American Journal of Orthopsychiatry, 70(1), January 2000 2000 American Orthopsychiatric Association, Inc.

Preschool Children's Exposure to Violence: Relation of Behavior Problems to Parent and Child Reports
Ariana Shahinfar, Ph.D., Nathan A. Fox, Ph.D., Lewis A. Leavitt, M.D. A group of!55 parents and their preschool children attending Head Start reported on the children's exposure to community violence, level of distress symptoms, and behavioral problems. The behavioral correlates of exposure were found to differ according to exposure modality: internalizing problems were more likely in children who witnessed violence, and externalizing problems in those victimized by violence. Issues regarding self-reports by preschool children are highlighted, and clinical and research implications discussed.

ommunity violence has been recognized as epidemic in the United States (Rosenberg & Fenley, 1991; Rosenberg, O'Carroll, & Powell, 1992). With this public-health framing of the problem has come a growing concern for the number of children who are exposed to violent events. Community violence can be defined as the presence of violence and violence-related events within an individual's proximal environment, including home, school, and neighborhood; it may involve direct or threatened harm, be witnessed or experienced, and involve known or unknown perpetrators. In a survey conducted in Washington, D.C. (Richters & Martinez, 1993), 61% of a sample of first- and second-grade children and 72% of fifth- and sixth-grade children reported witnessing violence in their community. In a similar survey (Bell & Jenkins, 1991) in Chicago, one-third of a sample of school-age children reported witnessing a homicide and two-thirds a serious assault. In New Orleans (Osofsky, Wewers, Hann, & Pick, 1993), 91% of 9-12 year-olds reported witnessing at least one violent incident. It is currently estimated that substantial numbers of children growing up in these violent neighborhoods have also

been the victims of community violence, often as innocent bystanders (Osofsky, 1995). As awareness of violence within the community has grown, the importance of research elucidating the correlates of such exposure for children has become especially urgent. Although the study of community violence has been informed by and is related to such other areas of trauma research as war and child maltreatment, several features distinguish it from these other types of trauma. First, it is pervasive. Unlike maltreatment or family violence, which are usually limited to the home environment, community violence infiltrates all ecological levelsin school, on the playground, and in the neighborhood, as well as in the home. Second, it presents a chronic threat, in contrast to the trauma of natural disaster, which is a time-limited event geographically unlikely to recur. Although not all children living in inner-city environments are continuously exposed to violent incidents, the random nature of community violence presents a constant threat to the sense of safety of both children and their parents (Osofsky, 1995). Third, community violence is distinguished from other types of violence by the alienation it engenders. For example,

A revised version of a paper submitted to Hie Journal in August 1998. Research was supported by a grant from tlie Metropolitan Life Foundation, and by a post-doctoral fellmvship aiaarded by tlie National Institute of Child Health and Human Development to the first author. Authors are at: Center for Developmental Science, University of North Carolina at Chapel Hill (Shahinfar); Institute for Child Study, University of Maryland at College Park (Fox); and Waisman Center, University of Wisconsin at Madison (Leavitt).

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war is based on ideological differences that lend purpose to its violence and act as a unifying force within each warring group. Liddell, Kemp, and Moema (1993) suggested that such purpose may have served as a protective factor for their sample of South African boys in moderating the traumatic effects of war. Community violence, on the other hand, alienates individuals from the community, leaving them with neither an ideological framework nor a reference group by which to understand its occurrence or find support. Several empirical studies have examined the incidence, prevalence, and correlates of exposure to community violence in school-age children and adolescents (Attar, Guerra, & Tolan, 1994; Bell & Jenkins, 1993; DuRant, Cadenhead, Pendergrast, Slovens, & Under, 1994; Fitzpatrick & Boldizar, 1993; Freeman, Mokros, & Poznanski, 1993; Gladstein, Rusonis, & Heald, 1992; Martinez & Richters, 1993; Osofsky, et al., 1993; Schubiner, Scott, & Tzelepis, 1993; Shakoor & Chalmers, 1991; Singer, Anglin, Song, & Lunghofer, 1995). In general, their findings suggest that children exposed to violence are more likely to display behavioral and psychological problems than are their nonexposed peers. For example, in a study of urban primaryand secondary-school students, Bell and Jenkins found reports of violence exposure to be associated with increased fighting among boys and younger children. Similarly, Schubiner et al. demonstrated that children who had been victims of violence were at greater risk for involvement in its perpetration than their nonvictim peers. In terms of psychological symptoms, Freeman and colleagues discovered a significant positive relation between reports of exposure to violence and depression in a group of 6-12-year-old urban children. Others have demonstrated significant associations between parent or child reports of violence exposure and distress symptoms such as anger, anxiety, sleep problems, and increased fears (Fitzpatrick & Boldizar, 1993; Martinez & Richters, 1993; Singer et al., 1995). It has been noted that symptoms reported by children exposed to violence parallel those of persons with post-traumatic stress disorder (Bell & Jenkins, 1993; Martinez & Richters, 1993). To date, the literature on exposure to violence has been concerned primarily with school-age and adolescent populations. Little research has focused on its prevalence and correlates in younger children. As a result, there is little information regarding rates of exposure and effects of community vi-

Violence Exposure and Preschool Children

olence on children below school age. Although anecdotal reports (Garbarino, Kostelny, & Dubrow, 1991) and findings from a hospital screening survey (Taylor, Zuckerman, Harik, & Groves, 1994) have suggested that infants and young children from large urban areas are indeed at risk for exposure to community violence, such exposure has not been examined using the sampling and methodology employed with older populations. Nor, it seems, have the psychological and behavioral correlates of preschool children's exposure been explored in a systematic way. The study reported here examined parent and child perceptions of the rates and correlates of violence exposure in a preschool sample. Children's perceptions of frequency of exposure were rated on a relatively new measure, the Violence Exposure (VEX) scale for children (Fox & Leavitt, 1995). Because preschool children are just beginning to grasp distinctions between fantasy and reality (Flavell, 1993; Woolley, 1998), information gathered from their self-reports may not reflect discrete incidents of exposure; thus, the utility of the VEX was as a tool for accessing these children's perceptions of violence. In addition to exposure, the children were asked to report on their symptoms of distress. Parents were also asked to report their children's exposure to violence, as well as the level of behavior problems they displayed. A study hypothesis was that children exposed to community violence would evidence higher levels of behavioral and distress symptomatology. Whether preschool children's exposure to community violence would be similar in prevalence to that reported in the literature on older children and adolescents was also of interest. METHOD Instrument Development A cartoon-based interview was developed to assess children's self-reports of exposure to violence. The resulting instrument, the VEX scale (Fox & Leavitt, 1995), was based on a measure designed by Richters and Martinez (1990) to assess elementary-school children's self-reports of such exposure. Whereas the Richters and Martinez instrument utilizes verbal descriptions of violent events, the VEX scale offers a cartoon depiction of each event in order to give the child a concrete reference point. Eight of the pictures show a central character, Chris, witnessing violent events, and six depict Chris as the victim of violent events.

Shahinfar et al
The violent incidents assessed by the preschool version of the VEX scale are beating, chasing, robbery, threat with a weapon, shooting, stabbing, pushing or shoving, and slapping. The children were asked about witnessing all of them, and about victimization by all but shooting or stabbing, partly because of the low probability that preschoolers would be victims of such events, partly out of concern for keeping the traumatic valence of the cartoon depictions at a minimum. Following the interviewer's explanation of what Chris is witnessing or experiencing in each picture, the children are asked how often they have been exposed to the same incident. Below each cartoon is a picture of four thermometers, each with the mercury at one of four labeled levels: never, once, a few times, and lots of times. For those incidents to which the child responds positively, the interviewer probes for information regarding where the event occurred, who was with the child at the time, and when the event occurred. The probing is intended to assess the veracity of the child's report on the basis of its relevance to the cartoon depiction. At the same time, the questions are designed to allow comparison between specific parent- and child-reported events. Preliminary testing of the VEX scale was completed with a pilot sample of 40 suburban, primarily Caucasian, preschool children in order to enrich construction of the items. As a result, several items were dropped due to a lack of clarity, and several new questions were incorporated. The latter were added to a) assess innocuous events to which the child was likely to have been exposed with varying frequency (e.g., watching television or seeing a child sitting on Santa's lap); b) provide a "psychological break" from the high valence items; and c) act as an internal test of the children's understanding of the questions. Finally, genderdifferentiated versions of the scale were developed to minimize the possibility that response would be affected by the children's inability to identify with a cross-gender character; except for the gender of the depicted character, the text remained the same in both versions. A distress symptom inventory was developed through modification of the Levonn instrument (Richters, Martinez, & Valla, 1990) to include only those cartoon depictions of symptoms relevant to the preschool years. As described elsewhere in more detail (Martinez & Richters, 1993), the Levonn is a cartoon-based interview in which

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the child is shown a picture of a character (named Levonn) experiencing different types of distress. Below each cartoon is a picture of three thermometers, each with the mercury at one of three labeled levels: never, some of the time, and a lot of the time. Children are asked to report how often they have felt like Levonn by pointing to the thermometer that best represents the frequency with which they have experienced the same symptoms.
Sample

The subjects comprised 155 families with a child between the ages of 3'A and 4'/2 living in a low-income, primarily African-American neighborhood near Washington, DC. Based on police crime statistics, the neighborhood fell into the moderately violent range, and the majority of crimes into the categories of robbery, aggravated assault, and larceny (Maryland State Police, 1995). The neighborhood consisted of singlefamily dwellings, and public-assisted and private apartment buildings. Of the families interviewed, 52% resided in apartments and 48% in detached homes, with 38% of the latter living with extended family. While green space and playgrounds were available, several parents anecdotally reported that children spent more time indoors due to safety concerns. Families were identified by their eligibility to participate in the Head Start program. Of the 155 children, 79 (51%) were boys and 76 (49%) female, while 98.8% were African-American. Of the primary caregivers, 141 (91%) were biological parents. The majority of the families (81.2%) were headed by a single caregiver, and 37% of the children received day-care. The average annual income for the sample was less than $7,200, and almost 50% of the sample were entirely supported by public assistance.
Procedure

During the summer months preceding the school year, families were contacted either during Head Start registration or over the phone and invited to participate in a one-hour interview to be conducted in their homes. The interview was part of a preliminary screening for inclusion in an aggression intervention program scheduled for the school year. The caregivers were told that the purpose of the interview was to learn more about their child's daily behavior and experiences. The data presented here concern the child behavior and vio-

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lence exposure portions of the interview. All families were compensated $25 for their participation in the project, and 95% of those contacted agreed to participate. Two interviewers visited the subjects' homes and independently (one from the children, the other from their primary caregiver) elicited information regarding the children's violence exposure and symptomatology. Interviewers and primary caregivers were matched on race and gender in 96% of the cases. After describing the interview content and assuring of confidentiality (except where required by law to protect the safety of the child or caregiver), informed consent was obtained by the parent interviewer. Interviewers administered questionnaires by reading items aloud and recording parents' verbal responses. The child interview was administered simultaneously, either in another room or in a remote area of the same room. Measures Parent Reports Child's exposure to violence. All primary caregivers completed a parent-report version of the VEX scale (Fox & Leavitt, 1995). The incidents assessed paralleled those of the child-report measure described above. For every event to which the caregiver responded positively, the interviewer immediately probed for information about where the event occurred, who the perpetrators and victims were, who was with the child at the time, and how long ago the exposure took place. Child behavior problems. Caregivers completed the Child Behavior Checklist (CBCL/4-18) (Achenbach, 1991), a widely used questionnaire for assessing the behavior problems of children and adolescents. They were asked to report on the frequency of specific types of child behavior during the previous six months. The CBCL yields a total behavior problem score, as well as broad-band scales for internalizing and externalizing problems. Internalizing behavior problems comprise the withdrawn, anxious/depressed, and somatic complaint CBCL subscales; externalizing behavior problems comprise the aggressive and delinquent subscales of the CBCL. Child Vocabulary Achievement At the beginning of the children's interviews, researchers spent approximately five minutes coloring pictures with the children in order to build rapport. They then announced that they had brought

Violence Exposure and Preschool Children

some picture games to play with the children. The first of these was the Peabody Picture Vocabulary Test-Revised (PPVT-R) (Dunn & Dunn, 1981), anindividually-administered, norm-referenced test of receptive vocabulary designed for persons above 21/2 years of age. Because the child is required to point to appropriate pictures in response to the experimenter's words, the PPVT-R does not require a baseline level of verbal ability; rather, it is an aptitude test of the child's cognitive development in the area of vocabulary achievement. It was included as part of the child interview to examine whether differences in cognitive development were related to children's ability to respond to the self-report format of the distress and exposure scales used in the study. Child Reports Distress symptoms. Children were next administered the preschool version of the Levonn (Richters et al, 1990), a cartoon-based interview tapping self-report of distress symptomatology. After being trained on the use of the thermometer response format with a sample question ("During the summer, how many times do you eat ice cream?"), children were asked how often they had felt like the cartoon character in each picture. The symptoms assessed included sadness, lack of appetite, fear of going outside because of possible violence, intrusive traumatic memories, and having nightmares. Exposure to violence. Each child completed the VEX scale (Fox & Leavitt, 1995) after the interviewer made the following statement:
I am going to show you some pictures that tell about a child whose name is Chris. I will show you one picture at a time and tell you what is happening in that picture. Afterwards, I will ask you questions about things you may have seen that are like what Chris saw or things that may have happened to you that are like what happened to Chris.

Care was taken to ensure that the children understood they should report only things they had seen or experienced in real life, not things seen on television, video, or in the movies. After completing the VEX scale, interviewers debriefed the children by asking them how the violence exposure pictures had made them feel. Interviewer and child then talked about what it is like to feel scared, and about people in the child's support network who make them feel safe. This debriefing served to ascertain whether children had been upset by the VEX drawings and, if so, to connect

Shahinfar et al
them with the appropriate supports. Very few of the children in the sample indicated, verbally or behaviorally, that they had been upset. Because of developmental limitations, it was possible that some of the children surveyed would not be able to generalize from a pictured event to incidents that had actually occurred in their own lives. To separate children not responding to the measure with real-life recollections from those who were, interviewers took notes throughout the assessments on how well children appeared to understand the VEX scale, based on their ability to respond to probes after responding positively to a violence exposure item. Children were designated as not understanding if they responded in any of three ways to the probe questions: 1) if they pointed to the picture when asked where they had seen a particular incident, 2) if they named the character in the picture as the person who was with them at the time of exposure, or 3) if their answers to the probe questions were clearly based on events not occurring in real life (e.g., to those on television). Data from children whose responses showed that they understood the nature of the questions were considered separately in the childreport analyses. RESULTS Preliminary Analyses Examination of children's responses to the VEX scale revealed three levels of understanding: children who (based on the criteria mentioned above) evidently understood the interview (W=73); children whose level of comprehension was either unclear or variable (#=56); and children who were unwilling or unable to complete the interview (N=26). With these three groups as factors, separate analyses of variance (ANOVAs) were computed on children's PPVT-R score (adjusted for age), CBCL score, distress symptomatology score, and parent- and child-reported VEX scale scores. Results revealed a main effect for group in which children who understood the VEX scale scored significantly higher on the PPVT-R than did those in either of the other two groups (F(2, 150)=11.86; /?=.000). Children who understood the VEX scale also reported significantly lower levels of total violence exposure (7^2, 150)=125.202;/7=.000) and distress symptomatology (F(2, 150)=14.87; p=.000) than did children in the other two groups. No group differences were found for parent reports of violence exposure or CBCL behavior problems.

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Data from the entire sample (#=155) were used for the parent-report analyses presented below. Only data from those children who gave clear indication of understanding the violence exposure scale (#=73; 36 girls, 37 boys) were considered for the child self-report analyses. Where appropriate, however, data from the full sample were used in examining relations among child-reported exposure and symptomatology, for the purposes of comparison. Community Violence Exposure Inter-item correlations, performed separately within parent (#=155) and child (#=73) reports of violence exposure, revealed two statistically and conceptually related aggregate types of exposure: to mild violence, and to severe violence. Incidents reflecting mild violence included exposure to beating, chasing, pushing or shoving, and slapping. Those reflecting severe violence included exposure to robbery, threats with a weapon, shooting, and stabbing. Inter-item reliability was assessed for children's reports of exposure to mild violence (8 items, Cronbach's tt=.80), parent's reports of exposure to mild violence (8 items, Cronbach's =.72), and children's reports of exposure to severe violence (6 items, Cronbach's =.86). Because so few parents reported their child witnessing or victimized by the severe violence items, there was not enough variability to assess the relation among the items that comprised this dimension. TABLE 1 presents the means for parent and child reports of each of the aggregate exposure factors, along with the percentage of respondents who indicated exposure to at least one item within each of the four factors: witnessing/victimization by mild violence, witnessing/victimization by severe violence. Overall, 66.5% of the parents and 78.1% of the children reported that the child had witnessed or been a victim of at least one violent incident. Table 1
PARENTS' AND CHILDREN'S REPORTS OF CHILDREN'S EXPOSURE TO VIOLENCE: AGGREGATE VEX ITEMS REPORT" VEX ITEM Total exposure to violence Witness to mild violence Victim of mild violence Witness to severe violence Victim of severe violence Exposure to one or more event(s). PARENT (W=155) 66.5% 57.4% 43.9%
7.7% 0.6%

CHILD (W=73) 78.1% 57.5% 53.4% 37.0% 31.5%

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Relation of Child and Parent Exposure Reports Pearson correlations computed between parent and child reports showed no significant relations on the mild violence dimensions of the witnessing and victimization scores. Because nearly half the children and even more of the parents in this study reported that the child had neither witnessed nor been a victim of severe violence, parent-child concordance for these dimensions was examined using chi-square analyses, with the witnessing and victimization dimensions of exposure to severe violence grouped according to child (no/yes exposure) and parent (no/yes exposure) responses; no significant relations were found. Examination of qualitative responses to the probe questions about the incidents reported by parents and children corroborated the statistical findings of discordance between parent and child reports of exposure. Thus, even when both parents and children responded positively to a violence exposure item, the details of their probe responses often seemed to refer to different incidents. Exposure and Distress Child Reports Pearson correlations were performed between children's total report of distress symptoms and the self-reported violence exposure aggregates. Correlations were modest, but significant, for the witnessing of mild violence (r=.29,p<.Q5), victimization by mild violence (r=.22, p=05), and witnessing of severe violence (r=.25, p<.05). No significant relation was found between child selfreport of distress symptoms and victimization by severe violence (r=.14, NS). Parent Exposure and Child Distress Reports Analyses performed on the relation between parent reports of violence exposure and child reports of distress symptoms yielded no significant findings. Exposure and Behavior Problems Relation of child gender and reported level of violence exposure to behavioral outcome was analyzed, and neither interaction nor main effects for gender were found. Also, no mean range differences for either parent or child reports of exposure or symptomatology by gender were found. Accordingly, gender was collapsed across subjects in the analyses presented below.

Violence Exposure and Preschool Children

Child Report of Exposure and Parent Report of Behavior Problems Analysis of children's reports of exposure and parents' reports of child symptomatology was completed in two waves. First, analyses were carried out on the full sample, without regard to children's clinically judged response to the VEX scale. Second, the same analyses were computed using only data that were gathered from the 73 children judged to have understood the interview. This strategy demonstrated valid patterns of relations between exposure and symptomatology that were unique to the group of children who understood the interview. Analyses of variance were performed separately on parent-reported behavior problems (internalizing, externalizing, and total problems), with child-reported violence exposure aggregates (no/yes exposure) as factors. On the full sample of child-reported exposure, no significant differences were found between groups in terms of parentreported behavior problems. On the data from children successfully responding to the VEX scale, however, a different pattern emerged. As indicated in FIGURE 1, children who reported witnessing mild violence were rated by their parents as displaying more internalizing problems than were children who did not report such exposure. (F(l,71)=4.44,p<.05). Conversely, children who reported victimization by mild violence were rated by their parents as displaying significantly more externalizing problems than were those who reported none (F(l,71)=6.19, p=.0l). Analyses examining the relation between child report of exposure to severe violence and parent report of behavior problems did not produce significant findings. Figure 1
CHILD BEHAVIOR PROBLEMS (CBCL) BY CHILD SELF-REPORT OF VIOLENCE EXPOSURE

Q INTERNALIZING EXTERNALIZING

YES

Shahinfar et al
Parent Reports of Exposure and Behavior Problems ANOVAs were computed separately on behavior problem scores (internalizing, externalizing, and total problems), with violence exposure aggregates (no/yes exposure) as factors. As depicted in FIGURE 2, and in accord with the pattern found among the child reports from the reduced sample, parents who reported that their child had witnessed mild violence also reported more internalizing behavior problems than did parents who did not report such witnessing (F(l, 153)=7.54, p<.0\). Parents who reported that their child had been a victim of mild violence also reported significantly higher externalizing behavior problems than did those who reported no such victimization (F(l, 153)=5.14, p<.05). Analyses of parent reports of behavior problems and exposure to severe violence yielded no significant findings. DISCUSSION The study reported here was designed to examine perceptions of prevalence, as well as correlates, of community violence exposure in a sample of preschool children. Information was gathered from parent reports of their children's experiences and distress symptomatology, and from interviews with the children themselvesa method that has proved valuable in studies of elementary-school children's and adolescents' exposure to violence (Richters & Martinez, 1993). Because of the lower age range investigated here, the findings contribute to the literature in both substantive and methodological terms. Consistent with the prevalence reported in studies of older children, this study's data indicated a disturbing rate of exposure to violence: 78.1% of the children and 66.5% of parents reported chilFigure 2
CHILD BEHAVIOR PROBLEMS (CBCL) BY PARENT REPORT OF CHILD'S VIOLENCE EXPOSURE

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dren's exposure to at least one incident of community violence. This suggests that the problem extends below the age groups commonly studied in this field, and that children are at risk for exposure to violence before they leave the protection of parents and home. Community violence appears to be part of the experience of even very young children, who presumably spend most of their time in the presence of parent or other adult caregivers. Data from this study also suggested modest but significant relations between children's reports of exposure to mild violence and of witnessing severe violence, and their response to a self-report measure of distress symptomatology. No such correlation, however, was found for children's reports of victimization by severe violence, perhaps because the reports were so few. For both parent and child reports, the behavioral correlates of violence exposure differed according to the modality through which the exposure occurred. Specifically, children who were reported by themselves or their parents as witnessing mild violence (beating, chasing, pushing/shoving, and slapping) were rated by their parents as displaying significantly more internalizing (withdrawn, anxious/depressed) problems than were their nonwitnessing peers. Children who were reported as victims of mild violence evidenced a higher frequency of externalizing (aggressive, disruptive) behavior than did their nonvictim peers. Despite poor parent-child concordance in terms of reports of exposure, the pattern relating witnessing violence to internalizing problems, and victimization to externalizing behavior was evident for both child and parent reports of exposure. These patterns might be explained as different types of defense processes activated by witnessing versus victimization. For example, children who witness violence rarely have the opportunity or resources to intervene in the event; rather, they must watch from the sidelines, recognizing their own inability to effect change in the situation. They may feel helpless, and this, in turn, may lead them to the withdrawal or anxiety characteristic of the internalizing typology. On the other hand, children victimized by violence must deal with the situation by tending to their own physical or emotional pain and, in a sense, this gives them a role in handling the exposure that the witnessing child lacks. Rather than withdrawing, victimized children may be more likely to learn aggressive, externalizing behavior as either a means of self-protection or a

14 ,

12.16
D INTERNALIZING EXTERNALIZING

12

10 8\ 6 4 2 0
YES

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Violence Exposure and Preschool Children

opment to children's ability to respond to the selfreport instrument, may help in further elucidating factors related to children's developing ability to give reliable self-reports. A second issue relevant to the limitations of using the VEX scale with a preschool sample is the development of children's ability to distinguish between fantasy and reality. In a recent review, Woolley (1998) concluded that children are not fundamentally different from adults in this ability, and that "...from the research reviewed...children by the age of 3 have considerable knowledge about fantasy and reality" (p. 1007). She does, however, acknowledge that the ability begins at around age three and improves steadily over the course of the next five years of development. Children in this study were between the ages of 3'/2 and 41/2on the cusp of emerging distinctions between fantasy and reality. It is important to note that among the subsample of children responding appropriately to the VEX scale, significant and meaningful relations were found between child reports of exposure to violence and parent reports of behavior problems. This pattern of findings, which mirrored those found when parent reports of both exposure and symptomatology were considered, was not present when the VEX scale responses from the entire sample of children's reports were considered. This suggests that meaningful data can be gathered from preschool children's perceptions of violence exposure if researchers are sensitive to variables that indicate children's levels understanding and responses to the measure's self-report format. Although the validity of children's reports of exposure could not be absolutely corroborated by parent's reports, it is clear that children's perceptions were linked to behavioral symptomatology. Another important issue in analyzing the children's reports is the discordance found between parent and child reports. This problem has also plagued violence research with other populations. In studies of elementary and adolescent samples that considered both child and parent reports of violence exposure, parent-child concordance was found to be low or even negatively correlated (Applebaum & Burns, 1991; Hill & Jones, 1997; Pynoos et al., 1987; Richters & Martinez, 1993; Schwarz & Kowalski, 1991). Richters and Martinez suggested attribution of this poor concordance to several factors: parents may be unaware of their children's exposure to violence; they may

way of relating to others. This link between modality of exposure and type of problem behavior (internalizing or externalizing) has been reported in a study investigating rural children's exposure to violence (Martin, Gordon, & Kupersmidt, 1995), and may prove valuable for exploration in research with other populations, as well. In terms of methodological contributions, this study introduced the VEX scale (Fox & Leavitt, 1995) as a new instrument for accessing perceptions of violence exposure in children as young as preschool age. With this advance, however, have come a number of methodological problems that deserve mention, some of them specific to the sample studied, others common to violence research in general. The first of these is related to the fact that not all children in the study were able to understand and complete the VEX scale. This raises questions about the utility of the instrument with a preschool sample. It is important to note that half the sample was clinically judged as able to respond appropriately, and could be distinguished from those judged unable to do so on the important independent measure of cognitive development as assessed by the PPVT-R. Thus, rather than disqualifying the VEX scale for use with preschool children, the findings highlight the importance of considering children's clinical cues, as well as their level of cognitive development, in assessing potential for appropriate response to the instrument. The accuracy, stability, and validity of measures designed for preschool populations are presently the topic of much debate in other areas of the selfreport literature (Beitchman, & Corradini, 1988; Ceci& Brack, 1993; Fantuzzo, McDermott, Manz, Hampton, & Burdick, 1996; Guralnick & Weinhouse, 1983; Hughes, 1988). The work conducted so far suggests that the ability of preschool children to respond to self-report measures may be related to such test construction variables as item content (Eder. 1989; Eder, Gerlach, & Perlmutter, 1987), as well as to individual child variables such as memory capacity and suggestibility (Ceci & Bruck, 1993). Furthermore, although judging frequency of occurrence has been shown to be unaffected by the age, ability, education, or motivation of the reporting individual (Hasher & Zacks, 1984), children's knowledge base may effect their recall of the frequency of particular stimuli (Harris, Mergler, Durso, & Jones, 1990). The present findings, which link level of cognitive devel-

Shahinfar et al
repress violence exposure information as either a passive or an active coping strategy (e.g., parents may not report on violence in the home for fear the child will be removed from the home by Social Services); or, particularly with younger children, the accuracy of children's self-reports may be compromised by their inability to distinguish between events they witnessed and those they only heard about. A fourth possibility is that children and parents construe what constitutes an act of violence differently, and thus report different experiences when faced with questions about exposure. It is possible that the discordance between parent and child reports in this study was related to a combination of the reasons ascribed to such discordance in older populations. Young children are commonly assumed to spend most of their time with primary caregivers, but 1990 census data indicated that 51% of American children under the age of six receive day care outside of the home (Hernandez, 1995). In the present sample, 37% of the children were in day care of some type. It is possible that reasons for the discord between parent and preschool child reports of exposure mirrored those cited in other studiesparents and children, even young children, spend at least part of their days apart. If day-care providers, as well as primary caregivers, had been interviewed, perhaps greater concordance would have been found between adult and child reports of exposure. Similarly, a higher level of concordance between reporters of exposure to violence among older children might be procured if researchers interviewed teachers or peers, in addition to parents. However, such a wide range of sources might make it difficult to judge which assessments of exposure were reliable. Because young children's developmental capacity for self-reporting is uncertain, it seems more likely that the discordance between parent and child reports of exposure reflects differences in perception. Although nearly half the sample of children could respond to probe questions and recall incidents of exposure to aggressive or violent events, very few of their reports paralleled those of their parents, even when both agreed that exposure had occurred. Parents and preschool children may have different interpretations of what constitutes a violent event. The fact that the preschool children often responded with different particulars from those offered by their parents for the same event suggests that the children's view of what was most

123 salient and striking differed from that of their parents. At the same time, parent and child reports of witnessing of or victimization by violence were linked to the same behavioral correlates, suggesting that particulars of the exposure were less important than endorsement of the fact of exposure. As such, the data from this study must be viewed as representing parent and child perceptions of violence exposure, the interpretation and reporting of which may or may not overlap. This reading of the data may also help explain discrepancies reported in the literature with older children and adolescents.
Clinical Significance

Perceptions may be particularly important from a clinical standpoint. For example, studies of children growing up in violent environments have demonstrated that it is the child's interpretation of a violent event, not the event itself, that may explain patterns of symptomatology and coping (Gibson, 1987; Liddell et al, 1993). Reports by preschool children in the current sample systematically varied with the degree of both child and parent reports of symptomatology, suggesting that the children's reports reflected some environmental stimulus related to either the presence or the perception of violence in their community. At the very least, the data offer a glimpse of the information that might be gathered about young children's experiences with community violence. Understanding children's perception and interpretation of events is critical toward helping them deal with trauma. The VEX scale may prove a useful tool in opening a dialogue with children about their perceptions of and experiences with community violence.
Implications for Research

The goal of this study was to provide data on perceptions of prevalence and correlates of community violence exposure among very young children, a group about which little is known. This is not to imply an attempt to uncover the causality of relations among exposure, distress symptoms, and behavior problems. For example, it is possible that externalizing behavior problems were related to victimization by violence because aggressive children prompted aggressive responses from their environments, not because environmental violence contributed to aggression in the children. Similarly, children with internalizing problems may

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have been more sensitive to violent stimuli in the environment and their reports of violence were, thus, a manifestation rather than a cause of distress. A much more detailed examination of contextual issues (e.g., place of exposure, parental processing of the event) would be necessary to achieve a full understanding of the impact of violent events on children. New models for understanding the relevance of the contextual features of exposure have been recently articulated by Lynch and Cicchetti (1998) and will, ideally, inform future generations of researchers. The role of such factors as family functioning and the quality of the parent-child relationship in ameliorating or exacerbating children's responses to violence exposure should also be considered. For example, if parents are the perpetrators of the violence, the children may not receive support from them in reporting their exposure or associated symptomatology. Not all parents are unambivalent, beneficent caretakers. It is essential to investigate which features of family functioning and parent-child relationships can help resilient children avoid a negative outcome. This issue has been investigated in the child abuse and neglect literature, but is only beginning to be explored with regard to children's exposure to the broader dimensions of community violence (Gorman-Smith & Tolan, 1998). Finally, further research is needed to explore the different links between particular modalities of violence exposure and specific behavioral symptomatology. The social-learning model of behavioral development (Bandura, 1973, 1986) posits that exposure to aggressive role models increases children's chances of developing aggressive behavior problems. The findings of the present study and of others that have revealed differences between children's witnessing of and victimization by violence (Fitzpatrick, 1993; Martin, Gordon, & Kupersmidt, 1995; Schubiner, Scott, & Tzelepis, 1993) indicate that particular modalities of exposure may be associated with specific behavior problems. When considering prevention efforts designed to reduce aggressive and delinquent behavior, it may be especially important to identify those children who have been victims of violence.
CONCLUSION

Violence Exposure and Preschool Children

dren has not yet been fully addressed in the literature. This study is among the first to attempt a systematic examination of the prevalence of exposure to violence among a preschool population, since most of the research in this area has been primarily directed at school-age and adolescent populations. The current results support the notion that violence exposure represents a significant experience for children as young as preschoolers in some areas of the United States, and suggest that serious attention must be given to further research on the prevalence and remediation of this important social problem.
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For reprints: Ariana Shahinfar, Ph.D., Dept. of Psychology, La Salle University, 1900 West Olney Ave., Philadelphia, PA, 19141