1 Children aged 0-5 account for 48% of all children involved. 30% - PDF document

From Domestic Violence and Abuse Needs Assessment for Children and Young People in Norfolk. Norfolk Public Health, Stuart Keeble, Public Health Registrar , December 2014 1

Children aged 0-5 account for 48% of all children involved. 30% of abuse begins during pregnancy Why do you think most domestic abuse begins during pregnancy? Perpetrators “needs” not being met/prioritised, financial pressure, stress, changes in relationship i.e. woman’s body changes – she may not be interested in sex, 2

The effect of being exposed to DVA is dependent on the frequency and intensity of abuse witnessed, leading to poorer outcomes. Children exposed to DVA without suffering physical harm themselves display similar psychological and social outcomes as children who have been physically abused but not exposed to violence between parents Children and young people’s response to DVA differs by age, with preschool children particularly affected. Witnessing severe DVA is associated with a tripling of the likelihood of children developing conduct disorders . (Some evidence of link to ADHD) Serious behavioural problems are 17 times higher for boys and 10 times higher for girls who witnessed the abuse of their mother. Women reporting childhood physical abuse or witnessing inter-parental violence experience a four- to six-fold increase in risk of physical Intimate Partner Violence. Complex relationship between childhood experience of DA and likelihood of becoming a victim or perpetrator. Toxic Trio 3

70% teenage mothers in an abusive relationship In the womb - hearing is developing (babies show preference for mum’s favourite soap tune and for stories read by Mum) They also hear arguments and discord Research shows that stress and anxiety in pregnancy has harmful effects that can continue throughout the infant’s life dependent on its timing, magnitude and/or chronicity. Persistently high levels of stress hormones such as cortisol, are known to have damaging effects on the development of neural pathways in the fetal brain. (see further slide) Not only is domestic abuse in pregnancy associated with a wide range of compromised physical outcomes but also with postnatal depression and Post Traumatic Stress Disorder (PTSD) Ability to imagine a child at 6 months (mind-mindedness) is connected to a positive relationship – roots of empathy Women who had experienced domestic abuse had significantly more negative representations of their infants and themselves, and their babies were more likely to be insecurely attached. 4

Many new born infants, babies, and toddlers are witnessing violence (90% in same or next room). Infants who hear or see unresolved angry conflict or a parent being hurt may develop symptoms of PTSD, which renders them simultaneously over- reactive, helpless and immobilised with a lack of typical responses to adults, and loss of previously acquired developmental skills. In general, parents tend to underestimate the extent to which their children may be exposed to domestic violence and children in families with documented violence often give detailed reports of violence that their parents assumed went unnoticed. The impact varies according to the extent to which the violence affects the parenting relationship, and the mothers maternal sensitivity, mental health and stress. 5

While children are born with most of the brain cells (neurons) they will have for life, most of the connections between those cells (synapses) that guide everything from coordination to analytic skills are formed in early childhood. Both the formation and the reinforcement of connections between brain cells are strongly influenced by a child’s environment and relationships with parents and caregivers Children that grow up in an atmosphere of deprivation, low interaction with adults, or ongoing, persistent stress (from things like parental emotional instability, domestic or community violence, or food insecurity) may fail to build or maintain important brain connections. Ongoing or “toxic” stress causes visible changes in brain structure. These changes have real-world implications and costs: toxic stress has been connected to poor long-term health, social, and educational outcomes Levels of cortisol respond to attachment patterns: secure attachment, babies better able to cope with stress. Higher levels lead to poor self-regulation, shrinking connections and cell death in the brain. Severely abused or neglected children , subjected to chronic high levels of blood cortisol, can have head circumferences 25% smaller than average 6

The neurodevelopmental impact of violence in childhood – (nb Brains do not shrink!!) The more that threat related neural systems are activated during development, the more they become “built - in”. When a child perceives threat, their brain will orchestrate a total-body mobilisation to adapt to the challenge. There are 2 main human and animal response patterns : hyperarousal and dissociative Predominant pattern appears to shift from dissociative (common in babies and young children to hyperarousal during later development). The damaging effects of negative experiences depend on three factors: Amount of Exposure . Brains exposed to a greater amount of a negative experience are more likely to show significant damage. Duration . Brains exposed to negative stimulation over a longer period of time are likely to sustain more damage. Timing . Negative experiences during key sensitive periods in development are most likely to damage specific parts of the brain. Better brains for babies: http://www.bbbgeorgia.org/index.php 7

• Worse health outcomes due to missing routine medical and dental appointments or potential injuries from trying to protect one parent from another • Performance below expected ability at school due to an inability to concentrate or missing school because of the need to look after parents or siblings • (17 times higher for boys and 10 times higher for girls who witnessed the abuse of their mother) with some children from violent homes reacting to frustration with aggression and force • Ambivalent attitude to both parents - Strong disapproval of abusers behaviour but also feelings of anger directed at the abused for accepting the behaviour. • Use of violent or aggressive language and behaviour towards peers and adults which can lead to negative interactions and reinforces learning deficits and feeling of alienation

DVA impacts on parents’ (predominately mother) ability to parent which in itself effects attachment and the child’s emotional and social development Infants begin forming attachments even before they are born. During prenatal development, infants learn the sounds and smells of their mother. Shortly after birth, a newborn infant can recognize her mother's voice and smell, based on this prenatal experience. Infants show pleasure when an adult interacts with them and copies, infants show active distress when an adult does not interact and copy And they get distressed if the adult’s response is ‘frozen. (Stillface) Infants and their parents begin the process of bonding shortly after birth. Over time, infants form specific attachment relationships with their parents. These early attachments establish patterns for the way the child connects with people later in life. Extremely traumatic experiences — including suffering or witnessing abuse or neglect — interfere with young children's ability to develop secure attachments. When young children are repeatedly exposed to violent, threatening experiences, the most primitive areas of the brain may be over- developed. Areas that control positive emotional responses, such as the cerebral cortex and the limbic system, may not develop fully. As a result, children who experience trauma are at higher risk of forming insecure attachments 10

Not all children and young people show the same levels of adverse outcomes from being exposed to DVA with approximately a third of the child witnesses demonstrating outcomes that were similar to, or better than, those of non- witnesses Processes most protective begin in first year after birth: with the formation of a secure attachment relationship with primary caregiver. The mother’s ability to maintain her parenting abilities and perceived by the children to be positively supportive are important factors in moderating the abuse impact. Children whose mother’s mental health is not unduly affected by depression and anxiety also show greater resilience and they learn positive aspects of survivorship from mothers who model assertive and non violent responses to violence. Support from extended family or community is also significant, especially for minority ethnic children. These factors provide: • learning of empathy or emotional attachment to others; • opportunity to learn to control and balance feelings, especially those that can be destructive; • opportunity to develop capacities for higher levels of cognitive processing 11

Must make safeguarding referral if a children is living in a household where there is domestic abuse.