Children's Exposure to Violence and Traumatic Death

VioLit summary: OBJECTIVE: The purpose of this article by Pynoos and Nader was to provide descriptions of and a framework for understanding children's reactions to being exposed to violent events. It also provided suggestions for treatment of the grief responses and post traumatic stress symptoms often experienced by these children. METHODOLOGY: This study described children's typical responses to being exposed to such violence as domestic violence, suicide, homicide, rape, community violence, juvenile gang violence and severe car accidents. Children in this study participated in standard semi-structured interviews at the UCLA Neuropsychiatric Institute and Hospital's clinical prevention intervention program on violence. This study utilized these interviews along with the results from a posttraumatic stress reaction index, a child inventory of grief reactions, and parental descriptions of the children's postviolence responses to develop a framework for understanding children's responses to violence. The authors did not describe the sampling design nor indicate how many children were interviewed. FINDINGS/DISCUSSION: This study detailed seven violent traumatic events (domestic violence, suicide, homicide, rape, community violence, juvenile gang violence, and severe car accidents) to which children have been exposed and provided a vignette for each one which described the typical reactions by the children. Previous research has found the following: an estimated 3.3 million children witness spousal abuse annually with 33-50% of these children also being abused; each year thousands of children are directly or indirectly exposed to suicidal behaviors in their parents; children witness an estimated 10-20% of the 19,000 homicides which occur each year; when rape occurs in the home (about 40% of sexual assaults), children witness it in about 10% of the cases; a survey of inner-city elementary school children found that 15% had been exposed to gunfire in their neighborhood, 5% had experienced a robbery, and 3% had experienced the violent death of a loved one. Gang violence can often be found in elementary schools today and about 35,000 car accidents involve hitting a pedestrian or nonmotorist each year. This study created four symptom groupings resulting from children's exposure to violence and provided suggestions for treatment in each category on three levels: the classroom, the family and the individual child. The first category involved posttraumatic stress symptoms which this study claimed as common results of children's exposure to violence. These children often experienced disturbing intrusions of sounds and images, similar to flashbacks; reduced interest in usually enjoyable activities; feelings of isolation; distancing from friends; increased states of arousal; sleep disturbances; difficulty concentrating; high levels of fear and anxiety to specific traumatic reminders; and guilt. Treatment for these posttraumatic stress symptoms were within the classroom in order to address fears of reocurrence, feelings of vulnerability with the family, and to restore the child's personal integrity. The second symptoms grouping involved the children's persistent loss and grief reactions. Similar to adults, these children tried to ignore reality and search for the person killed or lost; dreamt and fantasized about a reunion with the lost person; and experienced anger, sadness, and depression. Unlike adults, the children often did not seek out support and could not separate the person from the violent event making reminiscing a traumatic event. The suggested treatment for these feelings of loss and grief were to address issues related to dying and loss within the classroom; to deal with issues of loss and attachment with the family; and to validate the child's attempts to recover from the loss. The third category of symptoms found in children who were exposed to violence involved the worry of the safety of significant others. Often the intense anxiety and concern about the safety of a loved one led the children either to be extremely apprehensive when the loved one was gone often creating sleep disturbances or to reject that person in order to avoid experiencing intrusive memories. The suggested treatment for these symptoms involved providing an outlet for immediate expression of these concerns in the classroom; restoring confidence in the family about interpersonal relationships; and addressing the child's challenge with re-establishing the interpersonal relationship with the loved one. The fourth category of symptoms involved memories of previous violent events triggered by experiencing the current violent event. These symptoms involved disturbing affects, renewed fears, disturbed sleeping patterns and intrusive images. The treatment suggestions for these renewed symptoms were to provide a screening by a teacher or mental health professional within the school; to provide the family with support for rediscussing past traumatic experiences; and to address any recurrence of symptoms which are related to previous trauma. Differences in symptoms do occur with the age of the child: pre-school children often exhibit decreased verbalization and cognitive confusion; school-aged children often exhibit more inconsistent, reckless behavior; and adolescents often exhibit extreme increases in dependence or extreme increases in independence which often involves delinquency or self-endangering behavior. AUTHORS' RECOMMENDATIONS: The authors claimed that there is a need for more research and evaluation of treatment strategies for children exposed to violence. They stressed the need for connecting individuals, families, schools and communities in the treatment process. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado) KW - Exposure to Violence KW - California KW - Witnessing Violence Effects KW - Post-Traumatic Stress Disorder KW - Domestic Violence Effects KW - Witnessing Community Violence KW - Grief KW - Child Witness KW - Psychological Victimization Effects KW - Witnessing Spouse Abuse KW - Spouse Abuse Effects KW - Sexual Assault Effects KW - Homicide Effects KW - Juvenile Gang KW - Gang Violence KW - Juvenile Violence KW - Adult Violence KW - Children of Battered Women KW - Interparental Violence KW - Partner Violence KW - Violence Against Women