Childhood abuse does long-term damage

The impact of abuse has lifelong implications. The seminal international Adverse Childhood Experiences (ACE) study showed that abuse is one of the leading causes of negative and detrimental outcomes across a person’s lifespan. These include the expected psychological torment and mental health challenges, while substance misuse and self-harm are another troubling trend. But the ramifications reach further still, affecting physical health. The study linked childhood adversity to higher rates of heart disease, stroke, chronic lung disease, obesity, poor overall health, and even some cancers. 

This leaves us no option but to take abuse seriously, and to believe and support the victims. Sadly, in a world of moral corruption, the sexual predators often roam unimpeded among us while victims hide and are silenced, sometimes forever. 

South Africa has one of the highest burdens of child abuse in the world. The 2016 Optimus Study found that roughly one in three young people experience some form of sexual abuse before the age of 18. Unexpectedly to many, boys are as vulnerable as girls. Socially, however, boys are often raised with the idea that boys don’t cry and need to “man up”. The message they absorb is that disclosure is not for them. 

A 2005 study conducted in Israel by Irit Hershkowitz and colleagues speaks to how often disclosure comes late, if at all. This national study of more than 26 000 children, interviewed between 1998 and 2002 using a carefully validated method, found that 65% disclosed when questioned, while 35% did not. The relationship to the suspect strongly influenced disclosure: children were markedly less willing to accuse a parent or parent figure than another adult. Girls disclosed slightly more often than boys overall, and the reluctance was especially concentrated among adolescent boys asked about sexual abuse by a parent figure. 

The teenage years are challenging on every front. Physical change converges with extensive neuroplasticity in the brain: neural pathways that no longer serve the child are pruned, while growth and new connections take their place. This makes the adolescent brain particularly sensitive to what is happening in the teenager’s life ‒ an impressionable, formative window. The ACE study confirmed what had long been suspected: children exposed to abuse and neglect frequently show scholastic regression. Learning difficulties and lower educational achievement take hold, and on top of school failure, relational and social problems often follow. 

The impact on mental health cannot be overstated. The compounding trauma of repeated abuse produces lasting emotional injury. Dissociation is one such response, in which the victim detaches what is happening to their body from their conscious mind. This altered awareness allows them to accept that someone they love or respect is hurting them. By pushing the boundaries of their consciousness, the child learns to treat the unbearable as normal, making a fragile peace with an attack their mind cannot reconcile. 

The perpetrator, meanwhile, is well versed in grooming the child and clearing the path to an ideal victim. They deliberately target a child who is disadvantaged, isolated, or lacking in confidence, qualities that lower the risk of disclosure. The offender builds a trusting bond, showering the child with kindness, support, help, or even gifts and money, positioning himself or herself as the answer to an emotional or practical gap. By filling that need, the offender becomes indispensable, all while systematically separating the child from their support network and isolating them further, until the abuser is the primary source of connection and reassurance. The physical abuse is then established gradually ‒ eroding boundaries, desensitising the victim, and normalising inappropriate sexual behaviour, deepening the confusion in an already disorganised mind. To keep control, the perpetrator wields shame, secrecy, fear, and reward. 

Yet the ACE study also carries an essential caveat. Childhood adversity is not simply a set of temporary events with no sequel. The study’s findings describe population-level risk, not prognosis or destiny. Many people who have access to protective factors ‒ supportive relationships, effective psychological therapy, stable communities, education, and other sources of resilience ‒ go on to lead healthy, fulfilling lives with the right interventions. 

Considering the recent disclosure of historic abuses that has reverberated through our community, I cannot help but commend the exceptional bravery of these survivors. They refuse to be silenced. It is not unusual to find sexual predators embedded within a community, and the difficulty of reporting and restoring justice is that survivors are so often reluctant to speak up and open criminal cases. The secondary trauma of speculation and judgement is fierce, and it reinjures the victim. 

Thankfully, that is not the case this time. We are fortunate to live under a robust Constitution, and the Children’s Act (38 of 2005) offers far more protection than children had in the 1980s. But prevention is always better than cure. Talking to your child, and building regular conversations in which they feel safe to open up, is critical to keeping them safe. 

I find it poignant that this story has come to light as South Africa commemorates Child Protection Week. Running this year from 29 May to 5 June, it reminds us to reframe the art of raising children. Just as it takes a village to raise a child, it takes 365 days of awareness to keep one safe. 

• Dr Efrat Barnes is a medical practitioner who has specialised in child protection medicine and forensic paediatrics for the past 17 years. She has been the head of the Child Abuse Unit at Charlotte Maxeke Johannesburg Academic Hospital since 2015.