The Effects of Community Violence on Children and Adolescents

The study of community violence includes examining both predatory violence (usually a stranger trying to take something of value using physical threats or direct violence) and violence arising from nonfamily interpersonal conflicts (this usually concerns acquaintances involved in an altercation). Both types of violence may include brutal acts such as shootings, rapes, stabbings, and beatings. Historically, the focus of media attention and scholarly research has been on crime-related trauma involving adults. However, increasingly it is recognized that many children and adolescents are exposed to violence in their own neighborhoods and schools. Furthermore, community violence is now recognized as a public health issue, especially among the young. Accordingly, researchers and clinicians concerned with community violence are intensifying their focus on youthful victims and the consequences of their trauma exposure, including the development of Posttraumatic Stress Disorder (PTSD).

How much community violence are youths experiencing?

A commonly held belief in the general population is that community violence only happens among gang members in inner-city neighborhoods. Indeed, those of lower socioeconomic status, those who are nonwhite, and those living in densely populated urban areas do appear to bear a disproportionately high burden of violence. However, as has been demonstrated by recent events occurring in diverse middle-class suburban and rural areas including Denver, Colorado; Springfield, Oregon; Jonesboro, Arkansas; and Granada Hills, California; children from all walks of life and all ages are at risk for exposure to community violence. In a national survey of girls and boys 10 to 16 years old, over one-third reported being the direct victim of different forms of violence including aggravated assault, attempted kidnapping, and sexual assault. Researchers have found that an even higher number of urban children have been exposed to indirect community violence (e.g., they have witnessed violence or know a victim). One study comparing urban elementary school children living in low-violence neighborhoods to those living in high-violence neighborhoods found that over 75 percent of those in high-violence neighborhoods had been exposed to community violence. (The study also revealed that there was no significant difference between the low-violence and high-violence neighborhoods when it came to children witnessing violent acts including stabbings, physical assault, and gang violence.) Yet, more than 50 percent of the parents of children living in high-violence neighborhoods stated that their children had not been exposed to violence in the community.

Are some youths at greater risk for exposure to community violence?

Unfortunately, there is no immunization for our children against exposure to community violence. However, researchers have identified factors that may increase a child's risk for exposure to community violence. As you might expect, living in poor, inner-city areas and being a minority appears to increase the risk for community violence exposure. Gang affiliation appears to be a key risk factor, as is involvement in substance abuse and exposure to domestic violence. Gender is another risk factor; males witness more community violence and are at higher risk for physical assault and other direct forms of community violence, whereas females are at higher risk for community-violence related sexual assault.

What are the effects of community violence?

If injured, a child or adolescent may have to cope with surgeries, disabilities, convalescence, and rehabilitation. In addition to the physical aftermath of traumatic injury, the psychological consequences can be serious. PTSD commonly develops after a child has been exposed to community violence.

Some people think that young children are not psychologically affected by exposure to community violence because they are too young to understand or remember the violence. However, studies have found posttraumatic symptoms and disorders among infants and toddlers. Symptoms expressed by children tend to look different from those expressed by adults. Children with PTSD display disorganized or agitated behavior and have nightmares that may include monsters. They may become withdrawn, fearful, or aggressive, and they may have difficulty paying attention. They may regress to earlier behaviors such as sucking their thumbs and bed-wetting, and they may develop separation anxiety. They may also engage in play that compulsively reenacts the violence.

Adolescents with PTSD also experience nightmares and intrusive thoughts about the trauma. They may be easily startled and avoid reminders of the trauma. They can become depressed, angry, distrustful, fearful, and alienated, and they may feel betrayed. Many do not feel they have a future and believe that they will not reach adulthood. This is especially common among adolescents who are chronically exposed to community violence. Other trauma-related reactions can include impaired self-esteem and body image, learning difficulties, and acting out or risk taking behaviors such as running away, drug or alcohol use, suicide attempts, and inappropriate sexual activities.

Children's and adolescents' risk for developing PTSD increases with the severity of exposure, the level of negative parental reactions to the exposure, and the child's physical proximity to the community violence.

The impact of community violence exposure is not felt by the youth alone. A child's or adolescent's exposure to community violence also affects his or her family. Extreme anxiety concerning the child's health and well-being is a common parental reaction. Resources for parents may be limited, which may lead to frustration and anger. Many parents blame themselves for not protecting their child adequately. They may become overprotective or use punitive discipline in response to their child's trauma-related acting out behavior. Relationships among family members can become strained. Parents find themselves having to face the task of reassuring their child while trying to cope with their own fears, especially if there is chronic risk for future community violence exposure.

What treatments are available for youths exposed to community violence?

Despite parents' best efforts, children and adolescents may be exposed to community violence. However, they can be helped to cope with the physical and psychological consequences. A caring, supportive adult in the child's life can greatly ease a child's distress. Spend time with the child and be sure the child understands that you are willing to listen. Encourage the child to talk about the trauma, but do not force him or her to speak. Answer questions honestly in developmentally appropriate language. Be aware that children may develop new problem behaviors in reaction to the trauma. These reactions will require patience and understanding. Seek assistance from friends, family, medical professionals, and mental-health professionals for you and your child.

While not as well studied as PTSD treatment for adults, there are several forms of individual and group PTSD treatment available for youths. Individual treatment provides a controlled, supportive therapeutic environment while group methods offer validation and help normalize victims' traumatic reactions by encouraging members to share with each other. Cognitive-behavioral group therapy has been shown to be effective for other youth trauma populations, such as those exposed to sexual abuse, and may be applied to community violence populations. However, increased efforts to provide appropriate clinical services are needed. A realistic starting point is the hospital emergency departments where community-violence related physical injuries are treated. Access to crisis intervention and short-term treatment for PTSD symptoms would greatly benefit youths and their families in these settings. The aforementioned forms of PTSD treatment could also be provided in school-based clinics, especially for youths victimized through witnessing or vicarious trauma.

Some progress has been made in developing violence prevention programs. The current focus for these programs is gang prevention and conflict resolution skill-building for high-risk youths. However, violence prevention programs appear to be more effective if children are engaged early (beginning before age 6) and the program includes intervention in children's home and school social environments. Programs should also continue to make specific efforts to reduce obvious high-risk behaviors among adolescents, such as gang involvement, heavy drinking, and carrying handguns.

References

Foy, D.W. & Goguen, C.A. (1998). Community violence-related PTSD in children and adolescents. PTSD Research Quarterly, 9(4), 1-6.

Sanders-Phillips, K. (1997). Assaultive violence in the community: Psychological responses of adolescent victims and their parents. Journal of Adolescent Health, 21, 356-365.

Scheeringa, M.S. & Zeanah, C.H. (1995). Symptom expression and trauma variables in children under 48 months of age. Infant Mental Health Journal, 16, 259-270.