CHILD ABUSE PROFESSIONAL TRAINING
SERIES #4
HOW DOES CHILD SEXUAL ABUSE AND WITNESSING DOMESTIC
VIOLENCE ALTER AND AFFECT THE COURSE OF DEVELOPMENT?
Fawn McNeil-Haber, PhD
CHILDHOOD TRAUMA
“Repeated trauma in adult life erodes the structure of the
personality already formed, but repeated trauma in childhood
forms and deforms the personality. The child trapped in an
abusive environment is faced with formidable tasks of
adaptation. She must find a way to preserve a sense of trust in
people who are untrustworthy, safety in a situation that is
unsafe, control in a situation that is terrifyingly unpredictable,
power in a situation of helplessness. Unable to care for or
protect herself, she must compensate for the failures of adult
care and protection with the only means at her disposal, an
immature system of psychological defenses.”
- Judith Herman, 1992
CHILDHOOD

Rapid brain development
most rapid between birth and 5 years old
 by 3 years old ~ 85% of adult volume


Primed to learn from our experiences

Early development and experiences provides a foundation for
later development.
The following slides are provided courtesy of The
National Child and Traumatic Stress Network's
Caring for Children Who Have Experienced Trauma:
A Workshop for Resource Parents (2010)
NORMATIVE DEVELOPMENTAL TASKS
Infants and toddlers
Preschoolers
Attachment
 Security
 Trust
 Emotion regulation
 Autonomy
 Recognition of and response
to emotional cues


Autonomy
 Agency
 Initiative
 Emotion regulation
 Self control
DEVELOPMENTAL TASKS
School-aged
Adolescence
Sustain attention for
learning and problem
solving
 Control Impulses
 Becoming Industrious
 Emotional Awareness
 Complex reasoning
 Friendships
 Manage anxieties


Independence
 Relationships
 Achievement
 Identity (Values)
 Abstract thought
 Anticipate and consider
consequences of behavior
 Control behaviors for long
term goals
 Accurately judge danger
and safety
In what ways does trauma impact these
normative developmental tasks?
COMPLEX TRAUMA
Children’s experiences of multiple traumatic events
that occur within the caregiving system
Neglect
 Emotional abuse
 Physical abuse
 Sexual abuse
 Witnessing Domestic Violence

(Cook et. al, 2003)
CHILD SEXUAL ABUSE
A sexual act imposed on a child who lacks emotional,
maturational, and cognitive development to understand and
consent to such acts.
 1 in 5 girls
 1 in 10 boys
 70% of sexual assaults occur before age 18
 > 90% of offenders are known to and trusted by victims
 Crime of control, betrayal, secrecy, isolation, intimidation and
helplessness
 A crime that is misunderstood by most adults including nonoffending parents
(Finklerhor & Jones, 2012; Snyder, 2000)
DOMESTIC VIOLENCE EXPOSURE
Commonly defined as a behavior, or pattern of behaviors, that
occurs between intimate partners with the aim of one partner
exerting control over the other through aggression, coercion,
abuse and/or violence.
 43% of female victims and 25% of male victims of DV live in
households with children (Bureau of Justice Statistics)
 Occurs disproportionately in home with children under 5 (Taylor
et. al, 1994)
45%-70% also physically abused1
 15 times more likely to be physically abused or neglected1
 Evidence for a raised cooccurrence of DV and CSA1
 The ability to parent is compromised1
1.(Holt et al, 2008)

SIMPLE VS. COMPLEX TRAUMA
Simple
Complex
Non-interpersonal
 Limited exposure (single
event)
 Shorter duration
 Occurrence at later
developmental stage
 Support of caretaker/family
 Secure attachment with
with primary caretaker(s)


Interpersonal
 Multiple exposures/types
 Longer duration
 Occurrence at an earlier
developmental stage
 Limited or no support
 Insecure attachment with
primary caretakers
(Lanktree & Briere, 2008)
COMPLEX TRAUMA
Mental, Emotional, Biological and Behavioral effects of
experiencing recurrent childhood abuse.
Seven domains of impairment
Attachment
 Biology
 Affect Regulation
 Dissociation
 Behavioral Control
 Cognition
 Self Concept

(Cook et. al, 2003)
ATTACHMENT
The emotional bond between an infant and caregiver serves to
create safety and security for that child.
Secure attachment
 Insecure attachments (avoidant and resistant)
 Disorganized attachments

Attachment continues to evolve throughout childhood and
adulthood.
DISORGANIZED ATTACHMENTS
“For some infants the caregiving environment so bizarre,
threatening, unpredictable, violent or frightening that not only
are the infants insecure, but they also cannot organize a
strategy for ensuring protective access to their caregivers.”
When in need of comfort, these infants demonstrate undirected,
odd, and contradictory behaviors.
(Cassidy & Mohr, 2001)
ATTACHMENT
Uncertainty about the reliability and predictability of the world
 Problems with boundaries
 Distrust and suspiciousness
 Inappropriate help seeking (e.g.social isolation;
undiscriminating affection)
 Interpersonal difficulties
 Difficulty attuning to other people’s emotional states
 Difficulty with perspective taking
 Difficulty enlisting other people as allies

(Cook et. al, 2003)
BIOLOGY
Brain development
 Hypersensitivity to physical contact
 Somatization
 Increased medical problems across a wide span, e.g., pelvic
pain, asthma, skin problems,autoimmune disorders,
pseudoseizures

(Cook et. al, 2003)
AFFECT REGULATION

Involves the ability to identify emotion and regulate the
experience of emotion

Begins at a very young age and continues throughout
childhood
AFFECT REGULATION

Difficulty with emotional self-regulation

Depression, Anger, Anxiety
Difficulty describing feelings and internal experience
 Problems knowing and describing internal states
 Difficulty communicating wishes and desires

(Cook et. al, 2003)
DISSOCIATION
Three primary functions of dissociation:
1.
Automatization of behavior in the face of psychologically
overwhelming circumstances
2.
Compartmentalization of painful memories and feelings
3.
The detachment from one’s self when confronting extreme
trauma
(Putnam, 1997)
DISSOCIATION

Distinct alterations in states of consciousness

Amnesia

Two or more distinct states of consciousness, with impaired
memory for state-based events
(Cook et. al, 2003)
BEHAVIORAL CONTROL
Refers to a person's ability to control their impulsive and manage
and direct their behavior in a responsible manner.
When attachment, affect regulation, biological functioning and
perceptual integration has been compromised behaviors
become dysregulated.
BEHAVIORAL CONTROL
Poor modulation of impulses
 Self-destructive behavior
 Aggression against others
 Pathological self-soothing behaviors
 Communication of traumatic past by reenactment in day-today behavior or play (sexual,aggressive, etc.)
 Difficulty understanding and complying with rules
 Sleep disturbances
 Eating disorders
 Substance abuse
 Excessive compliance
 Oppositional behavior
(Cook et. al, 2003)

COGNITION
Refers to higher brain functioning needed for
Executive Function
 Academic Advancement
 Abstract Reasoning
 Sustained Attention
 Flexibility
 Creativity

COGNITION
Difficulties in attention regulation and executive functioning
 Lack of sustained curiosity
 Problems with processing novel information
 Problems focusing on and completing tasks
 Difficulty planning and anticipating
 Problems understanding own contribution to what happens to
them
 Learning difficulties
 Problems with language development
 Problems with orientation in time and space

(Cook et. al, 2003)
SELF CONCEPT
The mental image or perception that an individual has of
his/herself and his/her abilities
SELF CONCEPT
Lack of a continuous, predictable sense of self
 Poor sense of separateness
 Disturbances of body image
 Low self-esteem
 Shame and guilt
 Feeling stigmatized

POST TRAUMATIC STRESS DISORDER
Exposed to a traumatic event that involved actual or threatened
death or serious injury, or a threat to the physical integrity of
oneself or others resulting in:
 Recurrent intrusive recollections


Avoidance of reminders


nightmares, intrusive thoughts, physical/emotional distress
of thoughts, of feelings, feeling distant, difficulty feeling positive
feelings
Increased physical arousal

sleep difficulties, concentration difficulties, anger, hypervigilance
TRAUMA SYMPTOMS FOR CSA
(BIRTH TO AGE 8)
Eating disorders
 Fear of sleeping alone
 Nightmares/Night terrors
 Separation anxiety
 Thumb- or object-sucking
 Enuresis (wetting accidents)
 Encopresis (soiling)
 Language regression
 Sexual talk
 Excessive masturbation
 Sexual acting out, posturing

Crying spells
 Hyperactivity
 Change in school behavior
 Regular tantrums
 Excessive fear (including of
men or women)
 Sadness or depression
 Suicidal thoughts
 Extreme nervousness

TRAUMA SYMPTOMS FOR CSA
(AGE 9 THROUGH ADOLESCENCE)
Fear of being alone
 Nightmares/Night terrors
 Peer problems
 Fights with family
 Poor self esteem
 Memory problems
 Intrusive recurrent thoughts
or flashbacks
 Excessive guilt/shame
 Mood swings
 Sexual acting out

Overly compliant
 Self mutilation
 Hypervigilance
 Substance abuse
 Avoidant, phobic behaviors
including sexual topics
 Sadness or depression
 Suicidal thoughts or
gestures
 Excessive nervousness
 Violent fantasies

TRAUMA SYMPTOMS FOR DVE
Birth to 5
6 to 11
Sleep disruption
 Eating disruptions
 Withdrawal
 Separation anxiety
 Inconsolable crying
 Regression
 Anxiety, fears
 Increased aggression
 Impulsive behavior


Sleep disruptions
 School Difficulties
 Aggression/Difficulty with
peer relationships
 Concentration problems
 Withdrawal and/or
emotional numbing
 School avoidance and/or
truancy
TRAUMA SYMPTOMS FOR DVE
12-18
Adulthood
Antisocial behavior
 School failure
 Impulsive/reckless behavior






School truancy
Substance abuse
Running away
Abusive dating relationships
Depression
 Anxiety
 Withdrawal

Depression
 Child Maltreatment
 Substance Abuse
 Intimate Partner Violence
ADVERSE CHILDHOOD EXPERIENCES (ACE)
STUDY
Ace Score 0-10
•
~ 2/3 experienced 1+ ACEs
emotional abuse
 physical abuse
1 in 5 reported 3+
 sexual abuse
http://www.cdc.gov/ace/prevalence.htm
 neglect
 lack of emotional support
 domestic violence exposure
 separated/divorced parents
 mentally ill household member
 alcoholic household member
 household member who went to prison

•
http://acestudy.org/yahoo_site_admin/assets/docs/ACE_Calculator-English.127143712.pdf
ADVERSE CHILDHOOD EXPERIENCES (ACE)
STUDY
ADVERSE CHILDHOOD EXPERIENCES (ACE)
STUDY
Alcoholism and alcohol
abuse
 Chronic obstructive
pulmonary disease (COPD)
 Depression
 Fetal death
 Health-related quality of life
 Illicit drug use
 Ischemic heart disease
 Liver disease

http://www.cdc.gov/ace/findings.htm
Risk for intimate partner
violence
 Multiple sexual partners
 Sexually transmitted
diseases (STDs)
 Smoking
 Suicide attempts
 Unintended pregnancies
 Early initiation of smoking
 Early initiation of sexual
activity
 Adolescent pregnancy

Do all children who witness domestic
violence grow up to become domestic
violence perpetrators?
DO ALL CHILDREN WHO WITNESS DV GROW UP
TO BECOME DV PERPETRATORS?
Family of Origin Violence is one of risk factors in Intimate
Partner Violence (Franklin et. al, 2011)
 Several studies to suggest that many children show resilience
in the face of interparental violence.

54% of 2-4 yr. olds showed positive adaptation. (Martinez-Toreya,
2009)
 31% of 8-14 yr. olds in a DV shelter didn't exhibit any signs of
maladjustment. (Gyrch et. al, 2000)
 67% of 8-16 yr. olds in a community sample score below clinical
cutoffs on internalizing and externalizing. (Spilsbury et. al, 2008)
 118 studies were analyzed. Results 37% of DV exposed children
were doing similarly or better than non-witnesses. (Kitzmann,
2003)

WHY DO PEOPLE RESPOND DIFFERENTLY TO
THE "SAME" TRAUMATIC EVENT?
Risk and Protective factors
Pre-trauma factors
 Factors specific to the trauma
 Post-trauma factors

RESILIENCY FACTORS
Having a supportive parent who can:
1. Believe and validate their child’s experience
2. Tolerate the child’s affect
3. Manage their own emotional response
(Cook, et. al, 2003)
RESILIENCY FACTORS
Easy disposition
 Positive beliefs about self
 Positive Temperment
 Internal locus of control
 external attribution of
blame
 High degree of mastery
 Spirituality

High self esteem in one area
 Positive attachment to
emotionally supportive and
competent adults
 Motivation to act effectively
 Development of cognitive
and self regulation abilities

RISK FACTORS
Poverty, which is related to poor educational achievement (a
protective factor)
 Parental unemployment
 Alcohol use
 Poor social supports
 Violence with a weapon
 Witnessing sexual abuse against the mother
 Co Occurrence of Physical Abuse
 Self blame appraisals

DO ALL CHILDREN WHO EXPOSED TO
DOMESTIC VIOLENCE GROW UP TO HAVE
VIOLENT RELATIONSHIPS?
Nope
REFERENCES
Bureau of Justice Statistics, Intimate Partner Violence in the U.S. 1993-2004, 2006.
Cassidy, J., & Mohr, J.J. (2001). Unsolvable fear, trauma, and psychopathology: Theory, research, and clinical considerations related to disorganized
attachment across the life span. Clinical Psychology: Science and Practice, 8, 275-298.
Cook, A., Blaustein, M., Spinazzola, J., & van der Kolk, B. (2003). Complex Trauma in Children: White Paper from the National Child Traumatic Stress Network
Complex Trauma Task Force. [White Paper] Retrieved from http://www.nctsn.org/sites/default/files/assets/pdfs/ComplexTrauma_All.pdf
Finklerhor, D. & Jones, L. (2012). Have sexual abuse and physical abuse declined since the 1990s? Crimes Against Children Research Center, C267.
Franklin, C.A., Menaker, T.A., & Kercher, G.A. (2011). The effects of Family-of-Origin Violence on Intimate Partner Violence. Retrieved from
http://dev.cjcenter.org/_files/cvi/7935%20Family%20of%20Origin%20Violence.pdf
Grych, J.H., Jouriles, E.N., Swank, P.R., McDonald, R., & Norwood, W.D. (2000). Patterns of adjustment among children of battered women. Journal of
Consulting and Clinical Psychology, 68, 84-94.
Herman, J. L. (1992). Trauma and Recovery. New York: Basic Books
Holt, S., Buckley, H., & Whelan, S. (2008). The impact of exposure to domestic violence on children and young people: A review of the literature. Child Abuse
and Neglect, 32, 797-810.
Kitzmann, K.M., Gaylord, N. K., Holt, A. R., & Kenny, E. D. (2003). Childwitness to domestic violence: Ameta-analytic review. Journal of Consulting and
Clinical Psychology, 71(2), 339–352.
Lanktree, C. & Briere, J. (2008). Integrative Treatment of Complex Trauma for Children (ITCT-C): A guide for the treatment of multiply-traumatized children
aged eight to twelve years. Retrieved from http://www.johnbriere.com/Child%20Trauma%20Tx%20Manual%20(LC%20PDF).pdf
Martinez-Torteya, C., Bogat, A., von Eye, A., & Levendonsky, A.A., (2009). Resilience among children exposed to domestic violence: The role of risk and
protective factors. Child Development, 80 562-577.
Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective. New York, NY: Guilford Press.
Spilsbury, J.C., Kahana, S., Drotar, D., Creeden, R., Flannery, D.J., & Friedman, S. (2008). Profiles of behavioral problems in children who witness domestic
violence. Violence and Victims, 23, 3-17.
Snyder, H N. (2000). Sexual assault of young children as reported to law enforcement: Victim, incident, and offender characteristics. National Center for
Juvenile Justice, U.S. Department of Justice. Retrieved December 31st, 2008, from http://www.ojp.usdoj.gov/bjs/abstract/saycrle.htm
Taylor, L., Zuckerman, B., Harik, V. & Groves, B. (1994).Witnessing violence by young children and their mothers. Journal of Developmental and Behavioral
Pediatrics. 15, 120–123.