Int. J. Environ. Res. Public Health 2009, 6 3159 childhood abuse and IPV, parental alcohol use did not predict reports of aggression or depression among college-student adult children of alcoholics (ACOAs). Undoubtedly, characteristics of the family environment contribute to the adjustment of COAs. Thus, the challenge for researchers is to refine the definition of risk by identifying specific mechanisms that lead to diverse outcomes among children raised by alcoholic parents. Although alcohol misuse during gestation has well-documented risk for physical and central nervous system insults that may result in cognitive, affective, growth, and morphologic sequelae [34], our theoretical explanations focus on factors relevant to alcohol-abusing couples that with intervention may be most amenable to change. 2.1. The Effects of IPV on Children in Their Homes The Department of Justice estimates that 3.3 to 10 million children are exposed to domestic violence annually [1]. McDonald et al. [36] found that approximately 15.5 million children live in households where IPV has occurred, with seven million living in homes where severe forms of partner aggression has occurred [36]. Although differences in the measurement of IPV have resulted in variability in the estimates of children’s exposure to IPV, regardless of the definition of IPV, these figures may underestimate the true magnitude of the problem. Witnessing severe interparental conflict has been linked to children’s feelings of terror and helplessness, fears for their own and their parents’ safety [37], and children’s depression, anxiety, somatic complaints, and sleep disruptions [38-41]. Cummings and Davies [42] contend that children evaluate marital conflict in terms of its implications for their emotional security and respond accordingly. Thus, IPV may affect children’s emotional security, and, in turn, may increase youth risk for adjustment problems [43]. In addition, chronic exposure to parental violence may also result in structural changes to a child’s frontal temporal lobe, resulting in difficulty organizing thoughts and problem-solving [44]. These changes in the brain chemistry may manifest themselves in terms of hypervigilant behaviors (e.g., keenly aware of gestures and sounds as possible violence indicators). In addition to the harmful effects that IPV may have on children’s emotional adjustment, exposure to IPV, and the victimization that children experience from their exposure to IPV, increase children’s proneness to bullying, aggressive, violent, and delinquent behavior [40,45-49]. Flannery, Singer, and Wester [50] found dangerously violent girls were 2–7 times more likely to have been exposed to violence, and were 3–5 times more likely than controls to have scored in the clinical range of depression, anxiety, posttraumatic stress, anger, and dissociation. Dangerously violent boys were 3–6 times more likely than controls to have been a victim of, or witness to violence [50]. Moreover, adolescent boys exposed to IPV are more likely to believe that use of aggression is acceptable in romantic relationships [51], and engage in more aggressive behaviors with their romantic partners [51,52]). It is important to recognize that these negative behavioral and developmental outcomes are independent of any direct abuse or neglect they may have also experienced from parental figures [53].