The Association Between Adverse Childhood Experiences (Aces) with Challenging Behaviors Among Public Ordinary Level Secondary School Students in Kinondoni Municipal, Dar Es Salaam

Abstract

Background: Adverse Childhood experiences (ACEs) are wide varieties of distressing events during a child’s life. These events are such as physical and emotional abuse and neglect as well as living in a dysfunctional household. Cultural and financial circumstances have left many children in Tanzania unattended by their parents or caregivers and therefore are put into risk of adversities. Untill now, there is limited or no known published data in this area, especially on the behavioral consequences of ACEs. A better understanding of the association of ACEs and students’ challenging behaviors will set useful insights for informing educational stake holders on the right interventions and support for students with challenging behaviors. Aim of the study: To determine the association between ACEs with challenging behaviors among public secondary school students in Kinondoni Municipal, Dar es Salaam. Materials and methods: Quantitative, cross-sectional survey design was used. A total of 422 students of Form I to Form IV from public secondary schools in Kinondoni Municipal were recruited. Simple random sampling technique was used to select 105 students in each of the four schools selected to meet the required number of study participants. The International Adverse Childhood Experiences (ACE – IQ) questionnaire was used to measure abuse (physical, emotional or sexual), neglect (physical, emotional) and household dysfunction (mental illness, substance abuse, physical violence, separation, divorce and incarceration in the family). The Strengths and Difficulties Questionnaire (SDQ) – a brief behavioral screening tool was used to measure conduct problems and hyperactivity. Collected data was analyzed by using SPSS version 23. The bivariate analysis model was used to establish the association between ACEs and challenging behaviors, whereas the p value of less than 0.05 was considered statistically significant. Variables which were statistically significant on bivariate analysis were entered into the multivariate model in order to control for confounders. Results: Of the consented 418 participants, majority belonged to 16 – 19 age group 252 (60.3%) whereas female participants were 253 (60.5%). More than half of the participants 220(52.6%) lived with both parents. The prevalence of challenging behavior was found to be284(67.93%) for aggression, 248(59.3%) for delinquency, 248(45.7%) for disruptive behavior and 270(64.6%) for attention deficiencies, aggression being the highest. The association was found between ACEs with challenging behaviors. Participants who reported to have had family dysfunction had 1.11 times the prevalence of challenging behavior compared to those who did not (cPR= 1.11, 95% CI 1.01 – 1.22, p = 0.034). Likewise, participants who reported to have had sexual abuse had 1.09 times the prevalence of challenging behavior compared to those who did not report sexual abuse (cPR = 1.09, 95% CI 1.04 – 1.14, p < 0.001). On multivariate analysis, students who experienced sexual abuse were more likely to develop challenging behaviors compared to students who did not (aPR= 1.06, 95% CI 1.02 – 1.11, p = 0.006). Conclusion: Challenging behaviors are high among the study participants. Family dysfunctions and sexual abuse was statistically significant independent risk factors highly associated with challenging behaviors among study participants. Recommendation: Parenting skills development addressing ACEs may result in reduction of challenging behaviours. Activists addressing childhood interventions need to be sensitized on the results of this study so as to address strategies that would address family dysfunctions and also reduce sexual abuse. Further research which will incorporate private schools is needed.