As shown in Fig. 1 , we employed a staged approach for moving from the EGM to a narrative synthesis of the literature presented in this special section. Using procedures from the Campbell Collaboration (Saran & White, 2018 ), an EGM was conducted to systematically identify and visually present all published quantitative research that examined the effect of IPV exposure on child outcomes. EGMs are developed using methods similar to systematic review by comprehensively and systematically searching and coding for evidence on a broad research topic. Due to the large scope of evidence mapped, critical appraisals of individual included studies are not often conducted; rather, EGMs provide a visual depiction of all relevant evidence (Saran & White, 2018 ). The purpose of an EGM is to inform research priority-setting, identify gaps in the broad research area, and define the focus of future systematic reviews (Katz et al., 2003 ). Flow chart of procedures of moving from an Evidence and Gap Map (EGM) to a narrative synthesis of evidence In order to identify relevant published quantitative studies that examine the effect of IPV exposure on child outcomes, seven electronic bibliographic databases (CINAHL, ERIC, LexisNexis, Medline, PsychINFO, Social Science Citation Index, and Social Work Abstracts) were searched for articles published up through August 2020. LexisNexis was only searched up until 2016, and not from 2017 through 2020, as it did not yield any included studies that were not already captured by the other six databases up to 2016. Key search terms included “(domestic OR interparental OR family OR marital OR interpersonal) AND (expos* OR witness*) AND (violen* OR conflict OR abus* OR batter*) AND (child* OR youth).” Citations were then transferred into a bibliographic software management tool and deduplicated. Inclusion criteria were as follows: the study (1) was peer-reviewed, published in English, and used quantitative methods; (2) contained participants ages birth through 17 years (or those with more than 80% of the sample ages under 18 to ensure majority of sample was within target age range); (3) measured IPV exposure compared with other children who had experienced another form of violence, polyvictimization, or who had never been exposed to violence; and (4) utilized validated or reliable scale with published psychometric data, administrative data, anthropometric data, biological outcome data, or measured the occurrence of a discrete and administratively verifiable event (e.g., hospitalization, being held back a grade in school) to measure child outcome variables. Articles were excluded if they were not peer-reviewed (e.g., dissertations), not available in English or full text, employed an adult retrospective report, only measured IPV exposure prenatally, and/or used qualitative methods, a case study, bivariate analyses with no multivariable analyses, or a descriptive design. In order to capture all published quantitative research, no limiters were set for the year of publication. Two research assistants independently coded each citation for inclusion or exclusion based on a provided data extraction form. Abstracts were first reviewed and, when necessary, full-text articles were examined to determine inclusion or removal. Conflicting inclusion or exclusion decisions were reconciled by a third, doctoral-level research assistant. Citations were harvested from all review papers, deduplicated, and coded independently by two research assistants for inclusion. After the screening process was completed, full-text articles were comprehensively reviewed. Research assistants completed the data extraction form for each included study, including details about the types of child outcomes evaluated, and the data were subsequently entered into a database. Two research assistants independently coded each included study into six child outcome categories: behavior problems (e.g., externalizing behaviors/behavior problems, aggression, delinquency, antisocial behavior), psychological outcomes (e.g., internalizing behaviors/symptoms, post-traumatic stress disorder or symptoms, anxiety symptoms/diagnosis, depression symptoms/diagnosis, emotional problems/dysregulation/insecurity), cognitive outcomes (e.g., acceptance of/appraisals of/beliefs about IPV, self-blame, academic functioning), social outcomes (e.g., social competence, bullying victimization or perpetration, peer relationships, dating violence victimization/perpetration), physical health outcomes (e.g., general health, lung functioning, BMI/obesity, medical engagement), and physiological outcomes (e.g., cortisol regulation, respiratory sinus arrhythmia/vagal regulation). Citations were assigned to more than one child outcome category if a study reported results for multiple outcomes. Conflicting child outcome category coding was reconciled by a third, doctoral-level research assistant. Research assistants then collaboratively identified the subcategories (e.g., academic functioning, general health) within each broader child outcome category according to outcomes’ conceptual or operational similarity. Two figures were developed to curate and visually present the body of published quantitative literature on the effects of IPV exposure on child outcomes. First, we created a graph displaying yearly and cumulative publications. Second, we created a graph displaying the density of publications by child outcome categories and subcategories. The EGM was used as the initial step in the planning of the systematic review papers. Based on findings from the EGM, we identified seven systematic review paper topics that had (a) a sufficient body of literature, and (b) either had no published systematic review on the topic, previous reviews on these topics were not systematic, or previous reviews focused on a narrow age range or developmental period. Next, our research team developed research questions for each paper topic. Finally, because rigorous systematic review methodology was used for the EGM to capture all published quantitative articles on the effect of IPV exposure on child outcomes, and rigorous screening and extracting methodology was used to assign included studies to child outcome categories and subcategories, a narrative synthesis of the evidence for each paper topic was completed. Searches from the seven databases yielded a total of 32,666 citations (see Fig. 2 ). After deduplication, 15,354 citations were identified for screening. Of those screened, 13,714 were excluded and the remaining 1,640 were screened for eligibility. Of the full-text articles, 1,258 did not meet eligibility criteria, resulting in a total of 381 citations included in the EGM. Research assistants coding the 15,354 screened citations agreed on 14,334 in terms of inclusion or exclusion (93.36%). The remaining 1,072 were screened by a third, doctoral-level research assistance for final determination of inclusion or exclusion. Flow of information through each phase of the systematic review. Note. SSCI Social Science Citation Index, SWA Social Work Abstracts. Parenthetical study counts across categorized outcome domains are not mutually exclusive; an included study in one outcome domain could also be included, as relevant, in other outcome domains Of the 381 included studies, 350 articles were empirical studies and 31 articles were review articles including eleven meta-analysis articles and twenty systematic review articles. The majority of articles ( n = 218) examined the effect of IPV exposure on behavior outcomes (empirical studies, n = 198; review articles, n = 20), followed by 178 articles that examined child psychological outcomes (empirical studies, n = 163; review articles, n = 15), 105 articles that examined child social outcomes (empirical studies, n = 91; review articles, n = 14), 75 articles that examined child cognitive outcomes (empirical studies, n = 66; review articles, n = 9), 53 articles that examined child physical health outcomes (empirical studies, n = 49; review articles, n = 4), and 23 articles that examined child physiological outcomes (empirical studies, n = 23; review articles, n = 0). Included articles were published between 1982 and 2020 with review articles published between 1998 and 2020. Figure 3 shows the yearly and cumulative totals of published articles examining the effect of IPV exposure on child outcomes. In general, there was an increasing number of publications each year. Figure 4 displays the density of publications by child outcome categories and subcategories. The top of the figure displays density distributed across years by child outcome subcategories, the middle of the figure shows the total number of articles by child outcome subcategories, and the bottom of the figure shows the total number of review articles by child outcome subcategories. Yearly and cumulative publications of the effects of IPV exposure on child outcomes Evidence and Gap Map (EGM) of the effects of IPV exposure on child outcomes . Note : The top of the figure displays density distributed across years by child outcome subcategories, the middle of the figure shows the total number of articles by child outcome subcategories, and the bottom of the figure shows the total number of review articles by child outcome subcategories Based on the EGM findings displayed in Fig. 4 , child outcome subcategories were reviewed by the research team and compared with published review articles (review articles are shown in Fig. 4 as yellow circles). Seven topics were identified for narrative synthesis and included in this special section: physical health and medical system engagement (31 articles; Holmes et al., 2021 ); adolescent dating violence victimization & perpetration (29 articles; Evans et al., 2021a ); social-emotional competence (26 articles; Bender et al., 2021 ); bullying victimization and perpetration (14 articles; Lee et al., 2021 ); IPV appraisal (13 articles; Evans et al., 2021b ); physiological functioning (23 articles; Berg et al., accepted ); and academic functioning (13 articles; Cage et al., 2021 ). Holmes et al. ( 2021 ) reviewed 31 articles that examined the physical health and medical system engagement of IPV-exposed children, and the methodological considerations that contribute to the field’s understanding of these relations. Regarding medical engagement, studies indicated that IPV-exposed children were less likely to be up to date on immunizations, and that IPV-exposed children experienced an increased rate of emergency room visits compared with non-exposed children. IPV exposure was also related to poorer lung functioning (i.e., asthma and respiratory problems), higher BMI score, and greater reported health concerns. Methodological considerations included study design, measurement of IPV exposure, measurement of medical engagement, and measurement of health outcomes. Evans et al. ( 2021a ) reviewed 29 articles focused on ADV outcomes among IPV-exposed youth. Findings were inconsistent regarding the link between IPV exposure and ADV perpetration and victimization. While several studies identified a significant relationship between IPV exposure and ADV victimization or perpetration, nearly an equal number of studies did not, thus highlighting the multifinality of outcomes in this population. Findings were similarly mixed regarding mechanisms proposed to link IPV exposure and ADV, including mental health symptoms, anger regulation, beliefs about the acceptability of violence, peer influences, and parenting practices. Research implications address the need for IPV-exposure studies on healthy relationship outcomes among this population, sexual and gender minority youth relationship patterns, and enhanced methodological rigor. Bender et al. ( 2021 ) reviewed 26 articles that examined social-emotional competence outcomes among IPV-exposed children. Across the majority of studies, IPV-exposed youth demonstrated lower levels of social-emotional competence, and higher levels of emotional dysregulation compared with their non-exposed peers. Findings on the effects of IPV exposure on empathy development in children were more heterogeneous. However, social-emotional skills were identified as significant intervening or conditioning mechanisms linking IPV exposure and other indicators of well-being (e.g., aggression, psychological distress), thus highlighting social-emotional competence as an important area for intervention. Developmental psychopathology and resilience theory are offered as guiding frameworks for further study of this topic. Lee et al. ( 2021 ) reviewed 14 articles that examined the relation between IPV exposure and bullying perpetration and victimization. Studies indicated a significant relationship between IPV exposure and both bullying perpetration and victimization. Individual (e.g., gender, race/ethnicity) and family environment (e.g., parenting) characteristics were examined. Multiple practice and policy implications were discussed, including methodological suggestions for future research and potential intervention approaches for IPV-exposed children experiencing bullying perpetration and victimization. Evans et al. ( 2021 ) reviewed 13 articles that examined children’s acceptance of parental IPV and appraisals of IPV, including perceived threat, self-blame attributions, and coping efficacy. A cognitive-contextual theoretical framework guided this review, focusing on how children’s adjustment is affected by their perceptions and interpretations of IPV, as well as child-level factors such as child age and gender. Findings revealed that children exposed to IPV had a higher likelihood of accepting parental IPV as normative or justifiable, which in turn predicted youths’ ADV perpetration and victimization outcomes. Furthermore, children’s appraisals of IPV threat and self-blame served as key cognitive intervening factors to explain the link between IPV exposure and other child outcomes, including self-efficacy, social anxiety, and internalizing problems. Implications for future research are discussed, including the necessity of examining IPV acceptance and appraisals across developmental stages, as well as more focused attention on coping efficacy as a key element in the appraisal process. Berg et al. ( accepted ) reviewed 23 articles that examined the effects of IPV exposure on children’s physiological functioning as measured by effects on the hypothalamus–pituitary–adrenal (HPA) axis and both sympathetic and parasympathetic components of the autonomic nervous system (ANS). Though findings generally demonstrated an effect of IPV exposure on HPA axis dysregulation as indexed by heightened salivary cortisol measured basally and in response to a laboratory stressor, more nuanced measurement of IPV exposure (e.g., recent trajectory of IPV exposure, frequency) will be important in future research delineating patterns of heightened vs. attenuated cortisol reactivity. Children’s stress activation response consequent of exposure to IPV was also measured by dysregulation of both sympathetic (indexed by skin conductance level and reactivity, blood pressure, and heart rate) and parasympathetic (indexed by respiratory sinus arrhythmia/vagal tone and reactivity) nervous systems of the ANS. Significant implications are noted for assessment and treatment of IPV-exposed youth, including the necessity of using neurodevelopmentally informed therapeutic approaches that target key bioregulatory functions implicated in the stress response system. Cage et al. ( 2021 ) reviewed 13 articles that examined the effects of IPV exposure on academic functioning. Most reviewed studies identified a negative association between IPV exposure and academic functioning as measured by grade retention, suspension and expulsion, truancy and absenteeism, disciplinary infractions, and failing grades. Negative effects were exacerbated for children dually exposed to IPV and child maltreatment. A primary research implication is the absence of a strong theoretical framework to explain the mechanisms that contribute to differential academic functioning between IPV-exposed and non-exposed youth.
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