Whether on the roads, in their classrooms or in their own homes the incidence of violence against hapless children has increased so much so that it has prompted the Government driven by its zero tolerance of violence against children to set up a special committee to look into this issue and bring to an end this widespread abuse inflicted on children as young as infants . As statistics on rape, physical violence , emotional taunts that lead to loss of self worth among children under 18 continue to rise, child activists and health authorities are now taking a new look at how the problem could be solved by adopting a more holistic approach to resolve this specific heath issue .
The Sunday Observer spoke to Consultant Child and Adolescent Psychiatrist and Secretary of the Sri Lanka Association for Child Development (SLACD) Dr Yasodha Rohanachandra, who has a hands-on experience in handling emotionally scarred children, to tell us what drives this violence and plans to make this new year safer for all children
Excerpts:
Q. Violence against children has spiked globally and in Sri Lanka. Due to this, the Health Ministry has decided to give priority to prevent such violence which impedes the normal development of a child. As violence has many meanings define violence and what it means.
A. The World Health Organization (WHO) defines violence as the intentional use of physical force or power, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal development, or deprivation.
Q. Gender wise and age wise who are included in this definition?
A. This definition involves self-directed violence, which refers to violence in which a person inflicts violence towards him/herself,including deliberate self-harm and suicide. It also involves inter-personal violence, which comprises violence between individuals. Inter-personal violence includes child maltreatment, intimate partner violence, elder abuse, violence at school or workplace and stranger violence (i.e. assault by strangers). Finally, this includes collective violence, which refers to violence committed by larger groups of individuals (i.e. social, political and economic violence).
Q. As this period of activism is focused mainly on children and women, describe the forms of violence that is globally seen inflicted among children.
A. Violence against children includes all forms of violence against people under 18 years, whether perpetrated by parents or other caregivers, peers, romantic partners, or strangers. This includes physical, sexual or emotional abuse, neglect of care.
Q. What are the commonest types of violence one sees inflicted on Lankan children according to your latest studies? What are the worst forms of physical violence against Lankan children in your latest data reports?
A. Physical, sexual and emotional abuse and neglect are all seen in Sri Lanka. According to a study done in 2018, the commonest form of child abuse in Sri Lanka was found to be physical abuse, where 45.4% of children have had some form of physical abuse by the age of 18. The prevalence of emotional abuse and sexual abuse in this study was 27.9% and 9.1%. Physical abuse and emotional abuse were commoner among boys, whereas sexual abuse was more prevalent among girls.
Q. Who are the main perpetrators?
A. Contrary to the common belief that children are more likely abused by strangers, children are most often abused by those known to them. In the study mentioned above, they found that parents and teachers were the commonest perpetrators of physical and emotional abuse. Most of the sexually abusive acts in this study were committed by neighbours or strangers. This is consistent with global findings.
Q. What are the main causes that have driven this violence against children?
A. At individual level, having a disability or mental health problems, low educational attainment and low income may make children vulnerable to be abused. Family factors such as family dysfunction, domestic violence, poor parenting practices, parental mental health problems, parental substance use and poor parent-child relationships may predispose to child abuse.
At community level, poverty, low social cohesion and easy access to substance may make children at risk of violence. Social and cultural norms also play an important role in violence against children. Cultural beliefs that tolerate emotional, physical and sexual violence against children exist throughout Sri Lanka. This may also contribute to high levels of violence against children.
Q. What are the main health impacts on them physically?
A. All forms of child abuse are associated with long term adverse effects. Physical abuse can cause physical injury and sexual abuse can result in pregnancy or acquiring sexually transmitted infections. In addition, recent research has demonstrated childhood abuse to be associated with physical ill health in adult life, including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. This shows the long-term detrimental effects of child abuse.
Q. Psychologically, what are the health consequences?
A. Physical and sexual abuse can be associated with immediate psychological consequences such as acute stress reaction or post traumatic stress disorder. These children are also at a higher risk of developing depression, anxiety disorders, eating disorders and self-harm and suicide. In addition, children subjected to sexual abuse may have difficulty in forming trusting relationships and may have difficulty in sexual relationships. All forms of abuse are associated with low self-esteem and lack of self-confidence.
These children are also more likely to lack positive coping skills and are at risk of substance use. The effects of child abuse can even be transmitted to the next generation. For example, a minority of children who have been subjected to harsh physical punishment or physical abuse during childhood go on to practice these disciplinary methods on their children.
In addition, children exposed to violence and other adversities are more likely to have academic difficulties, drop out of school and have difficulty finding and keeping a job. Thus, the resulting unemployment and poverty is likely to affect the next generation.
Q. As a specialist in the field of Early Childhood Development, how does violence affect a child’s potential for optimal development?
A. Exposure to early violence can cause permanent changes in the brain structure and function. Early traumatic experience can cause changes in the areas of the brain responsible for regulation of emotions. Therefore, these children may lack ability for emotional regulation and distress tolerance. Early exposure to violence can also hinder development of the areas of the brain responsible for planning, judgement and decision making. Also, early trauma affects the hormones in charge of the body’s stress response, which may result in these children having a heightened response to stress.
Q. What are the early signs of an abused child a carer must look out for?
A. Since children are often abused by those known to them, it is the parents’ responsibility to create a safe and positive environment for the child within their home. Any sudden change in a child’s behaviour may indicate an underlying abuse. In younger children, sudden onset fearfulness, clinginess, excessive crying and resorting back to child-like behaviours (e.g. wetting the bed again after a period of continence, starting thumb sucking in a child who had already overcome this) may indicate abuse or exposure to a traumatic event.
In older children and teenagers, sudden avoidance of certain places or people should arouse the suspicion of possible abuse. In addition, they may have sudden changes in behaviour such as fearfulness, changes in sleep and/or appetite, crying, self-harm and deteriorating school performance may indicate exposure to abuse or a traumatic experience.
Q. It is said that emotional scars that children suffer due to violence and child abuse last much longer unlike physical scars. As a Consultant Child and Adolescent Psychiatrist and Secretary of the Sri Lanka Association for Child Development with a hands-on experience in handling emotionally scarred children, share with us some of your experiences.
A. Many of the children I encounter in my day to day practice have social factors that predisposed them to develop mental health problems. Many of them live in dysfunctional families, are exposed to family violence and have poor parent-child relationships. Some are exposed to violence at school in the form of bullying or harsh physical punishment.
Although parents often expect the mental health services to ‘fix’ the child by giving medications, it does not work that way. The stressors in the child’s family or school environment need to be resolved for successful mental health outcomes.
Q. Do you have a hotline or special 24-hour line devoted only to complaints of child abuse as in other countries? What is the number?
A. Yes. The National Child Protection Authority has a 24-hour hotline to report any forms of child abuse. The hotline number is 1949.
Q. What about differently-abled children unable to protect themselves?
A. Life skills are cognitive, emotional, interpersonal and social skills that enable individuals to deal effectively with the challenges of everyday life. Evidence shows that preschool enrichment and social development programs, which target children early in life, can prevent aggression, improve social skills, boost educational achievement and improve job prospects and can be sustained into adulthood. Studies have also found positive effects of academic enrichment programs, incentives to complete schooling and vocational training programs on violence prevention.
Q. Does the SLACD have any plans for the future with regard to a new holistic approach that ensures the wellbeing of both children and women?
A. The SLACD is a multi-disciplinary organisation which aims to improve knowledge and skills of professionals working with children so that children at risk or are at early stages of difficulty are identified without delay. This would enable to design early intervention strategies, which will improve their ultimate outcome.
Q. Your message on preventing child abuse and gender based violence in the new year?
A. Increasing awareness among the public about child abuse and gender based violence and available services, capacity building of professionals involved in provision of services for these populations need to be done at a national level.