Intimate partner violence and its impact on children — formative SAQs

SAQ 1 (10 marks)

A seven-year-old boy is referred to the general paediatric clinic by his teacher for "behavioural problems and possible ADHD." His mother describes worsening aggression, distractibility, and emotional outbursts over the past six months, poor sleep, and frequent unexplained stomach aches. When you interview the boy alone, he asks quietly whether you can "make the shouting stop at night." You separately interview the mother, who appears tense and avoids eye contact, and discloses that her partner has been "pushing her around" and frightening her for over a year. There is a licensed firearm in the home. ^{[2] [3]}

1. State how this presentation distinguishes trauma exposure from primary ADHD, and why taking a trauma history is the discriminator. (3) ^[2]
2. Outline your immediate safety assessment and the time-critical actions you must take before the family leaves the encounter. (4) ^[4]
3. Describe your child-protection response and your referral of the non-offending parent, including the principle of not setting leaving as a condition of your support. (3) ^{[2] [6]}

Model answer — SAQ 1

(1) Trauma versus ADHD (3). Primary ADHD is persistent across all settings from early childhood, with no temporal link to family stress and no trauma history. Trauma-driven inattention and aggression emerged or worsened after family stress, are episodic and situational, and coexist with hypervigilance, exaggerated startle, sleep disturbance, somatic complaints, and regression. The temporal relationship to the family stress, the trauma-specific features, and the boy's own disclosure ("make the shouting stop at night") are the discriminators. The two can coexist, so taking a trauma history does not exclude ADHD — but failing to take one means treating the symptom while the cause continues. The most common exam-stem error is attributing a trauma-exposed child's symptoms to primary ADHD without taking a trauma history. ^{[2] [3]}

(2) Immediate safety assessment (4). The priority is physical safety for the child and the non-offending parent, run in parallel with the assessment. First, because the perpetrator is not the patient and the mother has disclosed privately, confirm the family is not leaving to an immediate threat and that she has a safe place to go. Second, the firearm is the single most time-critical risk: the presence of firearms in a home with IPV is the strongest predictor of intimate partner homicide, and the risk extends to the children. Ask about access, and work with the family, social work, and where necessary law enforcement to remove or secure the weapon before the family leaves — lethal-means restriction is a clinical act, not a deferred social-work referral. Third, ask whether the violence is escalating, whether the child has been directly threatened or harmed, and whether an escape plan exists. Fourth, agree a written safety plan — where they will go if violence escalates, who they will call, and a code word the child can use — and provide the local and national IPV helpline in a form the perpetrator cannot see. ^{[4] [2]}

(3) Child-protection response and parent referral (3). Exposure to IPV is itself a form of child harm — the toxic-stress cascade is the mechanism — so make the child-protection report on a reasonable belief of risk, not on diagnostic certainty. In most ANZ jurisdictions the threshold is met when a child lives in a home with ongoing IPV with coercive control, escalation, weapons, or direct threats to the child. Document in the child's record, mark it sensitive, and coordinate with social work before any information reaches the family — never document a disclosure in a record the perpetrator can access, as it can trigger retaliation. Refer the non-offending parent to IPV advocacy services (1800 RESPECT in Australia, Shine or Are You OK in Aotearoa New Zealand) without blame and without requiring her to leave the relationship: leaving is the period of highest danger, and the decision is hers. Supporting the non-offending parent is supporting the child, because she is usually the child's strongest buffer. Arrange trauma-focused cognitive behavioural therapy (TF-CBT) for the boy, developmental and mental-health follow-up, and a fixed review date. ^{[2] [6]}