Published onHealth Tip of the Week
Children of all ages are exposed to violence in concerning numbers each year, and that exposure brings with it a risk of lasting harm.
The Violence Prevention Initiative (VPI) at Children’s Hospital of Philadelphia works to reduce early exposure to violence and to make support and interventions available to reduce the impact when children are exposed to or are the victims of violence. In this article, VPI's experts share key findings and suggestions for parents.
How big a problem is childhood exposure to violence?
Any child may be exposed to violence, but some children and families face the particular challenges of living in communities where repeated exposure to violence is unfortunately common.
A 2015 study found that:
- More than one-third of children (37.3 percent) had been physically assaulted within the previous year and almost one in ten (9.7 percent) had been injured in the assault. Among younger children, the violence was most often at the hands of older siblings, while among teens, peers were the bigger threat.
- One in every seven children (15.2 percent) had experienced maltreatment by a caregiver in the previous year including physical abuse, verbal abuse or neglect.
- Almost one-quarter of children (24.5 percent) had witnessed an act of violence or crime in the previous year, including assault by family members and violence in the community. The rate was higher (36.9 percent) among teens (ages 14 to 17).
These experiences of violence can have lasting effects on children as they develop and age. Repeated exposure to violence is associated with physiologic and brain changes that may affect behavior and health. The effects can appear in adolescence as higher risks for school failure or substance abuse, and as an increase in violent behavior or being re-victimized. Some ways of tempering these effects are mentioned in sections below.
The risk of negative effects from exposure to violence is higher among children who have diagnoses of ADHD, oppositional defiant disorder, major depression and other conditions that may lead them to be more impulsive and to have difficulty reading social cues.
Signs that a child may be experiencing trauma
If your child has been exposed to violence, either as a victim or a witness, watch for signs of trauma. The National Child Traumatic Stress Network offers the following list of indicators. If your child shows two or more, you may want to consider a professional assessment.
- Difficulty controlling emotions — easily becomes sad, angry or scared
- Trouble controlling behavior
- Trouble remembering, concentrating or focusing — sometimes appears “spacey”
- Sleep problems; changes in appetite
- Complains of physical symptoms, but doctor can find no cause
- Difficulty forming and sustaining relationships with other children and with adults
- Seems to need and seek out more stimulation than other children
- Is jumpy or easily distracted by noises, movements and other changes in the environment
- Has many mental health diagnoses, but none seem to fit or explain the problems, and treatments for these problems are not helping
What can be done to help children and teens
The first step is to protect children from exposure to violence. That starts in the home with education and other interventions to promote respectful relationships with our children and our partners, and the adoption of positive discipline techniques. Children raised in a respectful and supportive environment at home are less likely to engage in abusive or bullying behavior with peers. It also involves working to help make all communities safe for children.
But we can’t protect our children from all exposure to violence when they are among peers or out in the community. When children are victims of or witness violence, the next step is to address the traumatic impact. Research by experts at CHOP’s Violence Prevention Initiative (VPI) and others have found a number of factors and measures to be helpful, including:
- Early identification of trauma and provision of support. VPI is helping to broaden the network of people who can provide this support by developing and delivering trauma-informed care training to adults who regularly interact with children from communities that are plagued by violence. VPI's Violence Intervention Program connects youth treated at CHOP for assault injury with case management, mental health services and other needed resources.
- Positive adult connections. When children and adolescents have adults in their lives who they look up to and who can help them handle tough situations, these mentors can have profound protective effects on their development. For many youth, family members can serve in this role. For others, teachers, community leaders or clergy can provide this support.
- Programs to reduce day-to-day aggression in schools and communities and to promote inclusive school climates that reduce the social isolation of at-risk youth. VPI's bullying prevention programs, designed for elementary and middle school-aged students, show children how to prevent aggression and bullying by recognizing and managing feelings, reading social cues, and being positive bystanders. These strategies can be helpful not only in handling physical but also in relational (gossip, social exclusion) and cyber conflicts among peers.
- Measures to close gaps in mental health services for children with emotional and behavioral problems and to provide a broader continuum of mental health care.
For more information
Finkelhor et al., “Prevalence of Childhood Exposure to Violence, Crime, and Abuse.” JAMA Pediatrics. August 2015.
Laura Vega, “We Are All Part of the Solution to Prevent Violence in Philadelphia.” Center for Injury Research and Prevention. August 22, 2019
Contributed by: Joel A. Fein, MD, MPH
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