Safety and Sobriety Manual
Best Practices in Domestic Violence and Substance Abuse

January 2005


Special Populations:  Children Dually Exposed to Batterers and Parental Substance Abuse

While a great deal of literature exists on children's exposure to domestic violence batterers and children's exposure to substance abuse, very little is written about the dual exposure, its impact and implication for intervention. From a review of the literature (Reid, Macchetto & Foster, 1999; Governor's Commission on Domestic Violence, 1995), three principals were cited most often:

  • The best way to protect children is to support their mothers' efforts to attain safety and sobriety.
  • Family violence and addiction take the mother away from her children both physically and emotionally.
  • Protective/resiliency factors can decrease the harm caused by some risk factors and can prevent certain risk factors from developing.

Extent of the Problem

  • 3.3 million-10 million children are at risk of exposure to family violence.
  • 80-90% of these children are aware of the violence.
  • Children in homes with domestic violence are abused or neglected at a rate 15 times higher than the national average.
  • In 60-75% of families where a woman is battered the children are battered as well.
  • 63% of youthful murderers kill their mother's abuser.
  • Children older than 5 or 6 have a tendency to identify with the abuser and lose respect for the victim.
  • The most serious cases of child abuse resulting in emergency room treatment are often "extensions of the battering rampages launched against the child's mother, with 70% of the serious injuries to children and 89% of the fatal injuries inflicted by men." (Governor's Commission on Domestic Violence, 1995).
  • 50% of the time police respond to domestic violence calls, children are present.
  • 71 % of victims using a domestic violence shelter bring their children.
  • The United States Conference of Mayors found nationally 75% of all homeless women and children are on the streets because of violence in the home.
  • 67% of state child welfare workers said that AOD families are "much more likely" to re-enter the child welfare system over a 5-year period compared to non AOD-involved families.
  • Alcohol is abused by more than 15 million American adults.
  • Children whose parents abuse substances are almost 3 times more likely to be abused and 4 times more likely to be neglected.
  • At least 40 million children live in homes where the primary caretaker is addicted to alcohol or other drugs.
  • Up to 675,000 children per year suffer serious abuse or neglect as a result of that substance abuse.
  • 2 out of 3 cases of "child abuse" have a co-occurrence of domestic violence and substance abuse.
    • The best way to protect children is to support their mothers' efforts to attain safety and sobriety.

Effects of Domestic Violence on Children

Prior to birth

  • Victims of domestic violence are at increased risk for miscarriage during pregnancy.

Infants and toddlers (birth - 2 1/2)

  • Developmental delays - walking, talking, focusing.
  • Failure to thrive - slowed growth and development.
  • Emotional withdrawal - failure to bond/attach.
  • Frequent illness.
  • Intense fear of adults.
  • Incessant screaming (resulting in more family strain).

Preschool (ages 3 - 6)

All of the previously mentioned plus:

  • Language delays.
  • Decreased motor abilities - physical agility/coordination.
  • Easily frustrated and intolerant.
  • Acting out/aggressive behavior/violence as a form of communication.
  • Increased startle response.
  • Violence re-enacted in play.
  • Low self esteem.

Elementary (ages 7 - 11)

All of the previously mentioned plus:

  • Decreased verbal or cognitive skills.
  • Behavior problems.
  • Inability to empathize with others.
  • Nightmares.
  • Fearfulness.
  • Withdrawn/depressed/despondent.
  • Chronic physical complaints.
  • Bullying.
  • Taking on predator or prey roles.
  • Violence re-enacted in play.
  • Sleeping in class/truancy.
  • Shame.
  • Self-destructive behaviors.
  • Higher risk for suicide.
  • Isolation from peers.
  • Perfectionistic thinking - attempts to fix situation, which reduces likelihood of identification.

Adolescents (ages 12 - 17)

All of the previously mentioned plus:

  • Feelings of guilt.
  • Delinquent behavior.
  • Running away.
  • Alcohol/drug use.
  • Eating disorders (need to control).
  • Among sexually activity teens, males are more likely to be sexual offenders and females are more likely to be sexually assaulted.
  • Re-enacting relationships - based on control/dominance and not respecffequality.
  • Parental care taking at personal cost.

Post Traumatic Stress Disorder

While not all children exposed to domestic violence batterers develop symptoms of Post Traumatic Stress Disorder (PTSD), 50 to 70% of exposed children suffer from PTSD. PTSD is an anxiety disorder which can have an onset at any age following exposure to a psychologically traumatic event that would generally be considered outside the range of typical human experience.

Children suffering from PTSD are often misdiagnosed as having Attention Deficit Disorder (ADD) due to symptoms of difficulty concentrating and diminished interest or participation in school work and activities.

Beyond exposure risks

Beyond the risks associate with exposure or witnessing battering domestic violence, the child is also at increased risk of injury related to violence in the home:

  • Thrown objects hit the child.
  • Infant is dropped by the victim when the victim is being abused.
  • The child is injured when intervening in violence.
  • Intentional violence to the child intended to intimidate or control the victim.
  • Abuser's displaced frustration toward the child results in injury.

Through the eyes of a child

Children exposed to domestic violence have a vantage to view the violence that is not available to either the victim or the abuser. Through the eyes of a child the violence occurs suddenly, allowing no opportunity to prepare; the event is unusual and unpredictable and outside of the child's experience; in the passive role, the child is able to fully attend to the act; absorbing the attacker's aggression and the victim's suffering.

Children who observe domestic violence often report feeling:

  • Shame for families.
  • Powerlessness.
  • Lack of trust.
  • Feeling scared and unsafe.

Their efforts in normalizing their experience may result in the following beliefs:

  • Violence is an act of love.
  • Hurting others to control them is acceptable.
  • Males are mean.
  • Females are weak and powerless.
  • Violence lacks consequences.
    • Through the eyes of a child the violence occurs suddenly, allowing no opportunity to prepare; the event is unusual and unpredictable and outside of the child's experience; in the passive role, the child is able to fully attend to the act; absorbing the attacker's aggression and the victim's suffering.

Resiliency factors

While many factors may determine how the child adjusts to exposure to domestic violence the following resiliency factors are most often cited:

  • Child's age.
  • Relationship to the abuser.
  • Relationship with the victim.
  • Social supports.
  • Duration of the violence.

Effects of Parental Substance Abuse on Children

Prenatal exposure to illicit drugs

Use of illicit drugs during pregnancy can impact the health of the unborn in varying ways such as:

  • The increased risk of stillbirth.
  • Premature detachment of the placenta.
  • Smaller than normal head size/low birth weight.
  • Central nervous system damage-developmental delays.
  • Risk of motor dysfunction.
  • Link to neo-natal respiratory patterns.
  • Link to Sudden Infant Death Syndrome (SIDS).

Prenatal exposure to alcohol

  • lncreased risk of spontaneous abortion or stillbirth.
  • Shorter gestation periods.
  • Reduced birth size and weight.
  • Fetal Alcohol Effect (FAE).
  • Fetal Alcohol Syndrome (FAS).

Unfortunately, it is difficult to predict the outcome because of the many variables such as the amount of drug used, purity of drug used, gestational age at exposure, coupled with other mitigating factors such as good prenatal care and nutrition.

While direct physical exposure to the substance can impact healthy births, many more children are affected by witnessing parental substance abuse.

Maladaptive responses

  • lncreased suicide risk.
  • Eating disorders.
  • 3-4 times more likely to become addicts.
  • Less internal locus of control.
  • Health problems - gastrointestinal disorders, migraines, asthma.
  • Hyperactivity.
  • Takes on role of parent/caretaker.

Academic effects

  • Learning disabilities.
  • Truancy.
  • Repeating grades.
  • Transferring schools.
  • Expulsion.
  • Inability to focus/concentrate.

Emotional effects

  • Guilt.
  • Feeling unloved.
  • Depression.
  • Anxiety.
  • Feeling invisible.
  • Insecurity.
  • Confusion.
  • Fearfulness.
  • Embarrassment/shamefulness.

The substance abusing or addicted parent is less able to parent because the substance use impairs thought processes, judgement, the parent's ability to be available both physically and emotionally, and the parent's ability to keep the child safe and healthy in cases where there is exposure to criminal activity.

Children exposed to parental substance abuse are often:

  • Unkempt.
  • Sleepy/tardy for school.
  • Preoccupied near end of school day.
  • Sophisticated in their knowledge of substance use.
  • Uncomfortable discussing substance use.
  • Depressed/withdrawn.
  • Acting out.
  • Without parental involvement in the child's activities.

When Domestic Violence and Substance Abuse Occur Together

Parents experiencing both domestic violence and substance abuse are emotionally and physically unavailable, unable to provide secure attachments for the child.

Children exposed to both parental domestic violence battering and substance abuse may experience emotional, educational and mental health deficits, depression, anxiety, eating and substance abuse disorders. The child may be preoccupied, tired, embarrassed, guilty, and fearful but is willing to commit to parental care taking despite the personal cost. The children may feel a need to both fix the family problem and keep it a secret while lacking trust in other adults and authorities. Prolonged exposure to domestic violence batterers and substance abuse,may result in the belief that substance abuse and domestic violence are normal occurrences, domestic violence and substance abuse are a natural means to obtain desired feelings and that violence/use/abuse lack sufficient consequences, all of which may lead to replication of the dysfunction in future family relationships.

Strength based interventions with these children require acknowledging and strengthening the child's resiliency factors.

Personal factors

  • Positive attitude.
  • Ability to adapt to change.
  • Belief in ability to handle things.

Family factors

  • Close-knit family.
  • Warmth.
  • Consistent age-appropriate discipline.
  • Parental supervision of children.

Environmental factors

  • Close friends.
  • Supportive extended family.
  • Community resources.
  • Family and communities that do not tolerate substance abuse.

Interventions with children exposed to both battering and substance abuse

Don't:

  • Press the child to talk; she or he will talk when ready.
  • Ask demanding questions (i.e., "Are you worried about school?")
  • Make promises you can't keep (i.e., "This won't happen again." "No one will hurt you anymore.")
  • Assume the mother's role, instead strengthen her ability to meet her child's needs.

Do:

  • Intervene early.
  • Assist the victim with her needs.
  • Believe the child.
  • Know appropriate resources for referral.
  • Talk to child in a calm, focused manner.
  • Keep talks short.
  • Focus on child's strengths.
  • Assist the child in creating a safety plan (if age-appropriate).
  • Provide child with nurturing environment.
  • Provide consistent, predictable pattern.
  • Acknowledge child's feelings.
  • Give child choices/sense of control.
  • Always end on a positive note.
  • Provide the child with support from other children so exposed.
  • Provide opportunities for constructive mother/child interaction.

Things to say to a child:

  • I am sorry you were hurt.
  • It's not your fault.
  • It's okay/safe to talk to me.
  • I'll do everything I can to keep you safe.
  • You have a right not to talk about it.
  • I want you to be safe.

Ways to help:

  • Comfort and reassure.
  • Offer basic information about what happened.
  • Tolerate regressive behavior.
  • Respect the child's fears.
  • Remind the child that at this moment s/he is safe.
  • Talk about feelings.
  • Provide opportunities and props for play.
  • Expect some difficult behavior.
  • Convey rules.
  • Return to normal routine.
  • Provide physical outlets.
  • Focus on images of strength, competence and survival.
  • Seek additional help/guidance if necessary.

Best Practice: Children Dually Exposed

Intervene with both the child and the adult(s):

  • Empower victims.
  • Hold perpetrators accountable.
  • Develop recovery plans that address violence and safety plans that address recovery.
  • Link safety, sobriety and child welfare needs.
  • Coordinate among systems serving the family.
  • Avoid conjoint counseling between perpetrators and victims.
  • Avoid service plans that allow the perpetrator to control the mother.
  • Call upon Prevention Resource Developers throughout the state who build partnerships among domestic violence, substance abuse and child welfare providers.
    • Prolonged exposure to domestic violence batterers and substance abuse may result in the belief that substance abuse and domestic violence are normal occurrences, domestic violence and substance abuse are a natural means to obtain desired feelings and that violence/use/abuse lack sufficient consequences, all of which may lead to replication of the dysfunction in future family relationships.