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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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