by Gregory K. Fritz, MD, Bradley Hospital medical director and Hasbro Children's Hospital child andfamily psychiatry director. Fritz is also editor of the Brown University Child and Adolescent Behavior Letter, where this article first appeared.
Although domestic violence, mainly men beating women, has been a fact of life for many centuries, it only has appeared as a legal issue in the past three decades in the United States. Before then, domestic violence was considered a family matter best handled privately-police policy, for example, discouraged arrest in domestic-violence cases.
Since the women's movement of the 1970s, domestic violence has come to be recognized as a serious social problem demanding the attention of the courts, police departments and social-welfare agencies. Despite the progress, however, domestic violence is still viewed as affecting primarily adults. Traditional services such as battered women's shelters do not provide access to needed care for the majority of exposed children.
A recent issue of "The Future of Children" (Vol. 9, No. 3, Winter 1999), the David and Lucile Packard Foundation has pulled together a series of articles that highlight the impact of domestic violence on children. Typical of this excellent series, the articles' thoroughness and breadth shed needed light on a shadowy area often overlooked.
Research estimates that 3.3 million to 10 million children in the United States are exposed to domestic violence each year. Though clearly large, the number is imprecise-a reflection of the lack of accurate data on the nature and scope of the problem. Without more extensive and reliable information on the prevalence of exposure and its impact on development, these children will remain largely invisible to professionals and policymakers.
Acknowledging the limitation of the database, it is nonetheless clear that exposure to domestic violence can damage a child's physical, emotional, social and cognitive development. Infants, school-age children and adolescents are all affected, with differences in responses stemming from their developmental levels. Very young children exposed to violence in their families show excessive irritability, sleep disturbances and regressive behavior. Older children may show anxiety, depression, decreased academic performance and lower levels of social competence and self-esteem.
The impact appears to be especially severe on adolescents, who show higher levels of aggression, conduct disorder, truancy and revenge-seeking. In cases of extreme exposure, children may experience symptoms of post-traumatic stress disorder similar to what is seen in children living in a war zone.
Children's dependence on their parents means that when one parent is the perpetrator and the other is the victim, the child's needs inevitably suffer. The battered parent rarely can provide adequate emotional support for the child, and ongoing contact with the batterer, which often occurs, is a constant stress. Domestic violence is usually not an isolated problem in an otherwise well-functioning family. In 30 to 60 percent of families in which domestic violence occurs, child maltreatment is also present.
Traditional services such as battered women's shelters do not provide access to needed care for the majority of exposed children. Child-care professionals, including teachers, pediatricians and mental-health workers, often lack training related to domestic violence and its impact on children.
New laws intended to help children in some areas may have unintended negative consequences for children exposed to domestic violence. For example, laws designed to minimize a child's time in foster care may result in premature adoption if the battered parent requires too long to get back on her feet. Laws promoting family reunification may backfire in cases of domestic violence if children are returned to a violent family situation. Recognition of the problem is the first step, but more research, new models of intervention and sustained commitment are essential to mitigate the impact of domestic violence on children.