Exposure And Preschool Development

Mirroring the broad psychological consequences on the development of school-aged children exposed to acts of community violence, mothers of preschoolers report child distress-related problems in various functioning domains including internalizing behavior problems (i.e., anxiety and depression), externalizing behavior problems (i.e., aggression), and trauma-specific PTSD symptoms. In the Shahinfar et al., study (2000) of Head Start preschoolers exposed to interpersonal violence, CBCL internalizing (mean = 5.3 vs. 3.5) and externalizing (mean = 13.2 vs. 9.6) behavior symptoms were more likely in children who witnessed violence than in those who did not. These results are difficult to interpret, however, once again because of the lack of distinction between types of violence exposure (i.e., community violence and family violence). Finally, the Aisenberg study (2001) of a small sample of 31 Latina mothers and their children found that children exposed to acts of community violence obtained significantly higher T-scores for both CBCL internalizing (m = 54) and externalizing (m = 55) behavior problems, as compared with children in the normative sample (m = 50). Boys scored consistently higher than girls on both scales as well, suggesting male gender vulnerability for preschoolers following exposure to acts of community violence.

Preschool children are also at risk for developing symptoms related to Posttraumatic Stress Disorder (PTSD). According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV, 1995), cardinal trauma-related PTSD symptoms include re-experiencing of the traumatic event, persistent avoidance of stimuli associated with the trauma, and symptoms of increased arousal (APA, 2000). In the Boston Community Violence Project, mothers of preschool children reported PTSD cardinal symptoms at a high frequency (Linares & Cloitre, 2004). For example, we found high rates of maternal endorsement of child PTSD symptoms for: re-experiencing (54%) new fears (82%), avoidance (53%), and hyper arousal (92%). Only re-experiencing symptoms during disregulated play, however, were related to exposure to community violence. Mothers with partial PTSD reported more re-experiencing symptoms as well as disregulated free play in their children than mothers with no PTSD (p < .05). These results supported the clinical use of observational methods using an alternative set of criteria for PTSD for preschool children as proposed by Scheeringa and colleagues (Scheeringa, Peebles, Cook, & Zeanah, 2001; Scheeringa, Zeanah, Myers, & Putnam, 2003). Our findings warned us against imposing a strict definition of PTSD based on DSM criteria developed for adults and older children to the diagnosis of preschool PTSD, without considering the unique developmental characteristics of this age period. For example, given that hyper arousal and transitional fears are very common during early childhood, caution is needed in interpreting symptom elevation in these domains as clinically important. Findings from our PTSD study underscore the need to attend to developmental level to differentiate clinically significant trauma-related PTSD symptoms from normative behaviors commonly seen during the preschool period.

The Boston Community Violence Project

Despite extensive research on the influence of multiple psychosocial risk factors on problem behavior (Forehand, Biggar, & Kotchick, 1998; Atzaba-Poria, Pike, & Deater-Deckard, 2004), community violence has been treated generally as an isolated risk variable, and seldom has been examined within a multidimensional, additive, fashion. It is likely that the preschooler's experience of community violence is not only determined by the levels and the characteristics of the exposure, and the child's understanding of the events, but also by contextual factors surrounding the child such as family relationships, maternal functioning, and parenting. The Boston Community Violence Project was designed to examine community violence within a larger psychosocial web of contextual influences. Little is known about whether exposure to community violence has a unique effect on child behavior problems, separately and beyond and above related risk factors. It is likely that multiple psychosocial stressors have an equal or higher detrimental impact on preschool internalizing and externalizing behavior problems among multiply disadvantaged preschoolers. The Boston Community Violence Project is a research project informed by ecological theory (Bronfenbrenner, 1979) that considers the child as a part of a larger ecological system of psychosocial influences (i.e., the mother-child system, the family, the neighborhood), and by an ecological-transactional perspective, which states that levels of the ecology interact on each other (Cicchetti & Lynch, 1993; 1995). In our multidimensional risk model of preschool problems we examined the influence of exposure to community violence after considering three sets of factors: demographic characteristics (maternal education, maternal immigrant status, and child age), exposure to family violence (partner violence to mother and to child), and maternal functioning (physical health, global distress, and the quality of parenting) In addition to focusing on the impact of exposure to community violence (e.g., frequency, type, and relationship to perpetrator) on preschool problems, by either witnessing or experiencing, we examined whether these effects were independent of other known risk factors affecting young children living in high crime neighborhoods, namely low maternal education, immigrant status, child older age, exposure to family violence, maternal distress, and quality of parenting.

Researchers who construct models of risk for child problems have stressed the need to attend to social class and ethnic background when studying minority children residing in the inner city (Gorman-Smith, Tolan, Zelli, & Huesmann, 1996). Lower maternal education, immigrant status, and older child age are selected because they may negatively impact on preschool outcomes. Lower maternal education increases the risk for child behavior problems among African American school children (Horn, Cheng, & Joseph, 2004). Immigration may be a source of stress for children and parents alike; older preschoolers are likely to have more behavior problems than younger preschoolers (even in a restricted range of ages 3-5). Earlier studies of community violence with school-aged children suggest that trauma-related symptoms vary by demographic and family characteristics. For example, Richters and Martinez (1993) found children of less educated mothers, living in unstable homes, experienced higher levels of distress than those of higher SES and more stable homes.

The Sample

Beginning in 1996, with funds from the National Institutes of Health (R01DA/MH11157), we began a series of maternal interviews with residents of selected inner city neighborhoods in Boston. We selected five urban contiguous residential zip codes with the highest crime police district rates (twice the citywide rate) for seven serious crimes (homicide, rape, robbery, simple assault, aggravated assault, burglary, and larceny) for the 5 years prior to the outset of the study (1991-1995) from which to draw a high-risk community sample of preschool children and their mothers. Residential zip codes corresponded to geographically contiguous census tracts with high concentration of ethnic minority residents, female-headed households, adolescent pregnancy, and school dropout rates, according to U.S. census data for 1990. The sampling strategy was aimed at over sampling dyads exposed to high levels of community violence; however, reported neighborhood crime varied widely due to the large geographic areas contained in zip codes demarcations (about 32,000 residents).

The original sample included 160 dyads and children were selected using a two step screening process described in detail elsewhere (Linares et al., 1999; Linares et al., 2001). Briefly, in level 1 screening, a consecutive sample of 689 children was identified from all current pediatric patients in a teaching city hospital who: (a) were between the ages of 3.0 and 5.11 years; and (b) resided in the preselected target neighborhoods. In level 2 screening, 89% of level 1 subjects were approached (via the telephone or an announced home visit) to determine willingness to participate and further assess study eligibility criteria. Due to the focus on the effects of community violence, stringent entry criteria were imposed to screen out mothers or children at high risk for adverse psychological outcomes due to other environmental or psychosocial stressors such as teenage parenting; children living in foster homes or shelters; residential instability; or medical disability. Level 2 screening resulted in a subject inclusion rate of 23%. Excluded mothers included those: (a) who were 18 years old or younger; (b) who resided in target address less than past 9/12 months; (c) who resided in shelters or other residential housing arrangement; (d) who were recipients of Social Supplement Income (SSI) due to a medical disability, such as a mental illness, mental retardation, or a chronic physical illness; and (e) who were not the child's primary caregiver. In addition, due to the linguistic limitations of the research team, mothers who did not speak English or Spanish were excluded. We excluded preschoolers with chronic medical problems, who were hospitalized for over two weeks in the last year, who had an identified developmental delay, genetic disability, prematurity (below 32 gestational weeks), serious birth complications, or who were SSI recipients. Refusal rate was 20%.

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