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Exposure to Violence
Psychological and Academic Correlates in Child Witnesses
Hallam Hurt, MD;
Elsa Malmud, PhD;
Nancy L. Brodsky, PhD;
Joan Giannetta, BA
Arch Pediatr Adolesc Med. 2001;155:1351-1356.
Background Inner-city children are frequently exposed to violence; however, there
are few data regarding the psychological and academic correlates of such exposure
in young children at school entry.
Objectives To document exposure to violence in inner-city children aged 7 years;
assess their feelings of distress; and evaluate the relationships of exposure
to violence with school performance, behavior, and self-esteem.
Setting A study center in an inner-city hospital.
Participants One hundred nineteen inner-city children evaluated at age 7 years; 119
caregivers (biological and foster).
Design As part of a longitudinal study, children were administered the following
by a masked examiner: Things I Have Seen and Heard (TISH) to assess exposure
to violence; Levonn, a cartoon-based interview for assessing children's distress
symptoms; and the Culture-Free Self-Esteem Inventory, Second Edition. School
performance was assessed by school reports and child behavior by the Child
Behavior Checklist (CBCL), the Parent Report Form, and the Teacher Report
Form. Caregivers for children were administered the parent report version
of the Checklist of Children's Distress Symptoms (CCDS-PRV) as well as the
CBCL Parent Report Form.
Main Outcome Measures Exposure to violence (TISH); feelings of distress (Levonn); school performance;
behavior (CBCL Parent Report Form and CBCL Teacher Report Form); and self-esteem
(Culture-Free Self-Esteem Inventory).
Results We found that these children were frequently exposed to violence. For
example, 75% had heard gun shots, 60% had seen drug deals, 18% had seen a
dead body outside, and 10% had seen a shooting or stabbing in the home (TISH).
Many showed signs of depression and anxiety; eg, 61% worried some or a lot
of the time that they might get killed or die and 19% sometimes wished they
were dead (Levonn). Higher exposure to violence (TISH Total Violence score)
was correlated with higher Levonn composite scores for depression and anxiety
and with lower self-esteem (P .04), and was also associated
with lower grade point average and more days of school absence (P.02). Caregiver assessment of child anxiety correlated poorly
with child report of anxiety (P = .58).
Conclusions Young inner-city children have a high exposure to violence by age 7
years; many show signs of distress that frequently are not recognized by caregivers.
Further, higher exposure to violence in children correlates with poorer performance
in school, symptoms of anxiety and depression, and lower self-esteem.
From the Division of Neonatology, Albert Einstein Medical Center (Drs
Hurt, Brodsky, and Malmud and Ms Giannetta), and the Jefferson Medical College
of Thomas Jefferson University (Drs Hurt and Brodsky), Philadelphia, Pa.
Corresponding author: Hallam Hurt, MD, Division of Neonatology, Albert
Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA 19141 (e-mail: hurth{at}aehn2.einstein.edu).
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