Trauma symptoms among infants exposed to intimate partner violence

Child Abuse & Neglect 30 (2006) 109–125

Trauma symptoms among infants exposed to intimate partner violence夽 G. Anne Bogat ∗ , Erika DeJonghe, Alytia A. Levendosky, William S. Davidson, Alexander von Eye Department of Psychology, Michigan State University, 107E Psychology Building, East Lansing, MI 48824-1116, USA Received 3 October 2003; received in revised form 25 July 2005; accepted 30 September 2005

Abstract Objective: To determine whether infants have a traumatic response to intimate partner violence (male violence toward their female partner; IPV) experienced by their mothers, two questions were explored: (1) Is the number of infant trauma symptoms related to the infant’s temperament and the mother’s mental health? (2) Does severity of violence moderate those relationships? Methodology: Forty-eight mothers reported whether their 1-year-old infants experienced trauma symptoms as a result of witnessing episodes of IPV during their first year of life. Mothers also reported on their own trauma symptoms that resulted from experiences of IPV. Results: For those infants experiencing severe IPV and whose mothers exhibit trauma symptoms, we were able to predict whether infants exhibited trauma symptoms (b = .53, p < .01). This was not true for children who witnessed less severe IPV (b = −.14, ns). Maternal depressive symptoms and difficult infant temperament did not predict infant trauma symptoms for either group of infants. Conclusion: Mothers report that infants as young as 1-year-old can experience trauma symptoms as a result of hearing or witnessing IPV. The significant relationship between infant and maternal trauma symptoms, especially among those infants experiencing severe IPV, are consistent with the theory of relational PTSD. Findings suggest that interventions for mothers and families need to consider the influence of the severity of IPV on very young children. © 2006 Elsevier Ltd. All rights reserved. Keywords: Trauma; Intimate partner violence; Domestic violence; Infants; Person orientation 夽 This study was supported, in part, by grants from the National Institute of Justice (#8-7958-MI-IJ) and Centers for Disease Control (R49/CCR518519-03-1). Portions of this paper were presented at the Society for Research in Child Development conference in Tampa, FL, April 2003. ∗ Corresponding author.

0145-2134/$ – see front matter © 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.chiabu.2005.09.002

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The present study investigated whether infants experience trauma symptoms when they are exposed to male violence directed toward their mothers (referred to as intimate partner violence—IPV). Empirical research has shown that when infants as young as 3 years of age witness IPV, they may develop trauma symptoms (e.g., Graham-Bermann & Levendosky, 1998). There is also clinical evidence that infants exposed to IPV may also develop trauma symptoms (e.g., Alessi & Hearn, 1984); however, there is little empirical work on infants, IPV, and trauma. In this paper, we demonstrate that infants exposed to IPV exhibit trauma symptoms. We also propose that characteristics of the traumatic event, child characteristics, and caregiver responses are important for explaining why some infants show trauma symptoms and others do not. We take an explicitly person-centered perspective to this research (Bergman & Magnusson, 1997; Bogat, Levendosky, & von Eye, 2005; von Eye & Bergman, 2003), demonstrating that infants with specific profiles have different reactions to IPV.

Children and traumatic events and traumatic responses Research indicates that preschool- and school-age children exhibit trauma symptoms as a result of witnessing IPV (e.g., Graham-Bermann & Levendosky, 1998; Kilpatrick & Williams, 1997; Levendosky, Huth-Bocks, Semel, & Shapiro, 2002). A recent meta-analysis suggested that effect sizes for trauma symptoms occurring as a result of IPV exposure were greater than those for other forms of internalizing behaviors (Kitzmann, Gaylord, Holt, & Kenny, 2003). While the presence of trauma symptoms has not been as well-documented in infants exposed to IPV, evidence does suggest that infants may be similarly affected. Descriptions of infants exposed to IPV note problem behavior consistent with trauma symptoms such as eating problems, sleep disturbances, lack of normal responsiveness to adults, mood disturbances, and problems interacting with peers and adults (Layzer, Goodson, & deLange, 1985). Clinical reports indicate that infants who were exposed to IPV have poor health, poor sleeping habits, are highly irritable, and exhibit high rates of screaming and crying (Alessi & Hearn, 1984; Davidson, 1978). In addition, empirical research on infants’ responses to nonviolent conflict finds that those who were exposed to more frequent interparental anger were more likely to become emotionally aroused by displaying anger, distress, or attempts to comfort or reconcile their angry parents when compared to infants exposed to infrequent parental anger (Cummings, Zahn Waxler, & Radke-Yarrow, 1981). Finally, Scheeringa and Zeanah (1995) examined the case records of infants exposed to various traumatic events, including IPV. Threat to a caregiver, compared to other traumas, was most likely to result in specific symptoms such as hyperarousal, fear, and aggression; in more severe symptoms; and in the diagnosis of PTSD. The infants in this study had experienced and witnessed a variety of traumatic events; therefore, conclusions could not be drawn about whether the trauma symptoms exhibited were directly or solely attributable to IPV.

Predictors of trauma symptoms Infants and children exposed to IPV display a variety of responses ranging from severe traumatization to apparent resilience; thus, factors beyond the simple presence or absence of IPV must account for the development of trauma symptoms. Criteria for diagnosis of Traumatic Stress Disorder (TSD; Diagnostic Classification: 0–3, Zero to Three, 1994) indicate that factors such as child and caregiver

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characteristics and characteristics of the traumatic event must be considered in diagnosis. We hypothesized that these factors might also be relevant in the expression of infant trauma symptoms, generally, regardless of whether the infant meets criteria for TSD. Infant characteristics (temperament and gender) and caregiver responses (caregiver depression and trauma symptoms) were examined as predictors, and the severity of IPV to which the infant was exposed (a characteristic of the traumatic event) was proposed as a moderator of the relationship between the predictors and whether infants exhibited trauma symptoms. Infant characteristics Infant temperament. A difficult temperament can both influence an infant’s immediate response to a stressor, such as IPV (Hyson & Izard, 1985), as well as serve as a risk factor for later negative emotional and behavioral adjustment (e.g., Braungart-Ricker & Stifter, 1996). Particularly relevant to the present investigation, Easterbrooks, Cummings, and Emde (1994), studying toddlers exposed to nonviolent marital disputes, found that a difficult temperament was related to greater reactivity to the dispute. However, questions about the influence of difficult temperament remain. For example, Karraker, Lake, and Parry (1994) found that difficult infant temperament was associated with more negative emotional responses to stressful events. However, infants’ behaviors after the negative emotional response (presumably regulatory behaviors) appeared to be independent of temperament, suggesting that these “coping strategies” may be related to the infant’s learning from successful previous attempts at coping rather than temperamental factors. Additionally, there is evidence that “goodness-of-fit” between the infant and his/her environment has an important influence on infant outcomes (Lerner, 1984; Thomas & Chess, 1984). For example, Crockenberg (1981) found that demanding infants were at risk of later problems only if they encountered a caretaking environment that was unresponsive to their needs. This suggests that infants possessing difficult temperaments only encounter problems if they live in an environment that creates “a chronic or excessive state of stress” for the infant (Strelau, 1995, p. 67). If infants have a good fit with their environments, they are relatively buffered from stress, and their reactive temperaments will not function as a risk factor. In fact, there is some evidence that in nonstimulating environments, temperamental reactivity may be associated with positive outcomes (Fox, 1989). Infant gender. The gender of the infant might be a predictor of infant trauma symptoms for several reasons. First, women who experience trauma and abuse may project their own experiences onto their children (Lieberman & Van Horn, 1998; Lieberman & Zeanah, 1995). For male children, mothers in abusive relationships are particularly likely to make negative aggressive attributions about their son’s behavior (Lieberman, 1996). For female children, mothers are especially tuned into the negative effects of IPV due to concern that their daughters might be victims in the future (Levendosky, Lynch, & Graham-Bermann, 2000). These differences could affect how mothers parent, especially as it relates to emotion regulation, and thus, ultimately affect whether infants develop trauma symptoms. Second, female infants may simply witness more IPV than male infants, because female infants are held more often by their mothers than are male infants (Benenson, Morash, & Petrakos, 1998; Lindahl & Heimann, 1997, 2002). There is no research examining whether male and female infants have a differential traumatic reaction to IPV. Empirical evidence is mixed as to whether gender differentially influences outcomes among

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older children exposed to IPV. Some studies find that boys from violent families have more externalizing problems than do girls (e.g., Wolfe, Jaffe, Wilson, Kaye, & Zak, 1988; Wolfe, Jaffe, Wilson, & Zak, 1985), whereas other studies do not (e.g., Jaffee, Moffitt, Caspi, Taylor, & Arseneault, 2002; Levendosky et al., 2002). In related research, Cummings, Iannotti, and Zahn-Waxler (1985) found that repeated exposure of 2-year-old children to simulated, angry interactions led girls to show more distress and boys to show more aggression. Reynolds, Wallace, Hill, Weist, and Nabors (2001) found that school-age boys’ PTSD symptoms were related to depression and self-esteem, whereas girls’ were not. Two empirical studies, examining traumatic events other than witnessing IPV, reported that girls have more PTSD symptoms than do boys (Green et al., 1991; Wolfe, Sas, & Wekerle, 1994). Clinical impressions in another study indicated that boys had more symptoms immediately after the traumatic event (not IPV), but girls had more symptoms 1 year later; gender was also differentially associated with particular symptoms (Kiser et al., 1988). Finally, Scheeringa and Zeanah (1995) found no differences in PTSD among male and female infants exposed to various traumatic events (including IPV). Response of the mother The interactions between a mother and her infant, particularly those that involve positive, responsive caretaking (e.g., secure attachment) have been proposed as one mechanism by which infants learn emotional regulation (Schore, 2001, cf. Kochanska, 1995). Because maternal and infant affect regulation systems interact (e.g., Schore, 1994, 2001), the mother’s dysregulated system could adversely affect infant stress regulation. Two maternal factors, whether mothers exhibit trauma and depressive symptoms, both of which frequently result from experiences of IPV (e.g., Bogat, Levendosky, Theran, von Eye, & Davidson, 2003; Levendosky & Graham-Bermann, 2001; Trotter, Bogat & Levendosky, 2004), might be important predictors of whether infants exhibit trauma symptoms. Mothers who exhibit trauma symptoms. Women who experience IPV are at an increased risk for exhibiting trauma symptoms, including PTSD (e.g., Houskamp & Foy, 1991; Kemp, Green, Hovanitz, & Rawlings, 1995; Kemp, Rawlings, & Green, 1991). Severity and recency of current abuse have been associated with both an increased likelihood of as well as more severe PTSD and trauma symptoms (Astin, Lawrence, & Foy, 1993; Bogat et al., 2003; Houskamp & Foy, 1991; Kemp et al., 1995; Kemp et al., 1991). A mother’s emotional response to IPV is likely to influence her infant’s. If the mother is available to reassure the infant, she may be more likely to regulate the infant’s emotional system, and thus, the infant would be more likely to bring his/her emotions back to stasis. Alternatively, if the mother was, herself, traumatized and emotionally unavailable, the infant’s stress and emotional systems would remain over-stimulated and unregulated. Scheeringa and Zeanah (2001) propose the idea of relational PTSD in describing the co-occurrence of PTSD symptoms in an adult caregiver and a young child; that is, the experience of one member of the dyad can trigger symptoms in the other member. A synchrony between caretakers and children (who are not infants) has been documented in the aftermath of both natural and man-made disasters (e.g., Koplewicz et al., 2002; Wasserstein & La Greca, 1998). The co-occurrence of trauma symptoms among parents and children is not restricted to infants and has been found in situations of sexual abuse in preschool and school-age girls (Cohen & Mannarino, 1996, 2000; Mannarino & Cohen, 1996). However, one study of school-aged children exposed to IPV

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found that their mothers’ emotional well-being was not a mediator of their own trauma symptoms, which were only directly affected by the severity of the violence to which they were exposed (Kilpatrick & Williams, 1998). It is possible, of course, that the relationship between maternal trauma and child trauma is different in infants and older children. Mothers who exhibit depressive symptoms. It is expected that mothers with depressive symptoms are more likely to have children who exhibit trauma symptoms. Numerous studies indicate that women who experience IPV are likely to exhibit depressive symptoms (e.g., Campbell, Kub, Belknap, & Templin, 1997; Levendosky et al., 2004). Much research has documented that depressed parents have impaired parenting skills, and this is related to their children’s functioning across many age ranges (e.g., Lyons-Ruth, Wolfe, Lyubchik, & Steingard, 2002; Sameroff, Seifer, & Zax, 1982); however, not all children are negatively affected (e.g., Campbell, Cohn, & Meyers, 1995; Murray, Fiori-Cowley, Hooper, & Cooper, 1996). Factors such as the heterogeneity of depression, the type of sample (clinical vs. community), and self- or professional diagnosis all contribute to whether studies find significant relationships (NICHD Early Child Care Research Network, 1999). Depression is believed to affect maternal caretaking behaviors by contributing to reduced attention and interest in the child (e.g., Gelfand & Teti, 1990; Zahn-Waxler, Iannotti, Cummings, & Denham, 1990), including not assisting the child with emotion regulation (e.g., Cummings & Cicchetti, 1990; Zahn-Waxler et al., 1990). English, Marshall, and Stewart (2003) found that caregiver functioning (including depression) was a mediator between IPV and child outcomes between the ages of 4 and 6. Some authors have argued that maternal depression has stronger effects on young children, compared to older children, because of their nearly total dependence on the caretaker (Beardslee, Bemporad, Keller, & Klerman, 1983; Cummings & Cicchetti, 1990). We are unaware of any studies examining, in the context of IPV, whether mothers with depressive symptoms influence whether their infants develop trauma symptoms. Mothers’ experiences of the severity of IPV as a moderator of trauma symptoms. We propose that the relationship between the predictors above (maternal trauma symptoms, maternal depression, and difficult temperament) and infant trauma symptoms depends on the experiences of IPV of the mothers and the children. Studies indicate that the severity of violence that an infant is exposed to early in life may be a moderator of later behavior problems (e.g., see Kitzmann et al., 2003). In their review article, Kitzmann et al. (2003) suggest that children who witness less severe forms of IPV may have mild negative responses that are most similar to children who witness marital discord that is not violent; children exposed to more severe forms of IPV have more problematic symptoms, similar to those of children who have been abused. In other words, children’s experiences of the severity of IPV matter; those children exposed to more severe IPV have more severe symptoms (e.g., Cummings et al., 1981), and threat to caregiver, amongst many different traumatic events, seems to be the most damaging to children (Scheeringa & Zeanah, 1995). Although numerous studies have found a direct relationship between maternal and infant trauma symptoms, moderating influences have not been tested. The emotional security hypothesis (ESH) proposes that the severity of the event is salient for young children and that there are different expectations for children’s responses to a severe versus a less severe event (Cummings & Davies, 1996). Interparental conflict that is destructive presents a threat to the emotional security of the child. Children repeatedly exposed to interparental conflict are likely to exhibit emotional insecurity as characterized by (1) high levels of emotional reactivity, (2) regulation of exposure to parental conflict including both active avoidance and attempts at intervention, and (3) negative/hostile internal representations of interparental relationships (Davies,

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Harold, Goeke-Morey, & Cummings, 2002). Infants exposed to severe violence will exhibit emotional security, and thus, will be more vulnerable to the deleterious effects of maternal traumatization. Thus, ESH suggests that infants’ differential exposure to the severity of the interparental conflict will moderate the effect of maternal trauma on infant trauma. In a similar fashion, whether infants with particular temperaments will express trauma symptoms may depend on the infant’s exposure to different severities of violence. Infant outcomes seem to be the result of an interaction between temperament and environmental stressors (e.g., Crockenberg, 1981); however, one study, including some of the same participants as those in the present study, suggests that at extremes of environmental stress, temperament may not be influential. DeJonghe, Bogat, Levendosky, von Eye, and Davidson (2005) found that infants exposed to IPV during the past year, compared to those not exposed, showed more distress when presented with a simulated episode of mild, verbal conflict. However, infants with difficult temperament, compared to those with easier temperaments, only had less distress when they had not been exposed to IPV. These results suggest that an environment in which IPV occurs might be so stressful that it “overrides” any effects of temperament. In other words, the environment in homes where IPV occurs may be so stressful that it is a poor “fit” for any infant, regardless of whether they have easy or difficult temperaments. However, this study did not examine the variability of responses among those infants who experienced various severities of IPV; thus, it is unknown whether all households with IPV or just those with more severe IPV have this effect.

Summary This study examined whether 1-year-olds exhibited trauma symptoms as a result of exposure to episodes of IPV. Little research has examined the relationship between mothers’ and infants’ trauma responses to IPV. Because the extant literature suggests that children have different emotional responses to the severity of violence they witness, we hypothesized that: Those infants exposed to severe IPV, compared to less severe IPV, would have more infant trauma symptoms, as reported by the mother. We also predicted that for those infants exposed to severe IPV, but not less severe IPV, mothers who exhibited trauma symptoms and depressive symptoms would be likely to report that their infants had trauma symptoms. This prediction is grounded in the literature that indicates a strong correspondence between mother and child trauma symptoms in situations involving traumatic events other than IPV. Because mothers and children exposed to severe IPV have more negative responses than mothers and children exposed to less severe IPV, we hypothesized that those infants exposed to severe IPV are more likely to have mothers who exhibit trauma symptoms and depressive symptoms. These qualities create additional stressors affecting parenting, which then are more likely to result in poor child outcomes (Hammen, 1992; Sameroff, Seifer, Baldwin, & Baldwin, 1993; Seifer, 1995). We predicted an opposite moderation effect for infant temperament. We expected, as in the research by DeJonghe et al. (2005), that exposure to IPV creates a ceiling effect for children who have both easy and difficult temperaments. In that research, children’s exposure to different severities of IPV was not examined. In this study, we hypothesized that, for those infants exposed to less severe IPV and who had difficult temperaments, we could predict infant trauma symptoms. We predicted no such relationship for infants with difficult temperaments who were exposed to severe IPV. Finally, exploratory analyses determined whether males and females differed in the number of infant trauma symptoms that their mothers reported.

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Method Participants Participants were 48 mother-infant dyads, a sub-set of 206 women initially recruited during pregnancy to participate in the Mother-Infant Study, a longitudinal study of the effects of IPV on mother-infant relationships (Bogat, Levendosky, & Davidson, 1999; Levendosky, Bogat, Davidson, & von Eye, 2000). The original sample was recruited from a tri-county area in mid-Michigan from 52 different sites, including public settings, prenatal clinics, and social service programs for women and children. Flyers were placed in these sites (e.g., waiting rooms, community bulletin boards) with information about how to contact project staff. The original sample was recruited so that approximately one-half of the women experienced IPV during pregnancy and the other half did not. Criteria for inclusion in the original study were: women had to be between 18 and 40 years of age, they had to have proficiency in English sufficient to complete questionnaires, and the first interview had to occur during their last trimester of pregnancy. The 48 participants are those dyads in which (a) the mother experienced IPV during the first year of the children’s lives and (b) she indicated that her infant “saw or heard” one or more of these incidents (as measured by the Severity of Violence Against Women Scales; Marshall, 1992). The remaining 158 mother/infant dyads did not meet both of these criteria. The 48 mothers were 66.7% Caucasian, 20.8% African-American, 2.1% Latina, 2.1% Native American, and 2.1% Asian-American/Pacific Islander. The median monthly family income was $1,270.00. Most women were single (52.1%); 27.1% were married, 18.7% were separated/divorced, and 2.1% were widowed. The highest level of education obtained by the mothers was 39.6% high school, 43.8% some college, 8.3% trade school, 4.2% BA/BS degree, and 4.2% graduate degree. The average age of the mothers at the time of the interview was 25.67 years (SD = 5.27). Sixteen male and 32 female infants were the children of the 48 women. The mothers identified the race/ethnicity of their infants as 39.6% Caucasian, 22.9% African-American, 31.3% multiracial, 2.1% Asian, and 2.1% Native American. The average age of the infants was 1.10 years (SD = .12) at the time of the interview. Measures Demographics. A questionnaire was administered to obtain basic demographic information such as maternal and infant race/ethnicity, mother’s education, relationship status, income, and age. Toddler Temperament Scale (TTS: Fullard, McDevitt, & Carey, 1984). The TTS is a 97-item maternal report measure that assesses infant temperament for infants 12–36 months of age. Respondents rate their infants’ recent and current behavior, based on the previous 4–6 weeks, on a 6-point scale ranging from “Almost Never” to “Almost Always.” A “difficult temperament” variable was created by summing scores on five of the TTS subscales—rhythmicity, adaptability, approach-withdrawal, intensity, and negative mood (Saylor, Boyce, & Price, 2003). Higher scores on this variable represent tendencies to be less rhythmic, less adaptable, more likely to withdraw, react more intensely to stimuli, and have more negative mood. Examples of items include “the child cries after fall or bump,” “the child sits still while waiting for food,” and “the child is still wary of strangers after 15 minutes.” Coefficient α for this variable was .87.

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Severity of Violence Against Women Scales (SVAWS; Marshall, 1992). The SVAWS assesses psychological and physical violence a woman might experience from her partners. Respondents note the frequency with which each of the 46 events occurred on a 4-point scale ranging from “never” to “many times.” For this study, mothers indicated whether they had experienced any of the events during the past year (first year of the infant’s life) as well as whether their infants had heard or witnessed each event. Violence scores for the women ranged from 1 to 86 (M = 17.85, SD = 18.89); scores for the infants ranged from 1 to 86 (M = 9.31, SD = 16.01). Children were divided into two groups based on the type of violence they witnessed. Those children who witnessed physical violence or threats of moderate physical violence (items 9 and above on the SVAWS) were the “severe” IPV exposure group (e.g., “punched you,” “destroyed something belonging to you”). Children who only witnessed incidents of abuse below this threshold were the “less-severe” IPV exposure group (e.g., “acted like a bully toward you,” “destroyed something belonging to you”). Marshall (1992) reported high internal reliability for a community sample. Coefficient α for this sample was .95. Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). The BDI is 21-item measure which measures symptoms and attitudes of depression (e.g., guilty feelings, body image, indecisiveness). Participants select which of four evaluative statements for each category best reflects how they have been feeling during the past week. The statements are ranked in order of increasing severity and assigned a point value ranging from 0 to 3. These values are summed to obtain an overall score. In the present study, the coefficient α was .80. PTSD Scale for Battered Women (Saunders, 1994). This scale measures psychological traumatic responses based on the DSM-IV criteria for PTSD. Participants rate how many times they have experienced 17 items, such as “unpleasant memories of the behaviors you can’t keep out of you mind” and “being overly alert” as a result of psychological and/or physical abuse. Participants respond on an 8-point scale ranging from “never” to “over 100 times.” Scores in the current sample ranged from 0 to 76; coefficient α was .94. Saunders (1994) reported a .94 reliability coefficient, and a high correlation (r = .58) with other PTSD scales. Infant Traumatic Stress Questionnaire (ITSQ). The ITSQ is an 8-item questionnaire designed by the study authors based on 3 of the 4 general criteria for diagnosis of Traumatic Stress Disorder in the Diagnostic Classification: 0–3 (Zero to Three, 1994). The three general criteria sampled were “numbing,” “increased arousal,” and “fears or aggression.” “Re-experiencing” was not included as it seemed unlikely that mothers could reliably detect such behavior in 1-year-olds. Mothers were also asked whether infants experienced “new symptoms” as a result of witnessing or hearing the traumatic event. Items were re-worded to be understood by the mother and to capture the developmental stage of a 1-yearold. For instance, the DC: 0–3 manual criterion “temporary loss of previously acquired developmental skills, e.g., toilet training, language, relating to others” was re-worded to: “After the event happened, did your child seem more baby-like? (i.e., stop doing something he or she was previously able to do such as walking, feeding?).” The DC: 0–3 criterion, “pessimism or self-defeating behavior, manipulativeness (designed to gain control), or masochistic provocativeness (behavior that provokes abuse)” was re-worded to read “After the event happened, did your child act in ways that made you want to punish him/her?”

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The instrument was tied to mother’s report of whether her infant saw or heard any of the episodes of IPV that she experienced. If the mother did not experience IPV, she was not administered this questionnaire. If she did, she was asked whether or not her infant experienced any of the 18 behaviors in response to the most serious IPV event. The participant responds “Yes” or “No” to each question and scores are summed. Possible scores range from 0 to 16. The range of scores in this sample was 0–7 (M = 1.04, SD = 1.87). The coefficient α was .67. A copy of the measure may be obtained from the first author. Procedure Data collection took place as part of a larger, longitudinal study examining the risk and resilience factors of women and children living with IPV. For the present research, participants were contacted just before their children’s first birthdays and asked to come to the project office for an interview. Numerous assessments of mothers and infants were undertaken, not all are reported here. Female undergraduate research assistants were trained to administer the instruments used in this study. All research assistants observed skilled graduate students administer the instruments and then completed at least three practice interviews, observed by the graduate students. Research assistants were required to reach at least 95% reliability for standard administration of measures prior to conducting independent assessments of participants. Undergraduate research assistants were blind with regard to the hypotheses of the study, the results of previous assessments, the mothers’ abuse statuses, and the mothers’ histories of partner abuse (questionnaires about IPV were the last instruments given to the participants). Prior to data collection, mothers provided written informed consent for themselves and their infants. Mothers were administered questionnaires while their infants were assessed in an adjoining, but private room. Mothers were paid for their participation and infants received an age appropriate book. All procedures for this investigation were approved by the IRBs of Michigan State University and Sparrow Hospital.

Results Data analysis Pearson product moment correlation coefficients were calculated for all the predictor and criterion variables. To test the moderation hypotheses, infants were divided into two groups, those exposed to “severe violence” (n = 28) and those exposed to “less-severe violence” (n = 20), based on the criteria described above. We estimated separate linear regressions for each group, because using a dichotomous moderator provides separate parameter estimates (see Baron & Kenny, 1986). To test the exploratory hypothesis, a χ2 test determined whether mothers were more likely to report that girl infants, rather than boy infants, had witnessed the IPV. Description of maternal and infant trauma responses Thirty-eight of the 48 mothers (79.2%) self-reported at least one trauma symptom in response to an experience of IPV. Among these 38 women, 36 endorsed symptoms of re-experiencing the traumatic event,

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Table 1 Correlations among predictor and outcome variables (N = 48) Number of IPV Number of infant trauma episodes witnessed by infant symptoms Number of infant trauma symptoms Number of IPV episodes witnessed by infant Difficult infant temperament Gender Number of maternal trauma symptoms Maternal depressive symptoms * **

Difficult infant temperament

Infant gender

Number of maternal trauma symptoms

Maternal depressive symptoms

.33* −.05

−.22

−.10 .49**

−.05 .27

−.11 .06

−.06

−.02

−.04

−.11

−.11

.19

p < .05, two-tailed. p < .01, two-tailed.

33 reported symptoms of avoidance, and 28 reported symptoms of arousal. Eighteen of the 38 women (47.4% of the symptomatic women or 37.5% of the total sample) self-endorsed symptoms placing them above the threshold for the presence of PTSD, according to DSM-IV criteria. Mothers indicated that 18 of the 48 infants (37.5%) displayed at least one trauma symptom in the 2 weeks following an episode of IPV that the infant witnessed. Of these 18 infants, 9 had symptoms of increased arousal, 10 had symptoms of numbing or interfering with development, and 10 had new symptoms, fears, or increased aggression. Maternal report of the number of episodes of IPV witnessed by the infant was correlated with total number of infant trauma symptoms (r = .33, p < .05) (Table 1). Infants’ symptoms of numbing or interference with development and new symptoms were significantly correlated with total number of maternal trauma symptoms endorsed (r = .43, p < .01, r = .45, p < 01; respectively). Total number of trauma symptoms experienced by the mother was significantly correlated with total number of infant trauma symptoms (r = .49, p < .01) (Table 1). Predicting infant trauma symptoms We tested whether the severity of violence witnessed by the infant moderated the relationships between any of the three predictors (maternal trauma symptoms, maternal depressive symptoms, and infant difficult temperament) and the criterion variable (infant trauma symptoms). Maternal trauma symptoms predicted the total number of infant trauma symptoms for those infants witnessing severe violence (b = .53, p < .01), but not for those infants witnessing less severe violence (b = −.14, ns). Maternal depressive (MD) symptoms and difficult infant temperament (DIT) did not predict infant trauma symptoms for infants witnessing either severe or less severe violence (MD: b = .03, ns, and b = −.02, ns, respectively; DIT: (b = −.04, ns and b = .21, ns, respectively).

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Gender and witnessing IPV Our exploratory hypothesis was whether mothers of girls, compared to mothers of boys, were more likely to report that their infants had witnessed IPV. We examined this hypothesis in the following manner. In addition to the 48 mother/infant dyads whose data were used in the previous analyses (i.e., those infants whose mothers experienced IPV and who also saw the incident), 29 additional mothers in our study indicated that they had experienced IPV, but their infants had not seen or heard the incident. There were no differences between these two groups on four demographic variables (maternal relationship status, education, age, or income) or the amount of violence experienced by the mothers. Results supported the hypothesis: mothers of girls were more likely to report that their infants had witnessed the IPV [χ2 (1, N = 77) = 4.72, p < .05].

Discussion In this study, nearly half (44%) of the infants exposed to IPV had at least one trauma symptom. These findings are different from those of preschool and school-age children, where researchers find that most children who witnessed IPV had at least one symptom of trauma (e.g., Graham-Bermann & Levendosky, 1998; Levendosky et al., 2002). The mothers in our study may be underreporting their infants’ symptoms. However, the discrepancy between our study and others may be accurate, as the mothers in our study do not seem to underreport significantly their own trauma symptoms. Our findings for maternal reports of trauma symptoms were consistent with prior research (e.g., Houskamp & Foy, 1991; Kemp et al., 1995; Kemp et al., 1991). There was a significant relationship between maternal and infant trauma symptoms, and, as predicted, the relationship between maternal and infant trauma symptoms was related to whether infants had been exposed to severe or less severe IPV. That is, infants exhibited trauma when their mothers did, only when their mothers experienced severe violence. This may be an explanation for why some infants experience trauma symptoms and others do not. When infants witness severe IPV, they appear to experience an additional stressor; in this case, the distress of their mothers. Our findings are consistent with the theory of relational PTSD (Scheeringa & Zeanah, 2001), which posits that the co-occurrence of trauma symptoms in a parent and young child results when the adult’s responses are not well-regulated, and thus, enhance the child’s responses. These parental responses can include emotional withdrawal and lack of responsiveness to the child, behaving in an overprotective and fearful manner toward the child, and/or remaining preoccupied with the traumatic event. Infants are particularly vulnerable to relational PTSD because of their close physical proximity to and emotional relationship with their parents. The parent’s emotional regulation either promotes or inhibits the infant’s developing abilities to self-regulate his/her emotions. However, our findings suggest that, for those infants exposed to severe IPV, the environmental stressor itself moderates the relationship between mothers’ and infants’ trauma responses. This is consistent with the emotional security hypothesis (Cummings & Davies, 1996), which suggests that IPV has more salience and more negative effects among children who witness severe IPV. In our research, depressive symptoms among mothers were unrelated to whether infants exhibited trauma symptoms, and thus, did not predict infant responses for either those infants witnessing severe or less severe violence. Although depression has been related to the quality of caregiving (see Lyons-

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Ruth et al., 2002 for review), there are other studies indicating that not all children experience negative outcomes when living with depressed caretakers (NICHD Early Child Care Research Network, 1999). Kilpatrick and Williams (1998), who examined “maternal emotional well-being” as a mediator, did not find a relationship either. Depression or depressive affect may not be the central maternal response that leads to a correspondence between maternal and infant trauma symptoms. Our lack of significant findings may also be the result of problems with the depression measure. Only 4 women met the diagnosis for clinical depression (using 16 as a cutoff), and the range of scores in this sample was quite truncated (range: 0–21). Thus, future research should examine depression or depressive affect among a sample of depressed women or with a more sensitive measure of depressive symptoms. We hypothesized that for those infants with difficult temperaments, they would exhibit trauma symptoms only if they had witnessed less severe violence. In our sample, whether or not infants had a difficult temperament did not predict trauma symptoms in either group (those who witnessed severe or less severe IPV). Finally, among the 77 women who had experienced IPV in the infant’s first year of life, mothers of girls were significantly more likely to report that their infants witnessed violence than were the mothers of boys. This result is intriguing, but more research is needed to replicate the findings. Perhaps female infants do witness more IPV than male infants as a result of the differential caregiving patterns associated with infant gender. There is some evidence that mothers have greater physical proximity to their female as compared to their male infants, including more time holding the female infants (Benenson et al., 1998; Lindahl & Heimann, 1997, 2002). Thus, female infants may be more likely to be nearby when an abusive event occurs. Alternatively, male and female infants may witness the same number of violent events, but mothers may be more attuned to the presence of their female infants during episodes of IPV. This may reflect a heightened vigilance to their daughters’ responses to the violence out of concern that their daughters may be future victims of IPV (Levendosky, Lynch, et al., 2000) or that females are more likely to develop trauma symptoms, than are males, when exposed to IPV. The present study has some limitations. First, we did not assess other traumatic events that the infant might have experienced during the year. Thus, although the report of trauma response was tied specifically to the mother’s report of the child witnessing IPV, it cannot be ruled out that additional, unknown traumatic events exacerbated or caused the infant’s response. In addition, the presence of a control group of infants who had experienced a traumatic event, other than IPV, and whose mothers reported possible trauma symptoms as a result of this experience, could have best ruled out the possibility that the responses we noted for the infants in this study were not simply the result of developmental changes. Second, reliance on maternal report of what the infant observed may have led to an underestimation of the number of children in the sample who were exposed to violence or the amount of violence they may have seen or heard. For example, older children often describe detailed accounts of inter-parental violence that parents never realized they witnessed (Jaffe, Wolfe, & Wilson, 1990). It is also possible that the sample of mothers who indicated their children had experienced a trauma symptom as a result of witnessing IPV might be biased in the opposite direction. These mothers may be over-reporting trauma symptoms both in themselves and in their infants. Third, the mothers did not report at what period during the infant’s first year that the IPV episode was witnessed. We assume that these events occurred in months 6–12 because the developmental abilities (e.g., memory, discrimination of facial expressions, etc.) needed to express trauma symptoms are not present before 6 months (see Scheeringa & Gaensbauer, 2000, for a review). The low number of infant trauma symptoms reported by the mothers may reflect that many of the episodes of IPV occurred too early in the infant’s life for him/her to respond. Specific information from

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the mother about when the IPV occurred in the infant’s first year would have bolstered the reliability of her reports. Fourth, our measure of infant trauma (the ITSQ) lacks reliability and validity data; thus, it is not known how much the psychometric properties of the instrument influenced the results of this research. Our study was conducted, and our infant trauma measure was written, based on the criteria for Traumatic Stress Disorder in the DC 0–3 (Diagnostic Classification: 0–3, Zero to Three, 1994). In the revised DC 0–3 manual (Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC: 0-3R); Zero to Three, 2005), the diagnosis is now “Posttraumatic Stress Disorder,” which closely follows the criteria proposed for adults in the DSM-IVR, including the need for symptoms to persist longer than 1 month. Future research examining trauma symptoms in infants may want to ask about symptoms that reflect these newly published PTSD criteria. Despite these limitations, the present study highlights that mothers report that their 1-year-old infants experience trauma symptoms as a result of witnessing IPV. Thus, interventions with families experiencing IPV may need to include consideration of its effects on infants. Further research, with larger samples, will be needed to examine the complex ways that factors such as mother’s mental health, mother’s history of exposure to other traumatic events, and other environmental stressors (e.g., poverty, poor housing, and high levels of violence in the larger community) may affect whether infants exposed to IPV develop infant trauma symptoms.

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R´esum´e Objectif : Afin de d´eterminer si les b´eb´es manifestent des r´eactions de traumatisme dans le cas o`u leur m`ere serait la victime de violence par son conjoint, on a pos´e deux questions: (1) est-ce qu’il existe une relation entre le nombre de symptˆomes et le temp´erament de l’enfant/la sant´e mentale de sa m`ere? (2) Est-ce que la gravit´e de la violence des conjoints affecte cette relation?

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M´ethode : Quarante-huit m`eres ont relat´e si leur enfant aˆ g´e d’un an avait manifest´e des symptˆomes de traumatismes apr`es avoir e´ t´e expos´e a` des e´ pisodes de violence conjugale durant la premi`ere ann´ee de sa vie. Les m`eres ont aussi fait rapport sur leurs propres symptˆomes de traumatismes suite a` des e´ pisodes de violence conjugale. R´esultats : Les symptˆomes des m`eres servent a` pr´edire les symptˆomes des b´eb´es dans les cas de violence grave, mais non dans les cas de violence moins s´ev`ere. On n’a not´e aucune relation entre les symptˆomes de d´epression maternelle et le temp´erament difficile de l’enfant, peu importe la gravit´e de la violence. Conclusions : Les m`eres relatent que des enfants, mˆeme les b´eb´es d’un an peuvent vivre des symptˆomes de traumatismes lorsque t´emoins de violence conjugale. La relation importante qui existe entre les symptˆomes maternels et les symptˆomes des enfants va de paire avec la th´eorie du d´esordre des symptˆomes posttraumatiques. Les constats portent a` croire que les interventions visant les m`eres et leur famille doivent prendre en consid´eration les effets de la violence conjugale sur les tr`es jeunes enfants. Resumen Objetivo: Determinar si los ni˜nos presentan una respuesta traum´atica ante la violencia dom´estica (VD) experimentada por sus madres. Se exploran dos cuestiones: ¿el n´umero de s´ıntomas traum´aticos en el ni˜no est´a relacionado con el temperamento infantil y la salud mental de la madre? ¿la severidad de la violencia tiene un efecto moderador en estas relaciones? Metodolog´ıa: Un total de 48 madres informaron de si sus hijos de 1 a˜no de edad hab´ıan experimentado s´ıntomas de trauma como resultado de haber sido testigos de episodios de VD durante su primer a˜no de vida. Las madres tambi´en informaron sobre sus propios s´ıntomas traum´aticos que fueron resultado de sus experiencias de VD. Resultados: Los s´ıntomas de trauma en las madres tienen capacidad predictiva sobre la sintomatolog´ıa de trauma en los ni˜nos para los casos de violencia severa pero no para los de violencia menos severa. Los s´ıntomas de depresi´on materna y el temperamento dif´ıcil del ni˜no no tienen valor predictivo para la sintomatolog´ıa de trauma en el ni˜no para ninguno de ambos grupos. Conclusiones: Las madres informaron de que ni˜nos de 1 a˜no de edad pueden experimentar s´ıntomas de trauma como resultado de haber escuchado u observado VD. Esta relaci´on significativa entre s´ıntomas maternos e infantiles de trauma es consistente con la teor´ıa del PTSD relacional. Los hallazgos sugieren que las intervenciones con las madres y las familias necesitan tener en consideraci´on la influencia de la VD en ni˜nos muy j´ovenes.