Child Exposure to Violence: The Underlying Effect of Trauma Symptoms on Behavior Problems

Purpose: Although many studies have found a significant link between violence exposure and behavior problems among children (Fowler, Tompsett, Braciszewski, Jacques-Tiura, & Baltes, 2009), relatively little empirical attention has been paid to identifying the mediators of this association. Gaps in knowledge also remain with respect to the differential effects of witnessing violence and violence victimization on behavior problems. The purpose of the present study was to examine 1) whether being a witness to or victim of violence influences children’s behavior problems and 2) whether trauma symptoms mediate these influences.  

Methods: This study used data from the National Survey of Child and Adolescent Well-being (NCSAW-I). A total of 1772 children (ages 8-15) were included in the analysis. Violence exposure was assessed using the Violence Exposure Scale for children (VEX-R).  The VEX-R measures children’s exposure to mild (e.g., pushing, yelling, spanking, shoving) to severe (e.g., stabbing, shooting, threatening with a gun or knife) violence in the home. Two subscales, violence witness intensity scale and violence victim intensity scale, were used in the analysis. Trauma symptoms were measured using the10 items in the Trauma Symptom Checklist for Children (TSCC). Behavior problems were assessed using the Child Behavior Checklist (CBCL-4-18) where caregivers reported internalizing and externalizing behavior problems. Structural equation modeling (using AMOS 21) was performed  to test direct and indirect pathways between violence exposure (witnessing and victimization) and behavior problems.

Findings: Indices of goodness-of-fit of the mediation model showed an acceptable fit, CFI=.95, RMSEA=.06, SRMR=.04. The results of direct, indirect, and total effect from the structural equation modeling indicated that witnessing violence had no total effect on behavior problems (β=.03, p=.38), indicating no significant association between witnessing violence and internalizing/ externalizing symptoms.  Violence victimization, however, had a significant total effect on children's behavior problems (β=.19, p=.001). Being a victim of violence was directly associated with greater behavior problems (direct effect: β=.16, p=.001). Additionally, violence victimization showed a significant indirect effect (β=.03, p<.001), suggesting that trauma symptoms partially mediated the impact of violence victimization on internalizing and externalizing behavior problems.

Conclusion and Implications: This study examined direct and indirect associations between violence exposure (witnessing and victimization) and children’s internalizing and externalizing behavior problems. This study adds to the literature on risk factors and mediators related to behavior problems in school-aged children. Results highlight the role of trauma symptoms as critical mechanisms underlying the association between violence victimization and behavior problems. It therefore points to the importance of providing effective and targeted trauma-focused treatment and intervention programs for children who have been victims of violence in order to reduce the negative consequences they experience.