By the age of 17, 6 in every 10 South African children will undergo at least one adverse childhood experience (ACE) – defined as stressful and potentially traumatic situations that occur during childhood and adolescence and threaten their safety, security, trust or bodily integrity.”
Childhood trauma, says psychiatrist and member of SA Society of Psychiatrists (SASOP), Dr Wisani Makhomisane, can impact on the developing brain and have lifelong after-effects on mental and physical health, limiting children’s prospects in education, employment and positive functioning in society.
A 2023 South African study found that each ACE event in childhood raised the risk of adulthood depression by 12%, anxiety by 10% and inability to manage stress by 17%.[i] Adult participants in the research had experienced an average of three ACE events by the age of 17.
Dr Makhomisane says “Children have a right to be protected from ACEs, which limit their ability to realise their full potential. Timely and appropriate intervention in cases of childhood trauma can lessen the impact on future mental and physical health.”
Adverse childhood experiences include physical, sexual or emotional abuse; emotional and physical neglect; and experiencing serious accidents or medical conditions. Adverse experiences in the home, community or school are also counted as ACEs, for example exposure to domestic or community violence, violence or abuse at school, living in poverty or homelessness, family break-ups, or living with a parent with mental health or substance abuse problems.
Instability or grief due to separation from parents, or the imprisonment or death of a parent, caregiver or close relative also causes stress and trauma that can impact on a child’s development.
Adverse childhood experiences and trauma can also stem from children’s online lives, for example, cyber-bullying, threats, harassment and sexual abuse and exploitation.
She likened the impact of ACEs on the developing brain to being “chased by a lion for days and weeks on end”.
“The brain would be on high alert all the time and that internal alarm system does not ‘turn off’ even once the child is in a safe environment. A brain adapted to a threatening or unpredictable world will not work as well in a non-threatening environment. This leads to children misinterpreting positive social cues and normal social interactions as threatening and responding with aggression.”
“This can predispose children to mental health issues later in life,” she said.
Dr Makhomisane said that South Africa’s high levels of poverty, interpersonal violence, and a societal history of trauma, along with ongoing impacts of the Covid-19 pandemic on losses of family members and loss of income, all contributed to greater risks of ACEs for the country’s children and a higher risk of mental health disorders.
She highlighted several statistics that reveal the high levels of abuse and violence suffered by South African children:
- More than half (56%) of SA adolescents between 10 and 17 experienced physical abuse in their lifetimes, 35% experienced emotional abuse and 9% were sexually abused. Almost a third of South African children experienced multiple forms of abuse.
- Statistics South Africa reported in 2023 that 1 in 10 children experienced maltreatment at school – including corporal punishment, bullying and physical or verbal abuse by teachers or other learners.
- Rape accounted for 40% of reported crimes against children 17 and under in 2019/20, as well as common assault (24%), assault with intent to cause grievous bodily harm (assault GBH, 17%) and sexual assault 8.5%.
- Half of SA’s households with children aged 17 and under experience domestic violence against women or children, and 9 in 10 of households have experienced conflict over child support or maintenance.
Explaining the impact of ACEs and trauma on children, Dr Makhomisane said that early childhood experiences and relationships are important ‘building blocks’ for the developing brain. They set the stage for adult relationships, behaviours, mental and physical health, and social outcomes.
“Adverse childhood experiences, trauma and unstable living environments can cause toxic stress – prolonged activation of the body’s stress-response system, with continuously high levels of cortisol, chronic stress, making it more difficult for the brain to grow and learn.
“Not all stress in childhood is bad. Stress such as starting at a new school is necessary for the child to learn coping skills for the future. But if stress is chronic and uncontrolled then it becomes toxic to the brain,” Dr Makhomisane said.
She said toxic stress during childhood could harm the nervous, endocrine, and immune systems, with the resulting changes to the brain affecting children’s learning ability, attention, decision-making, impulse and emotional control, and overall behaviour.
“Children growing up under conditions of toxic stress due to ACEs not only struggle to learn and complete schooling, but are also at increased risk of becoming involved in crime and violence, substance abuse and other risky health behaviours. They may have difficulty forming healthy and stable relationships and maintaining employment.”
ACEs are also linked to chronic health conditions such as diabetes and heart disease, substance abuse and mental health disorders in adulthood.
Signs that a child may be experiencing trauma and need help include difficulties in interpersonal relationships and trust, social isolation, separation anxiety and sleeping disturbances or eating problems.
They may have low self-esteem and difficulty regulating their emotions, being easily upset or difficulty in calming, problems communicating their emotions or needs, and engaging in self-destructive, aggressive or oppositional behaviour, or exhibiting excessive compliance.
Learning and cognitive signs can include difficulty paying attention, focusing on or completing tasks, planning and anticipating consequences, and problems with language development.
Dr Makhomisane said psychotherapy, such as cognitive behavioural therapy, was the most effective in helping children to process and cope with the impacts of ACEs and trauma and reduce the risk of future harm.
She urged health care professionals to screen for trauma such as child abuse and neglect and refer for appropriate treatment for the child, and social work interventions for parents or caregivers.
“Interventions should empower young people affected by ACEs to build life skills and healthy relationships with a trusted adult to foster emotional and practical support.
“Training for parents, foster parents or caregivers can support them in dealing with complex trauma symptoms.
“There is also a need for trauma-informed schools where teachers are trained to identify possible trauma symptoms and provide caring relationships during a child’s difficult time. Teachers can model healthy social-emotional skills and help make the children feel safe as, at times, teachers could be their only trusted adult,” she said.
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