Pediatrics 2006;118;e235-e242
J. David Hawkins Nerissa S. Bauer, Todd I. Herrenkohl, Paula Lozano, Frederick P. Rivara, Karl G. Hill
ARTICLE
Childhood Bullying Involvement and Exposure to
Intimate Partner Violence
Nerissa S. Bauer, MD, MPHa, Todd I. Herrenkohl, PhDb, Paula Lozano, MD, MPHa, Frederick P. Rivara, MD, MPHa,c, Karl G. Hill, PhDb,
J. David Hawkins, PhDb Departments of aPediatrics and cEpidemiology, Child Health Institute, and bSocial Development Research Group, School of Social Work, University of Washington, Seattle, Washington
The authors have indicated they have no financial relationships relevant to this article to disclose.
ABSTRACT
OBJECTIVE. Our objectives with this study were to describe the prevalence of bullying
involvement (ie, bullying and victimization) among children from a multigenerational
study and to examine the relationship of these childhood behaviors and
exposure to intimate partner violence.
METHODS.A community-based cohort of 112 children (aged 6 to 13 years) was asked
to self-report on physical, verbal, and relational types of bullying and victimization
experienced in the past year. Parents reported on their child’s externalizing and
internalizing behaviors during the previous 6 months using items from Achenbach’s
Child Behavior Checklist. The frequency of parental experiences of intimate
partner violence perpetration and victimization at 2 time points during the preceding
5 years was measured using Conflict Tactics Scale items. The association of
intimate partner violence and parent-reported child behavioral problems was
examined, followed by exposure to intimate partner violence and child-reported
bullying or victimization. Parental risk factors (eg, race/ethnicity, education, problem
drinking) that predispose to intimate partner violence were controlled for
using propensity score statistical modeling.
RESULTS. Eighty-two (73.2%) children reported being victimized by peers, and 38
(33.9%) children reported bullying behaviors in the past year. More reports came
from girls than from boys (55% for victimization and 61% for bullying). Almost all
(97%) child bullies were also victims themselves. Intimate partner violence was
reported by parent respondents in 53 (50.5%) households at any or both of the 2
time points. Exposure to intimate partner violence was not associated with childreported
relational bullying behaviors or victimization by peers, However, intimate
partner violence–exposed children were at increased risk for problematic levels of
externalizing behavior/physical aggression and internalizing behaviors.
CONCLUSIONS. In our sample, children who were 6 to 13 years of age reported a
substantial amount of bullying and victimization; a large majority were bullyvictims
and female. Regression analyses did not show that children who were
www.pediatrics.org/cgi/doi/10.1542/
peds.2005-2509
doi:10.1542/peds.2005-2509
Key Words
bullying, intimate partner violence,
behavior disorders/problems
Abbreviations
IPV—intimate partner violence
Gn—generation n
SSDP—Social Development Research
Project
CBCL—Child Behavior Checklist
RR—relative risk
CI—confidence interval
OR—odds ratio
Accepted for publication Jan 30, 2006
Address correspondence to Nerissa S. Bauer,
MD, University of Washington, Child Health
Institute, 6200 NE 74th St, Suite 210, Seattle,
WA 98115-8160. E-mail: nerissa@u.
washington.edu
PEDIATRICS (ISSN Numbers: Print, 0031-4005;
Online, 1098-4275). Copyright©2006 by the
American Academy of Pediatrics
PEDIATRICS Volume 118, Number 2, August 2006 e235
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exposed to intimate partner violence were more likely to
engage in relational bullying. However, children who
are exposed to intimate partner violence have a higher
likelihood of internalizing behaviors and physical aggression.
CHILDHOOD BULLYING AND victimization are serious
problems that can threaten a child’s socioemotional
development. Bullying is defined as conscious, repeated
acts of physical, verbal (eg, name-calling), or relational
(eg, social exclusion, spreading rumors) aggression that
causes injury or discomfort to the target1 between children
of differing physical size and strength.2 Bullies,
victims, and bully-victims are at risk for a variety of
psychological, peer, and school problems.1,3,4 Victims also
are at increased risk for suicide5 and school violence.6
Bullying behaviors can emerge as early as elementary
school age and usually peak during middle school. A
large US study found that 11% of children in grades 6 to
10 bullied others “sometimes,” with an additional 9%
bullying more frequently.3 Former victims were more
likely to have poorer self-esteem and experience depression
at age 23; likewise, 70% of bullies who were identified
in seventh and ninth grades were involved in
criminal activity by age 24,7 yet little is known about risk
factors that may predispose a child toward frequent bullying
or victimization. Bullies tend to experience inconsistent
authoritarian parenting styles and exhibit impulsive
tendencies.8 Identification of predisposing factors in
the home and environment (eg, school climate) can lead
to timely identification of at-risk children and provide
the basis for targeted interventions.
One possible risk factor for bullying is exposure to
intimate partner violence (IPV). It is estimated that between
3.3 and 10 million children in the United States
witness IPV in their homes annually.9 On the basis of
theories of social learning10 and emotional dysregulation,
11 children who are exposed to IPV in their homes
can be at particular risk for learning negative relationship
patterns. Through their early experiences with primary
caregivers and siblings, children learn rules of relationships
and begin to construct their views of the
world. IPV is defined as physical, emotional, or sexual
acts of aggression (actual or perceived) between 2 partners
(eg, marital or nonmarital, current or past) that
occur repetitively with the intent to harm.12 Exposure to
IPV can influence a child’s perception of violence as an
acceptable method of resolving conflict.
Children who are exposed to IPV exhibit both internalizing
and externalizing behavior problems in the
borderline to clinical range,13–15 yet little is known
about the influence that witnessing IPV, either directly
or indirectly, has on children’s peer relationships. Specifically,
little is known about the impact of IPV on a
child’s likelihood of becoming a bully or bully-victim.
Given the paucity of research in this area, we examined
the prevalence of bullying and victimization among
children who were drawn from a longitudinal, multigenerational,
community-based sample. In addition, we
examined the relationship between exposure to IPV and
subsequent bullying and victimization. Here, we differentiated
between physical forms of bullying (eg, externalizing
behavior/physical aggression) and those that
are more relational in nature. We also examined the
association between IPV and internalizing behaviors in
children.
Our study was organized in 2 parts. First, we examined
the relationship of IPV and externalizing and
internalizing behaviors in children. We hypothesized
that children who were exposed to IPV would exhibit
problematic behaviors at the upper quartile. We then
examined whether IPV exposure increases the risk for
relational bullying as a stand-alone outcome.
METHODS
Our study used data from 2 closely related longitudinal
studies with first- (G1), second- (G2), and thirdgeneration
(G3) participants. We used a cohort of
children (G3) who were between the ages of 6 and 13
years and living in Seattle, Washington. Parents (G2)
of the selected children originally were enrolled in the
Seattle Social Development Project (SSDP) in 1985
on entering the fifth grade. There were 808 participants
from 18 Seattle public elementary schools that
served diverse neighborhoods, including households
(G1) within high-crime areas that consisted of lower
socioeconomic status and mixed ethnicity/race,16 representing
77% of all fifth graders from these 18 schools.
As G2 participants began having their own families,
eligible parents (G2) who agreed to participate (N 208)
and their eldest biological child (G3) were enrolled in
another longitudinal study (SSDP Intergenerational
Study) in 2002. Recruited G2 parents (N 208) did not
differ from those who were eligible but not recruited
(N 73) in terms of gender; childhood neighborhood
disorganization; childhood poverty; adolescent problem
behavior; cigarette use or marijuana use in adolescence;
binge drinking, cigarette use, or marijuana use at ages 21
to 24; educational attainment at age 24; marital status
at age 27; or G1 binge drinking, cigarette use, or marijuana
use.17 Of the 208 parents and children, 89 children
were younger than 6 years and were unable to participate
in the child survey. Seven children did not have
complete data. Our data were derived from this
sample of 112 G2 participants and their 6- to 13-year-old
children. Study procedures were approved by the University
of Washington Human Subjects Protection
Committee.
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Dependent Variables
Part 1: Parental Reports of Child’s Externalizing and
Internalizing Behaviors
We created 4 scales to measure more generalized acts of
aggression, as well as other school-related and peerrelated
behaviors, using selected items from Achenbach’s
Child Behavior Checklist (CBCL/6–18).18 A subset
of CBCL items that have been shown to be reliable
and valid indicators of Diagnostic and Statistical Manual of
Mental Disorders diagnostic categories were used in the
intergenerational study. Items that were used in these
scales correspond with those that were used in various
other studies19 based on original CBCL constructs, although
we modified our scales to reduce overlap in the
items and to capture the most salient characteristics of
each behavior.20 Primary parent respondents were asked
to rate how true each statement was for their child in the
previous 6 months on a 3-point scale: not true, somewhat
or sometimes true, or very or often true. In total,
we used 13 items (Cronbach’s .812) to capture
childhood externalizing behaviors; 3 items were used to
capture internalizing behaviors (Cronbach’s .623).
Other behavioral problems, such as attention (4 items;
Cronbach’s .988) and social problems (3 items;
Cronbach’s .603), were also included. Ratings for
each child on each of the 4 subscales were computed. To
isolate those who were at highest risk on each behavior,
we separated cases in the highest 25% of each score
distribution from those in the remaining 75%. This procedure
was used in other studies from SSDP and elsewhere
as an alternative to modeling highly skewed variables
as continuous indicators.21–23
Part 2: Child Bullying and Victimization
Bullying and relational aggression were measured with
items from the revised Olweus Bully/Victim Questionnaire.
1,24 Children were asked to report incidents of bullying
and victimization that occurred in the past year.
Children of age 6 to 9 years responded “yes” or “no” to
a global indicator of bullying (“have you bullied others?”)
and 4 specific indicators of relational bullying
(“started rumors or told lies,” “teased others,” “did not
let someone in their group of friends,” and “told someone
they were not liked unless they did something I
wanted”). Victimization experiences were assessed with
similar measures (1 global indicator: “others have bullied
me”; and 4 specific behaviors: “others started rumors or
told lies about me,” “others teased me,” “someone told
me I was not in their group of friends,” and “someone
told me they wouldn’t like me unless I did something
they wanted”). When a child responded “yes” to 1 or
more of the indicators, he or she was classified as a bully
or a victim, respectively. This method sought to capture
children who perpetrate or experience bullying in any or
multiple forms.
In addition to the above indicators, children who
were 10 years and older responded to an additional
question from the Olweus Bully/Victim Questionnaire
on the experience of racism (“called someone names
that made fun of his or her race” and “I was called names
that made fun of my race”). The coding of the item was
done similarly to other indicators of bullying. Response
categories for children who were 10 years and older were
based on frequency of incidents in the past 12 months:
none, once or twice, sometimes, fairly often or almost
always.
Independent Variable: IPV
Parental history of IPV perpetration or victimization
was measured using 3 items from the Conflict Tactics
Scale25 that measured verbal/relational aggression and
physical violence tactics that were used between partners
to resolve conflict (“pushed/grabbed/slapped/
shoved,” “threatened to hit,” and “insulted/swore/cursed/
yelled”). Parent respondents were asked to rate the
frequency of incidents in the past year that occurred
between themselves and their partner at 2 discrete time
points (parent age 24 and parent age 27). Modified
response scale categories were: never, rarely, sometimes,
often, and very often. The cutoff of “sometimes” or greater
was used to denote a positive response of IPV because we
believed that it captured the recurrent nature of aggression
often characteristic of violent intimate adult relationships.
When a positive response was found for any of the 3
indicators for either perpetration or victimization, the respondent
was classified as such.
Covariates
Variables that are known to be highly correlated with
IPV were examined and used in the statistical analysis26–28:
maternal age at child birth (age 27), highest educational
level completed (age 21), race/ethnicity (age 27), participation
in Aid to Families with Dependent Children/
Temporary Assistance to Needy Families/food stamps
welfare programs (age 27), parental childhood history of
home violence (age 21), alcohol use (age 24 and 27),
and overall drug use (age 24). Alcohol use was assessed
using 2 indicators: average quantity/frequency of drinking
per week and binge drinking. The cutoff chosen was
based on the World Health Organization standards for
medium levels of regular drinking (average 4 glasses a
day in a 1-week period for men and 2 glasses a day in a
1-week period for women). A composite variable denoting
problem drinkers was defined as a positive response at
either time point for either of the 2 indicators.
Data Analysis
Part 1
We examined the effects of IPV on children’s externalizing
and internalizing behaviors to consider how our
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sample compared with previous studies.13–15,29 Bivariate
analyses were conducted using each of the 4 constructs
for measuring problem behaviors and IPV at each time
point and combined.
For examination of the association between IPV and
child problem behaviors, a composite variable for each
time point (ages 24 and 27) was needed to denote a
positive report of IPV perpetration and/or victimization.
The 2 composite variables then were used to create a
final composite variable to represent any report of IPV
at either or both time points. The selected covariates
were placed into the first part of the statistical model
with IPV as the outcome. Predicted values were saved
and used in the second step to represent a propensity for
IPV. In the second step, the model was fitted with both
the propensity score and the composite IPV variable with
1 of the parent-reported problem behavior constructs.
Logistic regression then was performed using the fitted
model. Using a propensity score for regression adjustment30
allowed us to control parsimoniously for parental
risk factors that are known to be correlated with IPV. We
repeated this procedure for each of the 4 behavior constructs
and IPV.
Part 2
We performed bivariate analyses of child-reported bullying
involvement and IPV at each time point and combined
time points. Frequencies of bullying and victimization
were examined for the overall sample, as well as
by age (ages 6–9 and 10–13) and gender.
For examination of the relationship between parental
reports of IPV and child bullying and victimization, a
separate, 2-step propensity score model was fit for each
child outcome. Logistic regression was then performed
using the fitted models for bullying and victimization.
RESULTS
The parent respondents in the current study predominantly
were female (78.6%), with a median age of 27
years (Table 1). Half were single and never married, 56%
reported incomes less than $31 000 a year, and almost
one third (31.6%) were enrolled in programs such as
Temporary Assistance to Needy Families or Aid to Families
with Dependent Children in the past 12 months.
One quarter of parents were younger than 18 years at
childbirth. Slightly more than half (52.7%) of children
in the final cohort were female.
IPV
A total of 42 (42.9%) of 98 households reported any
form of IPV at parent age 24. This rate was similar at
parent age 27: 41 (48.8%) of 84. Missing data required
exclusion of 14 participants at age 24 and 28 participants
at age 27 time points. Overlap of parental violence perpetrators
and victims was high, 54.8% and 73.2% at
parent age 24 and age 27 time points, respectively. IPV
was reported in 53 (50.5%) households for at least 1 of
the 2 time points with 7 excluded for missing data.
Child Bullying and Victimization
Overall, one third (33.9%) of children in our sample
reported bullying others in the past year (Table 2). Prevalence
of bullying was 34.6% for children who were 6 to
9 years of age and 32.4% for those who were 10 to 13
years of age. Only 5 (4.5%) children in our sample
responded positively to “I bullied others,” yet positive
responses to queries about specific acts of bullying led to
a much higher overall prevalence of bullying. Girls had
a higher prevalence of bullying for each indicator than
did boys.
Victimization by bullies was a common experience
among our sample, reported by 73.2% of children (Table 3).
The prevalence of victimization was 78.2% for children
who were younger than 10 years and 61.8% for those who
were older. Similar to the indicators for bullying, a discrepancy
existed between the reports of being bullied (32.1%)
and specific questions about victimization. As with bullying,
girls were more likely to report victimization than were
boys.
Bullies who also are bullied have been previously
defined and referred to as “bully-victims.”3,31 Of the 38
child bullies, 37 (97.4%) reported concomitant incidents
of victimization by peers. Conversely, 45.1% of victims
also reported being bullies.
TABLE 1 Parent-Reported Characteristics
Characteristic n (%)
Demographic
Female gender 88 (78.6)
Maternal age during first child birth18 y 27 (24.1)
Martial status
Single, never married 56 (50)
Married 37 (33)
Ethnicity/race
White 39 (34.8)
Black 50 (44.6)
Other 23 (20.5)
Socioeconomic
Highest education level completed
Less than high school 17 (15.4)
High school/GED 37 (33.7)
Technical/vocational school 18 (16.3)
College 38 (34.5)
Reported yearly income less than $31 000 63 (56.3)
Participated in AFDC/TANF/food stamps 31 (31.6)
Female child 59 (52.7)
Violence and substance abuse
History of exposure to family violence in childhood 22 (20)
Problem drinkera 66 (58.9)
Overall drug use 33 (29.5)
Any IPV 53 (50.5)
AFDC indicates Aid to Families With Dependent Children; TANF, Temporary Assistance to Needy
Families.
a Problem drinker is defined as positive report of binge drinking at either of the 2 measured time
points or drinking 4 glasses per day for men or 2 glasses per day for women in an average
week.
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IPV and Parent-Reported Child Externalizing and Internalizing
Behaviors
Of the 112 parent respondents, 22 were not the child’s
primary caregiver and therefore were excluded. The unadjusted
association of IPV at parent age 27 with externalizing
(aggressive) behaviors revealed a relative risk
(RR) of 5.2 (95% confidence interval [CI]: 1.6 –16.1);
with internalizing (withdrawn) behaviors, RR of 1.2
(95% CI: 0.5–2.6); with attention problems, RR of 1.6
(95% CI: 0.7–3.7); and with social problems, RR of 1.9
(95% CI: 1.0 –3.7).
Logistic regression using propensity score modeling
with each secondary dependent variable showed a statistically
significant association between IPV and child’s
externalizing behaviors (odds ratio [OR]: 3.1; 95% CI:
1.0 –9.5; Table 4). There were similar trends for IPV and
internalizing behaviors (OR: 1.6; 95% CI: 0.5– 4.6) and
attention (OR: 2.2; 95% CI: 0.7– 6.6). We did not find a
statistically significant association with parent-reported
social problems and IPV (OR: 1.0; 95% CI: 0.4 –2.6).
Analyses using IPV reports at parent age 24 and combined
time point revealed similar results.
IPV and Child-Reported Bullying Involvement
In unadjusted analysis, the risk for child bullying was
increased in those who were exposed to IPV that was
reported by the parent at age 27, although the CI included
1 (RR: 1.31; 95% CI: 0.7–2.5). Similarly, the risk
for bullying victimization was higher in those whose
parents reported IPV at age 27, although the CI included
1 (RR: 1.24; 95% CI: 0.9 –1.6). Analysis with parent IPV
reports at age 24 and combined reports at both time
points yielded similar results. We did not find an association
between parental IPV and child-reported bullying
(OR: 0.7; 95% CI: 0.3–1.8) or victimization by peers
(OR: 0.9; 95% CI: 0.4 –2.3) after adjusting for our selected
covariates using propensity score analysis
(Table 5).
TABLE 2 Child-Reported Bullying “Sometimes” or Greater in the Past Year
Parameter Frequency, n (%) Female/Male Ratio
Age 6–9
(N78)
Age 10–13
(N34)
Combined
(N112)
Bullied others 4 (5.1) 1 (2.9) 5 (4.5) 4:1
Teased others/made fun 13 (16.7) 9 (26.5) 22 (19.6) 1.2:1
Told lies/started rumors 10 (12.8) 1 (2.9) 11 (9.8) 2.7:1
Social exclusion 10 (12.8) 3 (8.8) 13 (11.6) 1.2:1
Would not like person unless did what I wanta 11 (14.1) 0 11 (9.8) 1.8:1
Made fun of race with namesb — 0 — —
Overall bully 27 (34.6) 11 (32.4) 38 (33.9) 1.5:1
a Reported among younger children only, because none of the older children endorsed this behavior.
b Asked only of older children.
TABLE 3 Child-Reported Victimization by Peers “Sometimes” or Greater in the Past Year
Parameter Frequency, n (%) Female/Male Ratio
Age 6-9
(N78)
Age 10-13
(N34)
Combined
(N112)
Bullied by others 28 (35.9) 8 (23.5) 36 (32.1) 1.6:1
Teased by others/made fun of me 43 (55.1) 20 (58.8) 63 (56.3) 1.3:1
Subject of lies/rumors 39 (50) 10 (29.4) 49 (43.8) 1.3:1
Experienced social exclusion 36 (46.2) 11 (32.4) 47 (42) 1.8:1
Told would not be liked unless I did something 34 (43.6) 7 (20.6) 41 (36.6) 1.4:1
My race was made fun of with namesa — 8 (23.5) 8 (7.1) 1:1
Overall victim 61 (78.2) 21 (61.8) 82 (73.2) 1.2:1
a Asked only of older children.
TABLE 4 Parent-Reported Child Behavior in Past 6 Months
Outcomea RR 95% CI
Externalizing 3.1 1.0–9.5
Internalizing 1.6 0.5–4.6
Social problems 1.0 0.4–2.6
Attention problems 2.2 0.7–6.6
a Propensity score model adjusted with 7 covariates associated with parent’s risk for IPV: race/
ethnicity, highest level of education, welfare recipient, childhood exposure to violence, teen
parent, problem drinker, and overall drug use.
TABLE 5 Multivariate Regression: Association of IPV and Child-
Reported Bullying Involvement
Outcomea OR 95% CI
Bullying 0.7 0.3–1.8
Victimization 0.9 0.4–2.3
a Propensity score model adjusted.
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DISCUSSION
Bullying others and being victimized by peers were
highly prevalent in this sample of children. Girls in our
sample were more likely to report bullying others and
engaged more frequently in relational aggressive acts
when compared with boys. When parents were asked to
report on their child’s behaviors, children who were
exposed to IPV displayed a higher rate of both physically
aggressive and internalizing behaviors, when compared
with children whose parents did not have any history of
IPV. Exposed children were more likely to display problems
with attention.
Involvement in bullying is a common phenomenon
during school-age years.3,7,32,33 Our overall reported prevalence
of bullying is higher than national estimates reported
by Nansel et al34 in 2002, most likely for 3 reasons.
First, our study included children who were 6 to 13
years of age, whereas previous studies focused on middle
school–aged students.29,31,35 Little is known about the
incidence of bullying in children who are younger than
9 years. Schools across the country are of varying grade
compositions and types (eg, alternative, K–8, K–12),
making it harder to isolate the influence of student age
on the effect on bullying involvement and overall school
climate. In addition, the bullying indicators that were
used in our study emphasized relational bullying behavior,
whereas previous studies have used both relational
and physical measures. A subset of relational type behaviors
are covert (eg, spreading rumors, social exclusion)
and were recently shown to be harder to detect by
both teachers and parents.36,37 Children are less likely to
report incidents of relational aggression when compared
with direct physical or direct verbal incidents.35 Therefore,
prevalence of bullying is highly dependent on the
behaviors studied and how questions about bullying are
posed. Thirdly, our cohort resided in diverse neighborhoods,
with a large proportion of households of lower
socioeconomic status, mixed ethnicity, and single teen
parents. Other studies found that these types of environmental
factors are associated with an increased prevalence
of bullying behaviors.4,38
Our rates of IPV and female-to-male family violence
are similar to other longitudinal community-based samples.
37 We recognize that these findings have been challenged
because the Conflict Tactics Scale39 does not elicit
information about relationship context, motivation of
the perpetrator, or potential of injury to the victim.
However, others have confirmed female individuals can
be aggressive, especially within the context of a relationship,
40,41 using moderately severe forms of aggression as
measured by Conflict Tactic Scale items.
Previous studies reported substantial consequences
for children (witnesses and victims) who live in homes
with IPV. Children experience a higher number of
health problems, such as asthma, gastrointestinal complaints,
headaches, and cold or flu,29,42 and are at risk for
development of posttraumatic stress among children
who are 6 to 12 years of age.43 Child victims of physical
and sexual abuse are more likely to engage in bullying or
be victimized by peers44 and have more emotional problems
over time when abuse is long term. Our results are
consistent with previous work showing that children
from violent homes exhibit high rates of externalizing
behavior problems and total behavioral problems.13–15,45
Our study is the first in the United States to examine
the association of child witnesses to IPV and bullying
involvement specifically. We attempted to capture the
different facets of bullying and examine its association
with IPV through our 2-part analysis. A previous
Italian study found an association of IPV and bullying
among Italian elementary and middle school students46
but was cross-sectional and relied on children
reporting bullying incidents in the previous 3 months
and whether their parents ever engaged in domestic
violence. Our sample was asked to report on bullying
and domestic violence incidents in the past year. We did
not find the hypothesized association between IPV exposure
and relational bullying or bullying victimization.
Rather, we found that children who were exposed
to IPV engaged in higher levels of generalized aggression
as measured by specific items that often are viewed and
used to represent physical bullying from the aggression
subscale of Achenbach’s CBCL.47 Our findings are important
in light of the work of Veenstra et al38 that used
peer ratings to classify children as bullies, bully-victims,
victims, or uninvolved in bullying. Teachers reported
bullies and bully-victims as having higher levels of aggression
when compared with other students who were
thought of as victims or uninvolved in bullying. This
highlights the correlation between peers’ perception of
bullies in the classroom and adult ratings of highly aggressive
children who use physical means to overpower
others. Our results, having the advantage of a longitudinal
study design, indicate that IPV exposure is more
related to physical, more aggressive, acts of bullying than
to relational acts of bullying.
There are several limitations to the study. Our sample
size was small compared with previous studies on bullying.
The measurement of bullying is imprecise and not
yet standardized, although there is general consensus of
specific features that constitute bullying. There are very
few instruments that measure bullying specifically.48
The bullying measures that were available in our study
represented examples of relational bullying and therefore
may elicit greater reporting of relational bullying
and victimization than of physical bullying and victimization.
In addition, child respondents were not given a
definition of what constitutes bullying as did previous
researchers.1,3,29,35,49 Another limitation is sole reliance on
child self-reporting of bullying behavior. Children who
are exposed to IPV may assimilate “acceptable” relationship
patterns that are learned in the home and thereby
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do not recognize their own negative peer interaction
style (eg, bullying involvement). Moreover, children involved
in bullying exhibit differential types of aggression
(eg, reactive versus proactive) depending on the situation
and whether they are mainly bullies, victims, or
bully-victims.50 Our measures did not capture children’s
perceptions of peer intentions or ascertain specifics on
the circumstances surrounding bullying incidents or
whether there were any triggers. Given that we found
an association between IPV and parent-reported externalizing
and internalizing child behaviors similar to past
studies, the systematic measurement of bullying may be
problematic, especially in those who come from violent
homes. Lastly, possible residual confounding by factors
we did not examine, such as exposure to general community
violence, child maltreatment, and harsh parenting
styles, could bias the result toward the null.
Exposure to IPV in childhood can have both immediate
and far-reaching effects on a child’s development.
The importance of identifying significant psychosocial
factors, both acute and chronic, cannot be understated.
Children rely on parents to model socially acceptable
ways of behavior; therefore, households with IPV pose a
significant risk to a child’s socioemotional development.
Children who are exposed to IPV have a higher risk for
displaying physically aggressive acts of bullying (eg,
pushing or shoving others, fighting) but are not more
likely to engage in relational bullying. Traditional instruments
that are used to capture bullying should separate
relational and physical acts of bullying because of gender
trends. Large longitudinal studies are needed to evaluate
the full extent of IPV on a child’s socioemotional development
and peer relations in those who witness violence
but are themselves not victims.
ACKNOWLEDGMENTS
This study was supported by grants R01DA12138 and
R01DA09679 from the Health Resources and Service
Administration, National Institute of Drug Abuse, and a
National Research Service Award Primary Care Research
Fellowship.
We acknowledge Jennifer Bailey, PhD, and Sabrina
Oesterle, PhD, Social Development Research Group, and
James F. Lymp, PhD, Child Health Institute, for consultation
on statistical methods.
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e242 BAUER et al
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DOI: 10.1542/peds.2005-2509
Pediatrics 2006;118;e235-e242
and J. David Hawkins
Nerissa S. Bauer, Todd I. Herrenkohl, Paula Lozano, Frederick P. Rivara, Karl G. Hill
Childhood Bullying Involvement and Exposure to Intimate Partner Violence
& Services
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