Domestic Violence & Traumatic Brain Injury the Silent Assassin

The overlap between traumatic brain injury (TBI) and violence is an important yet little understood problem. The exact number of violence-related TBIs each year is not known. The Centers for Disease Control and Prevention (CDC) estimates that 11% of TBI deaths, hospitalizations, and ED visits combined (a total of 156,000 each year) are related to assaults (Langlois et al, 2004). But this number likely is low because it excludes the many other TBIs, including concussions, caused by violence that go unidentified and unreported. Although not a focus of this article, prisoners and young children are two of the groups at high risk of a violence-related TBI that may not be identified. (See articles by Wald, et al, and Berger, this issue).

Furthermore, the problem of TBI and violence is complicated by the fact that violence is not only a cause, but a consequence of TBI. Specifically,TBI-related cognitive and behavioral problems can also result in aggressive behavior that leads to perpetration of violence, or a lack of insight and judgment, and resulting vulnerability, that can lead to victimization. Depression after TBI can lead to an increased risk of self-inflicted injury, including suicide (Oquendo et al., 2004). Although not a focus of this article, suicide is an important aspect of violence that is addressed elsewhere in this issue (See Brenner article).

The goal of this article is to increase awareness among TBI and health care professionals about the overlap between TBI and violence by summarizing the epidemiology and providing case examples for victimization and aggressive behavior. In addition, we focused on intimate partner violence and TBI because of the limited information published about this topic.

Violence as a Cause of Traumatic Brain Injury

Intimate Partner Violence

The term intimate partner violence (IPV) is also known as domestic violence, spouse abuse, or woman abuse. An “intimate partner” is defined as a current or former partner, including a spouse, boyfriend, or girlfriend (Saltzman et al., 1999). After a relationship ends, many people continue to be at risk for violence from former partners. Intimate partners can be the opposite or the same sex as the victim (Burke et al., 1999; Moracco et al., 2007).

Each year in the United States, women experience about 4.8 million intimate partner-related physical assaults and rapes; men are the victims of about 2.9 million intimate partner violencerelated physical assaults (Tjaden et al., 2000). However, these numbers may underestimate the extent of the problem as certain populations who are more likely to report IPV (prisoners, those living in shelters, transient people, and the homeless) are less likely to be surveyed.

The number of cases of TBI associated with intimate partner violence is not known. However, as mentioned above, CDC estimates that at least 156,000 TBI-related deaths, hospitalizations, and emergency department visits in the U.S. each year are related to assaults (Langlois, et al., 2004). Strangulation or blows to the head may occur in 50 to 90 percent of IPV physical assaults against women (Wolfe et al, 1997; Greenfield et al., 1998). Thus, the true number of violence-related TBIs may be much higher than the CDC estimate. Multiple TBIs, including concussions are frequently reported by incarcerated women with a history of IPV (Pamela Diamond, PhD, University of Texas-Houston, Personal Communication, October 2007).

In one study, 60 percent of the women with IPV-related TBI continued to exhibit TBI-related symptoms 3 months after the injury (Monahan and O’Leary, 1999). Women with TBI frequently exhibit reduced capacity to make informed, consistent choices about whether to leave or return to the perpetrating partner, and their ability to plan and to respond appropriately to safety, health, child care, and parenting issues may be significantly compromised (Monahan and O’Leary, 1999). This increases the likelihood that they will remain in a violent relationship and the risk of sustaining additional injuries, including TBI.

Many victims do not report IPV to police, friends, or family because they think others will not believe them and that the police cannot help (Tjaden et al., 2000).

This may be particularly true for persons with traumatic brain injury (Reichard et al., 2007) for several reasons. First, individuals with TBI are more likely to be dependent on a perpetrator for financial support and physical care. Second, communication problems associated with TBI may make it difficult for victims to report victimization. Third, the perpetrator may claim that the victim should not be taken seriously because of their TBI-related cognitive problems. Finally, victims may not be willing to admit that they have had a TBI because of the fear of negative consequences such as losing custody oftheir children.

Case example

Debra was born in in 1952. She spent 10 years in an abusive relationship with her female partner, and during that time sustained several possible concussions. In 2000, she was lying in bed asleep and was shot several times, including once in the head. She was rushed to the ER and remained in the hospital for 9 days for cranial hemorrhaging. (See sidebar “One Woman’s Story” for a more detailed account)

(Published with permission from Ms. Gray, obtained by the
Alabama Department of Rehabilitation Services)

Violence as a Consequence of TBI

Victimization

A victim is defined as a target of emotional abuse or threatened or actual physical or sexual violence (Saltzman, et al., 2002). Victimization can include physical violence, sexual violence, psychological or emotional abuse, stalking, and neglect.

Persons with disabilities are particularly vulnerable to violence, and their position of vulnerability often makes it more difficult to leave a violent situation. The number of persons with TBI in the U.S. who are victimized each year is not known and existing information regarding the victimization of persons with disabilities has been gleaned from a small number of studies (Marge, 2003). Such studies have shown that persons with disabilities are 4 to 10 times more likely to become a victim of violence, abuse, or neglect than persons without disabilities (Petersilia, 2001). One recent study found that men and women with activity limitations were more likely to experience physical, emotional, and financial abuse, and that women with activity limitations were more likely to experience sexual abuse (Cohen, et al., 2006). Another study found that women with disabilities were 40% more likely to experience intimate partner violence than women without disabilities (Brownridge, 2006).

Research suggests that certain conditions increase the likelihood of violence, abuse or neglect. One study found that violence was more likely among women with a physical disability when they also had more than one disability, a hearing impairment, or were divorced/separated (Milberger, et al., 2003). Another study found that men and women with activity limitations were more likely to report intimate partner violence if they were single, younger, had lower income, and/or had poor health (Cohen, et al., 2006). (For more detailed information about victimization, see the sidebar).

Little is known about the experience of victimization among persons with TBI, however. A recent qualitative research report by Reichard et al. (2007) has begun to shed some light on the problem and provides a number of examples. Selected narratives collected as part of this study are presented below.

Case examples

Victimization of persons with TBI
Physical abuse

I guess because I had on a shirt he didn’t like. I remember it was something about clothes and he threatened to cut the shirt off my body, and I told him he wasn’t cutting the shirt off my body, that I’d go take it off, and then he was going to cut the shirt to shreds, and I told him no, he wasn’t. That I’d take the shirt off but he wasn’t cutting the shirt up, and something about the shirt. He didn’t like the shirt or something, and he had the scissors and he got mad, and I took the scissors away from him, and that’s the only way I’d take off the shirt if he gave me the scissors, and that’s when he pounded me in the head.

Physical and financial abuse

Saturday evening, this fellow [name], who I was going to marry, he tore…he gave me a black eye, he tore up my apartment and demanded a $300 check. [This was not the first time this happened]. He’d hit me and stuff like that. I’ve gone to work with a black eye.

Seeking protection

I went to the police to see what I could do. They told me the temporary restraining order wasn’t worth the paper it was written on. They told me basically it was all a joke. I could get it, but he could show up with a gun and blow me away. That if I was going to do anything, I needed to do it and disappear. I needed to go out of state. I needed to file the papers, go out of state, and then not show up until the day of the court date. That I needed to go ahead and get what I needed done, do it fast, and then leave the state of [state name]. I told them I didn’t have no money. I didn’t have…if I left the state of [state name], how was I going to live? Where was I going to live? How was I going to get there? Due to seizures, I couldn’t drive. I didn’t have no way of driving. What was the deal? And they said they couldn’t help me.

Sexual abuse

I was at a car dealership … getting the car serviced and everything. This elderly man walked in, big smile on, plopped down right next to me, started talking to me very friendly. I started feeling very comfortable with him. Felt like he was like a father figure, you know because my father died when I was…about 5 or 6 years old. Then he started. He put his arm out back behind me. It was a loveseat type thing, which I was feeling very comfortable with him because I was identifying with a father. He started asking questions and so I was talking with him about [the problems he said he was having with his wife and what he could do about them]. And with that he kept getting closer to me… and he moved his hand from the back of the sofa down to the seat and all of a sudden I became aware he was shoving his hand at my butt, up under it and had his thumb stroking my thigh on the outside… my hip area…he was still engaging me in the conversation so that was distracting me…The next thing I know he’s got his hand up my short leg, over into my pubic area, probing, massaging, and I’m looking at him. What are you doing? He said…oh, you’ve just given me the thrill of my life today. And I said remove your hand… I came home rattled…The first thing I did was pick up the phone and I called [name of state] and talked to my friend there and I told him what happened, and I was in hysterics. I mean I was sobbing. I was frantic. I was shaking as I was holding the phone. It’s like I don’t understand why do these things keep happening, you know, and we talked about it and that’s when I first got the insight. He talked to me. He was friendly. You know, he was gentle. He started off appropriate. He kept me distracted, and he was the perfect predator…I’ve been in a situation of no control, … and … distracted, not really able to anticipate where stuff is going. I’m just trying to deal with each moment, so I mean that’s a problem because that means I’m wide open for rape and anything else, and I’ve been fortunate so far no one’s raped me. They’ve molested me, but they have not raped me.

Sexual abuse by a medical professional

It was the second [gynecological exam] in my whole life… [The doctor] dismissed the nurse and he told me to change into a paper gown and he didn’t leave the room….Yeah. And he made me put the thing so it opened in the front…, and then he came over and he pulled the paper open at my breast and everything and he was just looking and his looks were bedroom looks…., and then he took his hands and he started fondling my breasts. After [talking to me about sex and masturbation and touching my private area in a sexual way] … he put [the speculum] in hot and he said I can sterilize you if you ever tell anybody and besides you’ve got a brain injury. They’re not going to believe you.

Violence as a consequence of TBI

Aggressive behavior

According to Silver et al (2005), aggressive behavior after TBI includes explosive behavior that can be set off by minimal provocation and occur without warning. Episodes range in severity from irritability to outbursts that result in damage to property or assaults on others.

Reports of the incidence of aggression vary widely. Studies of patients with TBI conducted in medical outpatient settings typically report low rates of aggressive behavior (Kreutzer et al, 1999). In contrast, persons in a TBI neurobehavioral program displayed an average of about 280 aggressive acts per day during a 14-day period (Alderman et al, 2002). Sexual aggression was reported in 6.5% of a sample of male patients receiving either inpatient or outpatient TBI rehabilitation; the most common offenses were “touching” offenses followed by exhibitionism and overt sexual aggression (Simpson et al., 1999) Increasing evidence suggests that TBI-related aggressive behavior is strongly associated with depression (Kreutzer et al,1996; Tateno et al, 2003; Baguley et al, 2006).

Case examples

Paul was a new 16 year-old driver when he ran his car off the road and both he and his girlfriend sustained TBIs. After a 2 month coma and years of recovery, his social skills have not caught up with his age of 24. He was taken by police to the emergency room when a group of guys beat him severely and took his wallet. Surprised and humiliated, he responded, ”I don’t understand. I just asked them ‘do you want some of this.’ I guess they thought I wanted to fight because they just started beating me up.” Now four years later, despite his best intentions, he loses new friends when he throws things and screams obscenities at them. “They are looking at me and talking too loud” he says. “I said I’m sorry, I go too far before I know it.”

(Source: Cindi Johnson, Side-by-Side Clubhouse, Atlanta, GA, January, 2007).

After sustaining a brain injury in Iraq, Steve was diagnosed with post-traumatic stress disorder and depression. One of the effects of his brain injury is that he has a harder time keeping his emotions under control. He blurts out what he’s thinking or flashes his anger. Late one night driving his pickup truck, he and his wife, came to an intersection where he usually turned left. Now there was a ‘No left turn’ sign. Confused, he stopped and tried to figure out what to do. A policeman walked up. According to his wife “The cop, he shines the flashlight right in at Steve, and he’s screaming, ‘Can you not read, stupid?’ and he got irate. Steve said to his wife, ‘This guy just called me stupid.’ He let out the clutch on the truck and yelled at the cop. ‘I’ll show you stupid, because I’m not stupid. It just takes me longer to comprehend.’ ” He wanted to get out of the car then, but his wife told him “No, it’s not worth it.” She calmed him down and the couple drove on. In rehab, Steve is learning strategies to jog his memory and control his anger. He says “I bite my tongue so many times. I–they’ve taught me to really walk off, and it’s a hard thing for me to do, but I’m learning that.”

Adapted from National Public Radio report from November 29, 2005: http://www.npr.org/templates/story/story. php?storyId=5030571. Accessed 12/28/07

Reducing the toll of violence after TBI

Victimization

Screening for possible TBI among persons who have experienced intimate partner violence is critical to ensuring that those with TBI-related problems are diagnosed and receive needed services and/or accommodations. Professionals working in IPV prevention can benefit from information and training aimed at helping them identify and manage persons with TBI. Potentially useful methods for screening, identifying and assisting such cases have been proposed by both the Alabama Department of Rehabilitation Services and the Brain Injury Association of Virginia (See Interview with Maria Crowley, this issue, and sidebar of Intimate Partner [Domestic] Violence Resources). Additional research is needed to ensure that the screening methods for identifying TBI are both valid and reliable. The November-December 2007 issue of the Journal of Head Trauma Rehabilitation, which was devoted to articles about screening and identification of TBI, includes information about promising new screening methods.

Similarly, screening for victimization among persons with TBI is also important. Physicians are especially well-placed to conduct such screening. However, recent studies of the screening practices of physicians, including obstetrician–gynecologists, indicate that most conduct screening for violence only when warning signs are observed (Horan et al., 1998; Rodriguez et al., 1999).

Unfortunately, violence can exist in the absence of warning signs in the patient’s behavior or medical history. Women who are victims of violence may not present with symptoms, especially those who experience psychological or emotional abuse. They may conceal what they are experiencing at home. Because of the increased vulnerability of women with disabilities, including those with TBI, it is important to study the utility of screening these patients for IPV.

One of the most widely used screening tools is the Abuse Assessment Screen (McFarlane et al, 1992). This tool is short and has been tested in clinical settings. This and other tools for assessing IPV can be found in the Centers for Disease Control’s publicationIntimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings. [See Intimate Partner (Domestic) Violence Resources sidebar, page 16.]

Aggressive behavior

The need to improve the effectiveness of strategies to manage the anger, aggression, and disinhibition following TBI has been well established (Corrigan and Bach, 2005). The link between TBIrelated behavioral problems and violent victimization described in this article provides an additional reason why work in this area is vitally important. Improvements in behavioral management techniques might yield benefits beyond achieving reductions in problematic behaviors. This could include reduced risks for the forms of victimization that may accompany diminished coping abilities, impulse control problems, and increased irritability.

Conclusion

Violence as both a cause and a consequence of TBI is a serious problem. TBI professionals can play an important role in educating domestic violence workers, health care providers, and other professionals, including those in law enforcement, about ways to better identify and assist persons who experience violence. Additional research is needed to better quantify the extent of the problem and to ensure that screening methods for identifying a history of TBI are valid and reliable.

About the Authors

Jean A. Langlois, ScD, MPH is a senior epidemiologist with the Centers for Disease Control and Prevention. She holds master’s and doctoral degrees in injury epidemiology and health policy from the Johns Hopkins University School of Hygiene and Public Health. Dr. Langlois worked in pediatric traumatic brain injury rehabilitation at the Kennedy Krieger Institute at Johns Hopkins Hospital, and was a Senior Staff Fellow in epidemiology at the National Institute on Aging of the National Institutes of Health before joining the CDC. She has published numerousarticles and reports on traumatic brain injury, and is considered a national expert on the epidemiology of TBI. In 2006, she was the recipient of the Brain Injury Association of Ohio’s Awareness Award, and the North American Brain Injury Society’s Public Policy Award

Jeffrey E. Hall, Ph.D., M.S.P.H. is a behavioral scientist with CDC’s Division of Violence Prevention. He is a medical sociologist whose research has focused on etiologic aspects of youth violence, elder maltreatment, and violence against women.

Matt Breiding, Ph.D. is a behavioral scientist with CDC’s Division of Violence Prevention. He is a psychologist whose research has focused on the topics of intimate partner violence and sexual violence.

Audrey A. Reichard MPH, OTR is an epidemiologist who currently conducts research on occupational injuries at the CDC, National Institute for Occupational Safety and Health, Division of Safety Research. She previously worked in the CDC, National Center for Injury Prevention and Control, Division of Injury Response. Prior to beginning a full-time research position, she practiced as an occupational therapist.

Ms. McDonnell is the Executive Director of the Brain Injury Association of Virginia. She has a Bachelor of Science in Occupational Therapy from the Medical College of Virginia, a postgraduate Certificate in Health Care Management and Administration from Old Dominion University, and a Masters of Public Administration degree from Virginia Commonwealth University (VCU). Anne has over 20 years of experience in brain injury rehabilitation across a continuum of hospital and community based settings, and has worked as a consultant for state agencies and private service providers. She serves on the advisory boards for the VCU and Ohio Valley Center Traumatic Brain Injury Model Systems grants, and holds a clinical faculty position in the School of Occupational Therapy at VCU.

Marlena Wald, MLS, MPH is an epidemiologist at the National Center for Injury Prevention and Control, CDC. She has a strong interest in research on victimization of persons with TBI and is the developer CDC’s fact sheets on this topic and on TBI among prisoners.

References

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Baguley, I.J., Cooper, J., Felmingban, K. Aggressive behavior following traumatic brain injury: how common is common? Journal of Head Trauma Rehabilitation. 2006; 21(1):45-56.

Brownridge, DA. Partner violence against women with disabilities: prevalence, risk, and explanations. Violence Against Women. 2006; 12(9):805-22.

Burke, L K. Follingstad, D R. Violence in lesbian and gay relationships: theory, prevalence, and correlational factors. Clinical Psychology Review. 1999;19(5):487-512.

Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Annals of Epidemiology 2006;16(8):644-51.

Corrigan PW, Bach PA. Behavioral treatment. In Silver JM, McAllister TW, Yudofsky SC (eds): Textbook of Traumatic Brain Injury. Washington, DC: American Psychiatric Publishing, 2005.

Greenfield, L.A., and Rand, M. R. (1998). Violence by Intimates, NCJ-167237, US Department of Justice Bureau of Justice Statistics.

Horan DL, Chapin J, Klein L, Schmidt LA, Schulkin J. Domestic violence screening practices of obstetrician-gynecologists. Obstet Gynecol. 1998;92:785-789

Kreutzer, J.S., Marwitz, J.H., Seel, R., Serio, C.D. Validation of the neurobehavioral functioning inventory for adults with traumatic brain injury. Arch Phys Med Rehabil. 1996; 77:116-124.

Kreutzer JS, Seel RT, Marwitz JH. The Neurobehavioral Functioning Inventory (NFI) Manual. San Antonio, TX: The Psychological Corporation; 1999.

Langlois, J.A., Rutland-Brown, W., and Thomas, K.E. (2004) Traumatic brain injury in the United States: Emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.

Marge K. Introduction to violence and disability. In: Marge K, editor. A call to action: Ending crimes of violence against children and adults with disabilities, a report to the nation. Syracuse: State University of New York, Upstate Medical University; 2003. p. 1-16.

McFarlane J, Christoffel K, Bateman L, Miller V, Bullock L. Assessing for abuse: self-report versus nurse interview. Public Health Nurs. 1991;8:245-250.

Milberger S, Israel N, LeRoy B, Martin A, Potter L, Patchak-Schuster P. Violence against women with physical disabilities. Violence and Victims. 2003;18(5):581-91.

Monahan K, O’Leary KD. Head in jury and battered women: an initial inquiry. Health and Social Work. 1999;24(4):269-278.

Moracco KE, Runyan CW, Bowling JM, Earp JA. Women’s experiences with violence: a national study. Women’s Health Issues. 2007;17:3-12.

Oquendo MA. Harkavy Friedman J. Grunebaum MF, et al., Suicidal behavior and mild traumatic brain injury in major depression. Journal of Nervous and Mental Disease. 2004; 192(6): 430-434.

Petersilia JR. Crime victims with developmental disabilities: a review essay. Criminal Justice & Behavior. 2001; 28(6):655–94.

Rodriguez MA, Bauer HM, McLoughlin E, Grumbach K. Screening and intervention for intimate partner abuse: practices and attitudes of primary care physicians. JAMA. 1999; 282:468-474.

Reichard AA, Langlois JA, Sample PL, et al. Violence, abuse, and neglect among people with traumatic brain injuries. J Head Trauma Rehabil. 2007;12(6):390-402.

Saltzman LE, Fanslow JL, McMahon PM, Shelley GA. Intimate partner violence surveillance: uniform definitions and recommended data elements, Version 1.0. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2002.

Silver JM, Yudofsky SC, Anderson KE. Aggressive disorders. In Silver JM, McAllister TW, Yudofsky SC (eds): Textbook of Traumatic Brain Injury. Washington, DC: American Psychiatric Publishing, 2005.

Simpson, G., Blaszczynski, A., Hodgkinson, A. Sex offending as a psychosocial sequela of traumatic brain injury. Journal of Head Trauma Rehabilitation. 1999; 14:567-580.

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Wolfe, D. (1997). Interrupting the cycle of violence – Empowering youth to promote healthy relationships. In Wolfe, D., Mc-Mahon, R., and Peters, R.D. (Eds.), Child Abuse; New Directions in Prevention and Treatment Across the Lifespan; Sage Publications, Thousand Oaks California.

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Brain Injury from Violence just isnt ONE PUNCH

The “One Punch Kills” campaign in Australia has been successful in some respect to address violence amongst men on men. What has not been addressed is just one aggressive act of violence can leave a brain injury resulting from domestic violence.

They say one in three women in Australia are hospitalised each week and diagnosed with a Traumatic Brain Injury due to Domestic Violence. Yet the numbers are actually higher. I have met plenty of women and children  who are diagnosed with a brain injury after leaving a violent relationship. They are not part of these statistics. 

There is no real detailed research into Traumatic Brain Injury resulting from domestic violence. My own Traumatic Brain Injury was a result of Family Violence. I hid the diagnosis for five years because the stigma of such an injury.

Why? Well from other survivors of Domestic Violence, I learnt early on from their experiences that even discussing a brain injury resulting from domestic violence was frowned upon, and literally taboo.

Here as some of the survivors stories:

  1. Human Services suggests that such an injury could have an effect on being “capable mother” children were put into state care for three years. (2012)
  2. Victoria Police told one survivor that maybe “she asked for it” and that a man only gets that angry “when provoked”. The assault was investigated, (no medical records accessed) and no charges laid. (2014) She was unable to get Victims of Crime Compensation, because in Victoria if the person is not charged with an offence, you are cross examined by them at the Tribunal. She refused to be retraumatised by his abuse.
  3. Centrelink informed one mother that even though she had a Brain Injury (and that qualified her fro a disability pension) the injury was a result from her own behaviour. It took 18 months, three reviews at Centrelink, and then VCAT to be given a disability pension. (2015). Apparently if you acquire a traumatic brain injury from a car accident, this is deemed acceptable by Centrelink.
  4. Regional Hospital in Victoria informed a survivor that her blurred vision and headaches was probably from stress and refused to arrange a full diagnosis. Three weeks later after colapsing at home, she was flown to the Alfred Hospital and now has a plate in her head.
  5. Local doctors when presenting with symptoms of Traumatic Brain Injury, informing survivors that there is up to a 6 month waiting list on Medicare to have testing done. (Yet if you have a slight accident and are hospitalised and complain about headaches and blurred vision you automatically are tested.) One survivor died from a blood clot 6 weeks after assault. (2014).
  6. Another survivor is still waiting to be tested. She spends most of her time with headaches, slight vomiting, ringing in ears, dizziness. It has been 16 weeks and she is still on waiting list for tests. (2015)
  7. One survivor was misdiagnosed with mental illness until she was tested for another issue that resulted in confirmation she had a Traumatic Brain Injury. Now with the correct diagnosis and care plan in place she has regained her life somewhat. (2014). 

So how many other survivors of domestic violence out there that have a Traumatic Brain Injury undiagnosed or untreated?

Its just not one punch that can kill.

One push (survivor had head slammed up against brick wall)

One instrument (survivor hit with cricket bat to head)

One moment (survivor fell down stairs trying to escape violence)

One fall (survivor protecting child from violence picked up child attempted to run fell on concrete path slammed head into garden bed edging lost hearing to left ear as well)

Traumatic Brain Injury and domestic violence are interlinked, both by stigma and misunderstanding.

Family Violence Financial abuse “Im still paying off the debt 15 years after leaving”

Financial abuse not only negatively impacts the financial security of women when they are in the abusive relationship but well after they have left the abusive relationship. This leaves many women and their children in poverty and vulnerable to homelessness.

“Although there is no exact measure, research indicates that financial abuse in intimate relationships is widespread and common. It is known that a majority of women (between 80 – 90 per cent) seeking support for domestic and family violence have experienced financial abuse (Potmus et al, 2013; Sharp 2008; McDonald 2012:12).”

Family violence not only negatively impacts women’s financial security when they are in the abusive relationship, the lack of financial security continues post-separation. Many abusive men continue to financially abuse their ex-partners and exert control by abusing the courts and other government institutions such as the Child Support Agency.

“On an individual level, domestic violence creates complex economic issues for women and their children and disrupts their lives over the short and long-term. Regardless of their prior economic circumstances, many women experience financial risk or poverty as a result of domestic violence. These difficulties hamper their recovery and capacity to regain control over their lives.

Domestic violence directly affects women’s financial security in key areas of life: debts, bills and banking, accommodation, legal issues, health, transport, migration, employment, social security and child support.”  

In WIRE’s 2014 research report Relationship Problems and Money: Women talk about financial abuse, WIRE spoke to 59 women in focus groups about their experience of financial abuse and 145 women participated in an on-line survey.

Our findings clearly show that women’s financial security is negatively impacted in the short and long-term as a result of financial abuse.

“I had about $32,000 saved up in cash. I was working and I was working a lot, I was working a lot of hours and was doing a number of jobs going at the same time. I had plenty of money, probably for the first time I was sort of peaking in what I was earning. And also because the relationship was so abusive, my capacity to work went down as well and my income actually dropped because I wasn’t able to juggle everything and my energy levels just weren’t there.

And when I left I was about $7000 in debt and it was a bit heartbreaking because it’s so hard to save that amount of money.”  

In addition financial abuse often continues even after the intimate relationship has ended.

Our findings included that for many women the financial abuse manifested itself in many ways post separation including:

• Non-payment of Child Support payments

• The perpetrator acting as a vexatious litigant causing their ex-partner to use any savings they have to fund legal costs

• Perpetrators withholding money to pressure their ex-partner into financial deals that disadvantage them in the short and long-term.

“Well my ex-husband is definitely, blatantly, obviously using the system to abuse me. Like I said I am about to go to court for the eighth time for child support. He is taking me to court. He has a [child support] debt; he won’t pay it. He is not going through the child support system because he has already appealed it and they have said no. So he is going through the legal system because he has the money and he is spending more on legal fees than the child support.

It is just a control thing and it is just about breaking me down and he is doing all sorts of things within the system to abuse me.”

The financial abuse that women experience is further compounded by the gender pay gap which amounts to women on average earning 18.2 per cent less than men. This financial abuse is exacerbated by women having to juggle work and family due to primary care responsibilities for dependent children, limiting their access to employment and in many cases to more highly paid career options.

Innovation in providing support to women who have experienced financial abuse WIRE has built on its 2007 research ‘Women’s Financial Literacy Report ’ in order to provide a gendered response to financial abuse in the context of family violence.

This approach is both preventative as well as restorative. In this research it was determined that women’s relationship with money and the societal expectations of women as poor financial managers had a significant impact in how women respond to money issues and their perception of themselves as a good financial manager.

omen repeatedly told us that their partner would ridicule their skills as a financial manager as a way of perpetrating financial abuse and using money to control them. Women often cited that it was their relationship with money and what they believed to be the cultural or community norm that made them more vulnerable to financial abuse.

WIRE’s work in this financial abuse space includes working with women and understanding their relationship with money and how perpetrators exploit stereotypes of women being poor money managers.

WIRE along with other organisations from 2011 to 2013 received funding from a variety of sources to provide workshops and financial information to women that identified as currently experiencing financial abuse.

Generally these programs had very poor reach, with few women participating. As a result of these programs not meeting expectations WIRE undertook its 2014 research, Relationship Problems and Money: Women talk about financial abuse to build knowledge and understanding of the nature and impact of financial abuse in the context of family violence, to identify the barriers that prevent women from accessing their financial entitlements and other information that would improve their financial security outcome. T

he research findings included identifying strategies to overcome these barriers. As a result of the findings from our research and through collaboration and information sharing with other organisations in the financial abuse space, WIRE is in the process of undertaking new innovative projects that take into account all new available information regarding how best to work with women who have experienced financial abuse.

WIRE’s innovation Reducing financial abuse needs to occur at multiple levels – at the preventive level as well as the recovery level. To this end WIRE is doing the following:

Prevention:

Providing information and support to women entering new intimate relationships on engaging their partner in constructive money conversations.

The project is a financial capability project rather than a financial abuse project.By working with women and providing a space for them to understand their relationship with money and build their confidence and skills to talk to their intimate partner about money issues, women have the opportunity to take action if they see the early signs of financial abuse.

The second phase of this project is yet to be funded and includes creating a website for women on having money conversations with their partner.

As a prevention strategy this project has several advantages:

o Women do not have to identify as experiencing family violence to participate.

o The project is aimed at women who are entering or have newly formed relationships and thus a relationship in which the norms are being established.

If financial abuse is indicated by the woman’s responses to assessment questions about her financial relationship with her partner, the website will inform her that what she is experiencing may be financial abuse and that financial abuse is a form of family violence, and provide information regarding where she can seek support. This once again reaches women who may not have sought assistance for financial abuse.

Reducing the impact of financial abuse: WIRE will in 2015 commence an innovative program called New Beginning: Steps to a more secure financial future.

This program aims to enable women who have experienced family violence to improve their short, medium and long-term financial security outcomes by decreasing their financial recovery time.

The project provides women throughout Victoria with financial capability support through oneon-one support and workshops. Like the Strong Beginnings- Financial Equals project this program will provide women with information to enable them to assess their relationship with money and understand the tactics perpetrators use to control women and children through money.

These workshops and support will be provided by staff who have a Definition of financial capability: Financial capability is the combination of attitude, knowledge, skills, and self-efficacy needed to make and exercise money management decisions that best fit the circumstances of one’s life, within an enabling environment that includes, but is not limited to, access to appropriate financial services, understanding of financial capability and work within a strength-based, trauma-informed and gendered framework; thus enabling the support to be tailored to the needs of women that have experienced family violence.

• Training to the community services sector: WIRE is a recognised expert in the field of financial abuse and is also a registered training organisation with a long history of providing accredited and non-accredited training to the community sector.

To enable more community sector workers to recognise financial abuse and thus take appropriate action in concert with their clients, WIRE since 2011 has been delivering professional development training regarding financial abuse in the context of family violence.

Family violence and employment “[It} was a city of 10,000, so everyone knows everyone; we were in a high profile business so that definitely had a play. I mean it had a big impact on me being able to get work because my ex-husband retained the business and it was one of the largest businesses in town and he said to me, ‘Look I have blackened your name everywhere, you won’t be able to get employment because no one will be game enough to employ you because I will pull the business away from them and no one will be game enough to hire you’ and it was true because I applied for several jobs and I didn’t even get an interview so we moved cities … So I lost my career in that my qualifications weren’t transferrable and I didn’t realise that when we split and so I lost the business and my home and our farm and all the assets but I was lucky enough to retain enough to have a house.”

•••••• Any strategies developed to protect the financial security of women who have experienced family violence must enable women to acquire decent and secure employment. We have already established in this submission that women and their children who experience family violence are far more vulnerable to poverty, financial insecurity and homelessness.

The most effective way to counter poverty is meaningful and decently paid employment. “Gaining and maintaining paid work is pivotal in creating a secure financial future for victims of domestic violence and their families.”

However, participation in employment can be seriously undermined by ongoing abuse and its subsequent effects. Australian researchers, for example, found that some women had not been allowed to work while in a violent relationship and found it difficult to enter or re-enter the workforce post separation.

These findings are echoed in overseas studies, which highlight how domestic violence not only acts as a barrier to education, training, and employment but also can escalate when survivors seek or participate in such activities. In order to maintain control over their partners, abusers may interfere with women’s efforts to become self-sufficient.

Women affected by domestic violence are also more likely to have a disrupted work history and are more likely to occupy casual and part-time work than women with no experience of violence. In short, women escaping and experiencing domestic violence are often the most disadvantaged and vulnerable in the labour market.

Some researchers argue that the dominant approaches to domestic violence in Australia have been crisis oriented and focused on providing accommodation, welfare assistance, and emergency support services to women and children without looking towards job search and training to facilitate financial security independent of social service agencies.”

National Domestic Violence and Workplace Survey (2011) noted that two thirds of family violence survivors are in paid employment. This statistic highlights the importance of enabling women affected by family violence to continue their employment.

Apart from providing crucial financial security, employment often also provides support networks to women who are experiencing family violence. This strategy aimed at retaining women in employment is critical. The ACTU is presently running a case to insert Domestic Violence Clauses (including paid leave) into Modern Awards.

As of November 2013 over 1.2 million workers in Australia now have access to paid Family Violence leave. WIRE supports all employers incorporating the ACTU’s Domestic Violence Clauses into their industrial Agreements and policy documents. Some women may need to give up their employment to escape their abuser; others may not have had an opportunity to work whilst in an abusive relationship.

Thus many women who have experienced family violence will require additional assistance finding employment. Assistance provided to women who have experienced family violence needs to incorporate job search expertise, a strengths based approach to working with women and additionally have a strong understanding of the impact of family violence on women and children.

WIRE runs weekly job coaching for women. Often women who have experienced family violence attend job coaching to get support and advice on how to find employment.

Women who have experienced family violence often present to job coaching with multiple barriers to overcome which includes but is not limited to:

For women that have had to change their identity as a safety measure, they are not able to demonstrate a work history or provide referee details or written references to prospective employers.

Many women in abusive relationships are prevented by their abusive partner from working and earning an independent income, and thus they do not have a recent work history.

Many abusive men isolate their partners in order to exert control.

Over time the woman’s network diminishes, leaving the woman with few networks to utilise to find employment.

Women that have accessed security and housing in a family violence refuge must give up their usual routine – this includes any employment they may have had prior to leaving the abusive relationship.

Women are placed in refuges away from their local community; for some women this means moving from the city to a regional centre or vice versa. Maintaining employment in these circumstances is exceedingly difficult.

Women in abusive relationships can have a poor work history as a result of their abusive partner using control tactics which prevent the woman from keeping her job.

Examples of these tactics include:

Taking away the woman’s access to transportation to work

Refusing at short notice to care for children

Stalking the woman at work so that she is unable to perform her work

Women often report being psychologically exhausted by the violence and intimidation to the extent that they had difficulty holding down a job.

Women have increased absenteeism from work as a result of psychological and physical injuries inflicted on them by an abusive partner. These unexplained absences from work are often interpreted by an employer as the woman not caring about their job and being unprofessional. As a result women may lose their jobs.

Women’s confidence is greatly affected by the controlling, disrespectful and undermining behaviour of their abusive partner. This reduced confidence also manifests itself when women are looking for work.

Recommendations for addressing financial abuse and increasing women’s financial security

• Women who have experienced financial abuse to have access to timely and extensive financial counselling and support, that involves exploring women’s relationship with money and the impact that social stereotypes, family and upbringing may have had on a woman’s confidence in financial decision making.

• Women who have experienced family violence having access to specialist employment programs that include but are not limited to intensive job search support and job matching programs.

 • That all employers including the State government make available in their industrial agreements and policy documents the ACTU’s Domestic Violence Clause provisions. Increasing the effectiveness and accessibility of family violence services

Effective response: women accessing family violence support during their recovery phase The effects of family violence do not end when the abuse ends. The road to recovery can be a slow holistic process that encompasses emotional, physical and financial wellbeing.

“I wake up in the morning and I feel physically sick and I think, ‘Where do I start?’ I wake up every morning and I vomit in the shower.” ••••••• -describing having to cope with extreme poverty well after leaving the abusive relationship. -is unable to find work, struggles to find affordable accommodation and provide food for herself and her daughter.

Why doesn’t she just get over it? Unfortunately this is still a question asked by many in the community. The vast majority of family violence practitioners and services understand that the trauma women experience when subjected to family violence often leaves women with deep emotional, psychological, financial and physical scars.

Even so, many family violence services do not have the resources to provide these women with a service. Women that have not received assistance from family violence services at the point of leaving have increased difficulty accessing family violence specific services down the track.

This may be because their needs are viewed as being less critical than women that are at the point of leaving (one of the most dangerous times for women and children in abusive relationships), and most definitely due to the pull on resources to keep women and children that are deemed most in danger, safe.

Not all women will contact family violence services for assistance at the point of terminating an abusive relationship. Some will only seek assistance when particular flashpoints occur after the woman has left the abusive relationship; and others may seek assistance from the point of separation and as flashpoints occur post separation.

Examples of flashpoints include: 

Ex-partner begins to stalk physically or electronically

The woman faces a housing crisis

There is a recurrence of violence or the threat of violence from their ex-partner Ex-partner moves to a location close to the woman and her children

The woman becomes aware that the ex-partner is trying to locate her

There is an issue regarding child maintenance payments

Court hearings

The woman is feeling an emotional strain which is causing her difficulty with functioning at some level.

WIRE speaks to many women that have tried to access family violence services at these flashpoints. They often tell us that once the family violence service has conducted a safety screening, they are told that due to the number of women in crisis, their situation is not considered a priority.

For many women, the experience of being told that they are not a priority or their situation is not serious enough gives the message that they are on their own and they have failed to ‘just get on with life’.  Due to lack of resources and the high demand from women, family violence services are compelled to triage women requests for service.

We need to move to a system that is able to assist women not only at the point of crisis but throughout the recovery and rebuilding process.

Family violence services should:

utilize trauma-informed practice

have a strengths based approach

enable women to receive support for the long-term effects of family violence

take into account that some women may require long-term support, others short-term and/or episodic support

recognise that the experience of family violence makes women and their children more vulnerable to homelessness, financial insecurity, and continuing emotional distress; and that this vulnerability can exist for years after the woman has left the abusive relationship.

Proactively reaching women WIRE receives calls from women who have been told by police that they would be contacted by a family violence service, but this contact has not happened.

With the police attending 65,000 incidences of family violence last year WIRE is very aware that family violence providers throughout Victoria are overwhelmed by the increased numbers of L17s.

This is resulting in those services having to prioritise the L17s that they respond to first and the method by which they respond. For some women being told by the police that they will be contacted by a family violence service is their first experience of family violence support services and when that assistance does not materialise it is disappointing and discourages further contact with support services.

The introduction of L17s has been highly beneficial.

It has enabled family violence services to be proactive and contact women who would not have otherwise contacted a family violence service. This has often led to women and children leaving abusive relationships earlier with the assistance of specialist services.

Timely and proactive intervention by family violence services to women involved in family violence incidences attended to by police is a crucial element of Victoria’s family violence response and as such must be appropriately funded.

Recommendations for increasing the effectiveness and accessibility of family violence services:

That services that manage L17s are provided with additional funding so that they can act on the L17s within a reasonable time frame.

Women have access to family violence specific services and are able to engage with the family violence service delivery system on a short-term, long-term or episodic basis.

That family violence specific services are funded to support women who have experienced family violence related trauma and have ongoing issues as a result of the family violence they experienced, and this includes providing evidence-based family violence recovery programs and making support available to women.

Holding perpetrating men accountable for their actions In our community and in our institutions, the responsibility to manage family violence is often left to the women who are experiencing the violence.

It is the woman that holds the responsibility for ending the violence. This culture of blaming the victim needs to end. The culture of blaming the victim enables the perpetrator to have his behaviour excused and tolerated. It must be the individual perpetrating the violence that faces the consequences of their actions at every level of society. T

his includes at work, sporting clubs, churches, schools and in the justice system. All too often women must leave the family home to end the violence. This relocation often results in women losing their jobs and social networks, and removing their children from schools and friendship networks. The loss associated with having to relocate is a significant barrier to leaving an abusive relationship.

Women and children leaving an abusive relationship face a significant risk of homelessness. Women carry the financial burden of ending an abusive relationship. Women who have violent partners find their options are limited to either living with violence, or living in poverty and facing potential homelessness. The choice is not an enviable one.

The perpetrator is often very aware that their partner’s options are limited and uses this to further control the behaviour of their partner.

There are many ways to reinforce that perpetrating men are responsible for their violent and abusive behaviour, and that they will be held to account and experience negative consequences.

Recommendations to hold perpetrating men accountable for their actions:

That the legal system and family violence sector continue to reinforce the concept that the perpetrator should be made to leave the family home, and not the victim

That the perpetrator has financial responsibility for the child raising costs of their children including contributing to accommodation costs after the perpetrator has been removed from the family home

That rent concessions are available to women who need assistance paying rent for the family home after a perpetrator has left. This enables the woman and her children to remain in the family home.

That banks and financial institutions have trained staff to work with women who have experienced family violence, so that debts including mortgages can be renegotiated to assist the women to continue living in their family home.

Perpetrating males who do not have alternative accommodation are relocated to group dwellings where men’s behavioural change programs are compulsory.

All men that are charged with family violence related offences are mandated to attend family violence specific behavioural change programs.

Where appropriate, perpetrators have ankle bracelets to track their movements

All women who have experienced family violence have access to financial support so that they can make their house more secure, for example with CCTV cameras and new locks.

Women having access to workplace entitlements that will support them to continue their employment. This includes paid time to manage their family violence situation.

That if work equipment such as a work phone or car is used to commit an act of family violence even if it is not considered an act in which criminal charges can be laid that the perpetrator will be disciplined by the employer.

If the perpetrator and the victim have the same place of employment, the perpetrator must alter their work patterns to accommodate any Apprehended Violence Orders (AVOs).

Submission to the Royal Commission into Family Violence (Victoria) WIRE Women’s Information and Referral Exchange Inc.

That from kindergarten upwards within our education system, children are taught appropriate conflict resolution strategies and explicitly taught that family violence is not tolerated and the actions of the perpetrator are never justified.

“I am still paying off the debt 15 years after leaving.

Participant of WIRE’s Relationship Problems and Money

Women talk about financial abuse research 2014 Financial abuse is a form of family violence recognised by the Family Violence Protection Act (2008).

This was first published by WIRE as their submission to the Royal Commission of Family Violence 2015.

Witnessing Domestic Violence causes greater Asthma Incidence in Children

No home is perfect, but dysfunction in the home is now revealed to be especially dangerous for children at risk for asthma. A new study shows that children exposed to just one adverse childhood experience (ACE) had a 28 percent increased chance of developing asthma than those with no ACEs.

The study, published in the Annals of Allergy, Asthma and Immunology, the scientific publication of the American College of Allergy, Asthma and Immunology (ACAAI), used data from the National Survey of Children’s Health. The survey drew from interviews with parents of more than 92,000 children aged 0 to 17 years to explore the relationship between ACEs, such as witnessing domestic violence, and the development of asthma.

“Of all the children in the sample, 31 percent were exposed to at least one ACE – the most common one being living with a parent or guardian who got divorced or separated,” said lead study author Robyn D. Wing, MD. “What surprised us was that among the children who had been exposed to 5 or more ACEs, 25 percent of parents or guardians reported that their child had an asthma diagnosis – compared with only 12 percent for those with zero ACE exposures. The data showed that the more adverse childhood experiences (ACEs) a child is exposed to, the greater the probability he or she will develop asthma.”

In addition to domestic violence, parents were asked if the child lived with anyone who had a problem with alcohol or drugs; if they lived with anyone who was mentally ill, severely depressed or suicidal; if they lived with anyone who served time in jail or prison; if a parent or guardian was divorced or separated; or if a parent or guardian had died. Of the study population, 68 percent had 0 ACEs, 17 percent had 1 ACE, 3.8 percent had 3 ACEs and 0.93 percent had 5 or more ACEs. The study also asked about smoke exposure and whether the parents felt safe in their neighborhood.

“We know that young children are susceptible to numerous adverse factors that they may be exposed to in the home environment – including cigarette smoking, indoor triggers, and even, as this study shows, dysfunctional families and associated domestic violence” said allergist James Sublett, MD, ACAAI president. “It is even more important that these high risk children are identified and cared for by experts in the management of asthma. Board Certified Allergist/Immunologists have special training in optimizing the care of children with asthma.”

Many people aren’t aware that allergists are experts in treating asthma, and can help both children and adults manage symptoms. For more information about treatment of asthma, and to locate an allergist in your area, visit AllergyAndAsthmaRelief.org.

About ACAAI
The ACAAI is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. The College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit AllergyandAsthmaRelief.org.

Children with PTSD from trauma are being misdiagnosed with ADHD

I have seen this so many times when a child with Trauma is diagnosed with ADHD and medicated when they have PTSD. Better understanding of childrens reaction to Trauma, and types of treatment available needs to be researched and implemented.

Hyperactivity or Something Deeper? Childhood Trauma Misdiagnosed as ADHD

ADHD or PTSD?The fact that one in every 11 school-age children in the United States is diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) has warranted plenty of attention. Much research has focused on the efficacy of behavioral therapy or medication as well as a list of symptoms — hyperactivity, impulsiveness and inattention — used to identify ADHD.

According to the New York Times, the United States has one of the highest ADHD rates in the world, and nearly two-thirds of diagnosed children are treated with medication. This increase may indicate that borderline cases are now identified and treated, bringing help to patients in need.  However, doctors concerned with the spike in attention deficit disorder rates argue that the clinical criteria for diagnosis have blurred the line between normal and abnormal behavior — and question whether the well-known symptoms of ADHD can mask deeper issues in children.

Are some childhood ADHD symptoms actually a response to trauma?

The Atlantic reports that while completing her residency at Johns Hopkins Hospital, Dr. Nicole Brown observed that a high number of her low-income pediatric patients had ADHD diagnoses. However, “Despite our best efforts in referring them to behavioral therapy and starting them on stimulants, it was hard to get the symptoms under control.”

Dr. Brown’s questions about the phenomenon led her to believe that rather than suffering from clinical neurological issues, some children were manifesting symptoms of another issue: post-traumatic stress disorder (PTSD). She hypothesized that trauma-induced hypervigilance and dissociation were easy to mistake for inattention, a common attention-deficit symptom. Likewise, children with overburdened stress responses were likely to behave impulsively.

Four or more ‘adverse childhood events’ made children three times as likely to be on ADHD medication

Her research results, pulled from a survey on the health and well-being of 65,000 children in the United States, indicated that children with an ADHD diagnosis also experienced high levels of poverty, divorce, violence and substance abuse among family members. According to the survey, a history of four or more “adverse childhood events” meant a child was three times more likely to be taking ADHD medication.

In response to the data from Dr. Brown’s study, the American Academy of Pediatrics is attempting to help clinicians identify and assess trauma in potential ADHD patients by revising their diagnostic guidelines. Such diagnoses should be made thoughtfully, particularly because the standard medication treatment for ADHD tends to be stimulant medication. This treatment could potentially further trigger anxiety and fight-or-flight reactions in PTSD patients, making symptoms worse, not better.

Differentiating between symptoms of ADHD and PTSD is complicated

Although Dr. Brown’s research showed a significant correlation between childhood trauma and the rate of medication treatment for attention deficit disorder, it’s important to note that establishing the correlative or causative relationship between trauma, symptoms, and disease is extraordinarily difficult. Still, the potential connection remains clear.

Unfortunately, the realities of the medical system make differentiating between symptoms of ADHD and childhood trauma difficult. With short appointment times and a heavy reliance on the parental disclosure of trauma, medical professionals may be unable to easily and quickly discern disease from dis-ease.

Does having an attention deficit disorder put children at greater risk for trauma?

While Brown’s work seeks to discern attention deficit from PTSD, other researchers note the increased likelihood of trauma in the life and background of an ADHD patient. Many physicians acknowledge that there is little direct causal connection between post-traumatic stress disorder and clinical attention deficit disorders, but Dr. Ellen Littman’s research attempts to clarify their interrelationship, noting a high possibility that the characteristics of the disease make trauma both more likely and more impactful in those with ADHD. This certainly complicates the issue of diagnosis.

Ultimately, diagnosis is a complicated assessment process, no step of which should be taken lightly. As the AAP releases new guidelines, clinicians will become more likely to identify what have come to be known as the classical symptoms of ADHD as potential symptoms of a variety of independent — or potentially interplaying — clinical issues. With clear adversity and trauma assessments, physicians can then establish  a diagnosis which can ensure that children receive appropriate treatment with the least amount of side effects.

Monica Fuglei is a graduate of the University of Nebraska in Omaha 

I have seen this so many times when a child with Trauma is diagnosed with ADHD and medicated when they have PTSD. Better understanding of childrens reaction to Trauma, and types of treatment available needs to be researched and implemented.

Children who experience Childhood Trauma do not “just get over it”

Humans are relatively adaptable beings which is why we are thriving and not dying out like other species. Horrendous disasters such as the Philippines typhoon, the Boxing Day Tsunami, the nuclear disaster in Japan, the major wars of our time, and horrific famines see great suffering, but these events also inspires survival through adaptation. It turns out we possess a strong survival mechanism in our brains directly linked to our bodies, fight, flight, freeze, flop and friend (fffff).

traumaIn fact, the survival part of our brain, which is primitive yet effective, is the first to develop in utero starting at around 7 weeks. It regulates our breathing, digestive system, heart rate and temperature, along with the ‘fffff’ system which operates to preserve our life.

If we have to dodge a falling object, jump out of the path of a speeding car, keep very still to avoid being seen, run for the hills from a predator, or get someone potentially threatening ‘onside’ we need this to happen fast. If a baby is scared, cold, hungry, lonely, or in any way overwhelmed this triggers their survival system and they cry to bring an adult to them to help them survive.

If a baby is repeatedly scared and emotionally overwhelmed and they do not get their survival brain soothed, so they can cope, they begin to develop a brain and bodily system which is on hyper alert and the World seems to be a scary place. Sadly, this not something they can ‘just grow out of’. Far from it as what neuroscience is showing us from all the recent findings. An early experience has a profound effect on the way in which a child’s brain forms and operates as the survival brain is on over drive and senses threat everywhere so works too hard, too often, for too long.

Babies and young children systems are flooded with potent stress hormones which help in the event of needing the 5 fffff’s, but they are not good to have at high levels for too long. Imagine the feeling when you truly believe you have lost your wallet with all your cards and money in. You feel a bit faint, your brain is whirring, your heart racing, breathing is shallow, and you may get the urge to empty your bowels or bladder. Hopefully, this may only lasts for the usual 45 minute cycle for those who are not traumatised.

Then stress hormone levels drop and you can think more clearly and resume your day fairly unscathed. What if you are 4, 9 or 15 years old though, how will you cope, especially as your repetitive early childhood trauma of living with domestic violence, unavailable or rough carers, chaos and unpredictability has left you traumatised?

As I referred to at the start, humans are amazingly adaptable in order to survive, although not necessarily thrive. So a child’s system adapts to get whatever basic needs met it can and to live to the next moment, think soldier in a war zone kind of survival. In an abusive environment this will make sense but it is not something a child can just stop doing as their survival brain is in charge and has to do what it has learnt to keep them alive.

The kinds of survival behaviours they commonly develop are:

Regression

Presenting as helpless may have made carers frustrated, even angry and rough with them but will mean they sometimes had to touch a child who presented as unable to say get dressed or wipe their bottom or feed themselves – this can look like immaturity and ‘babyish’ behaviour in an 8 year old but it has previously served a purpose

Being held and touched kindly is a basic human need and tragically children in Romanian orphanages who were not, died. Almost ‘pathetically’ children often devise ways which can seem strange, given their age and previous capabilities, to get some physical contact, even if it’s unpleasant

Children often learn to survive by being ‘like a baby’ as they have either learnt that baby’s get more kindness and attention or have some inbuilt ‘memory’ of this – this can be negatively viewed as regression yet is often an expression of trust in carers as they feel safe enough post abuse to seek out kindness from them so it needs gentle handling and holding until the child is ready to move on. Imagine you had never experienced physical closeness and gentle touch but were driven to seek it out, that takes real courage.

Dramatic reactions

When a child is in the ‘I’ve lost my keys’ panic state most of the day, it’s like a pan boiling on the stove and the smallest extra heat causes it to boil over

The survival brain leaps into action at the slightest thing, an accidental shove from another child, a small scratch on the arm, a lost pencil, a ‘look’ from another child and the 5 fffff’s are triggered, for most children that’s flight but if cornered and unable to escape, or previously over used, it will be fight

Children may cry more readily and for much longer and louder as they do not have the ability to self soothe or to be soothed easily as their brain has not been exposed to this and is not wired that way so telling them to ‘calm down’ is of no use

They are feeling things as deeply as they seem to be at this point and are not just ‘attention seeking’

Disassociation

Disassociation or ‘zoning out’ is another way the brain and body copes with high levels of potentially toxic stress hormones for overly long periods. It can also be a learnt survival strategy, submit, switch off and wait for the frightening, painful, incomprehensible act to be over. This ability to switch off can look like defiance or non-compliance as a child may just stare ahead and not respond to requests from adults

Children cannot continuously cope with the muscle tension, nausea, thudding heart, racing thoughts so finding something to fixate on to soothe them can become a great coping strategy and again will look as if they are being non-compliant whereas they are escaping from their trauma the only way they know how.

How long until they do ‘get over it?’

It’s a fair question as why it’s so hard for traumatised children to trust caring adults. If they were removed from the abuse and trauma as a baby or even directly after birth, surely they should not be having these dramatic reactions?

Going back to our survival part of our brain, this is not designed to be the dominant part of anyone’s brain as we also have an emotional memories part and a thinking, reasoning, socially able cognitive part which should mostly be ‘in charge’. All three areas are interlinked and share info back and forth all the time but mostly we need to think before we act and then we do better. However, if your start in life has made your survival brain ‘hyper alert’ then to manage this is like repeatedly trying to get a squirrel into a matchbox!

Children need us to be calm, kind, to use rhythm, patience and to try to step into their world and emotional state and show empathy.As practitioners it can be helpful to research ways of supporting traumatised children, pushing for appropriate training and most importantly being very aware of the extra strain that comes with working with and caring for traumatised children. However, with the right long term acceptance, kindness and support children can get a better chance at eventually being able to manage their reactive survival brain which has, after all, got them this far. 

Domestic Violence Poses serious threat to Children

Children are exposed to or experience domestic violence in many ways. They may hear one parent/caregiver threaten the other, observe a parent who is out of control or reckless with anger, see one parent assault the other, or live with the aftermath of a violent assault. Many children are affected by hearing threats to the safety of their caregiver, regardless of whether it results in physical injury. Children who live with domestic violence are also at increased risk to become direct victims of child abuse. In short, domestic violence poses a serious threat to children’s emotional, psychological, and physical well-being, particularly if the violence is chronic.

Domestic violence poses a serious

   threat to children’s emotional,

   psychological, and physical well-

   being, particularly if the violence is

chronic.

Effects
Not all children exposed to violence are affected equally or in the same ways. For many children, exposure to domestic violence may be traumatic, and their reactions are similar to children’s reactions to other traumatic stressors.

Short-Term Effects of Domestic Violence on Children

Children’s immediate reactions to domestic violence may include:

  • Generalized anxiety
  • Sleeplessness
  • Nightmares
  • Difficulty concentrating
  • High activity levels
  • Increased aggression
  • Increased anxiety about being separated from a parent
  • Intense worry about their safety or the safety of a parent
Long-Term Effects of Domestic Violence on Children
 Long-term effects, especially from chronic exposure to domestic violence, may include:

  •  Physical health problems
  • Behavior problems in adolescence (e.g., juvenile delinquency, alcohol, substance abuse)
  • Emotional difficulties in adulthood (e.g., depression, anxiety disorders, PTSD)

Exposure to domestic violence has also been linked to poor school performance. Children who grow up with domestic violence may have impaired ability to concentrate; difficulty in completing school work; and lower scores on measures of verbal, motor, and social skills.

Children may learn that it is

acceptable to exert control or

relieve stress by using violence, or

that violence is linked to

expressions of intimacy and

affection.

In addition to these physical, behavioral, psychological, and cognitive effects, children who have been exposed to domestic violence often learn destructive lessons about the use of violence and power in relationships. Children may learn that it is acceptable to exert control or relieve stress by using violence, or that violence is in some way linked to expressions of intimacy and affection. These lessons can have a powerful negative effect on children in social situations and relationships throughout childhood and in later life.