Ms. See Lok Man, Mary Assistant Lecturer School of Nursing The University of Hong Kong Dr. Anna Choi Assistant Professor Department of Social Work and Social Administration The University of Hong Kong

1. An Overview on Children Exposure
to Interparental Violence: Definition,
Impact and Cultural Concerns
Ms. See Lok Man, Mary
Assistant Lecturer
School of Nursing
The University of Hong Kong
Dr. Anna Choi
Assistant Professor
Department of Social Work and Social Administration
The University of Hong Kong

2. An Overview on Children Exposure to
Interparental Violence: Definition, Impact and
Cultural Concerns
Outline:
1. Introduction
2. Methodology
3. Definition of “Children Exposure to Interparental Violence”
– Global definition
– Findings from literature review
– Discussion
4. Impact of children exposed to interparental violence
– Overview on impact across developmental stage
– Risk and protective factors
– Discussion
5. Discussion on the Chinese cultural view on Children exposure to
interparental violence

3. Introduction
• Children witnessing or being exposed to interparental violence has been a
global concerns. Around 15.5 million children in US were living in families
with intimate partner violence annually (McDonald, Jouriles, Ramisetty-
Mikler, et al., 2006).
• Existing studies and review showed interparental violence poses
deleterious short-term and long-term impact on the well-beings of the
children who were exposed to, in no matter form of exposure
• Inconsistency in definition of the term “children exposure to interparental
violence” was noted among existing studies
• The aim of this review was to
– Identify the inconsistency in definition of the terms and measurement of
interparental exposure among existing studies, and its differential influence on
child’s impact
– Update our knowledge in the pathway leading to the children’s negative
impacts of exposure of interparental violence from recent studies
– Discuss on the cultural and societal influence on children exposure to
interparental violence

4. Method
• Keyword search
– Parental conflicts/ violence, marital conflicts/ violence, intimate
partner violence, inter-parental conflicts/ violence, spousal
conflicts/ violence
– Child exposure/ witness
• Search Engine
– ERIC, Medline, PsycInfo, Sociological Abstracts, Social Service
Abstracts, CINAHL, Pubmed and Cochrane Library
• 2,610 results on Feburary, 2015
• 737 results remained after title screening and eliminating
the duplicates

5. Inclusion and Exclusion Criteria
• Inclusion Criteria
– Studies from recent 5 years
– Focus on exposure to interparental violence only
– Empirical study investigating impact on children
• Exclusion Criteria
– With other kinds of child maltreatment
– With other kinds of family problems
– The main outcome variables is not focus on exposed-child’s well-
beings
– Non-English articles
• After screening with the inclusion and exclusion criteria, 74 studies
included in this review

6. Definition

7. Global Definition of
Child Maltreatment
“All forms of physical and/or emotional ill-treatment, sexual
abuse, neglect or negligent treatment or commercial or other
exploitation, resulting in actual or potential harm to the child’s
health, survival, development or dignity in the context of a
relationship of responsibility, trust or power.”
(WHO, 2006)
“Any act of series of acts of commission or omission by a
parent or other caregiver that results in harm, potential for
harm, or threat of harm to a child.”
(CDC, 2008)

8. Global Definition of
Children Exposure to Interparental Violence
“Exposure of a child to violence between caregivers is
categorized as an Acts of omission, particularly if the
caregivers do not take available measures to protect
the child from exposure.”
(CDC, 2008)
“a child has been a witness to violence occurring
between the caregivers (or a caregiver and his/her
partner)”
(Public Health Agency of Canada, 2010)

9. Global Definition of Children
Exposure to Interparental Violence
• It was classified as the “Fifth type of child
maltreatment” in Canada
– With three subtypes:
• Indirect witness of physical violence
• Exposure to emotional violence
• Direct witness to physical violence
(Public Health Agency of Canada, 2010)

10. Picture retrieved from psyblogger.com
Direct
Involvement Indirect
Involvement
Direct Witness
Indirect Witness
Intervenes
Victimized
Participates
Prenatal exposure Eyewitness
Overhears
Observe the
initial effects
Experiences the
aftermaths
Hears about it
from others
(Holden, 2003)
Children Exposure to Interparental Violence

11. Findings from this review
Characteristics of Interparental Violence
• Types
– Physical interparental violence (n=62, 83%)
• Physical violence only (n=25)
• Physical and verbal aggression (n=9)
• Physical and psychological aggression (n=11)
• Physical, psychological, sexual aggression (n=16)
• Physical and sexual aggression (n=1)
– Verbal aggression only (n=4)
– Psychological aggression only (n=1)
– Not mentioned (n=7)
• Gender Pattern
– Bidirectional (n=35)
– Father-to-mother (n=29)
– Mother-to-father (n=1)

12. Findings from this review
Characteristics of Interparental Violence
• Source of informants
– Mother/ Father/ Caregiver Report (n=45)
– Children (n=10)
– Self-report (for retrospective studies (n=10)
– Multiple informants (with one is Children) (n=5)
– Others (n=2)
• Measurement used to measure Interparental violence
– Conflict Tactics Scale (n=16)
– Revised Conflict Tactics Scale (n=18)
– Conflict Tactics Scale- Couple Form- Revised (n=3)
– Children’s Perception of Interparental Conflict Scale (n=5)
– Other validated tools (Severity of Violence Against Women Scales, O’Leary-
Porter Scale, Abuse Assessment Screen, verbal aggression scale etc) (n=14)
– Non-validated tools (n=17)

13. Findings from this review
Degree of exposure
• 72% of the studies did not mention the degree of exposure in the studies (n=54)
– Among which, around one-third of the studies were child-report or retrospective report of IPV
(n=15)
• Only 28% of the studies define the degree of exposure by child
– Type
• Direct witnessing (n=14)
• Direct and indirect witnessing (n=7)
– Source of informants
• Mother (n=9)
• Children (n=8)
• Self-report in retrospective studies (n=3)
• Child welfare worker (n=1)
– Measurement
• Context of Intimate Partner Violence Interview
• CACI-2
• Children exposure to domestic violence scale
• Schedule for the Assessment of Intimate Partner Violence Exposure in Children
• Children’s Perception of Interparental Conflict Scale
• Children’s narrative reports

14. Gender Pattern of Interparental Violence
on Impact on Children
Outcome variables Mother-to-Father Violence Father-to-Mother Violence Bidirectional
Eriksson,
Mazerolle (2015)
Intimate partner violence
perpetration in
adulthood
No significant association with IPV
perpetration
For male only
Predict IPV perpetration
For male only
Predict IPV perpetration
Mandal & Hindin
(2015)
Family intimidation and
physical abuse
Experiencing family intimidation and
physical abuse
Use of family intimidation and
physical abuse
Experiencing family
intimidation and physical
abuse
Moretti, Bartolo,
Craig et al., (2014)
Aggression in romantic
relationships in
adolescence and young
adulthood
Girls showed greater interpersonal
rejection and increase aggression toward
romantic partners (for both physical and
psychological assault)
Girls showed increase romantic
partner psychological aggression
only
-
Mandal, Hindin
(2013)
Perpetration and
victimization of friend
(psychological aggression)
Associate with bidirectional friend
psychological aggression among males
No significant association Associate with bidirectional
friend psychological
aggression among males
Temple, Shorey,
Tortolero, et al.
(2013)
Teen dating violence
perpetration (physical
and psychological
aggression)
Associate with teen dating violence in boys
and girls
Associate with teen dating
violence in girls only
-
Milletich, Kelley,
Doane, et al.
(2010)
Perpetration of physical
aggression and
victimization
Increase women perpetrate their dating
partner physically
Increase men perpetrate their
dating partner physically
-
Wright, Fagan
(2012)
Externalizing and
Internalizing problems
No significant findings More impact on girls’ internalizing
mental health problems than boys
-

15. Conclusion
• Our findings echoed with previous findings
– Child exposure to interparental violence is usually inferred from parent report or other secondary sources of information, exposure is
operationally assumed by parents’ reports on intimate partner violence and equate them to children’s exposure, rather than actually
assessed
(Knutson, Lawrence, Taber, et al., 2009; Hungerford, Wait, Fritz, et al., 2012)
• Significance of gender pattern of interparental violence
– A more complete picture of the presence of the interparental violence the child exposed to
(Rigterink, Katz, Hessler, 2010)
– The differential impact of mother-to-father and father-to-mother intimate partner violence on children’s well-beings
(Hungerford, Wait, Fritz, et al., 2012)
– Existing knowledge still cannot fully conclude the relationship between gender pattern of interparental violence and the gender of the
exposed children
– Role-specific and gender specific influence on the impact on intergenerational transmission of violence and children’s adjustment were
noted
(Eriksson & Mazerolle , 2015)
• Significance of type of interparental violence being exposed to
– The types of violence children exposed to may have different impact on their child functioning
(Gonzalez, MacMillan, Tanaka, et al., 2014; Harding, Morelen & Thomassin, 2013)
• Significance of multiple informant report in assessing interparental violence
– Child report of maternal and paternal perpetration was associated with maternal report on paternal perpetration, but not maternal
perpetration
– Suggested that there may be desirable bias which cause under-reporting by perpetrator
(Harding, Morelen & Thomassin, et al., 2013)
• In conclusion, standardized definition and measurement of “exposure to interparental violence” in terms of types of
violence, pattern of violence, degree of exposure and source of information were crucial as these factors may affect the
impact on children

16. Impact of Children Exposed to
Interparental Violence

17. Impact of Children Exposure to
Interpaental Violence across the Lifespan
Infancy to Toddler
Developmental/ Cognitive
- Poorer development
- Poorer memory development (Gustafsson, Coffman,
Harris et al., 2013)
Behavioral
- More externalizing behaviors and negative
temperament (DeJonghe, Von Eye, Bogat, et al., 2011)
Physical
- Obese and steady overweight (Jun, Corliss, Boynton-
Jarrett, et al., 2012)
- Increase cortisol reactivity (Hibel, Granger, Blair, et al.)
Pre-School
Developmental/Cognitive
- Poorer development in language, personal-social, fine
motor adaptive (Gilbert, Bauer, Carroll, et al., 2013)
- Lower verbal ability (Graham-Bermann, Howell, Miller, et al.,
2010)
Behavioral
- Externalizing behavioral problems (Miller, Howell, Graham-
Bermann, 2012)
Physical
- More asthma, allergies, dizziness (Kuhlman, Howell,
Graham-Bermann, 2012)
- Obese and steady overweight (Boynton-Jarrett, Fargnoli,
Suglia, et al., 2010; Jun, Corliss, Boynton-Jarrett, et al., 2012)
- Alter child’s internal regulatory abilities (smaller increase in
vagal tone) (Rigterink, Katz, Hessler, 2010)

18. Childhood (6-12 years old)
Behavioral
- Externalizing behavioral problems (Olaya et al.,
2010)
- Increase PTSD (Olaya et al., 2010)
- Aggressive behavior and school problems
(Durand et al., 2011)
- More self-harm (Lamers-Winkelman et al.,
2012; Olaya et al., 2010)
- More eating/sleeping/pain problems (Lamers-
Winkelman et al., 2012; George et al., 2014;
Insana et al., 2014)
Physical
- Obese (Jun et al., 2012)
- More health complaints (Grip et al., 2014)
Emotional
- Emotional problems (Harding et al., 2013)
Cognitive
- Self blame (Goeke-Morey et al., 2013)
- Perceived threat (Goeke-Morey et al., 2013)
Adolescence
Behavioral
- Teen dating violence (Garrido et al.,
2013; Temple et al., 2013; Moretti et al.,
2014)
- Psychosocial problems (Garrido et al.,
2011)
- Internalizing behavior problems
(Begman et al., 2014; Wright & Fagan,
2012; Camacho et al., 2012)
- Sexual activity in adolescent (Voisin et
al., 2014)
- High school dropout (Tajima et al., 2011)
Adulthood
Behavioral
- Family intimidation and physical
abuse (Mandal & Hindin, 2015)
- Violence perpetration (Turcotte-
Seabury, 2010; Roberts et al., 2010)
- Dating violence perpetration
(Narayan et al., 2014; Moretti et al.,
2014)
- Friend psychological aggession (for
male only) (Mandal & Hindin, 2013)
- Reliance on disengagement coping
(Brown et al., 2013)
Mental
- Anxiety (Schiff et al., 2014)
- Depression (Schiff et al., 2014)
- Substance abuse (Schiff et al., 2014)
- Alcohol use problems (for female
only) (Smith et al., 2010)
Physical
- Decrease gray matter volume in
brain (Tomoda & Polcari, 2012)
Impact of Children Exposure to
Interpaental Violence across the Lifespan

19. Protective and Risk Factors
Infancy to Toddler
Protective factors
- Early sensitive maternal behavior (Hibel, Granger, Blair, et al.,
2011)
- Maternal cognitive growth fostering (Tailor & Letourneau,
2012)
Risk factors
- Less safe neighborhoods (Boynton-Jarrett, Fargnoli, Suglia, et
al., 2010)
Pre-School
Protective factors
- Increased in-home network size (Miller, VanZomern-Dohm, Howell, et
al., 2014)
- Better parenting (Howell, Graham-Bermann, Czyz, et al., 2010)
- Authoritative parenting (Holmes, 2013)
- Fewer maternal mental health problems (Howell, Graham-Bermann,
Czyz, et al., 2010)
- Less severe violence exposure (Howell, Graham-Bermann, Czyz, et al.,
2010)
Risk factors
- Poor maternal mental health (Holmes, 2013)
- Lower maternal warmth (Holmes, 2013)
- More frequent child physical and psychological violence (Holmes, 2013)
Childhood
Protective factors
- Positive behavior with siblings (Iturralde, Margolin, Shapiro,
2013)
- Father contact (non-violence/less violent father figure) (Hunter,
Graham-Bermann, 2013)
Risk factors
- Smaller age of first exposure (Graham, Bemann, Perkins, 2010)
- Siblings trauma symptoms (Tailor, Stewart-Tufescu, Piotrowski,
2015)
- Lower sibling warmth, higher sibling hostility (Piotrowski, Tailor,
Cormier, 2014)
- Negative maternal behavior (Tailor, Stewart-Tufescu,
Piotrowski, 2015)
- Poorer maternal psychopathology (Insana, Foley, Montgomer-
Downs, et al., 2014)
- Child’s negative emotionality (Goeke-Morey, Papp, Cummings,
2013)
Adolescence
Protective factors
- Lower physiological reactivity (Zemp et al., 2014)
- Positive behavior with siblings (Iturralde, Margolin, Shapiro, 2013)
- Sibling warmth (Tucker et al., 2013)
- Positive parenting (Garrido & Taussig, 2013)
- Maternal steady employment (Anderson & Bang, 2012)
- Prosocial peer relationship (Garrido & Taussig, 2013; Camacho et al.,
2012)
- Peer communication and peer trust (Tajima et al., 2011)
- Friendship competence (Brown et al., 2013)
Risk factors
- Lower sibling warmth, higher sibling hostility (Piotrowski et al., 2014)
- High relation sensitivity (Moretti et al., 2014)
- Relational victimization (Camacho et al., 2012)
- Limited anger management (Turcotte-Seabury, 2010)
- Justification of aggression (Clarey et al., 2010; Temple et al., 2013)
- Harsh discipline (Ehrensaft & Cohen, 2012)

20. Mediational Pathway from Existing Studies
Preschool Stage
Intimate
Partner
Violence
Externalizing
Problems
Child Traumatic
symptoms
Children’s ability
to understand
Internalizing
Problems

21. Mediational Pathway from Existing Studies
Childhood
Intimate
Partner
Violence
Externalizing
Problems
Parenting
- Harsh Discipline
- Parenting Practice
- Parenting Stress
Internalizing
Problems
Emotional
dysregulation/
Insecurity
Child Appraisals
Maternal
Psychological
functioning
Parentification

22. Mediational Pathway from Existing Studies
Adolescence
Intimate
Partner
Violence
Antisocial behavior
Relationship sensitivity
Anger control
Child Appraisals -
Acceptance of violence
Parenting
Dating Violence/
Future IPV
Child’s mental health –
PTSD symptoms
Early Sexual Activity
Emotional Insecurity
Child’s mental
health (depression/
anxiety)

23. Summary
• Summary on Impact
– Externalizing problems were proven across all five developmental stage
– During infancy to childhood stage, impact on development in multiple aspects were identified,
which may have long-term impact on the later-life of the exposed child
– From school age onwards, more attention was placed on the behavioral (externalizing and
internalizing problems)
– From adolescence to adulthood, studies mainly focused in exploring the long-term impact on
violence perpetration and adulthood mental health
• Summary on Protective and Risk factors
– The protective factors and risk factors can be categorized according to Ecological Model:
• Individual
– E.g. Child’s age, gender, Child cognitive appraisals, physiological activity etc.
• Relationship
– E.g. Siblings relationship, peer relationship, child-parent relationship
• Community &Societal
– E.g. Community awareness, societal norms
– Relationship factors were the most identified protective and risk factors
– During Infancy to Toddler stage and the pre-school, maternal factors contributed heavily on the
protective factors and risk factors for maladjustment
– Starting from childhood stage, siblings relationship quality becomes an important factor in
protecting the exposed child
– In the adolescence, apart from maternal and siblings factors, peer relationship becomes
influential

24. Summary
Summary in mediating pathway
• The mediating factors which were confirmed in recent studies:
– Child’s factors
• Child’s appraisals
• Emotion and mental health status
– Maternal factors
• Psychopathology
• Parenting
– Peer factors
• Relationship sensitivity
• Further studies need to be explored in what way the mediators act on child’s outcomes
– In our findings, parentification can be the direct mediator between the linkage of exposure to interparental
violence and internalizing problems, it can also a mediator between child’s self-blame and internalizing
problems
(Fortin, Douct, Damant, 2011)
• Since exposure to interparental violence is an complicated issue to be explored, more effort need
to be done in exploring other mediators (e.g. siblings factors, societal and cultural factorsetc)
– Qualitative studies can be done in exploring the potential relationship between mediators and child’s
adjustment
– Further longitudinal studies were needed in proving the potential pathway leading to child’s adjustment
– Gender, age, family characteristics, co-occurrence of other kinds of violence, characteristics of interparental
violence being exposed to should be take into consideration when testing the mediating factors
• By increase our understanding in the clinical pathway, this can provide us more evidence support in
designing intervention program

25. Cultural View on Children Exposure
to Interparental Violence

26. In Our Review
• Most of the studies conducted in United States
(n=50), followed by Canada (n=10)
• Others (n=14) were conducted in
– Philippine, Swiss, Australia, Mexico, Sweden, Spain,
Netherlands, Brazil, India and UK
• None of the studies conducted among Chinese
population in investigating purely on children
exposure to interparental violence

27. Interparental Violence:
Chinese Cultural View
• Family cultural norms
– Filial Piety
• “Filial piety should be the top priority among all other behaviors”
• Children may try not to challenge their parents and should considerate their
parents’ feelings in order not to further upset them
(O’Brian & Lau, 1995)
– Harmonious Relationship
• Cause subtle, avoidant and indirect approaches in solving conflict
• Covert interparental conflict style
(Li, Putallaz, Su, 2011)
– Not willing to disclose family matters to others
• children and parents tried not to talk about and seek help for the inter-parental
violence
(Lau et al., 1999)
• child maltreatment or intimate partner violence was perceived as private
matter
(Fry, McCoy & Swales, 2012)

28. Chinese Societal Norms
• Societal normative beliefs about aggression
– Low social awareness
– Acceptance of use of aggression
• Threatening, scolding, shaming was acceptable and
frequently used
– Different conceptualization of child abuse
• Did not think mildly injured or psychological abuse as an
abusive act
• Neglecting a child’s emotional needs was seen as normal in
Chinese culture
(Lau , Liu & Yu et al., 1999)

29. Future Directions
• Establish standardized definition and measurement of “exposure to
interparental violence” in terms of types of violence, pattern of violence,
degree of exposure and source of information
• For the impact, since the impact of exposure to interparental violence
started since infant stage, preventive measures should be taken as soon as
possible (e.g. during the pregnancy period)
• Further explore the mediational pathway was suggested in order to provide
more evidence in intervening the exposed children
• Increase social awareness on the importance of children exposed to
interparental violence
• Conduct studies among Chinese population in the area of children exposure
to interparental violence is necessary in order to explore if there is any
cultural difference with the existing findings in the western countries

30. Thank You
Email: slmary@hku.hk

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