Children and Adolescents' Violence: The Pattern and Determinants Beyond Psychological Theories

Full text

American Journal of
Pediatrics
2020; 6(2): 138-145
http://www.sciencepublishinggroup.com/j/ajp
doi: 10.11648/j.ajp.20200602.24
ISSN: 2472-0887 (Print); ISSN: 2472-0909 (Online)
Review Article
Children and Adolescents’ Violence: The Pattern and
Determinants Beyond Psychological Theories
Georges Pius Kamsu Moyo
Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
Email address:
To cite this article:
Georges Pius Kamsu Moyo. Children and Adolescents’ Violence: The Pattern and Determinants Beyond Psychological Theories. American
Journal of Pediatrics. Vol. 6, No. 2, 2020, pp. 138-145. doi: 10.11648/j.ajp.20200602.24
Received: February 7 2020; Accepted: February 27, 2020; Published: March 24, 2020
Abstract:
Background: Violence may be assimilated to actions or words that are intended to hurt. Youth violence includes a
wide range of aggressive acts that may vary from bullying and physical fighting, to most serious forms such as homicide.
Africa and Latin America are the continents where the highest rates of youth violence and homicide are reported. For many
years in the past, media violence exposure alone was incriminated for children violence, but as time went on, it became clear
that children violence is more of a resultant to a combination of factors contributing with varying degrees according to age, the
intensity of exposure to a predisposing factor and the individual’s predisposition or susceptibility to violence. This review aims
to present in simple and accessible terms the various aspects of children and adolescents’ violence. Epidemiological and
psycho-pathophysiological aspects are described, with emphasis laid on the various risk factors and possible preventive
measures. Method: A review based on past and recent publications treating the subject was done. The literature was screened,
with relevant information critically analyzed. Results: The recurrent predictive factors for children and adolescents’ violence
found in the literature are: the exposure to media and community violence, drug use and abuse, neuropsychiatric and
psychological disorders that manifest or worsen with violence, and inadequate parenting models. These predisposing factors
are underlined by some other determinants such as gender, genetic and individual factors, culture, poverty, and peer effect or
companionship principally. Conclusion: Violence in children is determined by intrinsic factors such as the developmental stage
or age, individual’s susceptibility or natural predisposition, and environmental factors such as media and community influences.
The most essential of the preventive measures are based on the reduction of the various risk factors and their determinants
which may be achieved by parental, scholar and governmental regulations.
Keywords:
Children, Adolescent, Youth, Violence
1. Epidemiology
The World Health Organization (WHO) in its 2002 report
on violence and health defines violence as “the intentional
use of physical force or power, threatened or actual, against
oneself, another person, or against a group or community,
that either results in or has likelihood of resulting in injury,
death, psychological harm, mal development or deprivation”
[1]. Youth violence includes a wide range of aggressive acts
that may vary from bullying and physical fighting, to most
serious forms such as homicide [1]. The highest rates of
youth homicide have been recorded in the African continent
and Latin America mainly [1]. Apart from the United States
of America (USA), most countries with youth homicide rates
above 10 per 100 000 are either developing countries or
countries facing difficulties with social and economic
changes [1]. It has been reported that for every young person
killed by violence, an estimated 20 to 40 other persons
receive injuries that require hospital treatment [1]. Children
violence has been of increasing concern for researchers over
a number of years now, although more studies have been
dedicated to violence perpetrated on children [2]. In all
countries, young males are the principal perpetrators of
violence among the pediatric population and are as well
oftentimes the victims of the most severe forms of
aggressions [1, 3]. Children violence appears to be a
psychologically-elaborated act in response to a

139 Georges Pius Kamsu Moyo: Children and Adolescents’ Violence: The Pattern and
Determinants Beyond Psychological Theories
socio-environmental malaise that yields to aggressive verbal
or physical exteriorization [2, 4]. It may be expressed at
home, in the street, at school or anywhere else. The various
outcomes and explanatory theories elaborated about children
violence are numerous and might seem confusing, especially
for non-initiates to psychology [2]. However, a reflective
analysis of various theories suggests a need for reassessment
of past concepts and theories appraisal of the various risk
factors and intervention measures, beyond psychological
considerations [2]. In effect, the WHO has emphasized the
necessity to adopt public health policies to prevent violence
and reduce related morbidity and mortality in societies [1].
Relevant suggestions have been made as to the association of
health services with violence prevention through family and
community interventions [1].
2. Psycho-pathophysiological
Background
2.1. Development of Violence
Children violence appears to vary with time and space as a
significant proportion of aggressive children are likely to
grow up to be aggressive adults, with levels of violence being
highly dependent of their environmental context [5-7].
During childhood, there is a mechanical tendency to
reproducing suggested behavior, good or bad as they may be
[2]. This process of “social learning” which is important for
development is the basis of the “social cognitive theory” [4].
A simplistic idealistic interpretation will suggest that good
and bad habits may be learned through the same processes
and perhaps at the same moment, but this does not happen in
reality as there may exist a natural inclination to destructive
or irresponsible behavior with anti-social learning and
vice-versa [2]. This assumption is derived from and may be
assimilated to the “catharsis theory” [2]. Moreover, contrarily
to adults in whom satisfaction may be obtained by mere
watching according to the “gratification theory”, in children,
instant satisfaction may go with learning and a need for
action [2]. However recent findings demonstrated that even
though childhood risk factors are known to predict the
development of later conduct problems including
aggressiveness, holistic assessment should equally consider
current factors likely to exacerbate violence [8]. Adolescence
is the period during which children referral to psychiatric
clinic culminates, with global reports showing that the rates
of violent offending are highest between 16 and 17 years of
age [9, 10]. Nevertheless, the age range between 10 and 14
years is a particular relevant age to focus upon because it
corresponds to the moment when children begin to seek more
autonomy and control over their own choices, with a desire
for auto affirmation and defiance [11]. Adolescence equally
corresponds to a period during which children increasingly
engage in negotiation with parents about rules and
regulations, while parents gradually relax and allow them
more freedom, perhaps to monitor their maturing process and
sense of responsibility [12, 13]. During adolescence, children
behavior may become very suggestible with
socio-environmental influences such as “peer effect” or
companionship and media which act in concert with
individual susceptibility, possibly determined by genetics
[11]. Thus during this period, parents’ rules may be less
considered with corresponding risks and equivalent
exposures to dangers [12].
2.2. Relative Effects of Parenting or Authority
Parental monitoring and adequate parenting styles may
have significant impacts on violence control in children [14].
Parents may use four different known approaches in reducing
children exposure to violence: the restrictive and the active
mediations, the inconsistent restriction style, or the autonomy
supportive style of mediation [15, 16]. All mediation models
may have advantages and inconveniences, but their success
mostly rely on the manner in which parents go about
administering them [17]. Restrictive mediation consists in
parents establishing strict rigid rules pertaining to a particular
activity, to which the child must abide [11]. This might be the
case with television, computer, video games, and other
undesired distractions. The restrictive parenting model is
described to be too controlling, especially in adolescents with
whom there is possibility of causing reverse effects as
opposition or revolt through phenomena such as the
“boomerang effect” or the “forbidden fruit effect” [18-21].
Restrictive mediation may be used in last resort where other
methods of mediation have failed [11].
The active model on its part consist in parents’ discussion
and explanation of the negative effects of a particular activity
to children, with an aim to conscientize or raise awareness, so
as to obtain children adhesion to rules and regulations,
according to the “self-determination theory” [22]. Its success
appears to be sex and age dependent, with more adhesion in
boys [11] and more success with children aged above 10
years [23].
The inconsistent restriction model consists in occasional
restriction while releasing or allowing at some other
occasions [11]. This parenting style has been found to be
associated with the greatest level of “boomerang effect”
[18-20]. In effect, inconsistent restriction model of parenting
may create sensations of unsatisfied needs with a desire to
have more, and eventually open access [11].
The autonomy-supportive style of mediation may be
considered as an ameliorated form of mediation that
combines characteristics of both restrictive and active
mediation styles [11]. Children are provided with
justifications to the established rules and their perspectives
seriously taken into consideration [11]. This model of
parenting is associated with internalization and acceptation of
rules and regulations among adolescents [11].
2.3. Conduct Disorder
A conduct disorder as far as violence is concerned is
defined as a repetitive and persistent pattern of violent and

American Journal of Pediatrics 2020; 6(2): 138-145 140
antisocial behavior as defined by the American Psychiatric
Association [24]. Whereas a violent misconduct may be
assimilated to a punctual wrongful violent behavior
motivated by an intentional purpose or indifference to the
consequences of one’s acts [25]. There exists a reciprocal and
directly proportional relationship between violent conduct in
children and community exposure to violence [7]. In effect,
exposure to violence through witnessing or victimization is
associated with violent conduct in children [7]. In the other
way round, most violent children tend to originate from
violent neighborhoods [7]. Such relationships are even
stronger in adolescents as they are further strengthened by
the common “self-provoked situations” which is
characteristic of adolescence [6, 26]. Therefore, there exist a
sort of “negative spiral effect” and a “vicious cycle” between
violent conduct in children and community violence
exposure, which may manifest with physical or verbal
aggressiveness [7].
Aggression or aggressiveness may be described as a
behavior aimed at causing physical or psychological damage
to someone [25-27]. It is a mode of violence expression and
the two terms may be synonymous according to the context.
There are two main forms of aggressive behaviors commonly
described in children, which are: reactive and proactive
aggressions [26]. Proactive aggression corresponds to an
instrumental pre-meditated and goal-oriented form of
aggression characterized by a relative low level of arousal or
excitation [25, 26]. The neurobiological seat of proactive
aggression is thought to be found in amygdala dysfunction
and a reduced response to distress signals [28, 29]. It may be
predictive of later delinquency, conduct problems and
violence in mid-adolescence as well as criminal behavior
later in life [30-32]. Proactive violence in children often
results from greater violence exposure which causes
individual’s desensitization to violence effects with
accommodation, habituation and eventually normalization
[25, 26].
On the other hand, reactive aggression refers to an
impulsive form of aggressiveness which is usually evoked by
high arousal and strong emotions such as anger and fear
[25-27]. It is better explained by the “frustration-anger”
model characterized by an emotional response to anger,
annoyance or disappointment resulting from a denied goal or
will, for which the individual may cope or react with anger,
aggressiveness or violence [32]. The neurobiological basis of
reactive aggression has been linked to orbito-frontal cortex
dysfunction and impaired emotion regulation [33, 34].
Community violence exposure, though less frequently, may
give rise to reactive aggressiveness by affecting the
“sensitivity in threating” violence stimulation, or the neural
arcs implicated in reactive aggression [25, 26]. More so,
reactive aggression is also described to be associated with
impulsivity and hostility [32-34].
A “cumulative effect” or process may be observed with
time when a growing child is continuously exposed to a
predisposing factor to violence, while “additive effect” or
“summation” of several factors may as well enhance
externalization behaviors [2, 35, 36]. The end result is the
perpetration of violence with different degrees and magnitude.
A maximum level beyond which the child cannot be more
violent may be soon reached, characterizing the “ceiling
effect” [25-27].
3. Predisposing Factors
3.1. The “Media Violence Theory”
Exposure to media violence has theoretically been
conceptualized as a modeling influence from which children
can learn aggressive behaviors, especially if acted by an
attractive character, rewarded or unpunished [37, 38]. There
is evidence that violence viewing from television, computer,
smart phones and video games produces substantial short
term likelihood to aggressive conduct especially in small
boys [3]. Nevertheless, long term effects may be observed
with continuous exposure, as suggested by the
“developmental theory” [2, 39]. About 93% of school
children spend more than 50% of their leisure time watching
television [3]. In 1992, the American Medical Association
reported an average television viewing in children estimated
at 27 hours per week and they would have seen close to 40
thousand murders by the age of 18 years [2]. Heavy
television viewing participates in making children adopt
virtual concepts such as violence acceptation as a societal
practice which they can transpose to reality by action [39].
Children may equally interpret media violence as suggested
games to play with other children [4]. It has been shown that
the more children are exposed to television violence, the
more aggressive they are in school, the greater they stand
chances to get into troubles by the age of 19, the more likely
they use violence against their children by 30 and the more
they would be reported for aggression by spouses and
convicted for crime [2, 40].
3.2. Community Violence
Exposure to community violence could be defined as the
witnessing of violence by an individual within a community
or being personally a victim, or both [27, 41]. It is a common
and persistent public health issue in many city neighborhoods
[42, 43]. According to the WHO, community violence
exposure (CVE) is a global public health problem with
highest incidences recorded in the USA, followed by Africa
[1, 43]. It has been described that the association between
CVE and violence in children is determined by the male sex
and poverty [36, 44, 45]. Moreover, actual CVE appears to
be more strongly associated with current violence in children
than past exposures [27]. There exists a reciprocal
relationship between CVE and the rate of delinquency in
children [27]. Studies have shown that closer proximity with
CVE is responsible for stronger psychological impacts in
children such as emotional distress and internalizing
symptoms which may serve as breeding ground for later
externalization through violence [25]. Therefore,
victimization in CVE accounts more than witnessing in terms

141 Georges Pius Kamsu Moyo: Children and Adolescents’ Violence: The Pattern and
Determinants Beyond Psychological Theories
of inducing emotional arousal and violence in children.
3.3. Inadequate Parenting Models
Some parenting models such as “active mediation” may
prove to be weak under certain circumstances for stubborn
children, giving them excess freedom than required. This is
reflected by higher rates of failure to discipline children [18,
46]. On the other hand, the too rigid restrictive mediation
style may provoke the “boomerang effect” with revolted
children, susceptible to engage in all forms of risky activities
such as drug abuse, overexposure to community and media
violence [18-21]. Furthermore, parents tolerating aggressive
fantasies in children, and violence-approving attitudes could
be mediators of violence [46]. It has been shown that in
context of high violence, lack of parental nurturance and
inadequate social emotional empathy may be associated with
increased violence in children [46].
3.4. Neuropsychiatric and Psychological Disorders
A number of pathological conditions in children may
manifest or get worse with violence. Mental illnesses such as
conduct disorders, personality disorders, autism, attention
deficit/hyperactive disorder, bipolar disorder and dysthymia,
schizophrenia and psychotic disorders, posttraumatic stress
disorders, intermittent explosive disorder, sexual sadism,
premenstrual syndrome, and dysphoric disorders have been
described as psychiatric and psychological conditions
associated with violence [47]. On the other hand, neurological
and metabolic conditions such as sequels of head trauma,
infection, Hutington chorea, Gilles de la Tourette’s disease,
Cushing’s disease, hyperthyroidism might give rise to
externalization behaviors with verbal or physical violence [47].
In effect this phenomenon is frequently described in European
countries, where close to 38.2% of the general population
exhibit mental disorders every year with 5% of them
manifesting with external behaviors [47]. It has been noted that
adolescents with poor financial background experience more
mental health problems than those living in higher income
neighborhoods [27]. Moreover, the fact that children with
conduct disorders experience more violence than others may
equally justify high levels of violence among them [25, 27,
28].
3.5. Drug Use and Abuse
From a relapse of drug epidemic in the 1990s, D. Johnson
concluded that drug use among children is a persistent and
recurrent problem requiring consistent and unremittent attention
[48]. Drug use and abuse among the pediatric population
concerns primarily adolescents [49]. There is a “negative spiral
effect” between drug use and violence in children, as victims of
violence are prone to use drugs which in turn predisposes them
to perpetrate more violence [48]. There is a diversity of illicit
drugs used, with a continuous rise in marijuana use worldwide,
though other drugs have begun to level up, notably with the
“tramadol phenomenon” in the sub-Saharan African region [50].
Fatalities, accidental and intentional events associated with drug
and alcohol use in the adolescent population represents one of
the leading causes of death among the 15 to 24-years-old
subpopulation [51-53]. More so, drug use in adolescents is a
high risk for school under-achievements, delinquency, teenage
pregnancy and depression [54, 55]. The earlier a child initiates
drug use, the higher is the risk for serious consequences and
adult substance abuse [56, 57]. There exist an “upgrading effect”
that leads to the consumption of increasing doses of the same
drug or switching to stronger drugs, and a “dependence/
addiction phenomenon” related to habit [56, 57]. Drug initiation
in children is believed to be determined by the interaction
between biological factors such as gender and
genetically-inherited predisposition [58-62],
cognitivo-behavioral factors including developmental and
conduct disorders [49, 63-65], and socio-environmental factors
such as the “peer effect” and companionship, poverty, and
facilitated access to drugs [66-69]. More specifically, the factors
identified as associated with drug use during adolescence
include poor self-image and esteem, low religiosity, poor school
performances, parental rejection, family dysfunction, abuse,
under or over controlling parents and parents’ divorce [66,
70-72].
4. Preventive Measures
4.1. Against Media Violence
Detailed studies might help profile the type of programs
heavy television viewers watch on a daily basis, in order to
enable orientation towards pro-social programming [2].
A public health perspective on media violence might be
aimed at considering the effect of violent imagery on children
within a broader context of child, families and communities,
welfare. This would improve the habits and behaviors of
children and adolescent viewers [2]. For example: the
universalization of age-limiting in programing or channel
access.
Parental monitoring of television, video games and
computer use should be improved by reducing children
access to violent imaging [2].
More attention could be directed to public health
interventions to reduce the extend and effects of violence in
the media for a universal intervention, and targeted
interventions for high risk individuals [2].
4.2. Against Community Violence Exposure
Multisystem and multidimensional family therapy could be
more effective in reducing conduct problems as opposed to
programs that do not consider individuals’ environments [73,
74].
There is an urgent need for the reinforcement of the role of
communities and societies in providing standard guidelines
and education to families [2].
Non-violent community youth competitions in sports,
educational activities and other oriented occupations
especially for children that do not attend school might be
further encouraged and diversified.

American Journal of Pediatrics 2020; 6(2): 138-145 142
Restriction to drug access may be further strengthened and
limited with increased community police surveillance.
4.3. For Adequate Parenting
Priority should be given to an autonomy-supportive style
of mediation [11].
Misconducts in children should be reprimanded with
convenient punishment [47].
In context of high violence, parental nurturance and social
emotional empathy is associated with reduced violence in
children and should be encouraged and adopted [47].
Parent nurturing with open communication with children
and positive parental support should be applied as much as
possible [75-77].
4.4. Against Neuropsychiatric and Psychological Disorders
Prompt diagnosis, adequate management and follow-up
may reduce complications in most cases [47].
The reinforcement of specialized education should be
encouraged in order to improve on intelligence and conduct
[47].
4.5. Propositions to Reduce Drug Use and Abuse
Teachers’ commitment to didactics and maintenance of low
dissensions, positive self-esteem, self-control, assertiveness,
social competence, academic achievements, sense of morality
in children may be further strengthened [77-79].
Regular church attendance should be encouraged in
children [80, 81].
Life skill training should be encouraged and Social
resistance skills based on culture and ethnic groups should be
favored [80-82].
Normative education based on models may be used more
often [48].
The institutio nalization of prevention efforts against
drug use with various approaches that may be universal
or selective as the case may be wo uld serve a great deal
[48].
5. Conclusion
For many years in the past, media violence exposure
alone was incriminated for children violence, although no
scientific research work had ever shown causality links
beyond exposition. As time went on, it became clear that
children violence is more of a resultant to a combination of
factors contributing with varying degrees according to age,
the intensity of exposure to a predisposing factor and the
individual’s predisposition or susceptibility to violence.
Five main predictive factors of children violence are
frequently described in the literature. Media violence
exposure is most addressed to younger children, while drug
use and abuse is almost specific to adolescents. All
pediatric subpopulations may however be significantly
affected by community violence exposure, neuropsychiatric
and psychological disorders that manifest or worsen with
violence, and inadequate parenting models. Nevertheless,
these predictive factors are underlined by some other
determinants such as gender, genetics, individual factor,
culture, poverty, and peer effect essentially. Preventive
measures are based mainly on the reduction of various risk
factors and their determinants.
Funding
Private.
Conflict of Interest
The authors declare that they have no competing interest.
Acknowledgements
All collaborators to this project.
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