Children in many countries are growing up surrounded by violence. It may happen at home, in their neighbourhoods, or both. Some children are directly harmed, while others witness violence between caregivers or in their communities. Either way, the impact can be profound.
Evidence shows that the relationship between violence exposure and poor mental health can be seen even before a child is old enough to go to school. Researchers are learning that early adversities can have lifelong consequences.
We are researchers in paediatric neuroscience and psychology who set out to understand how early experiences of violence are shaping young children’s cognitive and emotional health in low- and middle-income countries. Here we discuss our findings from a review of studies from 20 countries and new data from a large cohort of children in South Africa.
We found that violence exposure is extremely common in all the countries we looked at and that its effects on mental health are already visible in childhood.
The response will require action at all levels – families, communities, health systems and governments.
Gaps in the research
Early childhood (birth to 8 years) is a critical period for emotional, social and cognitive development. Mental health or cognitive difficulties that begin in the preschool years can shape children’s relationships, learning and wellbeing well into adolescence and adulthood. Yet, little is known about how violence affects children in the early years in low – and middle-income countries, where violence rates can be high. Most research focuses on school-age children or adolescents, missing the window when prevention may be most effective, in early childhood.
We aimed to fill that gap by collating existing knowledge and generating new evidence from South African children. This formed the basis of co-author Lucinda’s PhD thesis.
First, we reviewed 17 published studies from 20 low- and middle-income countries, examining how violence exposure affects children’s cognitive functioning. Second, we used data from almost 1,000 children in the Drakenstein Child Health Study, a long-running birth cohort in a peri-urban community outside Cape Town. We examined these children’s exposure to different types of violence by age four-and-a-half and assessed their mental health at age five.
What we found
Sadly, our findings revealed that violence exposure is extremely common.
The review found that over 70% of the studies drawing from 27,643 children from 20 countries, aged up to 11, across four continents, reported poor cognitive outcomes associated with experiencing maltreatment, intimate partner violence and war.
In our South African cohort, by age 4.5 years, 83% of children were exposed to some form of violence. This included witnessing community violence (74%), witnessing domestic violence (32%), and being direct victims in the community (13%) or at home (31%). Nearly half (45%) experienced more than one type of violence.
Read more:
Why South Africa’s children are vulnerable to violence and injuries
In many countries, early exposure to violence is not exceptional. It is a normal part of growing up for many children.
Regarding how violence affects mental health in early childhood, the South African data showed that preschool children exposed to more violence displayed more internalising symptoms, such as anxiety, fear, or sadness, and externalising symptoms, such as aggression, hyperactivity, and rule-breaking. Experiencing violence at home and witnessing violence in the community were particularly linked with these difficulties.
One of the clearest findings was that multiple exposures compounded the risk. Children who experienced both domestic and community violence were at particularly high risk of mental health difficulties, especially experiencing externalising symptoms.
Public health challenge
These results highlight a major public health challenge, which starts early. These patterns appear before school entry, suggesting that violence exposure can alter developmental pathways well before formal education begins.
Since the risks from mental health difficulties linked to violence were visible by age five, waiting to intervene until school-age misses a crucial opportunity.
Impacts to wellbeing in early childhood can cause some children to internalise distress and others to act out, but both can disrupt learning, relationships and future mental health.
It is a stark reality that in some communities, most children are affected by violence. Individual therapy alone cannot fix a problem this widespread. It is a population-level issue. Broader community and policy responses are needed, such as the INSPIRE strategies developed by the World Health Organization.
Where to from here
The reality is grim and calls for quick and informed action at all levels: families, communities, health systems, and governments. A successful response will include:
Early identification: Health and community services should routinely ask about violence exposure, including witnessing violence, during early childhood visits.
Support for families: Interventions that reduce domestic violence, strengthen parenting skills, and provide mental health and social support can protect both children and adults.
Addressing community violence: Safer neighbourhoods, violence prevention efforts and policing reforms should be implemented and also clearly linked with child mental health strategies in policy wording.
Policy that prioritises early childhood: Governments and NGOs should embed early violence prevention and child mental health promotion into national health and education strategies.
Monitoring and revising strategies: Improving data collection and data quality will help track progress and inform improvements to further interventions.
Read more:
Violence against children carries a huge cost for Africa: governments need to act urgently
Violence exposure in early childhood is widespread in low- and middle-income countries and has clear impacts on young children’s mental health. These effects emerge early, grow with multiple exposures, and require early intervention at every level. Protection and support are essential to build healthier and safer communities for the future.
There is hope as some organisations in South Africa are working to prevent violence against women and children, and intervening for those affected.