Prioritise prevention of childhood adversity, maltreatment

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OPINION

By Prof Kennedy Amone-P’olak

According to estimates from the World Health Organisation (WHO), one billion (about 42%) of the 2.4 billion children in the world today face maltreatment and adversity every year.

Ninety per cent of these children live in low and middle-income countries (LMICs), including Uganda, where maltreatment and adversity during childhood are widespread and the burden of mental health problems is significantly higher and rising.

Global costs associated with physical, psychological and sexual violence are estimated to reach as high as 8% of global GDP (currently estimated at $110 trillion).

Moreover, the consequences of maltreatment and adversity on children are long-lasting and intergenerational.

An abusive, deprived and impoverished environment is associated with deficits in social relationships, attachment and executive function (e.g., attention, short-term working memory, planning, and decision-making). Children who are maltreated or experience adversity are more likely to grow up to do the same to the next generation. Consequently, this cycle affects not only the future of an individual, but the family and the country as a whole.

Types of childhood adversity

Adversity and maltreatment throughout childhood encompass a range of experiences such as emotional, physical and sexual abuse and neglect. Other familial factors include domestic violence, incarceration, familial mental illness, substance abuse, child labour, and separation and divorce.

Besides dysfunction at the family level, childhood adversity and maltreatment may also emanate from the community and school.

Community violence and substance abuse, the toxic culture and climate of teasing and bullying in schools, and the forced recruitment of children into the armed forces, inter alia, may leave long-lasting signatures of trauma in the lives of children.

Mental health consequences of childhood adversity and maltreatment

Adversity and maltreatment during childhood have been systematically linked to a variety of mental health disorders (e.g., depression, anxiety, and psychosis), substance abuse, and other behavioural disorders (e.g., aggression).

There are various mechanisms through which childhood adversity and maltreatment can lead to mental illness. In this article, I’ll examine two different pathways: socialisation and biological processes.

Families, friends, schools, social media and religious organisations are some of the settings where socialisation takes place. A recent survey of children (12–15-year-olds) in primary schools in Kampala showed that only about half of them come from families where the mother and father live together in the same household.

Without pathologising and stigmatising them, most family formations like single motherhood and separated or divorced status may only be proxies for psychological distress, poverty, conflicts and family chaos. Generally, this may provide the context for emotional and physical abuse and neglect, substance abuse and other forms of family disfunction.

In general, compared to households headed by men, those headed by women experience disproportionately high levels of poverty. Poverty-stricken households experience a high density of stress often associated with child abuse, bad parenting techniques, family dysfunction, and poor child-parent interactions.

To raise their children, many single mothers must work extremely hard, which leaves them with little time to interact with and be available to their children.

Similarly, children’s emotional well-being is severely compromised by father absenteeism. Boys’ interaction with their fathers or father figures has a significant impact on their emotional well-being and regulation. On the other hand, research shows that the availability of fathers or father figures in the lives of their daughters has been linked to emotional well-being and delayed sexual debut, being with one sexual partner at a time, and low teenage pregnancy.

Furthermore, without the assistance of a spouse, single parents deal with a great deal of stress, conflict and dysfunction as they raise their children, especially teenagers. Children are sometimes left in the care of housekeepers, grandparents, or relatives, which exposes them to further emotional and physical abuse.

Consequently, all these situations coalesced to exacerbate the already adverse mental health toll on children in single-parent family formations.

The hypothalamic-pituitary-adrenal (HPA) axis is the biological system through which abuse and adversity have a lasting signature on the brains of children.

The HPA axis involves the central nervous and endocrine systems to regulate hormone balance in response to stress and external threats. It has been demonstrated that survivors of maltreatment and adversity in childhood show a dysregulated HPA axis. The dysregulated HPA axis, in turn, impairs their ability to cope with stress, makes the hormonal and immune systems overactive, and may lead to chronic inflammation, which predisposes the children to long-term mental health problems.

As a result, individuals who have survived childhood trauma and mistreatment live in an emotional maelstrom, frequently struggling to manage stress, have weaker control over thoughts and actions, and often turn to maladaptive coping strategies like alcohol and drug abuse as temporary fixes.

Interventions to reduce the toxic effects of childhood adversity and maltreatment

Interventions to address maltreatment and adversity in childhood are essential, if children are to reach their full potential.

The Government can provide community resources through which protection services, parent education (e.g., positive disciplining techniques, better rearing practices, strengthening parent-child relationships), and referral channels for interventions (e.g., LC councillors responsible for children, child welfare office, Police Family Protection Unit, etc.), and treatment (e.g., behavioural therapy, better coping styles, stress management, etc.) can be implemented.

The Children’s Bureau, which would evaluate each child’s health and well-being about every six months until the age of 16, may be incorporated into the main primary healthcare system. Medical doctors, social workers, psychologists and other healthcare professionals could readily monitor and assess children’s welfare through the children’s Bureau and any problems in the course of a child’s life would be quickly resolved.

Conclusion

Understanding factors that lock families in the path of early childhood adversity and maltreatment is vital for unleashing the full potential and future opportunities of children. A multifaceted cross-system intervention (e.g., schools, social work, psychological services, health services, and law enforcement) to protect, prevent and treat children affected by adversity and maltreatment is a national priority required to meet their developmental and mental health needs.

Childhood adversity and maltreatment are associated with increased long-term economic and health risks. The investment required to prevent childhood adversity and maltreatment is far less than the cost of childhood adversity and maltreatment. Prevention is not only cheaper; it pays.

The writer is a professor of psycho-traumatology kpamone@gmail.com