Aggression and Violent Behavior 17 (2012) 158–170

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Aggression and Violent Behavior

Intrafamilial physical victimization and externalizing behavior problems: Who

remain the ‘forgotten’ children?
Lynette M. Renner ⁎
School of Social Work, The University of Iowa, United States

a r t i c l e i n f o a b s t r a c t

Article history: Over the past few decades, researchers have documented positive associations between direct child maltreat-
Received 15 September 2011 ment and exposure to interpersonal violence (including intimate partner violence, community violence,
Received in revised form 9 December 2011 school violence, and media violence) and children's externalizing behavior problems. However, current fam-
Accepted 9 December 2011
ily violence literature largely ignores the effects of child abuse on other children in the family. A handful of
Available online 17 December 2011
studies have focused on exposure to child abuse and documented the behavioral effects on siblings, and
Keywords:
these studies lend support for broadening scholarship focused on this type of family violence. This article pre-
Family violence sents empirical research and theories that focus on the relationships between child physical abuse and expo-
Child maltreatment sure to intimate partner violence and children's externalizing behavior problems. Using this literature as a
Physical abuse foundation, an argument is made for the need to focus on children's exposure to child physical abuse. This
Victimization article presents information from the few studies that have focused on children who were exposed to the
Externalizing behaviors physical abuse of a sibling and offers theoretical frameworks, including social learning theory and psycholog-
Sibling ical proximity, as a foundation for future research. The article concludes with a discussion of services that
may be necessary for children who have been exposed to the physical abuse of a sibling, including services
focused on safety and mental health.
© 2011 Elsevier Ltd. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
2. Review of the literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
2.1. Child physical abuse and externalizing behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
2.2. Exposure to intimate partner violence and externalizing behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
2.3. Exposure to other forms of interpersonal violence and externalizing behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
2.4. Exposure to child physical abuse and externalizing behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
3. Theoretical frameworks that focus on violence and child functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
3.1. The effects of child physical abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
3.2. The effects of exposure to intimate partner violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
3.3. The effects of exposure to child physical abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
3.3.1. Proximity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
4. Implications for research and practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
4.1. Safety and protective services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
4.2. Mental health services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
5. Summary and conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168

1. Introduction

Interpersonal violence is a serious public health concern that affects

⁎ The University of Iowa, School of Social Work, 308 North Hall, Iowa City, IA 52242,
millions of people. It is estimated that 60% of American children have
United States. been exposed to violence, crime, or abuse in their homes, schools, and
E-mail address: lynette-renner@uiowa.edu. communities (Finkelhor, Turner, Ormrod, & Hamby, 2009). Two of the

1359-1789/$ – see front matter © 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.avb.2011.12.003
 L.M. Renner / Aggression and Violent Behavior 17 (2012) 158–170 159

more prevalent forms of family violence – child physical abuse and ex- Hansen, 2011); however, the developmental effects of children's expo-
posure to intimate partner violence (IPV1) – affect millions of children. sure to child abuse remain grossly understudied.
According to the Fourth National Incidence Study of Child Abuse The objective of this article is to utilize research on the effects of
and Neglect (NIS-4; Sedlak et al., 2010), more than 1.25 million chil- child physical abuse and exposure to physical IPV on children's exter-
dren experienced maltreatment during 2005–2006. Of these children, nalizing behaviors as a rationale for broadening the scope of family vio-
44% were abused (61% were neglected) and physical abuse was the lence. Highlighting tenets of social learning theory and proximity, this
majority type of abuse experienced (58% of the abused children, an article provides information as to why children exposed to a the physi-
estimated total of 323,000). During 2009, an estimated 3.3 million re- cal abuse of a sibling may exhibit behavioral characteristics that are sim-
ferrals, involving the alleged maltreatment of approximately six mil- ilar to children who are physically abused or exposed to physical IPV
lion children, were received by CPS agencies in the United States and may require similar safety and mental health interventions.
(USDHHS, 2010). Of these, an estimated 702,000 children were vic-
tims of maltreatment, with 17.8% having been physically abused. Em-
2. Review of the literature
pirical research estimates 15.5 million children live in families in
which physical IPV occurred at least once in the previous year, with
2.1. Child physical abuse and externalizing behaviors
seven million children living in families in which severe IPV occurred
(McDonald, Jouriles, Ramisetty-Mikler, Caetano, & Green, 2006). A
Although early documentation on the severity of child physical
national study on victimization estimates 16.3% of children ages
abuse was published by Dr. Ambrose Tardieu in France in 1860 (cited
0–17 witness an assault between their parents in their lifetime (Fin-
in Smith, 1975; cited in Wallace, 1996), very little empirical research in-
kelhor et al., 2009).
volving this population was published prior to the 1960s. In 1961, at an
Due to the initial inattention in research, children exposed to IPV
American Academy of Pediatrics symposium, Dr. C. Henry Kempe
have been referred to as ‘forgotten’ (Elbow, 1982), ‘silent’
coined the term ‘battered child syndrome’ (Radbill, 1968; Wallace,
(Augustyn, Parker, Groves, & Zuckerman, 1995; Groves, Zuckerman,
1996). Beginning with the literature on ‘battered child syndrome’
Marans, & Cohen, 1993; Kolar & Davey, 2007), ‘invisible’ (Osofsky,
(Helfer & Kempe, 1968; Kempe, Silverman, Steele, Droegemueller, &
1998) and ‘unintended’ (Rosenbaum & O'Leary, 1981) victims. In
Silver, 1962; Parker, 1965), scholars have increasingly examined the
1982, Pfouts, Schopler and Henley used the word ‘forgotten’ to de-
outcomes of children who have been physically abused. Over the past
scribe children exposed to IPV and children exposed to the abuse of
40 years, a variety of articles and books have been published on child
a sibling. However, in light of the abundance of high-quality empirical
maltreatment, and research on the effects of child physical abuse has
research and practice literature focused on children's exposure to IPV
cited increased medical and neurological, intellectual and cognitive, be-
over past few decades, this term may no longer accurately apply to
havioral, emotional and psychiatric problems (see a brief summary of
this population. The word ‘forgotten’, however, arguably still applies
findings in Miller-Perrin & Perrin, 2007).
to children exposed to the physical abuse of a sibling. 2
Over the past several decades, research specifically on the associ-
Prevalence data on children's exposure to child physical abuse is
ation between child physical abuse and externalizing behaviors has
lacking. However, research conducted with a national sample of 1467
dramatically increased. There is no consensus in the operational def-
children, ages 2–17, found that 7.2% experienced physical abuse, 6.8%
inition of externalizing behavior problems (Keil & Price, 2006); yet
were exposed to IPV, and 2.8% were exposed to the physical abuse of
externalizing problems often refer to a grouping of behaviors that
a sibling (Finkelhor, Ormrod, & Turner, 2009).
are manifested in children's outward behavior and reflect the child
Empirical research devoted to examining the effects of child mal-
negatively acting on the external environment. Externalizing behav-
treatment and exposure to IPV, community violence, school violence,
iors may include hyperactivity, delinquency, and subtypes of aggres-
and media violence and other forms of trauma on children's develop-
sion (Liu, 2004).
ment have flourished in the past few decades and shown rather con-
Many studies have documented associations between child phys-
sistent findings — especially with regard to children's increased
ical abuse and increased externalizing behavior problems, specifically
externalizing behaviors. Yet, despite increased research on each of
aggressive behaviors, among children (Connor, Doerfler, Volungis,
these types of interpersonal violence, most studies on the effects of
Steingard, & Melloni, 2003; Dodge, Pettit, & Bates, 1997; Dodge,
family violence remain focused on limited forms. In addition, studies
Pettit, Bates, & Valente, 1995; Feldman et al., 1995; Johnson et al.,
on direct child maltreatment focus primarily on one child in the fam-
2002; Manly, Kim, Rogosch, & Cicchetti, 2001; Prino & Peyrot, 1994;
ily – the child who is maltreated – and do not account for how other
Salzinger, Feldman, Hammer, & Rosario, 1993; Salzinger et al., 2002;
children in the family experience the abuse.
Shields & Cicchetti, 2001; Wolfe & Mosk, 1983). Physical abuse during
Children who are not directly abused but are exposed to the abuse
childhood also increases the likelihood of exhibiting later delinquen-
of a sibling may also be negatively affected. However, this group of
cy and violence perpetration (Fang & Corso, 2007; Fergusson &
children is not widely recognized by mental health and social service
Lynskey, 1997; Hawkins et al., 1998; Herrenkohl, Huang, Tajima, &
professionals or scholars. Some recent studies have noted that siblings
Whitney, 2003; Lansford et al., 2007; Mass, Herrenkohl, & Sousa,
and other non-offending family members are negatively affected by
2008; Smith & Thornberry, 1995; Stouthamer-Loeber, Loeber,
incidents of child sexual abuse (Baker, Tanis, & Rice, 2001; Tavkar &
Homish, & Wei, 2001). Other researchers have found support for the
relationship between parental physical discipline and children's in-
creased externalizing behaviors (Gershoff, 2002; Lansford et al.,
1
2011). The literature accumulated over the past few decades provides
Intimate partner violence (IPV) refers to acts of physical, sexual, and/or psycholog-
ical harm by current or former adult partners or spouses. It can also involve financial
significant empirical support for the association between direct child
abuse, threats of harm, and controlling and coercive behaviors. IPV exists along a con- physical abuse and increased externalizing behaviors.
tinuum from a single episode of violence to ongoing battering.
2
Exposure to the physical abuse of a sibling (where the perpetrator is often a parent,
the victim is a child, and the victim's sibling is exposed to the abuse) is a distinct type 2.2. Exposure to intimate partner violence and externalizing behaviors
of family violence that is separate from sibling abuse. Sibling abuse or sibling violence
refers to acts of abuse between siblings (where the perpetrator and victim are sib- Along with research on direct child physical abuse, it is important
lings). This type of family violence has garnered significant attention over the past sev-
eral years (see Eriksen & Jensen, 2006; Felson, 1983; Finkelhor, Turner, & Ormrod,
to understand how exposure to physical IPV is also associated with
2006; Kiselica & Morrill-Richards, 2007; Linares, 2006); however, it is important to dis- children's externalizing behaviors. Similar to empirical research on
tinguish between these two separate types of family violence. the effects of child physical abuse, research on children's exposure
160 L.M. Renner / Aggression and Violent Behavior 17 (2012) 158–170
to physical IPV has cited increased cognitive, behavioral, emotional,
physical, and social problems.
One of the first articles addressing domestic violence was published
in 1960 (Schultz, 1960) and a high level of interest in studying this adult
population emerged in the years following. Studies on children's expo-
sure to IPV emerged in the 1970s (see Levine, 1975; Moore, 1975) and
have drawn significant attention from researchers ever since. Early
studies on children's exposure to IPV focused on directly ‘witnessing’
or ‘observing’ violence. However, more recent studies have used the
more inclusive term of ‘exposure’ to intimate partner violence and ac-
knowledge there are several ways beyond being an eyewitness that a
child can be negatively affected by domestic violence. Holden's (2003)
taxonomy separated exposure into ten categories representing both di-
rect (e.g., child intervenes to stop violence; child observes the assault)
and indirect (e.g., child learns of violence through another person;
child sees aftermath of the assault) involvement.
As research efforts have increased over the past few decades, the
association between exposure to IPV and externalizing behaviors, in-
cluding aggression, violence, and delinquency, has become well-
established (Graham-Bermann & Levendosky, 1998; Herrera &
McCloskey, 2001; Ireland & Smith, 2009; Kernic et al., 2003;
Litrownik, Newton, Hunter, English, & Everson, 2003; Mahoney,
Donnelly, Boxer, & Lewis, 2003; McCloskey & Lichter, 2003). Several
reviews and meta-analyses have also documented the relationship
between exposure to IPV and externalizing behavior problems
among children and adolescents (Carlson, 2000; Carpenter & Stacks,
2009; Evans, Davies, & DiLillo, 2008; Fowler & Chanmugam, 2007;
Holt, Buckley, & Whelan, 2008; Kitzmann, Gaylord, Holt, & Kenny,
2003; Rudo, Powell, & Dunlap, 1998; Wolfe, Crooks, Lee, McIntyre-
Smith, & Jaffe, 2003).
2.3. Exposure to other forms of interpersonal violence and externalizing
behaviors
Research on children's exposure to community violence, school vi-
olence, and media violence has also grown over several years. Studies
on the behavioral effects of exposure to these non-familial forms of
violence have yielded results similar to studies on child physical
abuse and children's exposure to IPV. For example, in a sample of
youth ages 12 to 17 years (N = 423), McCabe, Hough, Yeh, Lucchini,
and Hazen (2005) found exposure to community violence contribut-
ed to the development of conduct disorder and externalizing symp-
toms, after controlling for child maltreatment and exposure to IPV.
Using a sample of 935 high-school students, O'Keefe (1997) found
that exposure to community and school violence was a significant
predictor of aggression among boys after controlling for the effects
of family violence and exposure to school violence significantly pre-
dicted aggression among girls. Other studies have documented in-
creased externalizing/aggressive behaviors among children and
adolescents who have been exposed to community violence
(Guerra, Huesmann, & Spindler, 2003; see reviews by Lynch, 2003;
Margolin & Gordis, 2000; McDonald & Richmond, 2008; see meta-
analysis by Fowler, Tompsett, Braciszewski, Jacques-Tiura, & Baltes,
2009), exposed to school violence (Janosz et al., 2008; Mrug, Loosier,
& Windle, 2008; Mrug & Windle, 2010), or exposed to television and
media violence, including on-line gaming and playing first-person
shooters (Anderson et al., 2010; Brown & Witherspoon, 2002;
Bushman & Huesmann, 2006; Christakis & Zimmerman, 2007;
Gentile, Lynch, Linder, & Walsh, 2004; Holtz & Appel, 2011;
Huesmann, Moise-Titus, Podolski, & Eron, 2003; Huesmann & Taylor,
2006).
2.4. Exposure to child physical abuse and externalizing behaviors
As previously stated, empirical research has shown increased
externalizing behaviors among children exposed to multiple types
of familial and non-familial violence. The negative effects of direct
child physical abuse and exposure to physical IPV on child functioning
have been well-documented in family violence literature; however,
the occurrence of family violence affects every member of the family
system. Just as children who are exposed to IPV have been found to
display adjustment difficulties similar to children who have been
physically abused, children who are exposed to the physical abuse
of a sibling are not likely immune to adverse effects.
According to Howells and Rosenbaum (2008), “No attention has
been paid to the potential effects of seeing a sibling being abused by
their parental figures” (p. 203). Indeed, very little recent research
has been conducted with regard to the effects of violence on siblings
exposed to child physical abuse. However, it seems reasonable to ex-
pect that children exposed to the physical abuse of a sibling would
display behavior problems similar to children exposed to other
forms of violence, such as IPV or community violence. When compar-
ing children who were abused and their siblings, Kempe and Kempe
(1976) concluded that when a child was abused and his/her sibling
was also “adequately evaluated” (p. 123), all children displayed se-
vere emotional pathology resulting from the psychological abuse
and neglect that often accompanies physical abuse. Beezley, Martin,
and Alexander (1976) wrote about concerns for children exposed to
the physical abuse of a sibling and stated that “the impact of witnes-
sing or being aware of abusive behavior toward a sibling must be a
momentous, psychological trauma” (p. 183).
A handful of studies conducted in the 1970s and 1980s provided a
foundation for this line of inquiry; yet, little research on siblings ex-
posed to child physical abuse has been conducted since. Table 1 pre-
sents a summary of research studies that have included siblings
(referred to as nonabused 3 children in some studies) exposed to
child physical abuse. Because so few studies have been conducted,
Table 1 lists findings across multiple domains of child functioning.
Those studies that specifically focused on externalizing behaviors
are summarized in the following paragraphs.
Following a modeling framework (e.g., social learning theory),
Bolton, Reich, and Gutierres (1977) compared four groups of children
(children who were abused, siblings of children who were abused,
control children, control siblings) and found that victims of abuse
had a low frequency (7.8%) of aggressive crimes (e.g., fighting, as-
sault) while their siblings had a much higher frequency (17.2%). It
was hypothesized that siblings were more likely to model behaviors
that did not appear to have consequences and that children who
were abused viewed aggression as hurtful and were less likely to re-
peat such behaviors. Jean-Gilles and Crittenden (1990) examined the
influence of children's shared environment and found children who
were maltreated and their siblings scored significantly above average
on a measure of stressful life events but only 12.5% of children in both
groups scored above average on behavior problems.
More recent research on siblings exposed to child physical abuse
has substantiated the results of earlier studies. For example, in a
study of 2402 children ages 3–18, Renner (2005) found that siblings
(ages 6–12) exposed to child physical abuse had higher externalizing
behavior scores compared to children in the same age group who had
experienced direct child physical abuse or been exposed to IPV. An-
other study that focused on 441 children who each experienced a sin-
gle type of family violence, Renner (accepted for publication), found
that children ages 3–5 and adolescents ages 13–18 who were exposed
3
Similar to debates regarding exposure to IPV (see Edleson, Gassman-Pines, & Hill,
2006; Kantor & Little, 2003; Rankin & Ornstein, 2009; Somer & Braunstein, 1999), it
is important to acknowledge that exposure to child physical abuse could arguably be
considered a unique or existing form (e.g., psychological abuse, neglect) of child mal-
treatment. The term ‘nonabused’ that occurs periodically in this article reflects lan-
guage used in the original sources and refers to siblings that have not been
physically abused. It does not imply the children have never experienced another type
of maltreatment, that they are not at risk of physical abuse, or that exposure to physical
abuse does not constitute child maltreatment.
Table 1
Studies that focused on children who were abused and their siblings.

Author Sample Domains assessed Key measures and/or procedures Study results related to siblings of children who
(Year of publication) were physically abused

Bolton et al. (1977)
774 children referred to the state for 1 of 4 types
(physical abuse, sexual abuse, emotional abuse,
physical abuse/neglect,) of child abuse and their
sibling comprised the experimental sample. 900
youth offenders selected through the juvenile
court and their sibling served as a control
sample. Each group was divided into “primary
targets” and “siblings” for a total of four groups
(abused, sibling of abused, control, sibling of
control).
Criminal behavior Escape crimes included: runaway, truancy, and
missing juvenile. Aggressive crimes included:
disturbing the peace, fighting, assault, assault
with a deadly weapon, aggravated assault and
battery, armed robbery, and strong arm robbery.
Children who were abused had a lower
frequency of aggressive crimes and a higher
frequency of escape crimes compared to their
sibling. Children who were abused had a higher
frequency of escape crimes than the other three
groups. Siblings of children who were abused
had the highest frequency of aggressive crimes
compared to the other three groups. Siblings of
children who were abused had a higher
frequency of escape crimes than the two control

L.M. Renner / Aggression and Violent Behavior 17 (2012) 158–170

groups.

Halperin (1981, 1983)
20 abusive families and 20 control families with
at least one natural parent residing in the home
and two children between ages 5–12. A total of
20 abused children (8 boys, 12 girls ages
7–11 years), 20 nonabused siblings (7 boys, 13
girls ages 6–10), and 40 control children from
20 families that had never been reported for
child abuse.
Children’s perceptions of their
family members
10–15 min, semi-structured interviews were
used. Each child was asked to describe his/her
mother, father, and sibling. The number of neg-
ative, positive, and neutral words was
documented.
No differences were found in the number of
positive or negative words used by children
who were abused and their siblings when
describing their parents or each other. Children
who were abused viewed their family members
less positively and more negatively than
children in the control families. Siblings from
abusive families viewed their family members
less positively than siblings from control
families.

Herrenkohl and 579 children. Of these children, 295 targets of
Herrenkohl (1979) one or more types of abuse and 284 nonabused
siblings. Boys = 50.9% of targets and 55.5% of
nontargets.
Physical health and development
Parents' perceptions of the child
Case records were examined for type of abuse
and child involved. Medical data was gathered
on child's birth weight, weeks of gestation, age
of mother at delivery, pregnancy and delivery
complications. Interviews were conducted with
151 female heads and 66 male heads of
household. Interviews assessed the quality of
the marital relationship, family stressors,
parent’s experiences of childhood discipline,
and the quality of the parental relationship with
each child.
Abused children had shorter gestation periods
than their nonabused siblings. Children who
had more infancy-related and developmental
problems than their sibling were more likely to
be targets of life-threatening neglect. Children
who were abused were described by their
mothers as having more emotional difficulties
(e.g. excessive eating or refusal to eat, pica,
frequent temper tantrums, moodiness, sleeping
problems). Children who were abused were
said to have negative qualities that reminded
parents of negative aspects of themselves as
children. Mothers perceived themselves as
having less control and influence over their
abused children than they had over their
nonabused children.

Howells and Rosenbaum 675 college students (307 males, 392 females)
(2008) who experienced child physical abuse or
exposure to IPV before age 18. The analysis
focused on witnessing the abuse of a sibling
included 385 females.
Behavior Measures of aggression and depressive
symptoms were used. Participants were
classified into one of four groups based on their
exposure to violence. Participants provided
information on the gender and relationship of
the perpetrator when applicable.
Participants who witnessed the abuse of their
sibling by both parents during childhood had
significantly higher depression and aggression
scores than participants in the nonwitness
group. Mean scores for depression were 7.54
and 4.28, while means for aggression were
32.38 and 21.29, respectively.

(continued on next page)

161

Table 1 (continued)
Author
(Year of publication)
Jean-Gilles and Crittenden
(1990)
Johnson and Morse (1968)
Lynch (1975, 1976)
Nakou, Adam, Stathacopoulou,
and Agathonos (1982)
Sample
Subsample of a dataset of 542 maltreating and
normative families. Three groups of families
(families under investigation for maltreatment,
community sample of volunteers, and families
served by mental health agencies) were
included. The subsample included 82 families
with two children (a focal child and a sibling)
both between ages 2–6 years. Twenty-eight of
the families were maltreating, 45 were recruited
from the community, and nine were referred by
mental health agencies. The focal children had a
mean age of 49.7 months and the siblings had a
mean age of 53.7 months; there were an equal
number of boys and girls.
101 children identified as abused (and 167 who
were not) from 85 families involved with the state's
Division of Services for Children and Youth
Department of Child Welfare. Instances of sexual
abuse and malnutrition were excluded. Cases
involving children over age 14 were also excluded.
Children were considered to be physically injured
(i.e., abused) or uninjured.
25 children who were abused and had one or more
siblings (n=35) who were not abused.
25 families in which a child b10 years old was
maltreated to the degree of requiring medical
intervention. The sample included 32 children (23
males, 9females) who had been physically abused
or neglected by a parent and their 53 siblings (23
males, 30 females).
Domains assessed Key measures and/or procedures
Behavior Data collection consisted of 2–3 home visits. All
Life events members of the family participated in the
Home environment assessment. The assessment included measures
focused on life events, physical and
interpersonal aspects of the home environment,
child behavior problems, and the severity of
maltreatment.
Physical health and development No specific measures were used. Data came
Behavior from police and hospital reports and child
welfare workers' descriptions of the children.
Physical health Information on prenatal and perinatal
experiences and early life histories was
gathered from detailed case histories for
children who were abused and their siblings.
Factors of interest included abnormal
pregnancy, whether the mother was admitted
to hospital during pregnancy, abnormal labor/
delivery, neonatal separation while in hospital
or other separations within the first six months,
and illness in the child’s first year of life. These
risk factors were used separately and were
combined to create a measure of the total
number of adverse factors for each child.
Physical health Medical histories, pediatric examinations and
psychosocial assessments were used to gather
information on premature birth, illness in first
months, severe handicap (e.g., severe mental
retardation, spasticity), milder handicap (e.g.,
epilepsy, mild mental retardation), poor
nutrition, and feeding problems.
162
Study results related to siblings of children who
were physically abused
Maltreated children and their siblings were
examined for the effects of shared environment
influences. Both maltreated children and their
L.M. Renner / Aggression and Violent Behavior 17 (2012) 158–170
siblings experienced stressful life events that
were significantly above average and one-third
of children in these two groups were in the
lowest quartile on the home environment scale.
12.5% of maltreated children and 12.5% of their
siblings had behavior problem scores above the
published norms.
Children who were abused were more aggressive
toward their siblings than vice versa. “Less than half
of the children who were abused showed
satisfactory mental and emotional development”
and the “uninjured children fared a little better”.
Both “injured and uninjured” children were “shy,
gloomy and passive” and all children were
“deprived of parental care and affection” (p. 150).
Mothers reported significantly more abnormal
pregnancies, admissions to the hospital during their
pregnancy and abnormal labor/deliveries with
their child who was later abused compared to the
siblings. Children who were abused were also more
likely to have been separated from their mothers
within the first 48 h and within the first six months
of life compared to their siblings. Seventy-six
percent (n=19) of the children who were abused
had two or more adverse factors in their early lives,
while 71% (n=25) of their siblings had none.
Children who were abused had poorer nutrition,
more feeding problems, more severe handicaps,
and were more often born prematurely compared
to their siblings.
Table 1 (continued)
Author Sample
(Year of publication)
Pfouts, Schopler, and Henley 73 families with confirmed incidents of child abuse
(1982) and IPV. Of the 141 children in the sample, 25
witnessed the abuse of their mother and another
24 witnessed the abuse of a sibling.
Renner (2005) 2402 children ages 3–18 from 1033 families. The
sample included three age groups: ages 3–5 years
(21.69%; 50.29% female), ages 6–12 (52.25%;
51.95% female), and, ages 13–18 (26.06%; 50.32%
female). The focus of the study was on three forms
of physical family violence — child physical abuse,
exposure to physical IPV, and exposure to child
physical abuse.
Renner (accepted for Subset of 441 children who experienced one of five
publication) types of family violence, including physical abuse,
neglect or sexual abuse, exposure to physical IPV,
exposure to psychological IPV, and exposure to a
sibling's physical abuse. Children in three age
groups were included: ages 3–5 (n=87), ages 6–12
(n=233), and ages 13–18 (n=121).
Tanimura, Matsui, and 23 sets of multiple births(22 twins, 1 triplet),
Kobayashi (1990) including 17 pairs of abused-nonabused siblings
and 6 pairs where both children were abused.
Note: Descriptors (e.g., nonabused, targets, witness, uninjured) were taken directly from the original studies.
Domains assessed Key measures and/or procedures
Academic Information on each child’s academics and
Behavior internalizing behaviors was collected through
case records and interviews with the social
worker who was responsible for each family’s
case.
Behavior The child’s caregiver provided information on
externalizing and internalizing behaviors.
Externalizing behavior items included how
often the child had temper tantrums, fought
with others, threatened or bullied others, got
angry easily, argued with others, and was
aggressive toward people/objects. Internalizing
behavior items included how often the child
showed anxiety about being with a group of
children, appeared lonely, acted sad or
depressed, and had low self-esteem.
Behavior The child’s caregiver provided information on
externalizing behaviors. Items included how
often the child had temper tantrums, fought
with others, threatened or bullied others, got
angry easily, argued with others, and was
aggressive toward people/objects.
Physical health Survey questionnaires were used to assess any
neonatal and congenital complications for each
child.
Study results related to siblings of children who
were physically abused
In school, 20% of children were withdrawn and 10%
reportedly acted out with their teachers. Children
who witnessed the abuse of a sibling were reported
to be depressed (37%) and anxious (40%) by their
caseworkers. Children who witnessed the abuse of
a sibling had better behavior in school and received
higher grades compared to children who witnessed
the abuse of their mother.
After controlling for child, parent, and family
characteristics, each type of physical family
violence was significantly associated with
increased behavior problems for a different age
group. Among children ages 3–5, the association
was between exposure to IPV and externalizing
behavior problem scores, among children ages
6–12, the association was between exposure to
child physical abuse and externalizing behavior
problem scores, and among adolescents ages
13–18, the associations were between physical
L.M. Renner / Aggression and Violent Behavior 17 (2012) 158–170
abuse and both externalizing and internalizing
behaviors.
Children exposed to a sibling's physical abuse had
the highest mean score on the measure of
externalizing behaviors among 13–18 year olds.
Children exposed to a sibling's physical abuse had
the second highest mean score for externalizing
behaviors among the two other age groups (second
to children ages 3–5 who were exposed to
psychological IPV and second to children ages 6–12
who were exposed to physical IPV). All children
exposed to a sibling's physical abuse had higher
mean externalizing behavior scores than children
who were physically abused.
A comparison of the abused-nonabused twins
found that in 16 of the 17 pairs, health problems
(e.g., serious medical problems, low birth
weight) could only be identified for the abused
child. Most abusers described the abused child
as ‘underdeveloped’, ‘unlovable’, ‘inactive’,
‘unattached to mother’, ‘much trouble’ and
‘autistic and negative attitude’.
163
164 L.M. Renner / Aggression and Violent Behavior 17 (2012) 158–170
to a sibling's physical abuse had higher mean externalizing scores
than children exposed to physical IPV and children who were physi-
cally abused. Among children ages 6–12, children exposed to physical
IPV had slightly higher externalizing behavior scores than children
exposed to child physical abuse. Children in this age group who
were exposed to physical IPV or physical abuse had higher externaliz-
ing behavior scores than children who were physically abused.
Howells and Rosenbaum (2008) found that female participants who
witnessed the abuse of their sibling had higher aggression and de-
pression scores than participants in the ‘no exposure’ group. The au-
thors noted that participants who witnessed the abuse of their
sibling had outcomes that were similar to those found among victims
of child physical abuse.
3. Theoretical frameworks that focus on violence and child
functioning
3.1. The effects of child physical abuse
Several theories have been used to account for direct effects of
victimization on child and adolescent aggressive behavior. One
hypothesis is that children reenact some version of the behavior
they experienced from their parent, having learned the uses of vio-
lence. Social learning theory is most often utilized as an explanation
for aggressive behavior and is used “almost exclusively to explain
how exposure to violent models could lead to elevated externalizing
behavior problems in children” (Carlson, 2000, p. 323). According to
social learning theory (Bandura, 1973, 1977, 1979, 1986), observa-
tion, imitation, and modeling are mechanisms by which children ex-
hibit aggressive behavior. Physical aggression between family
members provides children a model for learning aggressive behaviors
and for viewing violent behaviors within the family as normal and ac-
ceptable (Bandura, 1973; Feshbach, 1980). Children who are physi-
cally abused by a parent or children who are exposed to
interparental violence observe angry and aggressive behavior and
may interpret it as normative or effective. When aggressive behavior
is modeled and rewarded, children likely learn to model similar be-
havior in their own interactions with others, thereby accounting for
increased externalizing behaviors. From the social learning perspec-
tive, behavior is neither driven by inner forces nor solely attributed
to environmental influences; rather, it is best understood by recipro-
cal interactions that continuously occur between individuals and en-
vironmental determinants (Bandura, 1973). Social learning theory
views biological factors, observational learning, and reinforced
• This level includes children who do not witness the violence; however,
they do hear, know about and/or see the effects of the violence firsthand.
• These children are less vulnerable to the effects of violence than children
in either of the inner two circles, but they are still vulnerable.
• This level includes children who have the most distance from the
violence. They may indirectly witness or learn about the violence
through the media or other sources.
• These children are the least vulnerable to the effects of violence.
Fig. 1. Levels of physical proximity adapted from Rosenfeld (2001).
performance as the main origins of aggression and all three compo-
nents interact in order to learn and repeat violent behavior.
Social information processing theory has also been used to ac-
count for the link between childhood parental abuse and later exter-
nalizing behaviors (Dodge et al., 1995; Dodge et al., 1997). Social
information processing theory posits that children approach situa-
tions with biologically determined capabilities along with memories
accumulated through past experiences (Crick & Dodge, 1994). The
way children behaviorally respond to situations is based on how
they encode, interpret, and evaluate possible responses (Crick &
Dodge, 1996; Dodge & Crick, 1990). A central hypothesis of social in-
formation processing is that children who interpret information
about the behavior and intentions of others in aggressive ways are
more likely to respond with their own aggressive behavior. Children
who have been abused tend to misread social cues in instances
where threats are unclear or unintended and overestimate the hostile
intentions of others. Through this process, the child or adolescent
takes on the role of the aggressor against others who are perceived
as hostile.
Social development model (Catalano & Hawkins, 1996; Hawkins &
Weis, 1985) integrates social learning theory and social control theo-
ry. This model proposes that antisocial and delinquent behavior in
youth develops sequentially from socialization in the family, school,
and community in which children learn, and are then reinforced for,
poor behavior over time. The biosocial interaction model (Liu, 2004)
highlights the interaction between biological and social risk factors
in the development of children's externalizing behaviors.
3.2. The effects of exposure to intimate partner violence
To better understand children's behavioral responses to violence,
several theories have also been used in research of children exposed
to IPV. Some studies have found support for the social learning
model in the link between exposure to IPV and adverse developmen-
tal outcomes among children (Jouriles, Norwood, McDonald, & Peters,
2001; McCloskey & Lichter, 2003; O'Keefe, 1996; Spaccarelli,
Coatsworth, & Bowden, 1995). Stress and coping theories have also
been used to explain how children respond to IPV, which they inter-
pret as placing demands on them that they cannot meet, resulting in a
variety of problem-focused and emotion-focused coping responses
(Lazarus & Folkman, 1984). Exposure to IPV creates stress, fear, and
learned helplessness by the child and results in behavioral and emo-
tional problems (Jaffe, Wolfe, & Wilson, 1990).
• This level includes children who witness the violence.
• These children are less vulnerable to the effects of violence than
children in the inner circle, but are still quite vulnerable.
Children exposed to the
physical abuse of a sibling
Victims
• Children in this level experience direct violence.
• These children are the most vulnerable to the
effects of violence.
 L.M. Renner / Aggression and Violent Behavior 17 (2012) 158–170
• This level includes children who know the victims as acquaintances
or as friends but are not considered ‘close.’
• These children are less vulnerable to the effects of violence than
children in the second circle, but they are still vulnerable.
• This level includes children who identify with the victims. They may
see themselves as similar to the victims in age, family life, etc.
• Although less vulnerable than children in the other circles, these
children are still vulnerable to the effects of violence.
Fig. 2. Levels of psychological proximity adapted from Rosenfeld (2001).
Whereas social learning theory can be used to understand how
children exposed to IPV learn to model violence, other models may
be needed to help explain additional challenges in adjustment after
violence. These include relationship theories (see Graham-Bermann,
1998), developmental-ecological and developmental psychopatholo-
gy models (Cicchetti & Lynch, 1993; Cicchetti & Rizley, 1981;
Cicchetti & Toth, 1995; Lynch & Cicchetti, 1998) and a trauma per-
spective (Carlson & Dalenberg, 2000). Trauma theory has specifically
been put forth to explain the internalizing emotional and cognitive
problems of children who are abused (Graham-Bermann, 1998;
Graham-Bermann & Hughes, 1998; Pynoos, Sorenson, & Steinberg,
1993). Trauma theory focuses on children's negative adjustment fol-
lowing a traumatic childhood event or experience and posits that “re-
peated trauma in childhood forms and deforms the personality”
(Herman, 1997, p. 96). Using aspects of trauma theory and
cognitive-behavioral theory, Briere (1992, 2002) formulated the
self-trauma model which may be used to understand the distorted
cognitive patterns, emotional disturbance, and interpersonal prob-
lems associated with child physical abuse and exposure to IPV.
Two other conceptual models have been proposed to explain ad-
justment problems in children exposed to parental conflict, with
agreement that emotional, cognitive, and behavioral processes are
potential mediators. The cognitive-conceptual framework (Grych &
Fincham, 1990) has been used to understand how children evaluate
conflict, perceive threats and view their own ability to cope as impor-
tant processes in shaping emotional and behavioral responses. Grych,
Fincham, Jouriles, and McDonald (2000) expanded the original
cognitive-contextual framework and proposed children's appraisals
of threat and self-blame would mediate their exposure to interparen-
tal conflict and adjustment problems. The original framework was ex-
panded again to account for acts of violence between adults (Fosco,
DeBoard, & Grych, 2007) and is now more applicable to research on
the effects of exposure to IPV among children.
Emotional security theory (Davies & Cummings, 1994) shares
some similarities with social learning theory (Davies, Harold,
Goeke-Morey, & Cummings, 2002) in that it acknowledges exposure
to IPV has a direct effect on child functioning that cannot be
accounted for by parenting. However, the theory does highlight a
more indirect model to explain child functioning. Emotional security
theory also shares some similarities with attachment theory in that
it acknowledges the harmful effects of parental difficulties (e.g., low
warmth, unresponsiveness) on child adjustment problems due to
the child's difficulties in using the parents as sources of support and
165
• This level includes children who are socially close to people who
experience violence, such as members of their family, friends, and
others with whom they have a close personal relationship .
• These children are extremely vulnerable to the effects of violence.
Children exposed to the
physical abuse of a sibling
Victims
• Children in this level experience direct violence.
• These children are the most vulnerable to the
effects of violence.
protection (Davies & Woitach, 2008). Within emotional security the-
ory, however, maintaining security is a primary goal in other family
relationships beyond parent–child (Davies & Woitach, 2008). Thus,
emotional insecurity within the family may be interparental and par-
ent–child. Emotional security theory posits that exposure to IPV leads
to distress, which leads to behaviors a child uses to maintain emo-
tional security. The theory also posits that the degree of emotional se-
curity is reflected in a child's ability to regulate emotions and
behaviors. Insecurity in the interparental relationship may result in
a wide range of behaviors including fear, distress and vigilance, ag-
gressive behaviors, flight behaviors, and avoidance (Davies &
Woitach, 2008). Davies et al. (2002) found that children's insecurity
in the interparental relationship and attachment insecurity were
each uniquely associated with concurrent levels of adolescent inter-
nalizing symptoms (e.g., depression, anxiety) and externalizing
symptoms (e.g., aggression, delinquency). Emotional security was
also identified as an explanatory mechanism for children's internaliz-
ing and externalizing problems (Cummings, Schermerhorn, Davies,
Goeke-Morey, & Cummings, 2006).
3.3. The effects of exposure to child physical abuse
The similar and differential effects of shared experiences of chil-
dren's exposure to IPV (Jaffee, Moffitt, Caspi, Taylor, & Arseneault,
2002; Richmond & Stocker, 2003; Skopp, McDonald, Manke, &
Jouriles, 2005) and child neglect (Hines, Kantor, & Holt, 2006) have
received some investigation, but “the effects on siblings who have
not shared the same experiences, but continue to live with the affect-
ed child, have been relatively ignored” (Newman, Black, & Harris-
Hendriks, 1997, p. 140). Several frameworks may be helpful for un-
derstanding why children exposed to the physical abuse of a sibling
may exhibit a variety of negative outcomes, including increased ex-
ternalizing behaviors. These include social learning theory, a stress
process model, empathy deficits, and proximity.
Social learning theory appears to be a promising framework to use
in research focused on the behavioral effects of exposure to child phys-
ical abuse, especially when highlighting the transmission of aggressive
behaviors. Similar to how social learning theory (previously described
in this article) has been used to explain how children who are physical-
ly abused and/or exposed to physical IPV develop aggressive behaviors
(via modeling), children who are exposed to the physical abuse of a
sibling may also learn that aggressive actions are appropriate to use
in family and peer situations. Thus, children exposed to child physical
166 L.M. Renner / Aggression and Violent Behavior 17 (2012) 158–170
abuse may exhibit increased aggressive behaviors due to modeling
other family relationships. Siblings may identify with the aggressor
(e.g., parent) through silent collusion and use physical aggression to-
ward the child who has been abused (Tower, 1993) or use aggression
as a means of self-protection or as a defense to cover feelings of fear
that they may be the next child in the family to be abused. However,
a child exposed to the physical abuse of their sibling may also realize
the pain and suffering such behaviors bring, and siblings with an espe-
cially close and connected relationship to the abused child may develop
internalized behaviors as part of a ‘learned’ process.
Foster and Brooks-Gunn (2009) designed a stress process model
to bring together research in several dominant areas of literature
focused on violence that are often disconnected. This model specif-
ically focused on understanding children's responses to three forms
of physical violence, including child abuse, exposure to IPV and ex-
posure to community violence. The model focused on how multiple
stressors may occur in multiple ecological contexts (e.g., individual,
family, and neighborhood) and how these may directly influence
child functioning (e.g., externalizing and internalizing behaviors,
academic outcomes). The model also included mediating and mod-
erating resources at various ecological levels (e.g., child, family,
school, and neighborhood factors) that indirectly influence this re-
lationship. Although presented as a model focused on child physical
abuse, exposure to IPV, and exposure to community violence, this
stress process model could likely be extended to include other
forms of interpersonal violence that negatively influence child and
adolescent functioning — specifically, another form of physical fam-
ily violence, such as exposure to child physical abuse.
According to Hollingsworth, Glass, and Heisler (2007), empathy is
an essential concept for understanding the intergenerational trans-
mission of maltreating behaviors. The authors have presented a
model for the development of empathy deficits that they believe
exist in the siblings of children who are abused. Through this
model, which developed out of clinical practice, siblings may internal-
ize the parents' view that the child who is abused is ‘bad’ and conse-
quently develop empathy deficits. Empathy deficits may also develop
in siblings who unsuccessfully attempt to intervene on behalf of the
child who is abused and are subsequently punished for their actions
by a parent; furthermore, these deficits may develop when the parent
develops an alliance with the siblings against the child who is abused,
or when siblings witness consequences for the child who is abused
and become fearful of disobeying the parent. This model focuses on
explaining some aspects of a siblings' functioning, such as denial, de-
tachment, numbing, and avoidance. Components of the empathy def-
icit model may contribute to understanding the development of
externalizing behavior problems; however, because it focuses on in-
ternal states, it may be more valuable to understanding why children
exposed to the abuse of a sibling may exhibit increased internalizing
behaviors, such as depression, withdrawal, and hopelessness.
3.3.1. Proximity
The element of proximity has also been used in trauma literature to
explore a child's reactions to trauma or violence. Proximity can be
viewed as geographic as well as emotional (Webb, 2004). Proximity re-
fers to both physical and psychological closeness, the combination of
which has been found to affect the prediction of traumatic stress reac-
tions (Shahinfar & Fox, 1997). Physical proximity has been used to as-
sess individual's reactions to traumatic events based on how close they
were to the actual event (see Giannopoulou et al., 2006; Groome &
Soureti, 2004; and Shannon, Lonigan, Finch, & Taylor, 1994 for studies
focused on the effects of natural disasters). In a meta-analysis of the ef-
fects of community violence, Fowler et al. (2009) reported a positive
relationship between physical proximity to violence and children's ex-
ternalizing problems, with direct victimization predicting more exter-
nalizing problems than witnessing violence and witnessing violence
predicting more externalizing problems than hearing about violence.
The authors noted that greater physical proximity to community vio-
lence may lead to positive reinforcement for the use of violence as a
method of problem-solving as well as to emotional numbing that can
increase aggressive behaviors. However, physical proximity cannot
fully explain the vicarious stress reactions found in people who were
emotionally close to the victims of trauma (Shahinfar & Fox, 1997)
but were not present for the actual traumatic event. Physical proximity
has been briefly mentioned in relation to children's exposure to IPV
(see Groves, 1999); while, psychological proximity has not been read-
ily integrated into family violence literature.
Rosenfeld (2001) presented circles of physical vulnerability and
the circles of psychological/social vulnerability to help explain how
children were negatively affected by the events of September 11,
2001. Psychological proximity differs from physical proximity be-
cause it encompasses an emotional connection between the victim
of violence and another person. Elements of psychological proximity,
security and attachment to others have been utilized to understand
how children are affected by exposure to terrorism and war
(Pfefferbaum et al., 2004; Pine, Costello, & Masten, 2005), exposure
to community violence (Bell & Jenkins, 1991; Lynch & Cicchetti,
1998; Pynoos & Nader, 1988), and exposure to a sniper attack on
school grounds (Pynoos et al., 1987). Although proximity is more
often used in studies focusing on children's exposure to war or com-
munity violence, it can be extended to research on family violence.
Figs. 1 and 2 adapt Rosenfeld's (2001) ideas to children who are ex-
posed to the physical abuse of a sibling.
Children who are exposed to the physical abuse of a sibling may be
influenced by both physical and psychological proximity. When an in-
cident of child physical abuse occurs, siblings may be physically pre-
sent or nearby. Thus, siblings would be represented in the two
middle circles in Fig. 1, which represents physical proximity, and
they would be quite vulnerable to the negative effects of child physi-
cal abuse. Siblings would be represented near the inner circle in Fig. 2,
which represents psychological proximity, and they would be espe-
cially vulnerable to the negative effects of child physical abuse. Al-
though not focused on externalizing behaviors, Pynoos and Nader's
(1988) triage model posits the number and type of post-traumatic
symptoms are largely dependent on the child's proximity to violence.
Similar to Rosenfeld's (2001) circles of vulnerability, Pynoos and
Nader (1988) argue that children most directly exposed to violence
will be the most negatively affected. In families where a child is phys-
ically abused, proximity may be especially useful for understanding
how other children (e.g., siblings) in the family may also be negative-
ly affected. Although it is not yet known whether physical or psycho-
logical proximity has a greater effect on children's outcomes, the
notion of proximity to violence provides a rationale for why all chil-
dren in a maltreating family may be in need of various interventions.
4. Implications for research and practice
It seems that no child living with family violence can escape the
negative effects of violence, and yet, intervention strategies, clinical
services, and resources are most heavily focused on the child who is
abused and the abusing parents while little recognition is given to
the siblings who may also be left with severe consequences. In
1982, Pfouts et al. stated, “Long-term outcomes for these silent wit-
nesses to sibling abuse may have been largely overlooked by both re-
searchers and clinicians” (p. 368). As demonstrated in this article,
little research has been conducted with this group of children. Family
violence affects all members in a family and contributes to an espe-
cially unsettling foundation for children as it shapes their own behav-
iors and interpersonal relationships. Therefore, it is important to
increase research efforts to understand how child physical abuse af-
fects all children in the family.
Future research on how family violence affects children who are
exposed to child abuse and the sibling relationship may provide a
 L.M. Renner / Aggression and Violent Behavior 17 (2012) 158–170
more in-depth understanding of the impact of family violence upon
multiple family members. Previous research studies have neglected
to include siblings who were indirectly affected by violence and
have consequently provided an incomplete understanding of the ef-
fects of family violence. Studying all children living in a maltreating
family, along with children's relationships with a sibling who is
physically abused and relationships with the abusing and non-
abusing parent, would add considerable breadth and depth to the
family violence literature. Increased research efforts would allow for
a more comprehensive understanding of the effects of family violence
on children's development, and utilizing the notion of proximity
would allow for a more developed theoretical understanding of the
radiating impact of family violence. Additional research focused on
children exposed to child physical abuse will also have implications
for practice, especially when it is focused on safety and mental health
services.
4.1. Safety and protective services
Early literature cited ‘scapegoated’ children – one child who
served as the target of abuse – as commonplace in abusing families
(Cirillo & DiBlasio, 1992; Green, 1985; Justice & Justice, 1990) and
there is some evidence to suggest that when one child in a family is
physically abused, other children are not. Using information from
case records, early research found that in more than 87% of child wel-
fare cases, only one child in the family was abused (Thompson, Paget,
Bates, Mesch, & Putnam, 1971). A more recent study of 310 families
referred to a child protection unit for the abuse of one child (i.e., the
index child), found 44% of index children had no sibling that had
been maltreated, while 56% had at least one sibling who was also
abused (Hamilton-Giachritsis & Browne, 2005).
Although the prevalence of children exposed to their sibling's
physical abuse is not well-established, some authors have argued
that all siblings in a family should be assessed for possible abuse
when one child is physically abused, especially due to aspects of
shared environment and risks due to physical proximity. Hamilton-
Giachritsis and Browne (2005) found that parental (e.g., alcohol
abuse, mental health difficulties, intellectual disability, self-harm)
and family (e.g., unstable lifestyle, criminality) characteristics were
positively associated with risk to some or all siblings in families
where one child experienced maltreatment.
Campbell, Bogen, and Berger (2006) surveyed 93 U.S. physicians
recognized as experts in child abuse medicine to determine consen-
sus regarding the evaluation of contact children (i.e., other children
in the home, likely siblings, of a child that was physically abused).
Seventy-eight percent of survey respondents believed that contact
children occasionally had findings of physical abuse. In addition, all
respondents indicated that physicians determining physical abuse of
an index child should recommend a medical evaluation of other chil-
dren in the home, although there was a wide range both of how often
this was done in practice and what diagnostic evaluations were
recommended. Using three case scenarios, Vitale, Squires,
Zuckerbraun, and Berger (2010) compared recommendations provid-
ed by Child Protective Services (CPS) workers and child abuse physi-
cians (CAPs) on whether contact children (i.e., children living in a
home where an index child was physically abused) were also in
need of medical evaluations. The results revealed significant disagree-
ment between the two groups of professionals. Across the three sce-
narios, 97–100% of CAPs recommended a medical evaluation for the
contact children in the home, while 38–73% of CPS workers made
this recommendation. The authors stipulated that this difference
may be due to CPS workers' initial desire to conduct a home visit
and gathering information on medical and nonmedical risk before
recommending a medical evaluation or that CPS workers' may be
working under policies and procedures that limit their ability to
bring in contact children for medical evaluations.
167
The accumulating research on children's exposure to IPV has
caused changes to several states' child welfare systems. Recognizing
the potentially devastating effects that exposure to IPV can have on
child development, nearly half of U.S. states have statutes that cur-
rently address the issue of children's exposure to IPV (Children's
Bureau, 2009). However, there is still no agreement on which service
system (e.g., child welfare or domestic violence) is most responsible
for children exposed to IPV, and children exposed to child maltreat-
ment are not yet included in this debate. Child protection agencies
are mandated to assure children's safety and training on assessment
and interventions related to IPV and becoming increasingly common-
place among child welfare assessment procedures. Because the goal
of child welfare is to protect children, the safety of all children in
the family should be a priority when any abuse is encountered.
4.2. Mental health services
Previous research suggests that parents underestimate their chil-
dren's exposure to incidents of IPV (O'Brien, John, Margolin, & Erel,
1994) and this is likely the case for exposure to parent–child mal-
treatment. According to Beezley et al. (1976), “All members of the
family of an abused child have need of psychological help….. And sib-
lings of the abused child have psychological needs that are relevant
and important in their own right” (p. 169). Assessments focused on
physical safety and risks of harm are needed for all siblings in a family
where one child is abused. However, in light of psychological proxim-
ity and the vulnerability of siblings to be negatively affected by child
physical abuse in non-physical domains of functioning, the assess-
ment process should not end with physical safety alone.
Recognizing that abuse affects all members of a family, Kempe and
Kempe (1976) called for physical and neurological examinations, de-
velopmental assessments or psychological testing for “the abused
child and his siblings” (p. 123). Similarly, Halperin (1981) suggested
a three-phase process whereby all members of a family – the child
who is abused, his/her parents, and his/her siblings – are assessed
and treated. Practice literature has focused on the involvement of sib-
ling groups in treatment because the sibling relationship can be an es-
sential element to healing from family trauma. However, this
treatment focus typically involves siblings who experience the same
type of family violence (see Leavitt, Gardner, Gallagher, & Schamess,
1998; Tyndall-Lind, Landreth, & Giordano, 2001). In the case of child
maltreatment, siblings should not merely be contributors to treat-
ment offered to children who are abused. It is important to recognize
that siblings exposed to child abuse also experience negative conse-
quences and are also in need of individualized services.
Psychological proximity and characteristics of the sibling bond
may explain some of the early findings of abused children and their
sibling. One can hypothesize that even in violent families, feelings of
connectedness occur between members — especially among siblings.
Cicirelli (1996) points out that the theory of attachment is not re-
stricted to the mother–child interaction and children may develop
strong attachments to other individuals (e.g., siblings) who are re-
sponsive and supportive. Studies have found that a close sibling rela-
tionship may serve as a buffer to the impact of parental conflict
(Jenkins & Smith, 1990; Waddell, Pepler, & Moore, 2001) and that
children who are distressed due to exposure to parental conflict
often seek out a sibling for comfort and support (Bank & Kahn,
1982; Jenkins, Smith, & Graham, 1989). Sibling groups may receive
differential treatment from their parents, and differential treatment
is associated with emotional and behavioral difficulties in children
(Brody, 2004). Even if treated differently, however, children may de-
velop similar problems in functioning.
Children who are exposed to the physical abuse of a sibling may
have similar responses to children exposed to IPV. Siblings who are
not physically abused may develop feelings of guilt because they
were not abused, helplessness because they could not stop the
168 L.M. Renner / Aggression and Violent Behavior 17 (2012) 158–170
abuse, fear they will become the next child to be abused, and shame
over efforts to protect themselves from becoming abused (Gil,
1983). They may also feel responsible for the abuse or for not protect-
ing the victim (Office for Victims of Crime, 1999). These feelings and
actions may manifest into externalizing behaviors and aggression to-
ward others or internalizing behaviors, especially when the sibling
bond is strong. After finding that siblings exposed to child physical
abuse had similar outcome measures as children who were directly
abused, Howells and Rosenbaum (2008) concluded that this likely oc-
curred because “participants may identify more with their sibling” (p.
207).
Findings from the existing research that focused on siblings who
were exposed to child physical abuse indicated the need for these
children to be assessed for possible consequences to their physical,
emotional, cognitive and behavioral functioning. Siblings exposed to
child physical abuse would likely benefit from social skills groups fo-
cused on reducing aggressive behaviors and mental health services
focused on internalizing behavior problems. Siblings might also ben-
efit from improving academic skills and classroom behavior through
study skills groups and mentoring programs. Improving the safety
of the home environment and improving the quality of intra-
familial interpersonal relationships have enormous potential to
make positive differences in the lives of children exposed to child
physical abuse.
5. Summary and conclusions
All forms of family violence can have devastating consequences on
child functioning. Substantial increases in research on child physical
abuse and children's exposure to IPV over the past few decades
have resulted in a more sophisticated understanding of the effects
of these forms of family violence — specifically on children's external-
izing behavior problems. This expanded understanding has translated
into improvements in practice to increase children's safety and im-
prove their well-being. Despite these research and practice gains, lit-
tle is still known about how children are affected by exposure to child
physical abuse in the family environment. Only a handful of studies
have focused on this group of children, but the results indicate that
their functioning is also negatively affected. In order to better under-
stand the consequences of family violence, children exposed to par-
ent–child maltreatment must be included in future research. The
safety and well-being of these children must also be given adequate
attention by social service, mental health, and educational systems.
References
Anderson, C. A., Shibuya, A., Ihori, N., Swing, E. L., Bushman, B. J., Sakamoto, A., et al.
(2010). Violent video game effects on aggression, empathy, and prosocial behavior
in Eastern and Western countries: A meta-analytic review. Psychological Bulletin,
136(2), 151–173.
Augustyn, M., Parker, S., Groves, B. M., & Zuckerman, B. (1995). Silent victims: Children
who witness violence. Contemporary Pediatrics, 12(8), 35–57.
Baker, J. N., Tanis, H. J., & Rice, J. B. (2001). Including siblings in the treatment of child
sexual abuse. Journal of Child Sexual Abuse, 10, 1–16.
Bandura, A. (1973). Aggression: A social learning analysis. New York: Prentice Hall.
Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice Hall.
Bandura, A. (1979). The social learning perspective: Mechanisms of aggression. In H.
Toch (Ed.), Psychology of crime and criminal justice (pp. 198–236). New York:
Holt, Rinehart and Winston.
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory.
Englewood, CA: Prentice-Hall, Inc.
Bank, S. P., & Kahn, M. D. (1982). The sibling bond. New York: Basic Book Publishers.
Beezley, P., Martin, H., & Alexander, H. (1976). Comprehensive family oriented therapy.
In R. E. Helfer, & C. H. Kempe (Eds.), Child abuse and neglect. The family and the com-
munity. (pp. 169–194) Cambridge, MA: Ballinger Publishing Company.
Bell, C. C., & Jenkins, E. J. (1991). Traumatic stress and children. Journal of Health Care for
the Poor and Underserved, 2(1), 175–185.
Bolton, F. G., Reich, J. W., & Gutierres, S. E. (1977). Delinquency patterns in maltreated
children and siblings. Victimology: An International Journal, 2(2), 349–357.
Briere, J. (1992). Child abuse trauma: Theory and treatment of the lasting effects. New-
bury Park, CA: Sage Publications.
Briere, J. (2002). Treating adult survivors of severe childhood abuse and neglect: Fur-
ther development of an integrative model. In J. E. B. Myers, L. Berliner, J. Briere,
C. T. Hendrix, C. Jenny, & T. A. Reid (Eds.), The APSAC handbook on child maltreat-
ment (pp. 175–203). (2nd ed.). Thousand Oaks, CA: Sage Publications.
Brody, G. H. (2004). Siblings' direct and indirect contributions to child development.
Current Directions in Psychological Science, 13(3), 124–126.
Brown, J. D., & Witherspoon, E. M. (2002). The mass media and American adolescents'
health. Journal of Adolescent Health, 31, 153–170.
Bushman, B. J., & Huesmann, L. R. (2006). Short-term and long-term effects of violent media
on aggression in children and adults. Archives of Pediatrics & Adolescent Medicine, 160,
348–352.
Campbell, K. A., Bogen, D. L., & Berger, R. P. (2006). The other children: A survey of child
abuse physicians on the medical evaluation of children living with a physically
abused child. Archives of Pediatrics & Adolescent Medicine, 160, 1241–1246.
Carlson, B. E. (2000). Children exposed to domestic violence: Research findings and im-
plications for intervention. Trauma, Violence & Abuse, 1(4), 321–342.
Carlson, E. B., & Dalenberg, C. (2000). A conceptual framework for the impact of trau-
matic experiences. Trauma, Violence & Abuse, 1(1), 4–28.
Carpenter, G. L., & Stacks, A. M. (2009). Developmental effects of exposure to intimate
partner violence in early childhood: A review of the literature. Children and Youth
Services Review, 31(8), 831–839.
Catalano, R. F., & Hawkins, J. D. (1996). The social development model: A theory of an-
tisocial behavior. In J. D. Hawkins (Ed.), Delinquency and crime: Current theories
(pp. 149–197). New York: Cambridge University Press.
Children's Bureau (2009). Child witnesses to domestic violence: Summary of state laws.
Available through Child Welfare Information Gatewayhttp://www.childwelfare.gov/
systemwide/laws_policies/statutes/witnessdv.cfm
Christakis, D. A., & Zimmerman, F. J. (2007). Violent television viewing during preschool is
associated with antisocial behavior during school age. Pediatrics, 120(5), 993–999.
Cicchetti, D., & Lynch, M. (1993). Toward an ecological/transactional model of commu-
nity violence and child maltreatment: Consequences for children's development.
Psychiatry, 56(1), 96–118.
Cicchetti, D., & Rizley, R. (1981). Developmental perspectives on the etiology, interge-
nerational transmission, and sequelae of child maltreatment. New Directions for
Child Development, 11, 31–55.
Cicchetti, D., & Toth, S. L. (1995). A developmental psychopathology perspective on
child abuse and neglect. Journal of the American Academy of Child and Adolescent
Psychiatry, 34(5), 541–565.
Cicirelli, V. G. (1996). Sibling relationships in middle and old age. In G. H. Brody (Ed.),
Sibling relationships: Their causes and consequences (pp. 47–73). Norwood, NJ:
Ablex Publishing Corporation.
Cirillo, S., & DiBlasio, P. (1992). Families that abuse. Diagnosis and therapy. New York:
W.W. Norton & Company.
Connor, D. F., Doerfler, L. A., Volungis, A. M., Steingard, R. J., & Melloni, R. H., Jr. (2003). Aggres-
sive behavior in abused children. Annals of the New York Academy of Sciences, 1008,
79–90.
Crick, N. R., & Dodge, K. A. (1994). A review and reformulation of social information proces-
sing mechanisms in children's social adjustment. Psychological Bulletin, 115(1), 74–101.
Crick, N. R., & Dodge, K. A. (1996). Social information-processing mechanisms in reac-
tive and proactive aggression. Child Development, 67(3), 993–1002.
Cummings, E. M., Schermerhorn, A. C., Davies, P. T., Goeke-Morey, M. C., & Cummings, J. S.
(2006). Interparental discord and child adjustment: Prospective investigations of
emotional security as an explanatory mechanism. Child Development, 77(1), 132–152.
Davies, P. T., & Cummings, E. M. (1994). Marital conflict and child adjustment: An emo-
tional security hypothesis. Psychological Bulletin, 116(3), 387–411.
Davies, P. T., Harold, G. T., Goeke-Morey, M., & Cummings, E. M. (2002). Children's
emotional security and interparental conflict. Monographs of the Society for Re-
search in Child Development, 67, 1–129.
Davies, P. T., & Woitach, M. J. (2008). Children's emotional security in the interparental
relationship. Current Directions in Psychological Science, 17(4), 269–274.
Dodge, K. A., & Crick, N. R. (1990). Social information-processing bases of aggressive
behavior in children. Personality and Social Psychology Bulletin, 16(1), 8–22.
Dodge, K. A., Pettit, G. S., & Bates, J. E. (1997). How the experience of early physical
abuse leads children to become chronically aggressive. In D. Cicchetti, & S. L. Toth
(Eds.), Developmental perspectives on trauma: Theory, research, and intervention
(pp. 263–288). Rochester, NY: University of Rochester Press.
Dodge, K. A., Pettit, G. S., Bates, J. E., & Valente, E. (1995). Social information-processing
patterns partially mediate the effect of early physical abuse on later conduct prob-
lems. Journal of Abnormal Psychology, 104(4), 632–643.
Edleson, J. L., Gassman-Pines, J., & Hill, M. B. (2006). Defining child exposure to domes-
tic violence as neglect: Minnesota's difficult experience. Social Work, 51(2),
167–174.
Elbow, M. (1982). Children of violent marriages: The forgotten victims. Social Case-
work: The Journal of Contemporary Social Work, 63(8), 465–471.
Eriksen, S., & Jensen, V. (2006). All in the family? Family environment factors in sibling
violence. Journal of Family Violence, 21(8), 497–507.
Evans, S. E., Davies, C., & DiLillo, D. (2008). Exposure to domestic violence: A meta-analysis
of child and adolescent outcomes. Aggression and Violent Behavior, 13, 131–140.
Fang, X., & Corso, P. S. (2007). Child maltreatment, youth violence, and intimate part-
ner violence: Developmental relationships. American Journal of Preventive Medi-
cine, 33(4), 281–290.
Feldman, R. S., Salzinger, S., Rosario, M., Alvarado, L., Caraballo, L., & Hammer, M.
(1995). Parent, teacher, and peer ratings of physically abused and nonmaltreated
children's behavior. Journal of Abnormal Child Psychology, 23, 317–334.
Felson, R. B. (1983). Aggression and violence between siblings. Social Psychology Quar-
terly, 46(4), 271–285.
 L.M. Renner / Aggression and Violent Behavior 17 (2012) 158–170
Fergusson, D. M., & Lynskey, M. T. (1997). Physical punishment/maltreatment during
childhood and adjustment in young adulthood. Child Abuse & Neglect, 21(7), 617–630.
Feshbach, S. (1980). Child abuse and the dynamics of human aggression and violence.
In G. Gerbner, C. J. Ross, & E. Zigler (Eds.), Child abuse: An agenda for action
(pp. 48–60). New York: Oxford University Press.
Finkelhor, D., Ormrod, R. K., & Turner, H. A. (2009). Lifetime assessment of poly-victimization
in a national sample of children and youth. Child Abuse & Neglect, 33(7), 403–411.
Finkelhor, D., Turner, H., & Ormrod, R. (2006). Kid's stuff: The nature and impact of peer and
sibling violence on younger and older children. Child Abuse & Neglect, 30(12),
1401–1421.
Finkelhor, D., Turner, H., Ormrod, R., & Hamby, S. L. (2009). Violence, abuse, and crime ex-
posure in a national sample of children and youth. Pediatrics, 124(5), 1411–1423.
Fosco, G. M., DeBoard, R. L., & Grych, J. H. (2007). Making sense of family violence: Im-
plications of children's appraisals of interparental aggression for their short- and
long-term functioning. European Psychologist, 12(1), 6–16.
Foster, H., & Brooks-Gunn, J. (2009). Toward a stress process model of children's expo-
sure to physical family and community violence. Clinical Child and Family Psychol-
ogy Review, 12(2), 71–94.
Fowler, D. N., & Chanmugam, A. (2007). A critical review of quantitative analyses of
children exposed to domestic violence: Lessons for practice and research. Brief
Treatment and Crisis Intervention, 7(4), 322–344.
Fowler, P. J., Tompsett, C. J., Braciszewski, J. M., Jacques-Tiura, A. J., & Baltes, B. B. (2009).
Community violence: A meta-analysis on the effect of exposure and mental health out-
comes of children and adolescents. Development and Psychopathology, 21, 227–259.
Gentile, D. A., Lynch, P. J., Linder, J. R., & Walsh, D. A. (2004). The effects of violent video
game habits on adolescent hostility, aggressive behaviors, and school performance.
Journal of Adolescence, 27(1), 5–22.
Gershoff, E. T. (2002). Corporal punishment by parents and associated child behaviors
and experiences: A meta-analytic and theoretical review. Psychological Bulletin,
128(4), 539–579.
Giannopoulou, I., Strouthos, M., Smith, P., Dikaiakou, A., Galanopoulou, V., & Yule, W.
(2006). Post-traumatic stress reactions of children and adolescents exposed to
the Athens 1999 earthquake. European Psychiatry, 21(3), 160–166.
Gil, E. (1983). Outgrowing the pain: A book for and about adults abused as children. New
York: Dell Publishing.
Graham-Bermann, S. A. (1998). The impact of woman abuse on children's social devel-
opment: Research and theoretical perspectives. In G. W. Holden, R. Geffner, & E. N.
Jouriles (Eds.), Children exposed to marital violence: Theory, research, and applied is-
sues (pp. 21–54). Washington, DC: American Psychological Association.
Graham-Bermann, S. A., & Hughes, H. M. (1998). The impact of domestic violence and
emotional abuse on children: The intersection of research, theory, and clinical in-
tervention. Journal of Emotional Abuse, 1(2), 1–21.
Graham-Bermann, S. A., & Levendosky, A. A. (1998). The social functioning of
preschool-age children whose mothers are emotionally and physically abused.
Journal of Emotional Abuse, 1(1), 59–84.
Green, A. H. (1985). Children traumatized by physical abuse. In S. Eth, & R. S. Pynoos
(Eds.), Post-traumatic stress disorder in children (pp. 135–154). Washington, DC:
American Psychiatric Press, Inc.
Groome, D., & Soureti, A. (2004). Post-traumatic stress disorder and anxiety symptoms in
children exposed to the 1999 Greek earthquake. British Journal of Psychology, 95(3),
387–397.
Groves, B. M. (1999). Mental health services for children who witness domestic vio-
lence. The Future of Children, 9(3), 122–132.
Groves, B. M., Zuckerman, B., Marans, S., & Cohen, D. J. (1993). Silent victims. Children who
witness violence. JAMA: Journal of the American Medical Association, 269(2), 262–264.
Grych, J. H., & Fincham, F. D. (1990). Marital conflict and children's adjustment: A
cognitive-contextual framework. Psychological Bulletin, 108(2), 267–290.
Grych, J. H., Fincham, F. D., Jouriles, E. N., & McDonald, R. (2000). Interparental conflict
and child adjustment: Testing the meditational role of appraisals in the cognitive-
contextual framework. Child Development, 71(6), 1648–1661.
Guerra, N. G., Huesmann, L. R., & Spindler, A. (2003). Community violence exposure, so-
cial cognition, and aggression among urban elementary school children. Child De-
velopment, 74(5), 1561–1576.
Halperin, S. L. (1981). Abused and non-abused children's perceptions of their mothers,
fathers and siblings: Implications for a comprehensive family treatment plan. Fam-
ily Relations, 30(1), 89–96.
Halperin, S. M. (1983). Family perceptions of abused children and their siblings. Child
Abuse & Neglect, 7, 107–115.
Hamilton-Giachritsis, C. E., & Browne, K. D. (2005). A retrospective study of risk to sib-
lings in abusing families. Journal of Family Psychology, 19(4), 619–624.
Hawkins, J. D., Herrenkohl, T., Farrington, D. P., Brewer, D., Catalano, R. F., & Harachi, T.
W. (1998). A review of predictors of youth violence. In R. Loeber, & D. P. Farrington
(Eds.), Serious and violent juvenile offenders: Risk factors and successful interventions
(pp. 106–146). Thousand Oaks, CA: Sage.
Hawkins, J. D., & Weis, J. G. (1985). The social development model: An integrated approach
to delinquency prevention. Journal of Primary Prevention, 6(2), 73–97.
Helfer, R. E., & Kempe, C. H. (1968). The battered child. Chicago: The University of Chicago
Press.
Herman, J. L. (1997). Trauma and recovery. New York, NY: Basic Books.
Herrenkohl, E. C., & Herrenkohl, R. C. (1979). A comparison of abused children and their non-
abused siblings. Journal of the American Academy of Child Psychiatry, 18(2), 260–269.
Herrenkohl, T. I., Huang, B., Tajima, E. A., & Whitney, S. D. (2003). Examining the link
between child abuse and youth violence: An analysis of mediating mechanisms.
Journal of Interpersonal Violence, 18(10), 1189–1208.
Herrera, V. M., & McCloskey, L. A. (2001). Gender differences in the risk of delinquency
among youth exposed to family violence. Child Abuse & Neglect, 25(8), 1037–1051.
169
Hines, D. A., Kantor, G. K., & Holt, M. K. (2006). Similarities in siblings' experiences of
neglectful parenting behaviors. Child Abuse & Neglect, 30(6), 619–637.
Holden, G. W. (2003). Children exposed to domestic violence and child abuse: Termi-
nology and taxonomy. Clinical Child and Family Psychology Review, 6(3), 151–160.
Hollingsworth, J., Glass, J., & Heisler, K. W. (2007). Empathy deficits in siblings of se-
verely scapegoated children: A conceptual model. Journal of Emotional Abuse,
7(4), 69–88.
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 & Neglect, 32,
797–810.
Holtz, P., & Appel, M. (2011). Internet use and video gaming predict problem behavior
in early adolescence. Journal of Adolescence, 34, 49–58.
Howells, N. L., & Rosenbaum, A. (2008). Effects of perpetrator and victim gender on
negative outcomes of family violence. Journal of Family Violence, 23, 203–209.
Huesmann, L. R., Moise-Titus, J., Podolski, C., & Eron, L. D. (2003). Longitudinal relations
between children's exposure to TV violence and their aggressive and violent be-
havior in young adulthood: 1977–1992. Developmental Psychology, 39(2),
201–221.
Huesmann, L. R., & Taylor, L. D. (2006). The role of media violence in violent behavior.
Annual Review of Public Health, 27, 393–415.
Ireland, T. O., & Smith, C. A. (2009). Living in partner-violent families: Developmental
links to antisocial behavior and relationship violence. Journal of Youth and Adoles-
cence, 38(3), 323–339.
Jaffe, P., Wolfe, D., & Wilson, S. K. (1990). Children of battered women. Newbury Park:
Sage Publications, Inc.
Jaffee, S. R., Moffitt, T. E., Caspi, A., Taylor, A., & Arseneault, L. (2002). Influence of adult
domestic violence on children's internalizing and externalizing problems: An envi-
ronmentally informative twin study. Journal of the American Academy of Child and
Adolescent Psychiatry, 41(9), 1095–1103.
Janosz, M., Archambault, I., Pagani, L. S., Pascal, S., Morin, A. J. S., & Bowen, F. (2008). Are
there detrimental effects of witnessing school violence in early adolescence? Jour-
nal of Adolescent Health, 43(6), 600–608.
Jean-Gilles, M., & Crittenden, P. M. (1990). Maltreating families: A look at siblings. Fam-
ily Relations, 39(3), 323–329.
Jenkins, J. M., & Smith, M. A. (1990). Factors protecting children living in disharmoni-
ous homes: Maternal reports. Journal of the American Academy of Child and Adoles-
cent Psychiatry, 29(1), 60–69.
Jenkins, J. M., Smith, M. A., & Graham, P. J. (1989). Coping with parental quarrels. Jour-
nal of the American Academy of Child and Adolescent Psychiatry, 28(2), 182–189.
Johnson, R. M., Kotch, J. B., Catellier, D. J., Winsor, J. R., Dufort, V., Hunter, W., et al.
(2002). Adverse behavioral and emotional outcomes from child abuse and wit-
nessed violence. Child Maltreatment, 7(3), 179–186.
Johnson, B., & Morse, H. A. (1968). Injured children and their parents. Children, 15(4),
147–152.
Jouriles, E. N., Norwood, W. D., McDonald, R., & Peters, B. (2001). Domestic violence and
child adjustment. In J. H. Grych, & F. D. Fincham (Eds.), Interparental conflict and
child development: Theory, research, and applications (pp. 315–336). Cambridge, En-
gland: Cambridge University Press.
Justice, B., & Justice, R. (1990). The abusing family (Revised ed.). New York: Plenum Press.
Kantor, G. K., & Little, L. (2003). Defining the boundaries of child neglect: When does
domestic violence equate with parental failure to protect? Journal of Interpersonal
Violence, 18(4), 338–355.
Keil, V., & Price, J. M. (2006). Externalizing behavior disorders in child welfare settings:
Definition, prevalence, and implications for assessment and treatment. Children
and Youth Services Review, 28, 761–779.
Kempe, R., & Kempe, C. H. (1976). Assessing family pathology. In R. E. Helfer, & C. H. Kempe
(Eds.), Child abuse and neglect: The family and the community (pp. 115–126). Cam-
bridge, MA: Ballinger Publishing Company.
Kempe, C. H., Silverman, F. N., Steele, B. F., Droegemueller, W., & Silver, H. K. (1962). The
battered child syndrome. Journal of the American Medical Association, 181(1), 17–24.
Kernic, M. A., Wolf, M. E., Holt, V. L., McKnight, B., Huebner, C. E., & Rivara, F. P. (2003).
Behavioral problems among children whose mothers are abused by an intimate
partner. Child Abuse & Neglect, 27(11), 1231–1246.
Kiselica, M. S., & Morrill-Richards, M. (2007). Sibling maltreatment: The forgotten
abuse. Journal of Counseling and Development, 85(2), 148–161.
Kitzmann, K. M., Gaylord, N. K., Holt, A. R., & Kenny, E. D. (2003). Child witness to do-
mestic violence: A meta-analytic review. Journal of Consulting and Clinical Psychol-
ogy, 71(2), 339–352.
Kolar, K. R., & Davey, D. (2007). Silent victims: Children exposed to family violence. The
Journal of School Nursing, 23(2), 86–91.
Lansford, J. E., Criss, M. M., Laird, R. D., Shaw, D. S., Pettit, G. S., Bates, J. E., et al. (2011).
Reciprocal relations between parents' physical discipline and children's externaliz-
ing behavior during middle childhood and adolescence. Development and Psycho-
pathology, 23, 225–238.
Lansford, J. E., Miller-Johnson, S., Berlin, L. J., Dodge, K. A., Bates, J. E., & Pettit, G. S.
(2007). Early physical abuse and later violent delinquency: A prospective longitu-
dinal study. Child Maltreatment, 12(3), 233–245.
Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.
Leavitt, K. S., Gardner, S. A., Gallagher, M. M., & Schamess, G. (1998). Severely trauma-
tized siblings: A treatment strategy. Clinical Social Work Journal, 26(1), 55–71.
Levine, M. B. (1975). Interparental violence and its effect on the children: A study of 50
families in general practice. Medicine, Science, and the Law, 15(3), 172–176.
Linares, L. O. (2006). An understudied form of intra-family violence: Sibling-to-sibling
aggression among foster children. Aggression and Violent Behavior, 11(1), 95–109.
Litrownik, A. J., Newton, R., Hunter, W. M., English, D., & Everson, M. D. (2003). Expo-
sure to family violence in young at-risk children: A longitudinal look at the effects
170 L.M. Renner / Aggression and Violent Behavior 17 (2012) 158–170
of victimization and witnessed physical and psychological aggression. Journal of
Family Violence, 18(1), 59–73.
Liu, J. (2004). Childhood externalizing behavior: Theory and implications. Journal of
Child and Adolescent Psychiatric Nursing, 17(3), 93–103.
Lynch, M. A. (1975). Ill-health and child abuse. The Lancet, 306, 317–319.
Lynch, M. (1976). Risk factors in the child: A study of abused children and their siblings. In
H. P. Martin (Ed.), The abused child (pp. 43–56). Cambridge, Mass: Ballinger.
Lynch, M. (2003). Consequences of children's exposure to community violence. Clinical
Child and Family Psychology Review, 6(4), 265–274.
Lynch, M. E., & Cicchetti, D. (1998). An ecological-transactional analysis of children and
contexts: The longitudinal interplay among child maltreatment, community violence,
and children's symptomatology. Development and Psychopathology, 10, 235–257.
Mahoney, A., Donnelly, W. O., Boxer, P., & Lewis, T. (2003). Marital and severe parent-
to-adolescent physical aggression in clinic-referred families: Mother and adoles-
cent reports on co-occurrence and links to child behavior problems. Journal of Fam-
ily Psychology, 17(1), 3–19.
Manly, J. T., Kim, J. E., Rogosch, F. A., & Cicchetti, D. (2001). Dimensions of child mal-
treatment and children's adjustment: Contributions of developmental timing and
subtype. Development and Psychopathology, 13, 759–782.
Margolin, G., & Gordis, E. B. (2000). The effects of family and community violence on
children. Annual Review of Psychology, 51, 445–479.
Mass, C., Herrenkohl, T. I., & Sousa, C. (2008). Review of research on child maltreatment
and violence in youth. Trauma, Violence & Abuse, 9(1), 56–67.
McCabe, K. M., Hough, R. L., Yeh, M., Lucchini, S. E., & Hazen, A. (2005). The relation be-
tween violence exposure and conduct problems among adolescents: A prospective
study. The American Journal of Orthopsychiatry, 75(4), 575–584.
McCloskey, L. A., & Lichter, E. L. (2003). The contribution of marital violence to adolescent ag-
gression across different relationships. Journal of Interpersonal Violence, 18(4), 390–412.
McDonald, R., Jouriles, E. N., Ramisetty-Mikler, S., Caetano, R., & Green, C. E. (2006). Es-
timating the number of American children living in partner-violent families. Jour-
nal of Family Psychology, 20(1), 137–142.
McDonald, C. C., & Richmond, T. R. (2008). The relationship between community vio-
lence exposure and mental health symptoms in urban adolescents. Journal of Psy-
chiatric and Mental Health Nursing, 15, 833–849.
Miller-Perrin, C. L., & Perrin, R. D. (2007). Child maltreatment: An introduction (2nd ed.).
Thousand Oaks, CA: Sage Publications.
Moore, J. G. (1975). Yo-yo children — Victims of matrimonial violence. Child Welfare,
54(8), 557–566.
Mrug, S., Loosier, P. S., & Windle, M. (2008). Violence exposure across multiple con-
texts: Individual and joint effects on adjustment. The American Journal of Orthopsy-
chiatry, 78(1), 70–84.
Mrug, S., & Windle, M. (2010). Prospective effects of violence exposure across multiple
contexts on early adolescents' internalizing and externalizing problems. Journal of
Child Psychology and Psychiatry, 51(8), 953–961.
Nakou, S., Adam, H., Stathacopoulou, N., & Agathonos, H. (1982). Health status of
abused and neglected children and their siblings. Child Abuse & Neglect, 6(3),
279–284.
Newman, M., Black, D., & Harris-Hendriks, J. (1997). Victims of disaster, war, violence,
or homicide: Psychological effects on siblings. Child Psychology & Psychiatry Review,
2(4), 140–149.
O'Brien, M., John, R. S., Margolin, G., & Erel, O. (1994). Reliability and diagnostic efficacy
of parents' reports regarding children's exposure to marital aggression. Violence
and Victims, 9(1), 45–62.
O'Keefe, M. (1996). The differential effects of family violence on adolescent adjust-
ment. Child and Adolescent Social Work Journal, 13(1), 51–68.
O'Keefe, M. (1997). Adolescents' exposure to community and school violence: Preva-
lence and behavioral correlates. Journal of Adolescent Health, 20, 368–376.
Office for Victims of Crime (1999). Breaking the cycle of violence: Recommendations to
improve the criminal justice response to child victims and witnesses. Washington,
DC: U.S. Department of Justice (Retrieved December 1, 2011 from,). http://www.
ojp.usdoj.gov/ovc/publications/factshts/pdftxt/monograph.pdf
Osofsky, J. D. (1998). Children as invisible victims of domestic and community vio-
lence. In G. W. Holden, R. Geffner, & E. N. Jouriles (Eds.), Children exposed to marital
violence: Theory, research, and applied issues (pp. 95–117). Washington, DC: Amer-
ican Psychological Association.
Parker, G. E. (1965). The battered child syndrome. Medicine, Science, and the Law, 5(3),
160–163.
Pfefferbaum, B. J., De Voe, E. R., Stuber, J., Schiff, M., Klein, T. P., & Fairbrother, G. (2004).
Psychological impact of terrorism on children and families in the United States.
Journal of Aggression, Maltreatment and Trauma, 9(3–4), 305–317.
Pfouts, J. H., Schopler, J. H., & Henley, H. C., Jr. (1982). Forgotten victims of family vio-
lence. Social Work, 27, 367–368.
Pine, D. S., Costello, J., & Masten, A. (2005). Trauma, proximity, and developmental psy-
chopathology: The effects of war and terrorism on children. Neuropsychopharma-
cology, 30, 1781–1792.
Prino, C. T., & Peyrot, M. (1994). The effect of child physical abuse and neglect on aggres-
sive, withdrawn, and prosocial behavior. Child Abuse & Neglect, 18(10), 871–884.
Pynoos, R. S., Frederick, C., Nader, K., Arroyo, W., Steinberg, A., Eth, S., et al. (1987). Life
threat and posttraumatic stress in school-age children. Archives of General Psychia-
try, 44, 1057–1063.
Pynoos, R. S., & Nader, K. (1988). Psychological first aid and treatment approach to chil-
dren exposed to community violence: Research implications. Journal of Traumatic
Stress, 1(4), 445–473.
Pynoos, R. S., Sorenson, S., & Steinberg, A. (1993). Interpersonal violence and traumatic
stress reactions. In L. Goldberger, & S. Breznitz (Eds.), Theoretical and clinical as-
pects (pp. 550–573). (2nd ed.). New York, NY: Free Press.
Radbill, S. X. (1968). A history of child abuse and infanticide. In R. E. Helfer, & C. H. Kempe
(Eds.), The battered child (pp. 3–17). Chicago: The University of Chicago Press.
Rankin, J. M., & Ornstein, A. E. (2009). A commentary on mandatory reporting legisla-
tion in the United States, Canada, and Australia: A cross-jurisdictional review of
key features, differences, and issues. Child Maltreatment, 14(1), 121–123.
Renner, L.M. (2005). An integrated understanding of the effects of physical family vio-
lence on children's behavior problems. (Doctoral dissertation, University of
Wisconsin-Madison). Available from ProQuest Dissertations and Thesis database.
(UMI No. 3186061).
Renner, L.M. (accepted for publication). Single types of family violence victimization and
externalizing behaviors among children and adolescents. Journal of Family Violence.
Richmond, M. K., & Stocker, C. M. (2003). Siblings' differential experiences of marital conflict
and differences in psychological adjustment. Journal of Family Psychology, 17(3),
339–350.
Rosenbaum, A., & O'Leary, K. D. (1981). Children: The unintended victims of marital vi-
olence. The American Journal of Orthopsychiatry, 51(4), 692–699.
Rosenfeld, L. B. (2001). Children's response to terrorism. (Retrieved December 1, 2011,
from,). http://www.socialworkers.org/pressroom/events/911/rosenfeld.asp?print=1
Rudo, Z. H., Powell, D. S., & Dunlap, G. (1998). The effects of violence in the home on
children's emotional, behavioral, and social functioning: A review of literature.
Journal of Emotional and Behavioral Disorders, 6(2), 94–113.
Salzinger, S., Feldman, R. S., Hammer, M., & Rosario, M. (1993). The effects of physical
abuse on children's social relationships. Child Development, 64, 169–187.
Salzinger, S., Feldman, R. S., Ng-Mak, D. S., Mojica, E., Stockhammer, T., & Rosario, M.
(2002). Effects of partner violence and physical child abuse on child behavior: A
study of abused and comparison children. Journal of Family Violence, 17(1), 23–52.
Schultz, L. (1960). The wife assaulter. Journal of Social Therapy, 6(2), 103–112.
Sedlak, A. J., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Greene, A., et al. (2010).
Fourth National Incidence Study of Child Abuse and Neglect (NIS-4): Report to Con-
gress, executive summary. Washington, DC: U.S. Department of Health and Human
Services, Administration for Children and Families.
Shahinfar, A., & Fox, N. A. (1997). The effects of trauma on children: Conceptual and
methodological issues. In D. Cicchetti, & S. L. Toth (Eds.), Developmental perspec-
tives on trauma: Theory, research, and intervention (pp. 115–139). Rochester, NY:
University of Rochester Press.
Shannon, M. P., Lonigan, C. J., Finch, A. J., & Taylor, C. M. (1994). Children exposed to di-
saster: I. Epidemiology of post-traumatic symptoms and symptom profiles. Journal
of the American Academy of Child and Adolescent Psychiatry, 33(1), 80–93.
Shields, A., & Cicchetti, D. (2001). Parental maltreatment and emotion dysregulation as
risk factors for bullying and victimization in middle childhood. Journal of Clinical
Child Psychology, 30(3), 349–363.
Skopp, N. A., McDonald, R., Manke, B., & Jouriles, E. N. (2005). Siblings in domestically
violent families: Experiences of interparent conflict and adjustment problems.
Journal of Family Psychology, 19(2), 324–333.
Smith, S. M. (1975). The battered child syndrome. London: Butterworth & Co.
Smith, C., & Thornberry, T. P. (1995). The relationship between childhood maltreat-
ment and adolescent involvement in delinquency. Criminology, 33(4), 451–481.
Somer, E., & Braunstein, A. (1999). Are children exposed to interparental violence being
psychologically maltreated? Aggression and Violent Behavior, 4(4), 449–456.
Spaccarelli, S., Coatsworth, J. D., & Bowden, B. S. (1995). Exposure to serious family vi-
olence among incarcerated boys: Its association with violent offending and poten-
tial mediating variables. Violence and Victims, 10(3), 163–182.
Stouthamer-Loeber, M., Loeber, R., Homish, D. L., & Wei, E. (2001). Maltreatment of
boys and the development of disruptive and delinquent behavior. Development
and Psychopathology, 13(4), 941–955.
Tanimura, M., Matsui, I., & Kobayashi, N. (1990). Child abuse of one of a pair of twins in
Japan. The Lancet, 336, 1298–1299.
Tavkar, P., & Hansen, D. J. (2011). Interventions for families victimized by child sexual
abuse: Clinical issues and approaches for child advocacy center-based services. Ag-
gression and Violent Behavior, 16(3), 188–199.
Thompson, E. M., Paget, N. W., Bates, D. W., Mesch, M., & Putnam, T. I. (1971). Child
abuse: A community challenge. Buffalo, NY: Henry Stewart, Incorporated.
Tower, C. C. (1993). Understanding child abuse and neglect (2nd ed.). Boston, MA: Allyn &
Bacon.
Tyndall-Lind, A., Landreth, G. L., & Giordano, M. A. (2001). Intensive group play
therapy with child witnesses of domestic violence. International Journal of Play
Therapy, 10(1), 53–83.
U.S. Department of Health and Human Services [USDHHS], Administration for Children
and Families, Administration on Children, Youth and Families, Children's Bureau.
(2010). Child Maltreatment 2009. Available from http://www.acf.hhs.gov/
programs/cb/stats_research/index.htm#can.
Vitale, M. A., Squires, J., Zuckerbraun, N. S., & Berger, R. P. (2010). Evaluation of the sib-
lings of physically abused children: A comparison of child protective services case-
workers and child abuse physicians. Child Maltreatment, 15(2), 144–151.
Waddell, J., Pepler, D., & Moore, T. (2001). Observations of sibling interactions in vio-
lent families. Journal of Community Psychology, 29(3), 241–258.
Wallace, H. (1996). Family violence. Legal, medical, and social perspectives. Needham
Heights, MA: Allyn & Bacon.
Webb, N. B. (2004). The impact of traumatic stress and loss on children and families. In
N. B. Webb (Ed.), Mass trauma and violence: Helping families and children cope
(pp. 3–22). New York: The Guilford Press.
Wolfe, D. A., Crooks, C. V., Lee, V., McIntyre-Smith, A., & Jaffe, P. G. (2003). The effects of
children's exposure to domestic violence: A meta-analysis and critique. Clinical
Child and Family Psychology Review, 6(3), 171–187.
Wolfe, D. A., & Mosk, M. D. (1983). Behavioral comparisons of children from abusive
and distressed homes. Journal of Consulting and Clinical Psychology, 51(5), 702–708.