete’ issues, and emotional support with the tasks are provided to the mothers through home visitation programs. Parenting under stress is thus assisted. Healthy attachment relationships between the children and their competent non-abusing care-givers are encouraged through these interventions (Gerwitz and Edleson, 2007). The potentially damaging effects of spousal abuse are eliminated. The idea is to increase responsive parenting that buffer the children against poverty and violence. Battered women’s shelters and community-based domestic violence programs have taken in children too. Trauma treatment is also provided by community-based programs. Legal interventions are available for holding the batterer responsible for his attitude and empowering and supporting battered women. Advocates effectively support and protect women and children. Their services focus on mobilization of assets to meet their basic needs and minimize risks to the children (Gerwitz and Edleson, 2007). Successful interventions would be attending to the family’s economic and cultural context, using the natural supports around them.

Some Drawbacks

Several drawbacks are present now which need to be corrected as early as possible. Standardized measurements of exposure to domestic violence are very few and thereby cannot be considered faultless. Evaluations of the programs for early support of the maltreated child are not reliable as they are very few in number (Gerwitz and Edleson, 2007). The longitudinal studies which help one understand the interactions are also only minimal in number. We find our hands empty when we want to assess a child’s situation and uncover the risk and protective factors in his life. It is difficult for us to find out which developmental task has been affected due to exposure to violence Further how the exposure interacts with other risk and protective factors with the passage of time is difficult to be assessed.

Considerations for the future

Efforts must be taken to make necessary alterations in the ongoing Home Visitation Program and other early supports to the children (Gerwitz and Edleson, 2007). Risk and protective factors relating to the ethnic, cultural and community contexts are not established yet through studies. Poverty is still the biggest threat to school readiness for high risk children. Early cognitive and language skills are also important for school readiness. However for success in school and beyond, self –regulatory skills, social and peer competence are the critical skills. Some of the interventions offer only emotional support. Others enhance the tasks of development (Gerwitz and Edleson, 2007).

Importance of nurses

The Centre for Violence Prevention in the USA has declared that the nurses and other staff need to have a good working knowledge of the attitudes and skills necessary to impart quality care to victims of domestic violence (Brackeley, 2008).

A community campus partnership must be designed to improve care by using a logic model which has a few essential steps. Needs and assets assessment, capacity building, program selection, implementation and assessment, and final evaluation are the steps planned. The plan may have implications for other health institutions too (Brackeley, 2008).

Aims of Interventions

Maltreated children need to be given plenty of love and structured therapy to change them (Perry, 2001). They are to be nurtured and provided with sufficient bonding experiences, more than what they would have needed at their earlier childhood when it was denied them. The new experiences should help the child develop an attachment. Knowing more about the problems of attachment would prepare the new care-provider from misunderstanding the child’s response. The responses seen now would be a result of their earlier deprived childhood (Perry, 2001). Punishment must be twice thought over before practice. The maltreated children are never their age emotionally. Patience is necessary to understand their emotional age and behave accordingly. The children who have attachment problems may be sensitive to changes and chaos. Consistency, predictability and repetition on the part of the care-provider would help these children to be safe and secure (Perry, 2001). Appropriate social behaviors must be designed and taught. Listening by itself would help the children come out with their thoughts. These are the moments to reach out to the child. The maltreated children have plenty of memories and behaviors to forget. Ample patience is required to set them on their feet. The child’s progress is expected to be slow. The care-provider feels exhausted and demoralized occasionally. Sufficient care must be provided to themselves. Support groups and foster families must be taken advantage of (Perry, 2001).

Possible limitations of interventions

Competent enhancement programs and strength building policies are good for moulding a competent resilient individual who can live as a sociable and useful member of the community from a child who has faced family adversity (Werner, 2005, Pg. 8). However a limitation is expressed by Scarr (1992) who notes that rescuing children from adverse situations and returning them to normal development may be limited by ‘heritable dispositions like intelligence, temperament and psychobiologic reactivity’.

Good outcomes are seen when programs offer health, education, family support services, cross professional boundaries and view the child as part of a family and the family as part of the community (Schorr, 1988). The children are provided access to competent care-givers who equip them with problem solving skills, improve on their communication skills, enhance their self-esteem and act as role models for them (Werner, 2005, Pg.8)

Psychoeducation

Psycho educational groups with cognitive behavior therapy, learning and feminist theory are established. (Johnston, 2003). Efficacy of intervention models has not been checked (Graham-Bermann, 2001) and effective systematic evaluation has not been done so far (Graham-Bermann and Hughes, 2003). Children who have been exposed to domestic violence end up having a multitude of behavioral and psychological sequelae so that definite types of interventions have not been identified or used effectively (Borrego, 2008).

Multi-focusing

Interventions need to be multi-focused on the different domains. Those available concentrate either on the child or the parent. It is important that the relationship between the parent and child is focused upon (Borregeo, 2008). This concept of focusing on the parent-child relationship is fairly new. It has been shown to be effective in children with anxious attachment (Lieberman et al, 1991), maltreated children (Chafin et al, 2004) and children exhibiting oppositional behaviors (Brinkmeyer and Eyberg, 2003). The interventions have also been found effective in children with co-morbid separation anxiety disorder and oppositional defiant disorder (Chase and Eyberg, 2008).

CPP-FV

The Child–Parent Psychotherapy for Family Violence (CPP-FV; Lieberman et al. 2005a) is an accepted intervention where the psychodynamic attachment, cognitive behavioral aspects and social learning theories are combined (The National Child Traumatic Stress Network [NCTSN], 2007). Families with infants, toddlers and pre-school children are given this intervention. The therapist encourages the mother to play with her child. Effective protective behaviors would be modeled for the mother. The intervention hopefully improves the relationship between mother and child focusing on the understanding and normalization of their affective states. Emotional support is provided. Frequent communication and physical contact would improve their interaction and relationship. This therapy reduces the maladaptive states of both mother and child (Lieberman et al, 2005b).

PCIT

Another therapy which is gaining popularity is the PCIT or Parent-Child Interaction Therapy. It is an evidence-based and parent focused intervention. It is used for young children between 2 and 7 years having disruptive behavior problems (Schonfield and Eyberg, 2005). The goal of the therapy is teaching the parent skills that improve the relationship with the child. The parent is taught to be attentive when the child behaves appropriately and decrease attention when it does not.

Phase I Child Directed Phase

There are two phases: the child-directed and parent-directed. The first phase is based on the attachment theory and the second on the social learning theory. In the first phase (child-directed), or the Relationship Enhancement phase, the child leads the play while the parent uses the PRIDE skills to react to the child. Praising the child, Reflecting the child’s verbal communications, Imitating the child’s play, Describing what the child is doing during the play, and using Enthusiasm while interacting are the activities of the parent. The skills are applied when the child is behaving appropriately and the child is ignored otherwise (Harwood and Eyberg, 2006). The pro-social behaviors of the parents are enhanced in this phase. The therapist frequently prompts the parent to refrain from negative interactions and enhance the pro-social nurturing interactions. The child’s pro-social behaviors are also reinforced (Borrego and Urquiza, 1998).

Phase II PARENT Directed Phase

When the parents are comfortably skilled, the second phase is started, the parent-directed or Discipline phase. Effective child management skills which are also developmentally appropriate are used to reduce the child’s behavior problems. The parents would continue using the skills learned in the first phase. The parent gives specific commands, waits for the consequences and then uses one or more of the PRIDE skills learned when the child complies. If the child does not comply, the mother gives a verbal warning. If this does not produce results, the mother shows inattention. Seeing the mother inattentive, the child usually complies. The parent is taught to manage non compliance, aggression and other disruptive behaviors.

Advantages of PCIT

PCIT effectively decreases disruptive behaviors in children (Nixon et al, 2003). These changes are maintained over time (Hood and Eyberg, 2003). Untreated siblings also get the benefit of the therapy (Brestan et al, 1997). The parent’s stress levels and ability to abuse also changes (Borrego et al, 1999). PCIT is effective in separation anxiety disorder (Choate et al, 2005). It has been used effectively in various illnesses like ADHD, developmental disabilities and families with chronic illness and in various populations and with many participants together. Foster parents too can effectively manage their children with PCIT.

Domestic violence is a significant area which can utilize the PCIT in its various problems. Disruptive behavior, aggressive behavior, antisocial behavior, impaired social skills, internalizing problems, difficulty focusing on tasks, academic problems, insecure attachment and problems associated with imitation of batterer can all be handled with the PCIT (Borrego, 2008). Differential attention, effective discipline techniques (e.g.time out), parents modeling a positive non-aggressive behavior, using the PRIDE skills and teaching the children to verbalize anger, modeling of social skills, supportive parenting, enhancing the relationship, changing interactions which contribute to internalization, frequently praising and occasionally giving rewards when in good behavior are some of the techniques possible in PCIT to deal with or prevent domestic violence problems (Borrego, 2008).

On the spot assessment and correction

One advantage of PCIT is that direct on-the-spot assessment of the relationship can be made. The therapist can observe the participants and determine the behaviors occurring in excess (physical aggression by the child or criticisms by the parent), occurring insufficiently (child pro-social behaviors, praises by the parent) or absent (positive physical contact between the two). Target behaviors can be addressed using a specific treatment plan just for the two. The therapist is also able to guide the parent through if she is not performing well (Borrego, 2008). The therapist must practice the skills of the first phase on the mother in order to encourage or discourage her at times her skills falter. The mother can be taught stress and anger management as the mother interacts, (Schonfield and Eyberg, 2005).

Not right for some PCIT is not the right primary method for cases of traumatization. It can be used as an adjunct. In ongoing domestic violence, PCIT is not appropriate. In this case, safety issues must be addressed before the treatment. Before the treatment, the emotional, physical and psychological status of the parent and child need to be assessed.

New suggestions

Werner has suggested investigating the resilience of older people. She also speaks of intervention programs in churches, hospitals, community colleges and the military.

Future researches need to concentrate on the ‘gene-environment co-relations and interactions’ (Rutter and Silberg, 2002). Adverse environments negatively affect genetically vulnerable children in that their resilience is modified according to the vulnerability. (Werner, 2005, Pg.9).

APA’s Summit on Violence and Abuse in Relationships: Connecting Agendas and Forging New Directions.

The APA President, Alan E. Kazdin, PhD, indicated that ‘the summit is a first step in what should be an enduring effort by psychologists to reduce interpersonal violence, both within American society and the world as a whole’ (Chamberlin et al, 2008). Statistics of domestic violence were discussed here. One on four women was reported to have been assaulted sexually by an intimate partner. Though child abuse reports say that there is a decline from 12.5 to 12.1 per thousand children in the past five years, the real number is believed to be 3 times higher (Chamberlin et al, 2008).

“Seven million children have likely seen more severe aggression, such as beatings or gun violence” according to Jouriles from Southern Methodist University. Project Support, Kids Club and Child-Parent Psychotherapy are the three projects which have successfully helped the youngsters who have witnessed domestic violence (Chamberlin et al, 2008). One researcher said that the chronic stress of repeated exposure could cause changes to the frontal lobes. Organization of thoughts and problem solving ability would be affected. The child’s sensory and motor cortices become overdeveloped when the key area becomes affected. These children become too responsive to gestures and sounds which are predictors of violence (Chamberlin et al, 2008).

A Therapy which worked

Solution focused therapy in a youth.

Youth victims are hardly served by professional interventions routinely (Lewandowski et al, 2004, Pg. 17). Standardized measures to completely gauge the risk, resiliency factors and youth experiences in domestic violences are lacking (Edleson et al, 2007). Traditional psychotherapy does not seem to evoke a favorable response from youth (McAuley et al, 2006). Newer interventions like expressive writing, strength-focused practice, and e-mail therapy (Constantino et al, 2007) seem to have a better effect of improving coping abilities and psychological well-being.

Mainly E-Mail Communications: Moving with the times

An intervention combining in-person and e-mail communications and lasting 5 years was instituted between a therapist and a 13 year old youth of Greek-Cypriot origin who witnessed domestic violence and was later abused by his father (Georgiades, 2008). Georgiades’s study investigated how the solution-focused therapy affected his ‘academic performance, mental health, psychosocial adjustment and overall well-being of his intrafamilial system’. 81 e-mails were exchanged and several meetings were arranged between the therapist and youth. Better perpetrator –youth relationship was one positive outcome. Remission was seen in the youth’s depression and post traumatic stress problems. There was a hike in his academic performance. The boy was encouraged to make plans just in case his father faltered. A set-back occurred when his father had to consent to a divorce against his wishes. The father again abused the mother. The son then devised a plan to save his mother from the father. He was able to communicate with his father through a letter. The father regretted his earlier violence and promised to make amendments. They then met frequently.

It did work!

The basis of this therapy was the empowerment philosophy (Guitirez et al, 1998) and solution-focused interventions (de Schazer et al, 2007). The outcome of this therapy happens to be positive and the method can be seen as a useful one to use in youth who become affected by domestic violence.

Significance of culture

Background culture must be considered when deciding treatment. Some cultures still look upon domestic violence as a stigma (Georgiades, 2003).The people involved tend to hide this and suffer in silence. Discipline in some homes is still associated with physical punishment (Georgiades in press). Both parents assume the role of disciplinarian but the fathers are the usual authoritarians and exhibit macho characteristics (Dedoussi et al, 2004). The mothers are known to be more socializing, comforting and nurturing in behavior.

The basis of therapy

The empowerment philosophy and the solution-focused therapy believe in an individual’s intrinsic potential of devising solutions to his own problems. The therapist discovers this potential and guides him towards a positive direction. The client’s strengths are identified leading to the client-therapist partnership. The client trusts the therapist to give him good guidance. Targeted objectives are reached using the client’s competencies. Solution-focused interventions have been found effective (Burns and Hulusi, 2005). Exposure to domestic violence has a negative effect on the child-perpetrator relationship, their behavior in school and health including both physical and mental (Sullivan et al, 2007). Ethics needs to be the guideline when selecting interventions. The interests of the battered youth must be kept foremost in mind. Incorporating solution-focused interventions and e-mail therapy in the treatment of youths affected by domestic violence may be a good alternative to other interventions.

Interventions for fathers

This study has further led to a growing recognition for the need of interventions as child abuse is a huge problem in North America. Though mothers are considered to be the usual perpetrators, the fact that most families have no fathers must be considered. It was found that when 2-parent families are considered, the fathers are the greater perpetrators. In a Canadian study, it was found that the fathers have been found to be perpetrators in 71% cases of physical abuse and 69% involving emotional maltreatment (Crooks et al, 2006). In sexual abuse cases the fathers or step-fathers are the ones 3 and a half times more likely to be investigated.

One study identifies four pathways which are interconnected and account for the effects of child maltreatment (Kendall-Tackett, 2003). Physiological, behavioral, cognitive and emotional pathways have been identified for the negative outcomes. Abusive fathers do not recognize or prioritize their wards’ need for love, respect and autonomy. This is the reason for having interventions for maltreating fathers. They must be guided to address and counter their attitudes which lead them to use abusive control. Guidance can also be given to appreciate their children’s physical and emotional needs. They can then be taught parenting skills for more efficient child management or benefit from broad-based parental support (Scott and Crooks, 2004).

Father perpetrated abuse is more significant in numbers than abuse from the mothers. Men who are abusive to their wives also tend to be emotionally abusive to their children (Bancroft and Silverman, 2002). In group-based parenting programs, it is assumed that there was no marital conflict. However this would not have been the proper circumstances. An abusive father undergoing a parenting program without his nature being evident, will not do any good in the management of his child. The leader of the parenting program may just refer the parents to a marital counseling centre if he suspects a marital relationship problem. This intervention alone will positively be insufficient for changing his attitude and can even be dangerous in a father who is abusive to his wife and children. (Crooks, 2006). Interventions should be related to their relationships and abusive behaviors towards the wives (Salzinger et al, 2002).

Caring Dads

“Caring Dads: Helping Fathers Value Their Children.” is a program envisaged by Crooks to cater to the needs of abusive fathers. The objectives are to increase the father’s awareness of the impact of his abusive and neglectful behavior on the children, motivate the fathers to change, decrease the attitudes and perceptions causing maltreatment of children and improve the father-child relationship (Scott, Francis, Crooks, & Kelly, 2002). Following the 17-week treatment program, the fathers usually reduce their involvement in child-focused conflict and become more involved in child management strategies. Men who are abusive have to be discovered and goaded into the program. They do not voluntarily opt for it (Mahalik, Good, & Englar-Carlson, 2003). Most men believe that they do not need changes and feel defensive about being put into a treatment program. If these men enter the therapy in the pre-contemplative state of mind, the program would not be successful (Scott and Wolfe, 2003). It is essential that they be shifted into the contemplative stage before starting the therapy. They must gain the desire of making some changes. Motivational interviewing is the first part of the Caring dads Program and is meant for resistant clients who deny a problem (Miller and Rollnick , 1991). It enhances intrinsic motivation (Miller and Rollnick, 2002). Generally hostility is reduced and motivation is increased. A monitoring stance is taken in the second stage which is more related to process. The duality of men’s experiences is given consideration. The third stage involves careful monitoring and a healthy pro-social group process. Building rapport is the main essence of the program.

Breaking the cycle of abuse

I have selected an article speaking of the practical aspect of helping a woman who has undergone violence at the hands of her husband and a study which investigated the breaking of the cycle of abuse.

The Article By Linda Curry

A patient who has been in a marriage where domestic violence is frequent needs to be helped to break the cycle of abuse. The patient may be guided towards examining her feelings (Curry et al, 1988). Did she really have a warm marriage with plenty of love for each other? Why did the incidents of violence take place? Did her partner have any abnormal desires? Had he indulged in substance abuse? All theses question may help the patient see things in a new light. Her honest reflections on her life partner would help her see that he is a useless, unloving, person who may have been using her for his own pleasures and requirements (Curry et al, 1988). She would realize that she had been taken for a ride.

Relationship between therapist and client

Kindness and acceptance by the therapist is a beginning to the therapy. The therapist needs to be a good listener for the sessions and get the client to ‘bare her soul’. Helping a client to rebuild a shattered life is assisted by the empathetic care and persistent attention of a therapist. A trusting relationship needs to be built between the two (Curry et al, 1988). The next step involves the assistance to look at the situation realistically. Some clients find it hard to face facts. They may feel that their partners may relent and become good souls soon. The desire to save the marriage would be stronger than the reality of facing facts. It is a job to get these clients to understand that the situation will not change and that the partner is beyond redemption if he is (Curry et al, 1988). Some clients believe that they become failures if the marriage is not saved at all costs. Persistent counseling may be required to convince the client of the situation.

Necessary support

The next step is to support the client when she makes the decision to end her marriage and look forward (Curry et al, 1988). Probably the marriage lasted this long because of the partner’s threats and the client’s reluctance to change things. The following step is to support her through any associated crises with the help of her friends (Curry et al, 1988). The next is to allow the client to express her anger and slowly work through her depression. Her power as a mother and the sincerity with which she has looked after her children this far must be impressed upon the client. The domestic violence should not be pictured as her fault. It is when she has come to terms with her condition and is ready to live the remaining life well and with hope that she must be considered free of the trauma of her violent life (Curry et al, 1988).

The study By Egeland

A study has compared mothers who broke the cycle of abuse with mothers who did not (Egeland et al, 1988). Interviews and questionnanires helped uncover past and current relationships and their measurements, stressful events in their life and personality characteristics over a period of 64 months. 90% of the abusive group had a history of abuse whereas only 17% of the non abusive mothers gave a similar history in one study (Hunter and Kilstrom, 1979). In this study, the abuse rate across generations was found to be was low. The two groups of abused mothers (47 numbers) and the non abused (114 of them) were decided by questioning these ladies. 8 of the 47 complained that their care-giver did not provide the basic physical needs. Whichever group they were in, 44 mothers ‘maltreated their infants (Egeland et al, 1988). ‘Maltreatment’ was decided by the physical abuse or hostile or rejection patterns or psychological unavailable patterns or neglect from the mother. Most of the mothers were similar in their demographic characteristics. The ages were between 15 and 30 at the time of first delivery, 83% were single, 47% had not completed high school and 83% were white.

Who maintained and who broke

It was gauged that those mothers who obtained support in their childhood from some adults who were not abusive changed their attitudes and broke the cycle of abuse. They became emotionally supportive mothers. A similar result was obtained in the case of women who received some therapy or who had a stable, emotionally satisfying relationship with a mate. The mothers who had maintained the cycle of abuse turned out to be the anxious types who are also dependent, immature and depressed. They continued the cycle of maltreatment of their unfortunate children (Egeland et al, 1988).

Limitations

One limitation in this study is that there could have been a difference among some mothers in the non abused group who may have hidden the abuse they received in childhood. This would not have been wrongly expressed in the abused group and there is no reason to disbelieve them when they claim that abuse had been there in their childhood. The concept of the internal working model has not been adopted in this study (Egeland et al, 1988). The assessments were done at 3 months and 64 months of the study. Aggression and dependency showed changes with time. Many did not continue abuse. Relationship with a supportive adult or therapist may have changed their attitude to abuse. Those who continued in their maltreatment were not fully convinced about the necessity to be emotionally supportive to their children.

Some positive effects and some negative

One obvious conclusion of this study is that interventions can change the strong impact of early relationship experiences (Egeland et al, 1988). It was gauged that those mothers who obtained support in their childhood from some adults who were not abusive changed their attitudes and broke the cycle of abuse. They became emotionally supportive mothers. A similar result was obtained in the case of women who received some therapy or who had a stable, emotionally satisfying relationship with a mate. The mothers who had maintained the cycle of abuse turned out to be the anxious types who were also dependent, immature and depressed. They continued the cycle of maltreatment of their unfortunate children (Egeland et al, 1988).

Interventions for Women of Domestic Violence

A survey conducted by Spencer et al in 2008 found that many program directors are aware that their internal medicine residents need to be able the handle women who are the victims of domestic violence but they are not fully equipped. 42 of them participated in the survey. Most of them agreed that the 13 health competencies for women are not mastered in their programs. More than one-third of them realized that their internal residents who were going to be primary care doctors did not have the knowledge to ‘diagnose, treat, or counsel women with incontinence, vaginitis, domestic violence, preconception planning, or birth control needs’ by the time they finished their residency training (Spencer et al, 2008).

Gap in graduate medical education

In spite of national guidelines for women’s education, the residents’ programs are still wanting in the appropriate matter imparted to them on caring for women. Substantial improvements need to be made. This gap in graduate medical education was earlier reported in 1990 and persists even today. Several national guidelines have been published mandating improvements in women’s health training. Having an experienced program director who would incorporate more lectures on women’s health would turn out better equipped residents to handle the care of women (Spencer et al, 2008). An insight as to the whether resident training meets the needs of women after domestic violence will be obtained from the rigorous evaluation of current training programmes. Further changes can then be implemented to make residents fully competent to meet the care of abused women.

Ensuring good parenting

Another drawback seen is the inability to ensure good parenting (Stanley, 2007).

Parenting problems include mental health needs, domestic violence and substance abuse.

These issues have an influence on abuse, neglect or loss in childhood (Bifulco and Moran, 1998). When envisioning child services, it is necessary to identify adults’ problems too. Their capacity to parent may depend on their own experiences of abuse and neglect. (Woodcock, 2003). Practitioners in child health services must link with those adult services which offer parents individual support and therapeutic input. The behavior of children and their responses to the carers are influenced by the environment. Parenting in unsupportive environments, the carers have a very difficult time (Stanley, 2007).

Building the resilience of mothers and their children through a community- based program

The fact that many social programs have failed to increase the resilience of mothers and child in adverse situations can probably be attributed to the multiple problems involved, the lack of education of the mothers, inadequate social support, little access to transport and may be living in a highly violent neighborhood (Schellenbach et al, 2000, Pg 101). A community collaboration with a multi-systemic approach and targeted at mothers, children and the social systems (Schellenbach et al, 2000, Pg 102) which contain them has been adopted by the Oakland County in Michigan.

Michigan had high rates of infant mortality of twice the national average of 9/1000.

Child poverty was another drawback. 38% of the mothers were adolescent. Poverty below the age of 5 was 39%. Oakland had the lowest per capita income (Schellenbach et al, 2000, Pg 104). The need for a unifying system for the services to families was urgent as the prevalent services were many with no unifying system, making the beneficiaries totally confused.

An example deserving to be followed

The Healthy Families Oakland Community Partnership was the answer to a community based program which had powerful positive results. Home visitations were the main theme. The families were all assessed by this singular programme and those who needed intensive support were identified (Scellenbach et al, 2000, Pg 105). Regular weekly home visits were done. Accountability, professional support and skill development of the staff are plus points for the success of the programme (Schellenbach et al, 2000, Pg 106). The program provides parenting education on relevant topics. Parent skills are developed through observation and guided interventions. A family support specialist will develop a consistent, caring and supportive relationship with the parent or family (Schellenbach, 2000, Pg 106). Linkages to health, education and community services are also provided. This is now available country wide. However problems have risen in the administration. The salary scale in different areas is determined locally. Discrepancies in the salary have caused workers to move from one area to another, causing a dent in this successful program… This problem can be stopped by making conditions and salaries uniform. The success of the program has been asserted (Schellenbach et al, 2000, Pg. 107). The Gallup organization has considered the ‘engagement hierarchy, higher productivity, better employee return, increased customer satisfaction, better cost efficiencies and improved employee safety’ for putting the Oakland community program in the top quartile (Schellenbach et al, 2000, 107).

An important section of the community which could produce dramatic results

Law enforcement officers are a group in the community which could basically improve the results of a service program. They could use their authority to improve data collection on domestic violence and did a collection that covered a three year period in a study (Fantuzzo et al, 2007). The reliable collection of statistics enabled the study to examine incidents of domestic violence which most often had children involved. Substance use was found in one third of cases. Results also showed that the perpetrators were likely to be arrested if children witnessed the violence. The impact of the arrest of the father in front of the child could influence the emotional status of the child. The presence of the child increased the concerns of the police officer about the negative impact that could affect the child. The law enforcement officers had training in domestic violence after the leadership made a commitment to the cause.

Enlisting the services of powerful police officers could predict better results in a domestic violence study with positive targets of improving the general community. ‘Trained police personnel can serve as effective sentinels in a public health surveillance system for children exposed to domestic violence’ (Fantuzzo et al, 2007). A strong relationship between the police and the community in a coordinated manner can do wonders for children who are caught up in domestic violence. The police can also act as ‘gatekeepers’ who link the distressed families to services.

Final Statement

Having read much literature on the subject of domestic violence, I have come to the conclusion that child maltreatment is one aspect of domestic violence which necessarily needs to be stopped at all costs. Witnessing domestic violence or intimate partner relationship and being physically abused subject children to many negative outcomes. Some salient points found in recent literature have given me plenty of new ideas about domestic violence and the significance of not allowing maltreated children from going on to a life of negative outcomes and misery and have amply answered my research questions.

Children exposed to domestic violence against their mothers or victimized through physical abuse themselves have negative outcomes which include emotional adjustment, school behavioral problems and a tendency to delinquency. The combined effects of both domestic violence through witnessing it and being victimised through direct physical abuse will have more negative outcomes than with any one experience.

Child maltreatment is associated with externalizing and internalizing behavioral patterns.

Child abuse regardless of the gender of the parent has a greater consequence in the current violent behavior rather than spousal violence which the child witnessed.

The intergenerational transmission process allows for the co-relation of the degree of exposure to domestic violence in early childhood to the extent of current behavior.

The Attachment theory with variables like separation and loss increases the predictability of intergenerational transmission of DV more than the social learning process. Loss of the primary attachment figure is traumatic to the child and results in heavy emotional scarring. Attachment relationships show improvement on cessation of domestic violence. The number of times the respondent lived away from home was the biggest predictor of current violence in a study implying that separation, interpreted as a break in the healthy attachment was a predictor. Affect regulation is a mediator of the intergenerational transmission of violence against women.

The intergenerational transmission of physical punishment is predicted differently in males and females. Marital satisfaction moderates the intergenerational transmission of physical punishment or abusive parenting. Adult children who report that their parents had a conflictual relationship will have a more negative view of self, of others and will be more likely to have a fearful attachment style compared to adult children who do not report that their parents’ relationship was disturbed by marital conflict. Similarly adult children who have knowledge of their parents’ infidelity will have a more negative view of self, of others and will be more likely to have a fearful attachment style and to engage in infidelity, compared to adult children who do not reveal knowledge of their parents’ infidelity (i.e., who either are not aware of the infidelity or report that the parents did not engage in infidelity).

Children and families can be helped by providing a continuum of supports to help them become resilient and able to project healthy, affectionate, competent personalities who contribute to the development of society instead of being risks. These could include naturally occurring supports in the family and community. More intensive interventions may be needed occasionally like domestic violence advocates, social service and mental health agencies. Interventions that are targeted on the developmental tasks of early childhood and those that reduce the impact of the stressors should be sufficiently effective in helping the young children negotiate developmental changes. The development of prevention and intervention programs which are effective and disrupt the cycle of abuse or violence is based on the understanding or uncovering the risk and protective factors relating to a particular child exposed to violence. Poverty is still the biggest threat to school readiness for high risk children. Interventions or programs should aim at supporting secure or healthy attachments between young children and their non-abusive mothers.. A multi-thoeretical model starting with the social learning process and going onto disrupted attachments probably explains the current violence better. A secure adult is effective in providing care, exhibits efficacy in dealing with most stressors by themselves, adaptable, capable, trusting and understanding conforming to the psychobiological model of Bowlby.

A healthy and secure attachment helps the maltreated child to develop good emotional balance, resilience to stress, the confidence to explore further relationships through physical and social skills, put in a good academic performance and become generally competent. This healthy child continues this behavior in his adult relationships too. Incorporating a healthy attachment in the interventions planned for a maltreated child is of utmost necessity to build a resilience to negate the outcomes possible through intergenerational transmission of the violence or abuse he is exposed to.

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