Domestic violence is an ongoing experience of physical, psychological, and even sexual abuse in the home that is often a method used by one adult to establish control and power over another person (Flitcraft et al., 1992). Exposure by children to marital aggression is now a recognized public health concern. The investigation of the effects of the exposure to this type of aggression on the functioning of a child is a significant societal concern. Marital conflict is generally defined as any difference of opinion between martial or domestic partners whether it is minor or major. Marital conflict can assume many different forms including displays of both negative and positive emotions and/or constructive and destructive tactics. Marital aggression is characterized by physical and/or psychological abuse and would fall at the negative extreme on a continuum of marital conflict (Cummings, 1998). Marital psychological/verbal aggression refers to things such as threats, insults, and throwing objects. This has been considered by some to be a form of psychological abuse, whereas marital physical violence (domestic violence) is indicated by a physical assault on one partner's body (Jouriles, Norwood, & McDonald, 1996). Children who witness domestic violence are at risk for a number of developmental, psychological, and social difficulties. Treatment for exposure is often aimed at reducing or preventing domestic violence, but treatment for primary victims and batters is not more successful than legal interventions (Evans, Davies, & DiLillo, 2008). Discussion of Problem Area and Issue

Although public awareness about the rate of domestic violence is increasing, the public health consequences of domestic violence have begun to be recognized in the medical community. The majority of the early literature focused on the effect of domestic violence on the primary victim ignoring questions of the potential effects of witnessing domestic violence on secondary victims, such as children and ad adolescents who live in homes where such abuse occurs (Carlson, 2000). It has been estimated that between three and ten million American children and adolescents witness occurrences of domestic violence annually (Carlson, 2000). Here are ten facts from the U.S. Department of Justice regarding domestic violence (Rennison, 2003):

1. Eighty-five percent of cases of domestic violence involve female victims.

2. There is an estimated 1.3 million women victims of physical assault by an intimate partner each year.

3. Females who are between the ages of 20-24 years old are at the greatest risk of nonfatal intimate partner violence.

4. Nearly one-third of female homicide victims reported in the police records are killed by an intimate partner.

5. Less than one-fifth of victims reporting an injury occurring from intimate partner violence actually sought medical treatment.

6. The cost of intimate partner violence exceeds $5.8 billion each yea. Four billion dollars of this cost goes to direct medical and mental health services.

7. Victims of intimate partner violence lost nearly eight million days of paid work because of the violence perpetrated against them, a loss equivalent of more than 32,000 full-time jobs and nearly 5.6 million days of household productivity.

8. Thirty to sixty percent of perpetrators of intimate partner violence also abuse children in the household.

9. Witnessing violence between one's parents or caretakers is the strongest risk factor of transmitting violent behavior from one generation to the next.

10. Boys who witness domestic violence are twice as likely to abuse their own partners and children when they become adults.

Regarding domestic violence in the State of California there are several issues (California Partnership to End Domestic Violence, 2008):

1. California law enforcement received 176,299 domestic violence-related calls in 2006. Over eighty thousand of the calls involved weapons including firearms and knives.

2. Nearly 44, 000 people were arrested for domestic violence offenses in 2006. Of these 80% were men and 20% were women.

3. In 2008, ninety-nine women were murdered by their husbands, ex-husbands, or boyfriends in California. Fourteen men were killed by their wives, ex-wives or girlfriends.

4. California law enforcement received a total of 166,343 domestic violence calls in 2008 -- over 65,000 calls involved weapons.

Previous research has estimated that at least 3.3 million children witness physical and verbal spousal abuse each year. The range of behaviors in this estimate ranges from insults and hitting to fatal assaults with weapons (Carlson, 1984; Jaffe, Wolfe, & Wilson, 1990). As alarming as this statistic appears it may actually underestimate the exact numbers of children exposed to domestic violence because the data was gathered over 20 years ago and at that time the research did not include divorced parents or children under three years of age. More recent estimates suggest that more than 10 million children in the United States may be exposed to domestic violence...

There are many scholarly reviews of this literature that that have concluded that the exposure to domestic violence results in significant and measurable negative effects on children's functioning when these children are compared to children from nonviolent families e.g., (Fantuzzo & Lindquist, 1989). These negative effects affect the emotional functioning, behavioral functioning, social competence, achievement in school, cognitive functioning, psychological functioning, and general health of the children that witness domestic violence. Several of these negative effects have been replicated across different studies and they generally conform to the expected theoretical predictions and clinical expectations, but there are quite a few methodological issues that blur their interpretation.
The majority of researchers readily recognize that exposure to domestic violence is a nonspecific risk factor for developmental or later harm, thus illustrating the process of multifinality of development (Sameroff, 2000). This means that exposure to domestic violence is but one of a number of harm-producing factors that include things like child abuse, harsh parenting practices, and other types of trauma that hamper normal development and can potentially lead to negative but still mostly unpredictable outcomes in the short- and long-term. The literature on exposure to domestic violence also indicates that it creates a negative impact on children's and adolescents behavioral and adjustment above and beyond other coexisting factors (in other words such exposure is not simply a confound or a correlate but a separate additive factor).

Different terms have been utilized by researchers and clinicians to refer to children in households where domestic violence occurs. In the early research these children were referred to as either "observers" or "witnesses" of domestic violence (Fantuzzo & Lindquist, 1989; Kolbo, Blakely, & Engleman, 1996; Margolin, 1998). In the mid to late 1990s those terms were replaced by the term "exposure" to the domestic violence, a more inclusive term without the assumptions concerning the specific nature of the children's experiences with the violence. Exposure to domestic violence includes watching or hearing the violent events, direct involvement in the situation (e.g., trying to interfere with the parents or by calling the police), or by experiencing the aftermath (e.g., witnessing physical damage or observing maternal depression).

Some of the early reviews of the literature regarding the effects of domestic violence on children were performed in 1989 and 1996 (Fantuzzo & Lindquist, 1989; Kolbo, Blakely, & Engleman, 1996) indicated that children who were exposed to domestic violence demonstrated significantly more externalizing and internalizing behaviors than did children from nonviolent homes. More specifically, regarding externalizing behaviors, the studies examined differences across groups with regards to these behaviors found that children exposed to domestic violence displayed a tendency to be more aggressive and exhibited more behavior problems in school and in their communities. These problems ranged from simple temper tantrums to actual fights with others. Internalizing behavior issues displayed by the children exposed to domestic violence included depression, suicidal thoughts and behaviors, increased levels of anxiety (including more general fears and higher rates of phobias), higher rates of insomnia, more bed-wetting, and lower self-esteem when compared to children from homes without domestic violence.

There were several studies in the reviews that assessed problems related to cognitive and academic functioning. In general these studies found some significant differences between children reared in violent homes compared to those children that were raised in nonviolent, homes. Children exposed to domestic violence demonstrated an impaired ability to concentrate, more difficulty completing their schoolwork, and significantly lower performances on measures of verbal and motor skills.

The results across all studies were less clear regarding the effects of witnessing domestic violence on the social development of children. Fantuzzo and Lindquist (1989) reviewed 23 studies published between 1967 and 1987 and noted that the studies that examined aspects of social development found that both boys and girls from violent homes displayed significantly lower levels of social competence as determined by poorer problem-solving skills and lower levels of empathy compared to children from nonviolent homes. However, Kolbo, Blakely, and Engleman (1996) observed that out of five of eleven studies published between 1988 and 1996 that assessed variables related to social functioning did not find a…