Child Development - 2022 - Savopoulos - Intimate partner violence during infancy and cognitive outcomes in middle childhood.pdf

Child Development. 2022;00:1–16. wileyonlinelibrary.com/journal/cdev | 1
It is estimated that one in three children in Australia
grow up in homes where intimate partner violence (IPV)
is occurring (Gartland et al., 2016). IPV includes physi-
cal, psychological, and sexual abuse, as well as harass-
ment, intimidation, and financial control, and is a global
health concern for women and their children (World
Health Organization, 2012). Compared to other age
groups, infants are most likely to be present or in close
proximity when IPV occurs, and they make up the largest
group of children living in women's refuges with their
mothers after escaping abuse (Australian Association
for Infant Mental Health Inc., 2016). This is concerning
given that infancy is a critical period of development,
and trauma during this time can have effects across the
lifespan (Doyle & Cicchetti, 2017; Kaplow & Widom,
2007). The current study explores the associations be-
tween IPV exposure in infancy and cognitive outcomes
in middle childhood, including general cognitive ability
E M P I R I C A L A R T I C L E
Intimate partner violence during infancy and cognitive outcomes
in middle childhood: Results from an Australian community-
based
mother and child cohort study
Priscilla Savopoulos1,2
| Stephanie Brown1,3,4
| Peter J. Anderson1,5
|
Deirdre Gartland1,3
| Christina Bryant2
| Rebecca Giallo1,3,6
DOI: 10.1111/cdev.13736
Abbreviations: CAS, Composite Abuse Scale; CFI, comparative fit index; EF, executive function; HPA, hypothalamic–
pituitary–
adrenal; IPV, intimate partner
violence; NIH-
TB, National Institute of Health Toolbox; RMSEA, root mean square error of approximation; SEM, Structural Equation Modelling; SRMR,
standardized root mean squared residual; TLI, Tucker–
Lewis index; WASI-
II, Wechsler Abbreviated Scale of Intelligence II.
1
Murdoch Children’s Research Institute,
Parkville, Victoria, Australia
2
School of Psychological Sciences,
University of Melbourne, Parkville,
Victoria, Australia
3
Department of Paediatrics, University of
Melbourne, Parkville, Victoria, Australia
4
South Australian Health and Medical
Research Institute, Adelaide, South
Australia, Australia
5
School of Psychological Sciences, Monash
University, Clayton, Victoria, Australia
6
La Trobe University, Bundoora, Victoria,
Australia
Correspondence
Priscilla Savopoulos, Murdoch Children’s
Research Institute, Parkville, Victoria,
Australia.
Email: priscilla.savopoulos@mcri.edu.au
Funding information
MHS was supported by the Australian
National Health & Medical Research
Council (NHMRC) Grants 199222, 433006,
491205, and by Australian Rotary Health.
Research conducted at the Murdoch
Children's Research Institute is supported
by the Victorian Government Operational
Infrastructure Support Fund.
Abstract
The cognitive functioning of children who experience intimate partner violence
(IPV) has received less attention than their emotional-
behavioral outcomes.
Drawing upon data from 615 (48.4% female) 10-
year-
old Australian-
born children
and their mothers (9.6% of mothers born in non-
English speaking countries) par-
ticipating in a community-
based longitudinal study between 2004 and 2016, this
study examined the associations between IPV in infancy and cognition in middle
childhood (at age 10). Results showed that IPV in the first 12 months of life was
associated with lower general cognitive ability and poorer executive attention but
not working memory skills. IPV in middle childhood (in the 10th year postpartum)
was not associated with cognition. This study provides evidence for the long-
term
impact of early life exposure to IPV on children's cognition, and points to the im-
portance of early intervention to optimize development.
© 2022 The Authors. Child Development © 2022 Society for Research in Child Development

2 | SAVOPOULOS et al.
and executive functioning skills, in a large sample of chil-
dren from the Maternal Health Study.
IPV and child development
Children experience IPV directly and indirectly as it is as-
sociated with other adversities in the home environment
such as parent mental health difficulties, substance use,
significant financial stress, homelessness, and child abuse
(Wathen & MacMillan, 2013). These risk factors are also
associated with cognitive and mental health difficulties in
childhood and adolescence (David et al., 2012; Leijdesdorff
et al., 2017; Twardosz & Lutzker, 2010). Trauma during the
early stages of life can be detrimental to infants as they are
born vulnerable and reliant on their caregiving environ-
ment. From a developmental psychopathology and attach-
ment perspective, early life adversity can disrupt the quality
of attachment bonds between children and their caregiv-
ers, which is important for optimal brain development and
has been associated with adverse outcomes for children
such as poor emotion regulation and school performance
(Carpenter & Stacks, 2009; Herman-
Smith, 2013).
Intimate partner violence is considered a form of child
maltreatment and there is evidence for its impact on chil-
dren's emotional-
behavioral development (Wathen &
MacMillan, 2013). Meta-
analyses and reviews indicate in-
creased risk of trauma, depressive and anxiety symptoms,
and aggression and conduct problems (Artz et al., 2014;
Chan & Yeung, 2009; Evans et al., 2008; Kitzmann et al.,
2003). Although less researched, IPV also has the potential
to affect children's cognitive development. The trauma hy-
pothesis and developmental psychopathology frameworks
suggest that the trauma and stress associated with IPV
can affect brain development by prolonged activation of
the biological and neurological systems to manage stress
(Bevans et al., 2005; Cicchetti, 2016; Herman-
Smith, 2013;
Mueller & Tronick, 2019). High levels of glucocorticoids or
stress-
related hormones such as cortisol, epinephrine, and
norepinephrine can disrupt typical brain development,
altering neural pathways and disturbing the formation of
connections fundamental to a range of cognitive processes
(De Bellis & Zisk, 2014; Moffitt & Tank, 2013). Traumatic
stress in childhood can result in structural brain changes
such as reduced cerebellar and hippocampal volume, and
impaired limbic and prefrontal cortical areas (Carpenter
& Stacks, 2009; De Bellis & Zisk, 2014). These areas are as-
sociated with an array of critical cognitive skills necessary
for daily functioning, learning, and social interactions in-
cluding decision making and planning, memory, attention,
and problem solving (Carpenter & Stacks, 2009).
IPV, general cognitive ability, and executive
functioning
General cognitive ability, often measured as IQ, is a
commonly assessed aspect of cognitive functioning and
includes a broad range of skills including verbal abili-
ties, fluid reasoning, non-
verbal and perceptual organi-
zation, memory, and information processing speed.
Several studies have demonstrated that IPV is negatively
associated with IQ in childhood. For instance, compared
to non-
exposed children, children exposed to physical
IPV had lower IQ scores in a U.S. population-
based sam-
ple of 1073 adolescents (Platt et al., 2018) and in a study
of 264 children (aged 7–
14 years) in Brazil (Silva et al.,
2012). Even when accounting for child maltreatment,
physical IPV was associated with lower IQ in a sample of
over 1000 twins in the United Kingdom (Koenen et al.,
2003). More specifically, some studies have found that
IPV is associated with poorer verbal IQ. For example,
in a study of 62 children (aged 3–
5 years) in the United
States, physical IPV was associated with lower overall
and verbal IQ scores, but not performance IQ (Ybarra
et al., 2007). Similarly, IPV has been associated with
higher risk of language delays (Udo et al., 2016), and
poorer verbal abilities such as language expression and
comprehension, word knowledge, and concept for-
mation (Graham-
Bermann et al., 2010; Huth-
Bocks,
Levendosky, et al., 2001; Peterson et al., 2019).
Executive function (EF) skills are specific higher
order cognitive abilities or processes that enable con-
trol of thinking and behavior and are essential for goal-
directed and problem-
solving behavior (Anderson &
Reidy, 2012; Semrud-
Clikeman & Ellison, 2009). There
are several ways of conceptualizing EF (for a review, see
Baggetta & Alexander, 2016), with much debate regard-
ing whether it consists of unitary or diverse functions. A
commonly cited model suggests that EF comprises three
subdomains that are correlated but distinguishable:
working memory, inhibitory control, and set-
shifting
(Miyake et al., 2000). A model of EF in childhood sug-
gests that the development of EF includes inter-
related
components of information processing speed, goal set-
ting, cognitive flexibility including working memory and
set-
shifting skills, and attentional control which includes
inhibitory control and selective attention (Anderson,
2002). Processing speed, often measured using reaction
time and accuracy of output, refers to how quickly infor-
mation is processed and underpins many cognitive abil-
ities (Anderson, 2002; Carlozzi et al., 2013). Inhibitory
control skills involve being able to control and sustain
attentional focus and inhibit dominant responses when
necessary (Anderson, 2002; Miyake et al., 2000). Set-
shifting skills involve shifting and dividing attention,
rapidly alternating between tasks, concepts, and men-
tal sets (Miyake et al., 2000). Such attentional control
skills are important for memory, as a stimulus is less
likely to be recalled if the child was distracted (Semrud-
Clikeman & Ellison, 2009). Memory skills are vital to
daily functioning and include the storage, encoding, and
recall of appropriate information. Various components
of memory are required for learning, including working
memory, which involves the temporary storage of rele-
vant information to complete a task (Alloway, 2009). The

| 3
IPV IN INFANCY AND COGNITION IN MIDDLE CHILDHOOD
association between IPV and children's EF skills has re-
ceived less attention than IQ. In a study of 154 young
children (aged 5 years), physical IPV at 2–
3 years was as-
sociated with difficulties in inhibitory control, working
memory, and attention shifting (Gustafsson et al., 2015).
In other studies, physical IPV was associated with defi-
cits in short-
term, deliberate, and working memory in
a sample of 140 children (aged 5 years) exposed to IPV
before 30 months old (Gustafsson et al., 2013), and with
explicit memory in a sample of 69 children aged 5 years
(Jouriles et al., 2008). IPV was also associated with better
performance on tasks of attention and inhibitory control
in 5-to 6-
year-
old children (Roos et al., 2016).
IQ and EF are related but distinct constructs. Research
suggests that some domains of EF are more strongly re-
lated to IQ than others. For example, set-
shifting skills
are less related to IQ than working memory skills, a find-
ing that is consistent across child and adult populations
(Duan et al., 2010; Friedman et al., 2006). EF can predict
intelligence, and predict behaviors when controlling for
intelligence (Brydges et al., 2012; Friedman & Miyake,
2017). Evidence from individuals with brain injuries
shows that frontal lobe damage can influence EF and not
IQ, emphasizing a distinction between them (Friedman
et al., 2006). To our knowledge, no studies have evalu-
ated both EF and general cognitive abilities in children
exposed to IPV.
Limitations of past research
While there is some emerging literature regarding IPV
and child cognition, research to date primarily has been
limited to small samples and cross-
sectional designs,
with most of the studies conducted in the United States.
Cross-
sectional studies vary widely in timing of IPV ex-
posure and measurement of outcomes, and can include
groups of children of various ages, making it difficult to
extrapolate effects of ongoing exposure or exposure at
different developmental stages. Although several stud-
ies have examined the functioning of preschool-
aged
children exposed to IPV, few have examined the poten-
tial long-
term impacts of early life IPV on development,
particularly the cognitive functioning of older children.
Middle childhood is an important developmental stage;
children's higher order cognitive abilities and emotion
regulation skills are maturing, they are close to begin-
ning secondary education, and outcomes during this
stage are considered a precursor to future academic
success, social relationships, and employment (Dubow
et al., 2006; Fergusson et al., 1997). Furthermore, only a
small number of studies have investigated the important
area of EF, and these have been limited to assessments
of children under the age of six (Gustafsson et al., 2015;
Roos et al., 2016).
Much of the evidence to date has been based on limited
assessment of IPV, such as one-or two-
item measures, or
assessing only physical IPV or physical conflict, leading
to misclassification and under-
ascertainment of IPV ex-
posure (Dobash & Dobash, 2004; Hegarty et al., 1999),
failing to capture a broad range of both emotionally
and physically abusive behaviors and potentially biasing
findings. IPV refers to a “constellation of abuse” which
includes controlling and intimidating behaviors, and
such emotional abuse tactics can also have detrimental
effects for women and children's health, making it im-
portant to include emotional abuse in conceptualiza-
tions of IPV (Dobash & Dobash, 2004). Additionally,
few studies have been conducted with community sam-
ples, and very few have included repeated measurement
of IPV at multiple timepoints across childhood (Brown
et al., 2021).
The current study
The current study aimed to address several limita-
tions of previous research by drawing on data from an
Australian subsample of 615 mother-
child dyads who
attended a face-
to-
face cognitive assessment at age 10,
drawn from a larger community-
based longitudinal
study of 1507 pregnant women. The objective was to
investigate the association between children's early life
exposure to IPV (in the first 12 months of life) and their
cognitive functioning at age 10 years. A confirmatory
hypothesis testing approach was used. Informed by de-
velopmental trauma theories on early life adversity and
later developmental functioning, we generated a concep-
tual model of the longitudinal directional relationships
between IPV and children's later cognitive functioning
to be tested and confirmed. Specifically, the study aimed
to test direct effects of infant exposure to IPV on cogni-
tive functioning as well as indirect effects through mid-
dle childhood exposure (in the 10th year postpartum),
while controlling for co-
occurring adversities related
to socioeconomic disadvantage, and for maternal de-
pression. The specific domains of cognitive functioning
included general cognitive ability and EF. It was hypoth-
esized that IPV occurring during the first 12 months and
the 10th year postpartum would be associated with lower
general cognitive ability and poorer EF skills in middle
childhood.
METHOD
Study design and participants
Data were drawn from the Maternal Health Study, a
large population-
based longitudinal study of the physi-
cal and psychological health of first-
time mothers and
their children. Women were recruited during early preg-
nancy at six public hospitals in Melbourne, Australia.
Hospitals were chosen to include a range of public

maternity units with differing levels of perinatal services
across the Melbourne metropolitan area. All hospitals
invited to take part agreed to join the study. Study staff
mailed questionnaire packages to women when they
booked to give birth between April 2003 and December
2005. Women returned signed consent papers, contact
information, and completed questionnaires in reply paid
envelopes provided. To be eligible for the study women
needed to be aged 18 years or older, nulliparous, suf-
ficiently fluent in English to complete questionnaires,
and ≤24 weeks’ gestation at enrolment. Mothers com-
pleted baseline questionnaires at 10-24 weeks' gestation,
and follow-up questionnaires at 3, 6, 12, and 18 months
postpartum, and 4 and 10 years postpartum. At the 10-
year follow-
up, mother-
child dyads were also invited to
participate in a face-
to-
face interview. Mothers com-
pleted questionnaires related to child mental health and
language skills with one interviewer, while the index
10-year-old child completed a battery of cognitive and
language tests with a second interviewer. Interviewers
were trained in standardized test administration and
were blind to the child's IPV exposure status.
A total of 1507 women were enrolled in the study in
early pregnancy. At the 12-
month follow up 1357 women
participated, 950 women completed the 10-
year mater-
nal questionnaire, and 615 mother-
child dyads partici-
pated in the face-
to-
face assessments. In the present
study, participants with cognitive assessment data at
10 years (collected between 2014 and 2016) and IPV data
at 12 months (collected between 2004 and 2006) were
included (n = 615). Compared to the baseline sample at
enrolment (N = 1507), the mothers in the analysis sample
were more likely to be born in Australia or born overseas
in an English-
speaking country, in paid employment,
older, more educated, and have a higher income (p < .05).
Measures
Demographic information about the children, their
mother and family were collected from the mothers dur-
ing pregnancy and in the first 3 months after birth (see
Table 1). This included maternal age, maternal educa-
tion, maternal relationship status, maternal employment
status, maternal healthcare card status, mother's coun-
try of birth, whether English is the mother's first lan-
guage, and the sex of the child. Mothers also completed
the Edinburgh Postnatal Depression Scale at 12 months
postpartum (Cox et al., 1987).
Intimate partner violence
Mothers reported their experiences of IPV using the
Composite Abuse Scale (CAS; Hegarty et al., 1999) at
12 months postpartum and when the children were
10 years old. The CAS is a self-
report questionnaire that
assesses the extent to which women have experienced a
range of abusive behaviors by a current or former inti-
mate partner in the past year. The 18-
item version was
used in the current study. The items are rated on a 6-
point Likert scale with response options never, only once,
several times, once per month, once per week, and daily
(scored 0–
5). Example items include “tried to keep me
from seeing or talking to my family” (emotional abuse)
and “pushed, grabbed or shoved me” (physical abuse).
Total scale scores for physical and emotional IPV were
computed and modeled in the analyses. Cut points are
also available, where a score ≥1 on the physical scale is
defined as physical abuse, and a score of ≥3 on the emo-
tional scale is defined as emotional abuse (Hegarty et al.,
2005). The CAS has consistently demonstrated high reli-
ability and validity, and is recommended as an assess-
ment tool for identifying IPV by the National Centre for
Injury Prevention and Control (Thompson et al., 2006).
Cronbach's alpha for the current sample was .83 for emo-
tional abuse and .84 for physical abuse at 12 months,
and .92 for emotional abuse and .87 for physical abuse
at 10 years.
Children's cognitive functioning
Children were tested at 10 years old using the Wechsler
Abbreviated Scale of Intelligence II (WASI-
II; Wechsler,
2011) and selected subtests of the National Institute of
Health Toolbox (NIH-
TB) Cognitive Battery (Weintraub
et al., 2013).
The WASI-
II is an individually administered stan-
dardized assessment of intelligence for individuals aged
6–
90 years and uses a standardized sample for scoring.
The WASI-
II demonstrates excellent reliability and va-
lidity when correlated with other measures of intelligence
such as the WISC-
IV (McCrimmon & Smith, 2012). The
current research study used the two-
subtest version,
including the Vocabulary and Matrix Reasoning sub-
tests. The Vocabulary subtest measures word knowledge
and verbal concept formation, with children required
to provide definitions for words presented visually and
orally. The Matrix Reasoning subtest measures fluid
intelligence, simultaneous processing, and perceptual
organization. Children are asked to select the response
that completes a visual pattern. The two-
subtest version
takes approximately 15 min to administer and was se-
lected for efficiency in the study and to reduce burden on
participants during the child assessment. In the current
analyses, subtest T scores were used, with a mean of 50
and standard deviation of 10.
The NIH-
TB comprises several computer-
based stan-
dardized tests of cognitive functioning, including work-
ing memory, set shifting and inhibitory control, attention,
and language, including vocabulary and reading. While
the entire battery was administered in the study, the cur-
rent analyses only use data from the five subtests that

| 5
assess proposed components of EF. Pattern Comparison
Processing Speed Test is a measure of processing speed
in which children are asked to identify whether two vi-
sual images are the “same” or “not the same” as quickly
as possible. The images may differ on dimensions in-
cluding color. Flanker Inhibitory Control and Attention
Test is a measure of inhibitory control and selective at-
tention in which children indicate the direction of the
target stimulus when it is flanked by stimuli on either
side as quickly as possible. Dimensional Change Card
Sort Test is a measure of set shifting, cognitive flexibility
and inhibitory control, with children required to match
a target visual stimulus to one of two choice stimuli ac-
cording to shape or color. List Sorting Working Memory
Test is a measure of working memory in which children
are presented a series of stimuli one at a time on the com-
puter screen visually and orally, and children are asked
to repeat the stimuli in order of size, from smallest to
largest. Picture Sequence Memory Test assesses working
and episodic memory with children required to move
randomly presented pictures into the sequence previ-
ously shown. The NIH Toolbox is designed for use with
children and adults ranging from 3 to 85 years old, and
demonstrates adequate psychometric properties includ-
ing test–
retest reliability and convergent and discrimi-
nant validity across all subtests (Weintraub et al., 2013).
Age-
corrected standard scores for each subtest, with a
mean of 100 and standard deviation of 15, were used in
the present study.
Data analysis
Exploratory data analysis was conducted in SPSS (IBM
Corp, 2012) to describe means, standard deviations,
frequencies, and distribution of scores. A correlation
TA BL E 1 Demographic characteristics of the sample (N = 603–615)a
n (%)
Maternal education at pregnancy
University 350 (57.2)
Completed high school, apprenticeship or diploma 262 (42.8)
Maternal age at pregnancy
18–24 years 46 (7.5)
25–29 years 191 (31.1)
30–34 years 259 (42.1)
35–39 years 97 (15.8)
40+ years 22 (3.6)
Maternal relationship status at pregnancy
Married 381 (62)
Living with partner 212 (34.5)
Divorced or separated 1 (0.2)
Single 21 (3.4)
Maternal employment at pregnancy
In paid employment 540 (87.8)
Not in paid employment 75 (12.2)
Maternal healthcare card status at 3 months postpartum
Yes 110 (18.2)
No 496 (81.8)
Maternal country of birth
Australia 496 (81.0)
Overseas (English-
speaking country) 57 (9.3)
Overseas (non-
English speaking country) 59 (9.6)
English as first language
Yes 563 (91.7)
No 51 (8.3)
Child sex
Female 294 (48.4)
Male 314 (51.6)
a
Sample size varies due to missing data.

matrix was created to describe bivariate associations be-
tween key study variables.
Structural Equation Modelling (SEM) in MPlus
(Muthén & Muthén, 2007) was used to test the hypoth-
esized model specifying directional longitudinal rela-
tionships between IPV exposure and children's later
cognitive functioning. SEM is a methodology which al-
lows for nuanced measurement of theoretical constructs
with estimation of measurement error (Hox & Bechger,
1998). The first step of the SEM approach is to assess
the adequacy of the measurement model by testing the
construct validity of all the latent variables in the hy-
pothesized model as well as the discriminant validity be-
tween all constructs. This was particularly important for
determining and confirming how to best model the di-
rect assessments of cognitive functioning. This involved
testing and comparing the construct validity of a series
of theoretical models (e.g., one-
factor congeneric model
of cognitive functioning measured by all the direct as-
sessments vs. separate one-
factor congeneric models
of intellectual functioning and EF as measured by the
WASI and NIH-
TB, respectively) using confirmatory
factor analysis. After establishing construct validity,
discriminant validity between all the latent constructs
in the model was assessed by examining the correlations
among the latent constructs, and the standardized pat-
tern and structure coefficients. After specification of the
measurement model, the second step of SEM is to test
the structural model of the associations between the la-
tent constructs.
All models were estimated using maximum likelihood
estimation with robust standard errors to manage miss-
ing data and skewed data. Model fit was assessed using
the Chi-
square test, and other practical test indices in-
cluding the Tucker–
Lewis index (TLI), comparative fit
index (CFI), and root mean square error of approxi-
mation (RMSEA). Indices for the TLI and CFI should
exceed .90 for an acceptable fit, and values close to or
below .05 for the RMSEA are considered acceptable (Hu
& Bentler, 1999). Missing data were managed using full
information maximum likelihood.
The indirect effects of early life IPV on cognitive func-
tioning via IPV in the 10th year were estimated using the
product of coefficients approach (MacKinnon et al.,
2002) with the bias-
corrected bootstrap option (1000
draws) to obtain confidence intervals. A statistically sig-
nificant estimate with confidence intervals not crossing
zero is accepted as evidence of an indirect effect.
The following were included as covariates in analy-
ses: maternal age, highest level of education completed,
employment status, healthcare card status, and child sex
as these socioeconomic and demographic factors have
been shown to relate to child cognition or IPV (Bradley
& Corwyn, 2002; Galsworthy et al., 2001; Gartland et al.,
2016). The models were adjusted for these covariates by
estimating the covariances between them and all the
model variables. Secondary analyses included maternal
depression as a covariate as it is highly correlated with
experiences of IPV (Devries et al., 2013).
RESULTS
Descriptive statistics
Table 1 presents sample demographics. Missing data
were minimal (1.81% across all study variables), and
these were missing completely at random as evidenced
by Little's MCAR test, χ2
= 174.10, p = .40. Table 2 pre-
sents the descriptive statistics and correlations among all
the model variables. Each covariate except maternal em-
ployment was correlated with one or more of the cogni-
tive subtests. All variables were approximately normally
distributed except IPV and maternal depressive symp-
toms which were skewed.
Regarding IPV prevalence, 12.9% (78/604) of mothers
reported IPV during the first 12 months postpartum. Of
the women who reported IPV, 51% reported emotional
abuse only, 35% reported both physical and emotional
abuse, and 14% reported physical abuse only. At 10 years
postpartum, 13.5% (78/580) of mothers reported physical
or emotional IPV, with a similar pattern in the types of
IPV reported. The majority reported emotional abuse
alone (63%), almost a third reported both emotional and
physical abuse (32%), with physical abuse alone less com-
mon (5%).
Testing the measurement model of cognitive
functioning
Table 3 presents the measurement models of cognitive
functioning tested. A one-
factor congeneric model of
cognitive functioning as measured by all the WASI-
II
and NIH-
TB scales was a poor fit to the data. This sug-
gested that a single latent construct did not adequately
represent the specific cognitive skills measured by the
WASI-
II and NIH-
TB scales. A separate one-
factor con-
generic model of EF as measured by the NIH-
TB scales
was also a poor fit to the data. The standardized residu-
als and modification indices suggested that correlating
the error terms between the Picture Sequence and List
Sorting subtests would improve the model fit. This made
theoretical sense as these subtests both measure work-
ing memory skills, and the remaining subtests (Flanker,
Card Sort, Pattern Comparison) measure other aspects
of EF; processes involved in attentional control including
inhibitory control, set-
shifting, and processing speed.
This two-
factor model of working memory and executive
attention showed good model fit.
The final three-
factor model of working memory,
executive attention, and general cognitive ability was
an excellent fit to the data. There was a high correla-
tion between working memory and general cognitive

| 7
T
A
B
L
E
2

Descriptive
statistics
and
correlations
for
model
variables
and
covariates
Variable
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
1.
12 months
emotional
IPV
1
2.
12 months
physical
IPV
.60
***
1
3.
10 years
emotional
IPV
.33
***
.22
***
1
4.
10 years
physical
IPV
.10
*
.14
***
.65
***
1
5.
Card
sort
−.07
−.06
−.01
.02
1
6.
Flanker
−.01
−.05
.01
.02
.45
***
1
7.
Pattern
Comparison
−.04
−.05
−.06
−.01
.40
***
.36
***
1
8.
List
Sorting
−.10
*
−.06
−.03
.02
.16
***
.16
***
.13
***
1
9.
Picture
Sequence
−.04
.00
.03
.06
.15
***
.06
.14
***
.27
***
1
10.
Vocabulary
−.12
**
−.11
**
−.04
−.04
.17
***
.14
***
.02
.32
***
.15
***
1
11.
Matrix
Reasoning
−.06
−.05
−.08
−04
.17
***
.21
***
.09
*
.32
***
.25
***
.33
***
1
12.
Child
sex
−.00
.02
.02
.00
−.04
.06
−.02
.00
−.11
*
−.13
**
−.01
1
13.
Maternal
age
−.10
*
−.05
−.07
−.06
.01
.05
.02
.02
−.03
.15
***
.01
.00
1
14.
Maternal
education
−.06
−.08
−.07
−.12
**
.06
.04
−.06
.14
***
.00
.25
***
.15
***
−.03
.17
***
1
15.
Maternal
employment
.03
.01
.07
.02
−.05
−.01
.02
−.02
.05
−.04
−.06
.08
−.10
*
−.14
***
1
16.
Maternal
healthcare
card
status
−.12
**
−.07
−.16
***
−.14
***
.05
.02
.01
.10
*
.05
−.04
.02
−.06
.12
**
.06
−.19
***
1
17.
Maternal
depression
.27
***
.15
***
.12
**
.01
.02
.04
−.07
−.03
−.04
−.10
*
.01
.03
−.03
−.03
.04
−.02
1
M
1.15
.18
1.65
0.16
104.56
95.95
98.69
105.24
103.92
59.43
54.75
—
31.35
—
—
—
4.54
SD
3.50
1.11
5.24
1.09
10.61
10.78
16.53
11.71
14.93
8.74
9.45
—
4.50
—
—
—
4.57
Skewness
5.30
9.95
4.72
10.14
−0.16
0.31
0.18
0.03
0.25
−0.11
−0.07
—
0.17
—
—
—
1.21
Kurtosis
35.17
118.39
26.32
119.74
−0.14
−0.45
−0.22
0.15
−0.14
0.81
0.79
—
0.20
—
—
—
1.03
Note:
IPV = intimate
partner
violence
measured
with
Composite
Abuse
Scale;
5–
9
= National
Institute
of
Health
Toolbox
subtests;
10–
1
1 = Wechsler
Abbreviated
Scale
of
Intelligence
II
subtests;
12–
1
7 = covariates.
*p ≤ .05;
**p ≤ .01;
***p ≤ .001.

ability (r = .87), and the pattern and structure coef-
ficients indicated some lack of discriminant validity
between these constructs. This was not surprising as
working memory is strongly associated with a range
of cognitive abilities including intelligence (Alloway &
Alloway, 2010; Herlitz & Yonker, 2002; Luciano et al.,
2001; Rapport et al., 1997). On this strong theoretical
and conceptual basis, we chose to represent cognitive
functioning as a three-
factor model in the structural
model.
To further assess discriminant validity, a five-
factor
model of IPV in the first 12 months and 10th year post-
partum, executive attention, working memory, and gen-
eral cognitive ability as separate but related constructs
TA BL E 4 Factor pattern and structure coefficients for 5-
factor model of intimate partner violence (IPV) in first 12 months postpartum,
IPV in 10th year postpartum, executive attention, working memory, general cognitive ability
Subscales
IPV 12 months IPV 10 years Executive attention Working memory
General cognitive
ability
P S P S P S P S P S
IPV 12 months
Emotional abuse 0.99 0.99 0* 0.23 0* −0.06 0* 0.15 0* −0.14
Physical abuse 0.61 0.61 0* 0.14 0* −0.04 0* 0.09 0* −0.09
IPV 10 years
Emotional abuse 0* 0.33 1.41 1.41 0* −0.04 0* −0.05 0* −0.08
Physical abuse 0* 0.11 0.46 0.46 0* −0.01 0* −0.02 0* −0.03
Executive attention
Card sort 0* −0.05 0* −.02 0.71 0.71 0* 0.27 0* 0.28
Flanker 0* −0.04 0* −.02 0.65 0.65 0* 0.25 0* 0.25
Pattern
comparison
0* −0.04 0* −.02 0.55 0.55 0* 0.21 0* 0.22
Working memory
List sorting 0* −0.09 0* −.02 0* 0.25 0.64 0.64 0* 0.56
Picture sequence 0* −0.06 0* −.01 0* 0.16 0.43 0.43 0* 0.37
General cognitive ability
Vocabulary 0* −0.08 0* −.03 0* 0.21 0* 0.47 0.54 0.54
Matrix reasoning 0* −0.09 0* −.03 0* 0.24 0* 0.53 0.60 0.60
Note: Tabled values are standardized parameter estimates. Asterisked values are parameters fixed at reported levels to identify the model. Pattern coefficients are
all significant (p < .01).
Abbreviations: P, pattern coefficient; S, structure coefficient.
TA BL E 3 Measurement models of cognitive functioning
Measurement model χ2
(df) CFI TLI RMSEA (90% CI) SRMR
1f: Cognition
All subtests: Flanker, Card Sort, Pattern Comparison, List
Sorting, Picture Sequence, Vocabulary, Matrix Reasoning
205.23 (14)
p < .001
.64 .45 .15 (.13–.17) .08
1f: Executive functioning
Flanker, Card Sort, Pattern Comparison, List Sorting, Picture
Sequence
35.70 (5)
p < .001
.90 .80 .10 (.07–.13) .05
2f: Executive functioning
(Executive Attention = Flanker, Card Sort, Pattern
Comparison; Working Memory = List Sorting, Picture
Sequence)
5.74 (4)
p = .22
.99 .99 .03 (.00–.07) .02
3f: Executive attention, working memory, and general cognitive
ability
(Executive Attention = Flanker, Card Sort, Pattern
Comparison; Working Memory = List Sorting and Picture
Sequence; General Cognitive Ability = Vocabulary and
Matrix Reasoning)
25.99 (11)
p < .01 (.01)
.97 .95 .05 (.02–.07) .03
Abbreviations: CFI, comparative fit index; RMSEA, root mean square error of approximation; SRMR, standardized root mean squared residual; TLI, Tucker–
Lewis index.

| 9
was tested. The model was a good fit to the data, χ2
(34,
N = 615) = 52.70, p = .02, RMSEA = .03 90% CI [.01–
.05],
TLI = .96, and CFI = .98. The correlations between all
three cognitive constructs were significant at p < .001 (ex-
ecutive attention and working memory, r = .38; general
cognitive ability and executive attention, r = .39; general
cognitive ability and working memory, r = .87), while the
correlations between the IPV constructs and the cogni-
tive constructs ranged from −.03 to −.15. Table 4 displays
the pattern and structure coefficients for the five-
factor
model. The structure coefficients for all items, except for
working memory and general cognitive ability, were not
approximating the fixed pattern coefficients. There was
poor discriminant validity between working memory and
general cognitive ability, as evidenced by the high correla-
tion between the latent constructs and the approximation
of the pattern and structure coefficients for their respec-
tive items. To address this issue, in addition to testing the
hypothesized model, separate structural models for (a)
general cognitive ability only, and (b) working memory
and executive attention were tested as sensitivity analyses.
Testing the structural model
A model of the association between IPV (early life and
in the 10th year) and cognitive functioning at 10 years,
accounting for child sex, maternal age, maternal edu-
cation, maternal employment, and healthcare card sta-
tus was a good fit to the data, χ2
(63, N = 615) = 117.53,
p < .001, RMSEA = .04 (90% CI [.03–
.05]), TLI = .90,
and CFI = .95, standardized root mean squared residual
(SRMR) = .03. Figure 1 presents the structural model
and standardized path estimates.
The model shows that IPV in the first 12 months of
life was significantly associated with poorer executive at-
tention (inhibitory control, set-
shifting, and processing
speed) and lower general cognitive ability, but not work-
ing memory at age 10. IPV in the first 12 months of life
predicted IPV in the 10th year, but IPV in the 10th year
was not associated with any cognitive outcomes.
With respect to the associations between the cognitive
constructs and covariates, working memory was associ-
ated with maternal education and healthcare card status;
general cognitive ability was associated with maternal
age, maternal education, and child sex; and executive at-
tention was not associated with the covariates.
Table 5 presents the standardized estimates and 95%
CIs for the direct effects of early life IPV on cognitive
outcomes, covariances between cognitive outcomes, and
indirect effects of early life IPV on cognitive outcomes
via IPV in the 10th year. None of the indirect paths from
early life IPV to the cognitive outcomes via IPV in the
10th year were significant.
Sensitivity analyses
Due to evidence of poor discriminant validity between
general cognitive ability and working memory, we tested
separate structural models for (a) general cognitive abil-
ity only, and (b) working memory and executive attention.
The model for general cognitive ability was a good fit to
the data (χ2
(20, N = 615) = 28.20, p = .11, RMSEA = .03,
90% CI [.00–
.05], TLI = .96, and CFI = .98, SRMR = .02),
as was the model for working memory and executive at-
tention (χ2
(45, N = 615) = 69.51, p = .011, RMSEA = .03,
90% CI [.02–
.04], TLI = .94, and CFI = .97, SRMR = .02).
F IGU R E 1 Associations between IPV in first 12 months and 10th year postpartum and executive attention, working memory, and general
cognitive ability at 10 years, accounting for child sex and maternal socioeconomic and demographic variables. *p < .05. **p < .01. ***p < .001
IPV
12 months
IPV
10 years
EXECUTIVE
ATTENTION
10 years
WORKING
MEMORY
10 years
FLANKER
LIST SORTING
PATTERN
COMPARISON
CARD SORT
PICTURE
SEQUENCE
VOCABULARY
MATRIX
REASONING
.65***
.71***
.55***
.65***
.37***
.42***
GENERAL
COGNITIVE ABILITY
10 years
.61***
.54***
.86***
.38***
-.09*
-.16
-.18**
-.04
PHYSICAL
ABUSE
EMOTIONAL
ABUSE
PHYSICAL
ABUSE
EMOTIONAL
ABUSE
.76***
.78***
.71***
.93***
.28**
.001
.05

The direction and strength of the associations between
IPV and the cognitive outcomes in all models tested, in-
cluding the model tested in the main analyses, yielded
similar results, indicating that the findings were consist-
ent across the different conceptualizations of cognitive
variables.
Secondary analyses
To account for the co-
occurring early life adversity of
maternal depression with IPV, a model including mater-
nal depressive symptoms at 12 months postpartum as a
covariate was estimated. The model was a good fit to the
data, χ2
(69, N = 615) = 139.71, p < .001, RMSEA = .04,
90% CI [.03–
.05], TLI = .88, and CFI = .94, SRMR = .03.
In this model, early life IPV was still associated with
general cognitive ability (β = −.17, p < .01), but executive
attention was no longer associated with IPV (β = −.07,
p = .17). Although early life IPV and working memory
were not significantly associated in the primary analy-
ses, they were significantly associated in the model ac-
counting for maternal depression (β = −.15, p < .05). IPV
in the 10th year was still not significantly associated with
any of the cognitive variables.
DISCUSSION
This study used a longitudinal community-
based co-
hort to examine the association between IPV in infancy
and cognitive functioning in middle childhood. Results
showed that IPV in the first 12 months of life was as-
sociated with poorer executive attention skills including
inhibitory control, set-
shifting, and processing speed,
and lower general cognitive ability at age 10, but the as-
sociation with working memory skills failed to reach
statistical significance in the primary model. Unlike
early life IPV, middle childhood IPV (in the 10th year
postpartum) was not associated with cognitive function-
ing. These findings add to the evidence for the longer
term impacts of early life exposure to IPV on key areas
of children's cognitive development. While the path es-
timates between early life IPV and cognitive function-
ing at 10 years are small, this is to be expected given the
small number of children who experienced IPV and the
longitudinal nature of the analyses. Despite this, the as-
sociations highlight the enduring impact of early life IPV
on children's cognitive functioning, indicating key areas
where children may experience difficulties.
Intimate partner violence was associated with lower
general cognitive ability scores in this study. General
cognitive ability in middle childhood is associated with a
range of poor outcomes in adulthood, so the finding that
IPV in infancy is associated with lower scores at 10 years is
concerning. Lower general cognitive functioning may re-
sult in difficulties learning at school and progressing aca-
demically, with friendships, managing complex social and
emotional experiences, and developing self-
esteem, leav-
ing children at potential risk of future lower educational
attainment and subsequent socioeconomic disadvantage
(Dubow et al., 2006; Fergusson et al., 2005). Our findings
are consistent with previous studies which have demon-
strated that children experiencing IPV exhibit lower IQ
scores (Platt et al., 2018; Silva et al., 2012; Ybarra et al.,
2007) and can display IQ scores up to 8 points lower than
non-
exposed children (Koenen et al., 2003). Our study
builds upon this research by specifically investigating the
longer term impact of early life IPV on cognitive func-
tioning. It is consistent with a population-
based UK study
which assessed IPV prenatally and in the first 73 months
of life, and found IPV (particularly in the postnatal pe-
riod) was associated with lower IQ scores at 8 years old
(Abel et al., 2019). Taken together, these findings provide
some support for IPV in infancy as a traumatic and ad-
verse experience that has the potential to affect optimal
cognitive development.
TA BL E 5 Standardized estimates and confidence intervals for
direct paths, covariances, and indirect paths for the structural model
Paths and covariances Estimate [95% CI] p
Direct paths
IPV 12 months → IPV 10 years .28 [.07, .49] .009
IPV 12 months → Executive
attention
−.09 [−.17, −.01] .036
IPV 12 months → Working
memory
−.16 [−.35, .02] .079
IPV 12 months → General
cognitive ability
−.18 [−.31, −.05] .005
IPV 10 years → Executive
attention
.001 [−.12, .12] .988
IPV 10 years → Working
memory
.05 [−.08, .18] .441
IPV 10 years → General
cognitive ability
−.04 [−.17, .08] .496
Covariances
Executive attention ↔ Working
memory
.37 [.23, .52] <.001
Working memory ↔ General
cognitive ability
.86 [.69, 1.03] <.001
General cognitive
ability ↔ Executive attention
.38 [.23, .52] <.001
Indirect paths
IPV 12 months → IPV
10 years → Executive
attention
<.001 [−.04, .04] .990
10 years → Working
memory
.01 [−.05, .08] .637
10 years → General
cognitive ability
−.01 [−.05, .02] .493
Abbreviation: IPV, intimate partner violence.

| 11
This study also found that IPV in infancy was as-
sociated with poorer executive skills, including inhib-
itory control/selective attention, cognitive flexibility/
set-
shifting and processing speed, in the primary model.
Difficulties with executive skills are concerning as these
skills are necessary for academic and social success in
childhood (Semrud-
Clikeman & Ellison, 2009). For chil-
dren of this age group, the ability to organize, focus, and
follow through on plans and tasks, prioritize, and fol-
low directions are vital as they enter their senior primary
school years and transition to high school. Difficulties
with these behaviors may cause problems in a school
environment, for example, being organized to plan and
finish tasks in the classroom and being able to share and
take turns in games (Semrud-
Clikeman & Ellison, 2009).
Our findings are consistent with studies documenting as-
sociations between IPV and poorer EF (Gustafsson et al.,
2015) and the development of attention-
deficit hyperac-
tivity disorder and other externalizing problems (Artz
et al., 2014; Fong et al., 2019; Slopen & McLaughlin,
2013).
These findings highlight important implications of
trauma in early life. Infancy is a critical period of brain
maturation, and IPV is a stressor that can have lasting
impacts on children's cognitive functioning. Given the
rapid period of brain development in infancy, trauma
during this time places children at even greater risk of
poor development (Carpenter & Stacks, 2009; De Young
et al., 2011). The associations between IPV and cogni-
tion found in the present study are in accordance with
theories highlighting that early life brain development
is extremely sensitive to stress, particularly chronic and
high levels. Neurobiological stress mechanisms driven
by the hypothalamic–
pituitary–
adrenal (HPA)-
axis are
activated in response to trauma and can induce alter-
ations in the brain, namely through the distribution of
glucocorticoids, neuropeptides, and neurotransmitters
(Rincón-
Cortés & Sullivan, 2014). The HPA axis and
cortisol responses are particularly vulnerable in infancy
as they are still developing (Mueller & Tronick, 2019).
Adverse experiences at this time can lead to heightened
stress reactivity responses which render individuals sus-
ceptible to a range of stress-
related disorders throughout
life (Anda et al., 2006). Furthermore, depending on the
timing, consistency and type of adversity, various brain
regions can be disturbed by early life stress which can
result in cognitive function being affected long-
term
(Carpenter & Stacks, 2009).
While the association between memory and IPV did
not reach significance in the primary model, the estimate
of the association was similar to the associations between
IPV and the other cognitive variables. However, it is im-
portant to note that the confidence interval around this
estimate is large, suggesting that there is wide variability
in the relationship between IPV and memory. The wider
literature suggests that children who have experienced
IPV exhibit poorer memory skills, including short-
term,
working, and deliberate memory (Gustafsson et al., 2013)
and explicit memory (Jouriles et al., 2008). This finding
may be related to sample characteristics and severity of
IPV; perhaps memory deficits are more apparent when
families are exposed to cumulative risks. The emotional-
behavioral functioning of children in the context of IPV
should also be considered; internalizing difficulties,
high levels of anxiety and post-
traumatic stress disor-
der are associated with compromised memory and may
not be apparent in this sample (Beers & De Bellis, 2002;
Malarbi et al., 2017; Moradi et al., 1999).
Several important contextual factors were accounted
for in the models, including indicators of socioeconomic
disadvantage (maternal education, employment status,
and healthcare card status), child sex, and maternal age
at pregnancy. Importantly, maternal depression was in-
cluded as a relevant co-
occurring early life adversity.
IPV and maternal depression are highly related, with
women who experience IPV up to two times more likely
to experience symptoms of depression (Beydoun et al.,
2012; Devries et al., 2013). Once maternal depression
was added to the model, IPV became associated with
working memory, suggesting a potential moderating
or additive effect of these two early life adversities. It
may be that in the context of high levels of maternal
depression symptoms, the association between IPV
and working memory is stronger. It is also clear that
maternal depression plays a role in the pathway be-
tween IPV and executive attention, as IPV was no lon-
ger associated with executive attention once maternal
depression was added as a covariate. These findings
demonstrate the importance of maternal depression
when considering child development in the context of
IPV and the complexity of associations between early
life adversities and child outcomes. Maternal depres-
sion is consistently found to be associated with child
cognitive development (Deave et al., 2008; Grace et al.,
2003) and has been shown to have an important role
in pathways between IPV and both child intellectual
and language development (Conway et al., 2021; Huth-
Bocks, Levendosky, et al., 2001). The association be-
tween general cognitive ability and IPV held even when
controlling for maternal depression, suggesting that
IPV may have an independent effect on this domain of
child cognitive functioning over and above the influ-
ence of maternal depression.
Finally, we found that IPV in the 10th year was not
associated with cognitive outcomes, and that even the
indirect effects of early life IPV on cognitive outcomes
via IPV in the 10th year were not significant. This find-
ing may reflect the difference between the developmental
tasks and sensitivity to trauma apparent in the different
developmental stages. Compared to infancy, middle
childhood is a time where children are not as reliant
upon parental figures and have other protective factors
in their environment such as school and friendships,
which may render them more resilient and buffer against

any negative impacts of violence exposure; these mecha-
nisms are important to investigate going forward.
Our findings reflect repercussions of early life IPV,
which are necessary to consider given that IPV is com-
mon during pregnancy and early postpartum (Bunston
et al., 2017; Herman-
Smith, 2013; Mueller & Tronick,
2019). It is not surprising that a traumatic experience
like IPV is associated with cognitive outcomes in mid-
dle childhood, given that the infant brain is highly in-
fluenced and shaped by the caregiving environment
(Carpenter & Stacks, 2009). The infant must be viewed in
a relational context, whereby their surroundings are vital
to their existence and development (Bunston et al., 2017;
Paul, 2010; Winnicott, 1964). A culmination of adverse
factors is likely to affect an infant experiencing IPV, in-
cluding experiences of fear and dysregulated emotions,
along with the potential loss of attuned interactions and
optimal attachment with parents (Paul, 2010). Our find-
ings support the notion that while a baby may not explic-
itly remember the traumatic events to which they were
exposed, the effects of the experience can manifest in
developmental difficulties years afterward. It is possible
that the children in the sample experienced chronic bio-
logical stress responses due to early life trauma, which
can place the brain at risk of neuronal death and sub-
sequent cognitive processing difficulties. However, we
were unable to test the potential mediating pathway of
neurobiological mechanisms, nor attachment bonds and
the quality of caregiving.
Strengths, limitations, and areas for
future research
This study demonstrated that IPV in infancy is asso-
ciated with poorer cognitive functioning at 10 years
old. While several important variables were accounted
for, including IPV in the 10th year, child sex, and ma-
ternal indicators of socioeconomic disadvantage, this
study did not investigate the underlying mechanisms
in the relationship between IPV and child develop-
ment. There are many factors that can contribute to
children's difficulties over time, including aspects of
the home environment, parenting, and both child and
parent mental health, as well as children's neurobio-
logical processes which may be affected by trauma. In
this study maternal depression was included as a co-
variate, and changes in the associations in our models
signify the complex relationship between IPV, mater-
nal depression, and child outcomes. Future research is
needed to assess the potential mediating or moderating
role of maternal depression in the association between
early life IPV and child cognition. The bidirectional re-
lationship between children's cognitive and emotional
development also requires consideration, as a child's
emotional response to trauma can impact on daily cog-
nitive functioning. Future research should also explore
chronicity of exposure (e.g., in the time period between
infancy and middle childhood) to determine outcomes
related to different sensitive periods and types of ex-
posure. Future examination of such pathways will
enhance understanding of the role IPV plays in child
development and identify key times and areas for early
intervention.
This study provides a unique contribution to the ev-
idence of early-
life IPV exposure and longer-
term child
outcomes by drawing upon data from a community-
based sample, rather than clinical samples or samples
from domestic violence shelters. The SEM approach
enabled identification of a comprehensive and validated
measurement model of cognitive functioning, and a
comprehensive measure of IPV was used, designed to
assess both physical and emotional abuse. It is one of
the few studies to investigate the effects of IPV on later
cognitive development. The study's focus on identifying
cognitive difficulties in middle childhood is important to
understand children's learning and emotional needs as
they begin adolescence.
There are several limitations that must be noted. First,
the number of children in the sample who experienced
IPV was small, limiting the statistical power to identify
small effects and conduct more complex analyses to ex-
amine the associations between different patterns of IPV
over time and cognitive outcomes. We included a compre-
hensive measure of IPV that included both emotional and
physical violence but were unable to examine the different
effects of each on cognitive functioning. While the aim of
the study was to examine the association between IPV and
cognitive development specifically, other factors such as
parenting or mental health can also influence children's
cognitive development. This was beyond the scope of this
paper but should be examined going forward. Other po-
tential influences on children's cognitive functioning, in-
cluding traumatic events such as child abuse and neglect,
which can co-
occur with IPV (Hamby et al., 2010), and
maternal cognitive and executive functioning were not as-
sessed in the study and therefore unable to be adjusted
for. Future studies should include these important poten-
tial confounders in their analyses. Finally, sample limita-
tions must be noted. Only 12%–
13% of women reported
any IPV, which is likely to have affected study power to
detect smaller effects. While the original sample was rep-
resentative in terms of method of birth, infant birthweight
and gestation, younger women and women born over-
seas of non-
English speaking background were under-
represented. Selective attrition of the original sample
has increased selection bias over time. This sample was
predominantly English speaking and more socioeconom-
ically advantaged than the original cohort, and therefore
may not be fully representative of women and children ex-
periencing adversities associated with IPV. Women who
were under 25 at the time of having their first baby have
also been less likely to participate over time. These factors
are likely to have decreased prevalence estimates of IPV,

| 13
but are unlikely to impact on associations between model
variables (Martikainen et al., 2007).
Implications and conclusions
Despite these limitations, our hypothesis-
driven and
confirmatory research approach with a large cohort of
children and direct assessments of cognitive functioning
supports developmental psychopathology perspectives
positing that early life trauma can influence brain devel-
opment, and supports the existing evidence that IPV can
have long-
term effects on children's cognitive develop-
ment. Therefore, policy and service responses to prevent
infant exposure to IPV are essential, and early identifica-
tion of IPV in infancy is necessary for services to attempt
to curtail a trajectory of poor cognitive development
as children grow. Early identification and support for
women and children exposed to IPV has the potential
to improve longer term outcomes. Greater awareness of
IPV in maternal child health services or early maternity
services may lead to early intervention for children ex-
periencing IPV, which in turn may mitigate the effects
on cognitive development; surveillance or ongoing moni-
toring of children living in homes where IPV is known
to occur is crucial. Furthermore, interventions and sup-
ports to promote children's learning and development
are critical, particularly in the early childhood years,
where playgroups and supportive play therapy can pro-
vide cognitive stimulation and increase opportunities for
play-
based learning in a safe environment (Huth-
Bocks,
Schettini, et al., 2001; Kot et al., 1998; Tyndall-
Lind et al.,
2001). Relational dyadic therapies are also useful and
can support the mother and child's attachment bond,
thereby promoting a safe and healing space for a child to
learn (Lieberman et al., 2005, 2006). In the middle child-
hood years, educational supports may also be necessary
to encourage learning in the classroom so that children
do not fall behind, given that trauma can affect a child's
ability to concentrate and process information. It is also
important to note that not all children who are exposed
to IPV present with cognitive difficulties despite their
experiences. Future research should also aim to explore
potential protective mechanisms. Ultimately, prevention
and eradication of IPV would result in the best outcomes
for families.
ETHICS STATEMENT
The Maternal Health Study (MHS) received ethical
approval from La Trobe University (2002/38), Royal
Women's Hospital (2002/23), Southern Health (2002-
099B), Angliss Hospital and The Royal Children's
Hospital (27056A).
ORCID
Priscilla Savopoulos https://orcid.
org/0000-0002-2217-3397
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How to cite this article: Savopoulos, P., Brown, S.,
Anderson, P. J., Gartland, D., Bryant, C., &
Giallo, R. (2022). Intimate partner violence during
infancy and cognitive outcomes in middle
childhood: Results from an Australian
community-
based mother and child cohort study.
Child Development, 00, 1–
16. https://doi.org/10.1111/
cdev.13736

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