Domestic violence and abuse across the life-course

The impact of domestic violence and abuse on infant mental health

Wendy Bunston

Introduction

Infant Mental Health (IMH) is concerned with beginnings. First and foremost, beginning with the infants birth and early years. This includes understanding the parents/carers’ early beginnings, relationally and contextually, and how this has shaped who they are; and how the evolving infant-parents/carers’ relationship, with all the potential it holds, effects them in return. These threads then weave together to influence the developing infant and their caregiving world and intersect powerfully with multiple contextual factors such as race, culture, ideology, religion, gender and socio-economic considerations. Specific to this chapter is how domestic violence and abuse (DVA) within the primary caregiving relationship impacts the mental health of the infant.

Research has unequivocally demonstrated that DVA impacts the infants mental health and wellbeing (Schechter, Willheim, Stiardi, & Serpa, 2019). The repetition of early relational trauma in the caregiving world lays the foundation for all subsequent development (Stern, 1985/2003). As yet without words, the preverbal infant communicates volumes about their world, psychosomatically, relationally and emotionally. Holding the infants’ experience of DVA in mind calls for adults to resist the impulse to minimise or disappear this trauma, as

fully engaging with an infant or young child’s psychological distress is often too confronting and too painful ... if we are not prepared to go there, we leave the very small child alone to manage this by themselves, something they are neurologically, emotionally and physiologically ill-equipped to do.

(Bunston, 2017, p. 15)

Chapter overview

An overview of what is known about the developing infant begins this chapter. This will be followed by describing what IMH is and does, with prevailing research and thinking into the impacts of trauma on infants explained. The available research on the impacts of DVA on IMH will then be described in more detail and a critique of this research provided. Next will be a consideration of how to approach researching, as well as purposefully intervening with infants and mothers, and how fathers who use violence are included in this space. The final area explored involves hope, and the under-conceptualised, under-researched and underestimated hope infants hold for changing the future.

The developing infant

Infants demonstrate their ability for engaging with others, exploring their environment and demonstrating self-agency soon after birth (Zeanah Jr, 2009). The infant possesses a sense of self as separate to, but in relationship with others, and attempts to create connectedness, building their social and emotional competencies as they discover “ways-of-being-with-others” (Stern, 1985/2003, p. xii). This is “how communication begins and develops in infancy, how it influences the individual subjects movement, perception, and learning, and how the infant’s biologically grounded self-regulation of internal state and self-conscious purposefulness is sustained through active engagement with sympathetic others” (Trevarthen & Aitken, 2001, p. 3).

The sensate, embodied and physiological processes experienced by the newborn are shaped by how their caregiving system responds to and/or initiates each relational exchange. Such exchanges have been described as a neural “mapping of the other onto the self” (Ammaniti & Gallese, 2014, p. 8). This exchange is reciprocal, particularly with the mother, who, as the likely primary caregiver (DESA, 2011), is most significantly impacted by the experience of giving birth (Stern, 1998), and most vulnerable to experiencing DVA at the hands of men (WHO, 2013).

Essentially, the infant is neurologically ‘wired to connect’ and will innately seek out proximity with others, occurring even when those others may also be a source of harm (Main, Hesse, & Hesse, 2011). A major developmental task for the first years of life is the infant beginning to emotionally and physically regulate, internalising the outside experience of being held ‘well enough’ physically, emotionally and relationally by their caregiving context (Winnicott, 2002). Emotional affect regulation, that of being able to manage internal feeling states, occurs in the context of safety and active reassurance, as does the capacity to experience relational repair when things do not immediately go well (Tronick, 2007). “Feeling felt” is an important validation of the emerging sense of self and throughout one’s lifetime, as “empathy soothes us and makes us feel safe” (Fishbane, 2007, p. 403).

It is the caregiving context enveloping the infant which directly shapes their attachment/s and “the functional origins of the bodily-based implicit self” (Schore & Schore, 2008, p. 10). Further, the quality of the attachment the infant develops in their primary caregiving relationships directly impacts the infant’s neurological, physiological, psychological and emotional development (Schore, 2016; Siegel, 2012). It is the reciprocity the infant is capable of which seems extraordinary to many adults: their demonstrated ability to show empathy tor others, to initiate social engagement, and the evidence of implicit relational perceptiveness beginning in their first year of life (Liddle, Bradley, & McGrath, 2015).

Infant mental health

IMH focuses on the infant, their parent/s and the relational health of the caregiving system. Traditionally targeting the prenatal stage to age 3 (WAIMH, 2019), some now extend this to age 5. Zeanah Jr and Zeanah (2019, p. 6), quoting ZeroToThree (2001) explains that IMH is concerned with:

the young child’s capacity to experience, regulate and express emotions, form close and secure relationships, and explore the environment and learn. All of these capacities will be best accomplished within the context of the caregiving environment that includes family, community and cultural expectations tor young children.

In 2016 the World Association for Infant Mental Health (WAIMH) developed a “position paper on the rights of infants” (WAIMH, 2016, p. 4) declaring:

The infants status as a person is to include equal value for life regardless of gender or any individual characteristics such as those of disability . . . the right to be given nurturance that includes love, physical and emotional safety, adequate nutrition and sleep . . . the right to be protected from neglect, physical, sexual, and emotional abuse, including infant trafficking.

IMH is concerned with the overall welfare of infants, including adequate access to food, shelter and clothing as well as love, attention, protection and care (Weatherston, 2000). The infant is fully dependent on others for their survival and “cannot exist alone but is essentially part of a relationship” (Winnicott, 1964, p. 88).

As a field of enquiry, IMH began in the UK and US in the 1960s, drawing on developmental psychology and psychoanalysis (Harman, 2003; Zeanah Jr, 2019). Today, it is a large international, multidisciplinary, theoretically diverse, clinically based, scientific and research-informed field with most knowledge derived from research with infants from high-income countries (Bornstein, Put- nick, Park, Suwalsky, & Haynes, 2017). As such, IMH knowledge has largely been formulated by white, Western, upper middle-class practitioners, researchers and academics, using a heteronorma- tive lens and concerned with the influence of the early years across the lifespan. However, Western childrearing practices have been charged with being ethnocentric, posing challenges for differing cultural practices and what determines a beneficial start in life (Quinn & Mageo, 2013).

The mainstays of thinking within IMH includes attachment theory (Salter-Ainsworth & Bowlby, 1991), psychoanalytic and object relations concepts (Winnicott, 2002) and the transgenerational transmission of trauma (Fraiberg, Adelson, & Shapiro, 1975). Research into the brain throughout the 1990s laid the foundation for what is now a scientific agenda influencing IMH research and practice (Jones & Mendell, 1999), along with more recent explorations into epigenetics (Zeanah Jr, 2019). Current research into the cognitive and sensory-perceptual capacities of infants has definitively demonstrated that infants are not passive participants in the parent/infant relationship but competent and sentient beings in and of themselves, impacted by as well as impacting their caregiving environment (Ammaniti & Gallese, 2014).

Absent from IMH research and infant development generally, is a comprehensive examination of the effects of systemic racism, war, famine, ill-health, oppressive regimes and ideologies and the complexities facing low-income countries. The impacts of disease, poverty, malnutrition and lack of health care are conspicuous and measurable, receiving considerably more attention in the literature (Lu, Black, & Richter, 2016). Giving space to the experience of infants and their caregivers in low-income countries, their experience of violence and oppression, and the equally strong bonds and determination of mothers to protect and see their infants thrive, remains a challenge tor this sector.

Impacts of relational, emotional, physical trauma and abuse on the infant

Infants are at the greatest risk of harm, neglect and death than any other time in childhood (UNICEF, 2015) with DVA identified as a significant associated factor (Menon, 2014). Within high-income countries where DVA is present, infants and young children are at a heightened risk ot being removed from families by state-based child protection services and placed in kinship or non-familial care (Alaggia, Gadalla, Shlonsky, Jenney, & Daciuk, 2015). Less common, poorly understood and responded to are incidences of filicide, murder-suicide and tanrilicide, and the immediate and long-term impacts and consequences for surviving infants and siblings (Eyre, Milburn, & Bunston, 2020). Ot concern tor this chapter is what occurs for the infant when the caregiving environment is impacted by DVA such that the provision of‘good enough parenting’ is thwarted or severely jeopardised.

Early childhood maltreatment has been linked to symptoms of anxiety and depression during adolescence (Harpur, Polek, & van Harmelen, 2015); increased risk of developing cancer, cardiovascular difficulties and immune system deficiencies (Cicchetti, Hetzel, Rogosch, Handley, & Toth, 2016); and reduced cerebral volume, verbal memory retrieval, attention and cognitive deficits (Carrion, Wong, & Kletter, 2013). The Adverse Childhood Experiences (ACE) study involving 17,337 adults, including some who reported experiences of DV (Anda et al., 2006, p. 174), found a correlation between ACEs and substance abuse, neuropsychiatric syndromes, numerous health problems and relational difficulties.

To some extent the impacts of exposure to early infant trauma are interred (Schechter & Willheim, 2009). This is not to argue that they are not real, but that direct and time-specific correlates are hard to measure given much relational trauma impacting infants and young children occurs behind closed doors. Such trauma is infrequently reported, difficult to substantiate and too often minimised (Gilbert et al., 2009). Abuse may not be evident in infancy until a baby requires urgent medical attention, dies or impacts become apparent through longitudinal or retrospective studies (Enlow, Egeland, Blood, Wright, & Wright, 2012).

During pregnancy the foetal brain is vulnerable to acute maternal hormone expression resulting from trauma and stress and can leave enduring impacts (Berens & Nelson, 2019). Post- natally, the developing brain is ‘experience dependent’, shaped by their caregiving environment and with exposure to ongoing stress or trauma believed to significantly increase cortisol levels and the release of flight/fight hormones, epinephrine and norepinephrine, saturating the rapidly developing but immature brain. This is detrimental to cognitive development, affect regulation and optimal growth ot the brain (Carpenter & Stacks, 2009). Ongoing and significant early relational trauma and maltreatment has been demonstrated to impinge hippocampal, cerebellar and corpus callosum volume; impair synaptic growth; and risk damage to the prefrontal cortex and limbic regions (Teicher & Samson, 2013). Such functional losses are consistent with the classification ot paediatric posttraumatic stress disorder (Carrion et al., 2013).

Early implicit memories, particularly those created through trauma, are believed to remain operating throughout our lives, acting as the foundation upon, and intimately linked with later developing explicit memories and a sense of self (Van der Kolk, 2014). The right brain, responsible for the emotional, non-verbal self is dominant in the first 24 months of life and is highly vulnerable to cumulative, traumatic events “which are imprinted into the neurobiologi- cal structures that are maturing during the brain growth spurt ot the first two years of life, and therefore have far-reaching effects’’ (Schore, 2001, p. 208).

Poor emotional development in the preverbal period impacts later developing, left hemisphere language, cognition and social capabilities (Schore, 2016; Van der Kolk, 2014). Teicher, Samson, Polcari and McGreenery (2006) in their research into the various effects of childhood maltreatment found that the “combined exposure to verbal abuse and witnessing of DV was associated with extraordinarily large adverse effects, particularly on dissociation’’ (p. 997), an outcome which has profound implications for future interpersonal relationships, skill acquisition and learning.

Research into the impacts of DVA in the early years

Infants born to mothers who were assaulted whilst pregnant are twice as likely to have lower birth weights, and more likely to suffer toetal death or die within the first year of life with infant mortality higher amongst females in some developing countries (Menon, 2014). Research specifically targeting DVA exposure in the early years points to difficulties in three substantive and intimately interconnected areas:

  • • Forming healthy attachments.
  • • Affect regulation.
  • • Developmental pathways.

Forming healthy attachments

The infant develops within the context of their caregiving environment, forming a significant attachment to a specific caregiver/s which largely endures across time (Van Ryzin, Carlson, & Sroute, 2011). Four basic categories describe the type of attachment the infant develops through organising themselves in response to what they come to expect from each caregiver interaction (Crittenden & Ainsworth, 1989).

Secure Attachment: the infant is supported over time to develop a healthy and autonomous sense of self, engaging in play and discovery, experiencing their caregiver as a safe haven, finding continuity in this relationship and congruence in how to read and respond to the cues of others.

Anxious Ambivalent: an infant or young child is excessively clingy and loath to separate from their caregiver, yet does not appear to gain sufficient comfort from their closeness.

Anxious Avoidant: the infant appears to seldom use their caregiver as an emotional anchor yet will not stray too far. Proximity is desired but past experience has taught them that to express this need risks rejection.

Disorganised Attachment: the infant does not find sanctuary in their relationship with their primary caregiver/s. They experience a paradox of wanting to seek safety with, but feel frightened of approaching their caregiver/s, exhibiting complex, contradictive, inexplicable and disorientated behaviours.

DVA reflects a ‘disorder of an attachment’ within a caregiving system according to (Bowlby, 1984). He believed violence, from male to female, or parent to child, tended to be transmitted across generations. The excessive and distorted use of anger was used to prevent the threat of abandonment, maintain proximity or assert control over another. Bowlby (1984) was appalled that “family violence as a casual factor in psychiatry should have been so neglected by clinicians” (p. 9). A comprehensive meta-analysis of the literature found attachment styles which are classified as insecure, strongly correlate with violent offending behaviours (Ogilvie, Newman, Todd, & Beck, 2014). Lieberman, Chu, Van Horn and Harris (2011) argue that, where children are exposed to DVA, it is the child 5 years and under who are most likely to experience DVA yet are least likely to be provided with a service response.

The infant in utero and DVA

The circumstances surrounding an infants conception also has potential implications for their mental health. This includes, for example, where infants are conceived through rape or coercion, a mother experiences increasing violence targeted at herselt and the unborn foetus, a mother is prevented from seeking an abortion or is accused of infidelity. Such circumstances impact a mother’s feelings and ideas about the baby growing inside of her. “Maternal representations” describes how a mother comes to imagine what their baby is like, in character, temperament and personality, and the influence of her own current circumstances, and early experiences ofbeing parented (Benoit, Zeanah, Parker, Nicholson, & Coolbear, 1997). For the infant to find security in their attachment with their caregiver, their caregiver requires a healthy “awareness of mental processes in the self and other” (Fonagy, Steele, Steele, Moran, & Hig- gitt, 1991, p. 203). Ongoing threat and/or presence of harm impinges the capacity for healthy awareness of others in favour of survival.

Envisioning the infant and the impact of their arrival becomes very potent during pregnancy, for the mother, father or co-parent, as their own implicit and explicit childhood experiences and memories of how they were parented are activated. “Caregivers who have unresolved mourning or trauma” (Crawford & Benoit, 2009, p. 132) and who themselves were exposed to DVA as infants and children risk carrying states of mind which may inhibit the infant forming a close and healthy attachment (Malone, Levendosky, Dayton, & Bogat, 2010).

Attachment difficulties

Exposure to DVA during pregnancy and in the early years has significant impacts on the infant’s ability to attach securely to their mother and father. The Michigan “Mother-Infant Study” with 150 pregnant women experiencing DV (Levendosky, Leahy, Bogat, Davidson, & von Eye, 2006) found the quality of the attachment of the infant with their mother was negatively impacted where mothers experienced DV during the pregnancy and their first years of life. In part, this was caused by the DV interrupting the maternal capacity to positively hold in mind a sense of themselves becoming a mother and their growing sense of their infant. However, where a mother had left a violent relationship post the birth and before age 1, the child by age 4 was more likely to be securely attached (Levendosky, Bogat, Huth-Bocks, Rosenblum, & Von Eye, 2011).

Research from the Lehigh Longitudinal Study recruited 457 toddlers from 18 months up to children aged 6 (average age 4) and their primary caregivers, from both child welfare services and community day care centres (Herrenkohl & Herrenkohl, 2007). Attempts to strengthen their attachments to parents post their early childhood experience of violence and abuse was hypothesised to be insufficient to ameliorate the impacts of this early trauma (Sousa et al., 2011).

Attachment behaviours

An infant’s attachment behaviour emerges from their relational exchange with their caregiver/s. Inherent in creating security is a reciprocity of engagement, with the mother and/or father/ carer able to offer the infant responsive and attuned caregiving. This effectively provides the infant with external relational responses which help them to manage their own, overwhelming, internal emotional states; something they cannot do alone. If these states are со-managed with their mother’s, father’s or primary caregiver’s help, albeit not always perfectly but consistently enough; over time the infant internalises these neurophysiological competencies which allows the foundation for the developing child’s own increasing capacity for affect regulation. When faced with unpredictable or frightening responses an infant will initially exhibit proximityseeking behaviours. However, if these prove futile and occur repeatedly, “the younger the child, the less internal capacities they have at their disposal and the more likely they will be to dissociate. All of these defences serve to anaesthetise feelings of tear” (Bunston, 2017, p. 33). Maternal sensitivity decreases with DV, impacts maternal mental health and increases aggression and externalising difficulties in infants by age 1 as a result of maternal dysregulation (Levendosky et ah, 2006).

Criticism

Attachment theory is a dominant prism through which infant development and the impacts of DVA are understood. This includes using standardised and quantitative research approaches which (Lapierre, 2008) argues places “the problem primarily with women and their mothering” (p. 456) rather than the violent behaviour of men and serves to “obscure the variability of children’s individual experiences” (p. 455). Main et al. (2011) acknowledges that “all present methods of assessing attachment were designed for research purposes . . . and have yet to be sufficiently tested for their predictive powers with respect to the assessment of individuals” (p. 428). The ethics of using standardised procedures which force separations between mothers and infants to assess attachment profiles have been called into question (Bunston, 2016), whilst (White, Gibson, Wastell, & Walsh, 2019) argue that the dominance of attachment theory in research and practice needs to be challenged by a more realistic view of the complexities and power of human connections.

Buchanan, Power and Verity (2013) argue that the ascendancy of attachment thinking has precluded an appreciation of gendered violence and tailed to acknowledge the role fear plays in a mother’s protectiveness ot her infant and the developing infant/mother relationship. Attachment theory has promoted “mother blaming” contends Jackson & Mannix, (2004) and “failed to acknowledge the gendered nature of the social world” (p. 157).

Research with a large USA sample ot low income and ethnically diverse mothers and preschool children, Starting Early, Starting Smart, found a relational “spill-over” effect of living with DVA. They found that harsher maternal discipline was associated with inter-partner conflict, negatively impacted child development, but did not lessen maternal warmth, and situated the negative impacts of DVA with the violence, and not the mother (Whiteside-Mansell, Bradley, McKelvey, & Fussell, 2009). Letourneau et al. (2013) in a smaller Canadian study found that whilst there was some level of spill-over in caregiving practices resulting from DV, mothers and infants exhibited compensatory behaviours within their interactions in response to living with violence. Missing from the research is how compensatory relationships formed with others, such as extended family members, siblings, childcare personnel and others who may provide relational reparation. Nor has an appreciation of children’s own resilience been adequately explored. Furthermore, the interplay between other significant variables such as social, economic, racial and gender inequality seldom receive due attention in the research and practice space.

Affect regulation

The newborn, infant or very young child is reliant on their caregiver/s to manage their emotional wellbeing. “This process is internalized and over time builds the capacity for effective self-regulation” (Arvidson et al., 2011, p. 38). However, when a mother herself is overwhelmed by DVA, past traumatic memories and the struggle to survive; the capacity to manage her own dysregulation, let alone her infants is severely diminished. Levendosky, Bogat and Mar- tinez-Torteya (2013) found that “in the youngest children, affective dysregulation is the most dominant response to witnessing IPV” (p. 196). Internalising (withdrawal, shutting down) and externalising (oppositional behaviour, settling problems) difficulties are the most reported symptoms resulting from exposure to DV in infancy. Children at age 3 who had experienced DV across their lifetime exhibited arousal and avoidance symptoms which by school age were more likely to measure within the subclinical range for disturbances in internalising and externalising difficulties (Briggs-Gowan, Carter, & Ford, 2012).

Developmental pathways

DVA impacts the infants ability to find a secure attachment and safe haven to help organise heightened emotional states, impeding development. Early experiences matter. In their small-scale study, Letourneau et al. (2013) found “effects of exposure to IPV even on children younger than 3 years of age”. Whilst their study suggested that infants counteracted the effects ot Interpersonal Family Violence in their interactions with their mothers, “children in the sample scored significantly lower on the Ages and Stages Questionnaire (ASQ) Fine Motor and Problem Solving subscales and the means ot the remaining ASQ subscales were lower (although not significantly) than the norm” (Letourneau et al., 2013, p. 5S2).

Levendosky et al. (2013) found that as childrens ages increased so too did their traumatic symptoms. Where infants struggle with affect regulation young children start to exhibit “more cognitive and behavioural dysregulation as a response to witnessing IPV” (p. 196). Kitzmann, Gaylord, Holt and Kenny (2003) in their meta-analytic review of 118 studies into child witnesses to DV suggested that pre-schoolers were at greater risk of problems in social competence and sensitivity to anticipated parental conflict. Osofsky (2003) reported on the ripple effect of children exposed to DV and child maltreatment, observing “disturbances in school behaviour, mixed feelings toward parents with positive affect being mingled with anger, and difficulties in forming later relationships” (p. 166).

A study of 206 children in the USA from infancy to early school years measured intelligence quotient, language and academic progress across three points with delays becoming increasingly evident as children grew older (Enlow et al., 2012). DVA was associated with decreased cognitive capacity, and most evident in the cohort exposed to family violence from birth to 2 years. Similarly, a study involving 47 children (7—16 years) used multiple standardised measures to assess their cognitive functioning concluded that family violence inhibited executive functioning, and increased impulsivity and distractibility (Samuelson, Krueger, & Wilson, 2012). DVA impacts 1MH over generations, and shapes developmental trajectories as does “consideration of the ways in which historically informed systemic inequities intersect to create social conditions that increase risks for negative experiences such as IPV . . . and the compounded hardship that families face” (Grady, Hinshaw-Fuselier, & Friar, 2019, p. 634).

Practice interventions which start with the infant’s inclusion

Interventions targeting the impacts ot DVA traditionally focus on children only, mothers only, or have used conjoint models, with separate concurrent groups for children and their mothers, and with some combined time (Graham-Bermann, Miller-Graff, Howell, & Grogan-Kavlor, 2015; McWhirter, 2011). Interventions have tended to include verbal children from 4 upwards, leaving mothers responsible for attending to the resulting impacts of the trauma.

Approaches often emphasise education, behavioural change or enhancing maternal sensitivity (Letourneau et ah, 2015).

However, the need to intervene earlier is clearly indicated. Interventions with the infant in mind, particularly in relation to DVA, have been scarce. This reflects a generalised belief that infants do not remember, are not impacted or are too young to understand what is happening. Furthermore, anxiety abounds in misguided attempts to ensure that the relational, emotional and psychological safety' of infants is not further exacerbated by their inclusion in therapeutic interventions, resulting in infants being excluded from service responses. Unwittingly, this failure to actively involve the infant in therapeutic work risks disappearing their experience altogether.

The infants experience is relevant in dyadic and familial exchanges yet is made meaningless it they are not directly invited to participate and add their perspective to research, thinking and interventions which directly concern them (Bunston & Jones, 2020). Infants occupy the space where language has less meaning than action, participation, reciprocity and engagement. Infants are more than capable ot letting others know their feeling states and to be active participants in therapeutic interventions should others take care to observe, reflect and intuitively listen to them.

Interventions which are ‘infant inclusive’ (Bunston, 2017) are likely to see rapid changes. Such work includes Child-Parent Psychotherapy (Bernstein, Timmons, & Lieberman, 2019; Lieberman & Van Horn, 2009) which undertakes comprehensive dyadic work with the infant and parent. The Peek a Boo Club offers an ‘infant-led’ approach tor infants from birth to 4 years and their mothers within a group work setting (Bunston, 2015). Mothers in Mind uses a trauma informed, strengths-based group work intervention which caters for vulnerable infants under 4 and their mothers (Jenney, 2020).

Such work recognises the infant’s right to participate, and as the newest, least stuck and most receptive member of a family, the infant is often quickest to engage, ready to adapt and most amenable to change. The infant’s inclusion brings immediate interactional meaning into the research and treatment space as they bring their feeling states authentically to the fore. The infant’s interactions with their caregiver brings multifarious opportunities for intervention and reflection and presents evocative and immediate opportunities for revisiting parents’ own past experiences.

Involving fathers

Controversy surrounds developing interventions tor fathers who use violence and evaluation of such programmes remain limited (Labarre, Bourassa, Holden, Turcotte, & Letourneau, 2016); however, there is increasing recognition that infants and young children often remain living with or remain in contact with fathers who use violence. For better or for worse, infants and young children form attachments with their fathers which are meaningful, often complex, may be different to what others experience, deserve to be acknowledged and allowed space to be safely recognised and made sense of (Jones & Bunston, 2012). “As the product ofboth parents, the infant needs something good to take from both, helping them to grow their sense of identity as connected to, but also separate from, both their mother and father” (Bunston, 2017, p. 156). However, working with fathers who have used violence should by no means place the infant at risk. To the contrary, it is imperative to make blatant the safety of infants and young children as the centrepiece in any work which concerns them.

Amongst the small number of programmes available approaches vary. For example, Caring Dads works solely with the fathers through what is largely a group-based motivational intervention to enhance men’s capacity tor child sensitive parenting (McConnell, Barnard, & Taylor, 2017). Fathers for Change piloted an intervention which combined attachment, systems and cognitive approaches, and provided individual treatment, co-parenting sessions and targeted interactional change through videotaped sessions of fathers engaged in free play (Stover, 2015). The Bnhs on Board pilot programme worked with fathers post a men’s behaviour change programme, working directly with the infant/young child and their father in a group setting (Bunston, 2013). For Baby’s Sake commences their work with mothers and fathers during pregnancy, remains involved for the first two years and uses a ‘whole of family’ trauma and attachment- based approach (Domoney et al., 2019). Changing Futures tailored their work to flexibly meet the needs of the family and affect wider systems change (Stanley & Humphreys, 2017).

Labarre et al. (2016) argue that “it is vital to support fathers who wish to eliminate their violent behaviour and become positively engaged in their children’s lives” (p. 3). Analysing ten intervention programmes, Labarre et al. (2016) state that fathers need to take responsibility for their children, be accountable for their violence, need support to change and, as many remain involved in their children’s lives, use their motivation for wanting a relationship with their children as leverage for change.

Hope

Neuro-biologically, the birthing process “allows for mutual regulation of vital endocrine, autonomic, and central nervous systems of both mother and infant by elements ot their interaction with each other” (Schore, 2005, p. 207). Oxytocin, associated with building trust and bonding can be activated during pregnancy and birth (Clark et al., 2013; Kimura, Tanizawa, Kensaku, J, & Hiroto, 1992) and a sensitivity to environmental impacts is heightened (Luijk et al., 2011). This early stage of infancy is their most vulnerable, but most expectant, with services, support, engagement and openness to possibilities ripe. Newborns actively seek and invite their parents to connect with them and can bring something new to the lives ot their caregivers.

Young children exposed to DV have been shown to exhibit higher than usual sensitivity and clearer cues to their mothers than the norm, suggesting that the child actively participates in compensatory interactions with their mothers (Letourneau et al., 2013). Possibilities of change and wanting better for their children is a strong motivation for a mother to leave a violent relationship: “Infants and small children can represent hope for parents. This is in the form of repairing hurts from the past and creating something new. This is about capitalising on hope” (Bunston, 2017, p. 27).

Conclusion

This chapter has provided an overview of infant development, 1MH and the deleterious impacts of DV on the infant’s ability to find security within their attachments, and subsequent developmental trajectories. How the DVA sector responds to the challenges ot bringing the infants’ experiences of trauma and abuse into the forefront of this work will have implications for generations to come.

This chapter returns to where it began: with the evolving possibilities that the infant-parent relationship holds. The restorative hopefulness and receptivity of infants to change and healing, and the motivation many parents possess to grow a safe, different and healthy relationship with, and future for, their infants has yet to be fully recognised in DVA work. Not least because the infant and very young child is entitled, deserves and craves safe, respectful inclusion in all matters which concern them.

AcknoAvledgement

Many thanks to Associate Professor Brigid Jordan for her time and feedback on early sections of this chapter.

Critical findings

  • • From birth the infant possesses subjectivity, demonstrates reciprocity' and engages with their relational world.
  • • The infants mental health, general development and quality of attachment is adversely impacted by DVA.
  • • Keeping infants safe from harm does not prevent ‘infant inclusive practice’ nor their experiences of DVA to be kept in mind.
  • • Infants, as the newest members of families, can provide an entry point for engaging in change and hold hope for the future.

Implications for policy, practice, and research

  • • The infants experience can, and is entitled to be included in DVA practice, policies and research which concern them.
  • • The vulnerability of the infant to DVA calls for a greater service response.
  • • Recognition of wider social, gender and cultural inequalities for infants and their families experiencing DVA requires attention.
  • • The experience ot the infant can bring something new to DVA research and service responses.

References

Alaggia, R., Gadalla, T. M., Shlonsky, A., Jenney, A., & Daciuk, |. (2015). Does differential response make a difference: Examining domestic violence cases in child protection services. Child & Family Social

Work, 20(1), 83-95.

Ammaniti, M., & Gallese, V. (2014). The birth of intersubjectivity: Psychodynamics, neurobiology, and the self. New York, NY: W.W. Norton & Company.

Anda, R. F„ Felitti, V. J.. Bremner.J. D„ Walker, J. D„ Whitfield, C„ Perry, B. D„ . . . Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. European Archives oj Psychiatry and Clinical Neuroscience, 256(H), 174-186. doi: 10.1007Л00406-005-0624-4

Arvidson, J., Kinniburgh, K., Howard, K., Spinazzola, J., Strothers, H., Evans, M., . . . Blaustein, M. E. (2011). Treatment of complex trauma in young children: Developmental and cultural considerations in application of the arc intervention model. Journal of Child & Adolescent Trauma, 4(1), 34—51. doi:10. 1080/19361521.2011.545046

Benoit, D., Zeanah, С. H., Parker, К. C., Nicholson, E., & Coolbear, J. (1997). “Working model of the child interview”: Infant clinical status related to maternal perceptions. Infant Mental Health Journal,

18(1), 107-121.

Berens, A. E., & Nelson, C. A. (2019). Neurobiolog)' of fetal and infant development: Implications for infant mental health. In |. Charles & H. Zeanah (Eds.), Handbook of infant mental health (4th ed., pp. 41—80). New York, NY: The Guilford Press.

Bernstein, R. E., Timmons, A. C., & Lieberman, A. F. (2019). Interpersonal violence, maternal perception of infant emotion, and child-parent psychotherapy. Journal of Family Violence, 34(4), 309—320. dot: 10.1007/sl 0896-019-00041-7

Bornstein, M. H., Putnick, D. L., Park, Y., Suwalsky, J. T. D., & Haynes, О. M. (2017). Human infancy and parenting in global perspective: Specificity. Proceedings of the Royal Society B, 284, 20172168. doi: 10.1098/rspb. 2017.2168

Bowlby, J. (1984). Violence in the family as a disorder of the attachment and caregiving systems. American Journal of Psychoanalysis, 44(1), 9—27.

Briggs-Gowan, M. J., Carter, A. S., & Ford, J. D. (2012). Parsing the effects violence exposure in early childhood: Modeling developmental pathways. Journal of Pediatric Psychology, 37(1), 11—22. doi:10.1093/ jpepsy/jsr063

Buchanan, F., Power, C., & Verity, F. (2013). Domestic violence and the place of fear in mother/baby relationships: “What was I afraid of? Of making it worse.”. Journal of Interpersonal Violence, 28(9), 1817— 1838. doi:10.1177/0886260512469108

Bunston, W. (2013). “What about the fathers?” bringing “Dads on Board™” with their infants and toddlers following violence. Journal of Family Studies, 19(1), 70—79.

Bunston, W. (2015). Infant-led practice: Responding to infants and their mothers (and fathers) in the aftermath of domestic violence. In N. Stanley & C. Flumphreys (Eds.), Domestic violence and protecting children: New thinking and approaches. London, UK: Jessica Kingsley Publishers.

Bunston, W. (2016). How refuge provides 'refuge* to Infants: Fxploring how 'refuge* is provided to infants entering crisis accommodation with their mothers after fleeing family violence (PhD thesis). La Trobe University, Melbourne. Retrieved from http://hdl.handle.net/1959.9/559171

Bunston, W. (2017). Helping babies and children (0—6) to heal after family violence: A practical guide to infant- and child-led practice. London, UK: Jessica Kingsley Publishers.

Bunston, W., & Jones, S. J. (2020). Supporting vulnerable babies and young children: Interventions for working with trauma, mental health, illness and other complex challenges. London, UK: Jessica Kingsley Publishers.

Carpenter, G. L., & Stacks, A. M. (2009). Developmental effects of exposure to intimate partner violence in early childhood: A review of the literature. Children and Youth Services Review, 31(8), 831—839.

Carrion, V, Wong, S., & Kletter, H. (2013). Update on neuroimaging and cognitive functioning in maltreatment-related pediatric PTSD: Treatment implications. Journal of Family Violence, 28( 1), 53—61.

doi: 10.1007A10896-012-9489-2

Cicchetti, D, Hetzel, S., Rogosch, F. A., Handley, E. D, & Toth, S. L. (2016). An investigation of child maltreatment and epigenetic mechanisms of mental and physical health risk. Development and Psychopathology, 28(4pt2), 1305-1317. doi: 10.1017/S0954579416000869

Clark, C. L., St. John, N., Pasca, A. M., Hyde, S. A., Hornbeak, K., Abramova, M., . . . Penn, A. A. (2013). Neonatal CSF oxytocin levels are associated with parent report of infant soothability and sociability. Psyclioneuroendocrinology, 38(7), 1208—1212.

Crawford, A., & Benoit, D. (2009). Caregivers’ disrupted representations of the unborn child predict later infant — Caregiver disorganized attachment and disrupted interactions. Infant Mental Health Journal, 30(2), 124-144. doi: 10.1002/imhj.20207

Crittenden, P. M., & Ainsworth, M. D. S. (1989). Child maltreatment and attachment theory. In D. Cicchetti & V. Carlson (Eds.), Child maltreatment: Theory and research on the causes and consequences of child abuse and neglect (pp. 432—463). Cambridge, UK: Cambridge University Press.

DESA. (2011). Men in families and family policy in a changing world. New York, NY: United Nations. Retrieved from www.un.org/esa/socdev/family/docs/men-m-families.pdf

Domoney, J., Fulton, E., Stanley, N., McIntyre, A., Heslin, M., Byford, S., . . . Trevilhon, K. (2019). For baby’s sake: Intervention development and evaluation design of a whole-family perinatal intervention to break the cycle of domestic abuse. Journal of Family Violence, 34(6), 539—551. doi: 10.1007/ si0896-019-00037-3

Enlow, M. B., Egeland, B., Blood, E. A., Wright, R. O., & Wright, R. J. (2012). Interpersonal trauma exposure and cognitive development in children to age 8 years: A longitudinal study. Journal of Epidemiology and Community Health, 66(11), 1005—1010. doi: 10.1136/jech-2011-200727

Eyre, K., Milburn, N., & Bunston, W. (2020). ‘Murder in their family’: Making space for the experience of the infant impacted by familial murder. In W. Bunston & S. J. Jones (Eds.), Supporting vulnerable babies and young children: Interventions for working with trauma, mental health, illness and other complex challenges (pp. 107—123). UK: Jessica Kingsley Publishers.

Fishbane, M. D. (2007). Wired to connect: Neuroscience, relationships, and therapy. Family Process, 46(3), 395H-12.

Fonagy, P, Steele, M., Steele, H., Moran, G. S., & Higgitt, A. C. (1991). The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment. Infant Mental Health

Journal, 12(3), 201-218. doi: 10.1002/1097-0355(199123) 12:3 < 201 ::aid-imhj2280120307 > 3.0.co;2-7

Fraiberg, S., Adelson, E., & Shapiro, V. (1975). Ghosts in the nursery. Journal of the American Academy of Child Psychiatry, /4(3), 387-421.

Gilbert, R., Kemp, A., Thoburn, J., Sidebotham, P., Radford, L., Glaser, D., & MacMillan, H. L. (2009). Recognising and responding to child maltreatment. The Lancet, 373(9658), 167—180. doi:10.1016/ SO 140-6736(08)61707-9

Grady, G., Hmshaw-Fuselier, S., & Friar, N. (2019). Expanding perspectives: A social inequities lens on intimate partner violence, reproductive justice, and infant mental health. Infant Mental Health Journal,

40(5), 624-639. doi: 10.1002/imhj.21809

Graham-Bermann, S. A., Miller-Graff, L. E., Howell, К. H., & Grogan-Kaylor, A. (2015). An efficacy trial of an intervention program for children exposed to intimate partner violence. Child Psychiatry and

Human Development, 46(b), 928—939. doi: 10.1007/sl 0578-015-0532-4 Harman, R. J. (2003). Thirty years in infant mental health. Zero-To- Three, 24(1), 22—28.

Harpur, L. J., Polek, E., & van Harmelen, A. L. (2015). The role of timing of maltreatment and child intelligence in pathways to low symptoms of depression and anxiety in adolescence. Child Abuse &

Neglect, 47, 24-37.

Herrenkohl, T. I., & Herrenkohl, R. C. (2007). Examining the overlap and prediction of multiple forms of child maltreatment, stressors, and socioeconomic status: A longitudinal analysis of youth outcomes. Journal of Family Violence, 22(7), 553—562. doi: 10.1007/sl 0896-007-9107-x Jackson, D., & Mannix, J. (2004). Giving voice to the burden of blame: A feminist study of mothers’ experiences of mother blaming. International Journal of Nursing Practice, 10(4), 150—158.

doi: 10.111 l/j.l440-172X.2004.00474.x

Jenney, A. (2020). Keeping the child in mind when thinking about violence in families. In W. Bunston & S. J. Jones (Eds.), Supporting vulnerable babies and young children: Interventions of working with trauma, mental health, illness and other complex challenges (pp. 91—123). London, UK: Jessica Kingsley Publishers.

Jones, E. G., & Mendell, L. M. (1999). Assessing the decade of the brain. Science, 284(5415), 739. doi: 10.1126/science

Jones, S., & Bunston, W. (2012). The “original couple”: Enabling mothers and infants to think about what destroys as well as engenders love, when there has been intimate partner violence. Couple and Family Psychoanalysis, 2(2), 215—232.

Kimura, T, Tamzawa, O., Kensaku, M., J, В. M., & Hiroto, O. (1992). Structure and expression of a human oxytocin receptor. Nature, 356(6369), 526—529.

Kitzmann, К. M., Gaylord, N. K., Holt, A. R., & Kenny, E. D. (2003). Child witnesses to domestic violence: A meta-analytic review'.Journal of Consulting and Clinical Psychology, 71(2), 399—352.

Labarre, M., Bourassa, C., Holden, G. W., Turcotte, P, & Letourneau, N. (2016). Intervening with fathers in the context of intimate partner violence: An analysis of ten programs and suggestions for a research

agenda Journal of Child Custody, 13(1), 1-29. doi:10.1080/15379418.2016.1127793 Lapierre, S. (2008). Mothering in the context of domestic violence: The pervasiveness of a deficit model of mothering. Child & Family Social Work, 13(4), 454—463. doi:10.1111/j.1365-2206.2008. 00563.x

Letourneau, N., Morris, C. Y., Secco, L., Stew-art, M., Hughes, J., & Critchley, K. (2013). Mothers and infants exposed to intimate partner violence compensate. Violence and Victims, 28(4), 571—586. Letourneau, N., Tryphonopoulos, P, Giesbrecht, G., Dennis, C. L., Bhogal, S., & Watson, B. (2015). Narrative and meta-analytic review of interventions aiming to improve maternal — Child attachment security. Infant Mental Health Journal, 36(4), 366—387. doi:10.1002/imhj.21525 Levendosky, A. A., Bogat, G. A., Huth-Bocks, A. C., Rosenblum, K., & Von Eye, A. (2011). The effects of domestic violence on the stability of attachment from infancy to preschool. Journal of Clinical Child &

Adolescent Psychology, 40(3), 398-410. doi:10.1080/15374416.2011.563460 Levendosky, A. A., Bogat, G. A., & Martinez-Torteya, C. (2013). PTSD symptoms in young children exposed to intimate partner violence. Violence Against Women, 19(2), 187—201.

Levendosky, A. A., Leahy, K. L., Bogat, G. A., Davidson, W. S., & von Eye, A. (2006). Domestic violence, maternal parenting, maternal mental health, and infant externalizing behavior. Journal of Family Psychology, 20(4), 544-552.

Liddle, M.-J. E., Bradley, B. S., & McGrath, A. (2015). Baby empathy: Infant distress and peer prosocial responses. Infant Mental Health Journal, 36(4), 446—458. doi:10.1002/imhj.21519 Lieberman, A. F., Chu, A., Van Horn, P, & Harris, W. W. (2011). Trauma in early childhood: Empirical evidence and clinical implications. Development and Psychopathology, 23(2), 397—410. doi: 10.1017/ S0954579411000137

Lieberman, A. F., & Van Horn, P. (2009). Child-parent psychotherapy. In С. H. Zenah Jr (Ed.), Handbook of infant mental health (3rd ed., pp. 439-449). New York, NY: The Guilford Press.

Lu, C., Black, M. M., & Richter, L. M. (2016). Risk of poor development in young children in low- income and middle-income countries: An estimation and analysis at the global, regional, and country

level. The Lancet Global Health, 4(12), e916-e922. doi: 10.1016/S2214-109X(16)30266-2

Luijk, M. P. С. M., Roisman, G. I., Haltigan, |. Ю., Tiemeier, H., Booth-LaForce, C., van Ijzen-

doorn, M. H.....Bakermans-Kranenburg, M. J. (2011). Dopaminergic, serotonergic, and oxy-

tonergic candidate genes associated with infant attachment security and disorganization? In search of main and interaction effects. Journal of Child Psychology and Psychiatry, 52(12), 1295—1307. doi: 10.1111/j. 1469-7610.2011.02440.x

Mam, M., Hesse, E., & Hesse, S. (2011). Attachment theory and research: Overview with suggested applications to child custody. Family Court Review, 49(3), 426-463.

Malone, J. C., Levendosky, A. A., Dayton, C. J., & Bogat, G. A. (2010). Understanding the “ghosts in the nursery” of pregnant women experiencing domestic violence: Prenatal maternal representations and histories of childhood maltreatment. Infant Mental Health Journal, 5/(4), 432—454.

McConnell, N., Barnard, M., & Taylor, J. (2017). Caring dads safer children: Families’perspectives on an intervention for maltreating fathers. Psychology of Violence, 7(3), 406—416.

McWhirter, P. T. (2011). Differential therapeutic outcomes of community-based group interventions for women and children exposed to intimate partner violence. Journal of Interpersonal Violence, 26(12), 2457-2482.

Menon, S. (2014). Unfinished lives: The effect of domestic violence on neonatal and infant mortality (No. 2014— 27). Retrieved from http://hdl.handle.net/10419/126472

Ogilvie, C. A., Newman, E., Todd, L., & Peck, D. (2014). Attachment & violent offending: A metaanalysis. Aggression and Violent Behavior, 19(4), 322—339. doi:10.1016/j.avb.2014.04.007

Osofsky, J. D. (2003). Prevalence of childrens exposure to domestic violence and child maltreatment: Implications for prevention and intervention. Clinical Child and Family Psychology Review, 6(3), 161—170.

Quinn, N., & Mageo, J. (Eds.). (2013). Attachment reconsidered: Cultural perspectives on a western theory. New York, NY: Palgrave Macmillan.

Salter-Ainsworth, M. D, & Bowlby, J. (1991). An ethological approach to personality development. American Psychologist, 46(4), 333—341.

Samuelson, K. W., Krueger, С. E., & Wilson, C. (2012). Relationships between maternal emotion regulation, parenting, and children’s executive functioning in families exposed to intimate partner violence.

Journal of Interpersonal Violence, 27(17), 3532-3550. doi: 10.1177/0886260512445385

Schechter, D. S., & Willheim, E. (2009). The effects of violent experiences on infants and young children. In С. H. Zenahjr (Ed.), Handbook of infant mental health (pp. 197—213). New York, NY: The Guilford Press.

Schechter, D. S., Willheim, E., Suardi, F, & Serpa, S., Rusconi. (2019). The effects of violent experiences on infants and young children. In С. H. Zeanah Jr (Ed.), Handbook of infant mental health (4th ed., pp. 219-238). New York, NY: The Guilford Press.

Schore, A. N. (2001). The effects of early relational trauma on the right brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22(1—2), 201—269.

Schore, A. N. (2005). Back to basics attachment, affect regulation, and the developing right brain: Linking developmental neuroscience to pediatrics. Pediatrics in Revieiv, 26(6), 204—217.

Schore, A. N. (2016). Affect regulation and the origin of the self: The neurobiology of emotional development. New York, NY: Routledge.

Schore, J. R., & Schore, A. N. (2008). Modern attachment theory: The central role of affect regulation in development and treatment. Clinical Social Work Journal, 56(1), 9—20.

Siegel, D. J. (2012). Developing Mind: How relationships and the brain interact to shape who we are (2nd ed.). New York, NY: The Guilford Press.

Sousa, C., Herrenkohl, T. I., Moylan, C. A., Tajima, E. A., Klika, J. B., Herrenkohl, R. C., & Russo, M. J. (2011). Longitudinal study on the effects of child abuse and children’s exposure to domestic violence, parent-child attachments, and antisocial behavior in adolescence. Journal of Interpersonal Violence, 26(1),

111-136. doi: 10.1177/0886260510362883

Stanley, N., & Humphreys, C. (2017). Identifying the key components of a ‘whole family’ intervention for families experiencing domestic violence and abuse. Journal of Gender-Based Violence, /(1), 99—115. doi: 10.1332/239868017X14913081639164

Stern, D. N. (1985/2003). The interpersonal world of the infant: A view from psychoanalysis and developmental psychology. London: Karnac Books.

Stern, D. N. (1998). Mothers’emotional needs. Pediatrics, /02(5), 1250—1252.

Stover, C. S. (2015). Fathers for change for substance use and intimate partner violence: Initial community pilot. Family Process, 54(4), 600—609. doi: 10.1111/famp. 12136.

Teicher, M. H., & Samson, J. A. (2013). Childhood maltreatment and psychopathology': A case for ecophenotypic variants as clinically and neurobiologically distinct subtypes. American Journal of Psychiatry, 770(10), 1114-1133. doi: 10.1176/appi.ajp.2013.12070957 Teicher, M. H., Samson, J. A., Polcari, A., & McGreenery, С. E. (2006). Sticks, stones, and hurtful words: Relative effects of various forms of childhood maltreatment. American Journal of Psychiatry, 163(b),

993-1000.

Trevarthen, C., & Aitken, K. (2001). Infant intersubjectivity: Research, theory, and clinical applications.

Journal of Child Psychology and Psychiatry, 42(1), 3—48.

Tronick, E. Z. (2007). The neurobehavioral and social-emotional development of infants and children. New York, NY: W.W. Norton & Company.

UNICEF. (2015). Committing to child survival: A promise renewed. New York, NY: UNICEF. Retrieved from www.unicef.org/publications/index_83078.html

Van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. London: Penguin Books.

Van Ryzin, M. J., Carlson, E. A., & Sroufe, L. A. (2011). Attachment discontinuity in a high-risk sample.

Attachment & Human Development, 13(4), 381-401. doi:10.1080/14616734.2011.584403 WAIMH. (2016). WAIMH position paper on the rights of infants. Perspectives in Mental Health, 1—2, 3—5. Retrieved from https://perspectives.waimh.org/2016/06/15/waimh-position-paper-on-the- rights-of-infants/

WAIMH. (2019). Overview. Retrieved September 27, 2019, from https://waimh.org/page/about_waimh Weatherston, D. J. (2000). The infant mental health specialist. Zero to 77nrc(October/November), 3—10. White, S., Gibson, M., Wastell, D., & Walsh, P. (Eds.). (2020). Reassessing attachment theory in child welfare. Bristol, UK: Policy Press.

Whiteside-Mansell, L., Bradley, R. H., McKelvey; L., & Fussell, J. J. (2009). Parenting: Linking impacts of interpartner conflict to preschool childrens social behavior. Journal of Pediatric Nursing, 24(5), 389—400. doi: 10.1016/j.pedn.2007.08.017

WHO. (2013). Global and regional estimates of violence against women. Geneva: World Health Organization. Winmcott, D. W. (1964). The child, the family, and the outside world. Harmondsworth, UK: Penguin Books. Winmcott, D. W. (2002). Winnicott on the child. Cambridge, MA: Perseus Publishing.

Zeanahjr, С. H. (2009). Handbook of infant mental health. New York, NY: The Guilford Publication. Zeanahjr, С. H. (2019). Handbook of infant mental health (4th ed.). New York, NY: The Guilford Press. Zeanahjr, С. H., & Zeanah, P. D. (2019). Infant mental health: The clinical science of early experience.

InJ. Charles & H. Zeanah (Eds.), Handbook of infant mental health. New York, NY: The Guilford Press. ZeroToThree. (2001). Definition of infant mental health. Washington, DC: Zero-to-Three Infant Mental Health Steering Committee.

 
Source
< Prev   CONTENTS   Source   Next >