In a recently released issue of Pediatrics(10.1542/peds.2019-2955), Dr. Joshua Jeong and colleagues examine the association between early childhood development (ECD) and intimate partner violence (IPV) in low and middle income countries (LMICs): their research question was whether maternal and paternal stimulation mediate the relationship between ECD and IPV. Parental stimulation includes actions that parents take to engage with their children, such as playing, reading, counting and singing. The authors used data from the Demographic and Health Surveys, which are standardized household surveys conducted in LMICs, enabling “apples to apples” comparisons between countries in very different regions and continents. Data from 11 countries which had included both the childhood development and intimate partner violence “modules” (question sets) from 2011-2018 were analyzed – the final sample included more than 15,000 children aged 3-6 years and their parents. An accompanying commentary by Dr. Leslie Davidson and Rachel Gruver (10.1542/peds.2020-0823) highlights the unique features of this study, and outlines potential next steps. We learn that more than one third of mothers in this LMIC population sample experienced IPV in the past 12 months. In the United States (US), at least 1 in 4 women and 1 in 10 men have experienced IPV, thus even given a very different setting, this study is highly relevant to US practitioners.
Maternal and paternal stimulation were measured by the main caregiver’s report of parental engagement in 6 different behaviors – playing with the child, naming or counting or drawing with the child, reading books or looking at pictures, telling stories, singing songs or taking the child outside. It is fascinating that recording the presence or absence of these concrete actions has been shown to have validity both with observational data and and with assessed developmental outcomes. Could we regularly incorporate this “6 pack” of clear and highly specific activities into both our parenting assessment and anticipatory guidance for families in the office setting? Many pediatricians of course ask about and encourage talking, reading and singing, but I’m not sure we think of these six activities as a cohesive core group of positive parenting behaviors. In Jeong and colleagues’ analysis, this maternal and paternal stimulation data were used in a path analysis (which is really well explained for non-statisticians) to figure out whether decreased parental stimulation explained the impact of IPV on ECD after adjusting for socioeconomic factors, and child and parent descriptors. Decreased stimulation did, in fact, “modestly explain” the detrimental impact of IPV on ECD (to be specific, the negative association between IPV and ECD).
This unique and well done study opens the door to so many questions, both theoretical and practical. In what other ways does IPV influence ECD? What is the impact on the child’s development of witnessing violence or of experiencing violence in the home? How is this different at differing ages? And pragmatically, what culture-specific interventions will reduce IPV and home violence so that every child is able to grow and develop in a safe and secure home? We have our work cut out for us in tackling these critically important arenas, not just in LMICs but at home too.