Child Sexual Abuse: Prevention, Identification and Action

1. Child Sexual Abuse: Prevention, Identification and Action

2. Agenda • What is child sexual abuse (CSA) • Dynamics of CSA • How children experience CSA • Perpetrator risks and dynamics • Cultural considerations • Responding

3. What is CSA? • Any interaction when the child is being used for sexual stimulation of the child or the perpetrator or observer. • Contact sexual abuse • Non-contact sexual abuse • Care and/or custody of the child (CPS)

4. Sexual Assault/Statutory Rape • Sexual Assault: • Assault of a sexual nature or sexual act without consent. • Statutory Rape: • Sexual activity where the child is below the legal age of consent. • Different term, age differentials and particulars for charging across states. http://aspe.hhs.gov/hsp/08/sr/statelaws/summary.shtml

6. Sexual Trafficking • Child sex trafficking includes any child involved in commercial sex (Polaris Project) • Florida, Illinois, Connecticut and Maryland • State regulations governing Social Services Departments to provide services to victims of Human Sex Trafficking • Check with your local jurisdictions about mandated reporting.

7. CSA History • Exploded into awareness in the 1980s. • 322% increase in reports (National Center on Child Abuse and Neglect, 1988). • Credibility of reports questioned. • Complaints of false allegations and brain-washing. • Nationwide agencies develop methods and protocols for investigating CSA allegations.

8. Dynamics of CSA • Unique crime with unique behaviors and dynamics • Rarely third-party witness or medical evidence • Only 4-5% of children who give a credible history of sexual abuse have a specific finding on medical exam. • 94-95% of all children who give a history of sexual abuse have a normal or nonspecific medical exam.

9. Dynamics of CSA: Myths • Denials of the extent of CSA • Perpetrator stereotypes • Minimizations or exaggerations of the extent of harm CSA poses on the child • Diffusions of perpetrator blame

10. Extent of CSA: How common is it? High incidence and prevalence • 1 in 4 girls • 1 in 6 to 7 boys …Will be sexually abused before the age of 18. • Elevated risk for younger children and children with disabilities.

11. Extent of CSA: How common is it? • 300,000 cases reported in United States • Only reported cases; unknown how many cases actually exist • Only 10% of children report their abuse

12. Extent of CSA: How common is it? • Myth: • Only happens in poor, uneducated communities… • Fact: • Inconsistent and scarce findings that race or socioeconomic status are risks • Unlike physical abuse

13. Perpetrator Stereotypes • Myths • Stranger danger • Media focus • All CSA perpetrators are male • Dirty, perverted men • Men who sexual abuse boys are homosexual

14. Perpetrator Stereotypes • 70-90% of alleged abusers are people the child knows and trusts • 90% of alleged offenders are male; however, there are documented cases of female perpetrators • Highly under-reported and not recognized • CSA alleged offenders tend to be married, employed and heterosexual

15. How Children Experience Abuse • Child Sexual Abuse Accommodation Syndrome (CSAAS) • Roland C. Summit, M.D. (1983) • Widely known theory for understanding dynamics of child sexual victimization • However, merely a clinical opinion, not scientific instrument • Anecdotal, not backed by research

16. Child Sexual Abuse Accommodation Syndrome (CSAAS) • Five categories: • Secrecy • Helplessness • Entrapment and Accommodation • Delayed, unconvincing disclosure • Retraction and Recantation

17. Secrecy • Happens when child is alone with their abuser. • “This is our secret.” • “Don’t tell anyone, or else.” • “Nobody will believe you.” Both the source of fear and the promise of safety.

18. Helplessness • Authoritarian relationship • No child has equal power to say no to a parental figure or to anticipate the consequences of sexual involvement with an adult caretaker. • Expectation for child to cry out and run away • Almost every child fails. • Fight, flight, freeze. • Difficult for courts and law-enforcement to understand • Disbelief and rejection by non-offending caregiver = self-blame, self-hate, guilt for allowing the acts to occur.

19. Entrapment and Accommodation • Abuse is not usually a one-time occurrence. • Multiple incidents • Grooming • Accommodating to escalating sexual demands. • Child faced with continued helpless victimization must learn to somehow achieve a sense of power and control. • Child prepares for the sexual act before it happens: • Undresses and places themselves in a position for their perpetrator. • Child initiates the sexual act.

20. How Children Experience Abuse • Usually happens under the disguise of love or attention: • Bath time • Bedtime • While watching TV on the couch • Wresting and tickling • Games • Abusers use these and physical contact opportunities to sexually touch children.

21. Natural reactions of healthy child to profoundly unnatural and unhealthy caregiver environment. Coach on your soccer team always tells you what a great job you’re doing on the field; he couldn’t get along without you; if he had his way, you’d be voted most valuable player. Everyone loves coach, so it makes you feel good that you have his attention. Then while he’s driving you home, he starts saying things like how during showers he noticed you were really developing into a man. He begins commenting on the size of your penis and how some day you’re going to make a girl really happy. All of a sudden the good feeling goes away and you feel embarrassed, confused, maybe frightened.

22. How Children Experience Abuse • Is this really abuse? • Confusing emotions: • Ordinary, non-sexual interactions when not being abused. • Way the community views the abuser – good citizen. • He didn’t mean it – It must have been an accident. • Victim thinks he/she is weird for having a bad reaction to what happened.

23. How Children Experience Abuse • This must be love • Grooming – abuse is concealed by love and attention • Kids respond to loving attention. Like to have people spend time with them, give them treats and make them feel loved. • Some kids enjoy the physical closeness and physical feelings that can happen in the abuse situation. They seek out the abuser for attention.

24. How Children Experience Abuse • “It felt good to me and I wanted it.” • 15y/o abused by older brother • “It was my mom’s boyfriend and he treated me like his girlfriend – holding my hand when we went to the mall, telling me I was so good-looking. I felt special.” • 14y/o abused by mother’s boyfriend • “I liked it in a way. I kind of felt loved. He’d always be there for me.” • 16y/o abused by biological father

25. How Children Experience Abuse • I deserve this. • Perpetrator tell you, “you seduced me.” • Adults are never do wrong.

26. How Children Experience Abuse: Disclosure and Discovery • Accidental vs. Purposeful Disclosure • Majority of cases are accidental discovery (74%) • More likely in pre-schoolers • Sexualized behavior or inappropriate statements • Exposure to an alleged suspect • Share with a friend who did not keep the secret • Child has Sexually Transmitted Infection • Child is pregnant

27. How Children Experience Abuse: Disclosure and Discovery • Purposeful disclosure: • Educational awareness (school prevention programs) • Influence of peers (predominantly young teens) • Proximity to perpetrator • Departure of perpetrator or threat of return of perpetrator • Timely disclosure • Anger (adolescent group)

28. How Children Experience Abuse: Disclosure and Discovery • Disclosure is a process not and event. • Most on-going sexual abuse is never disclosed (retrospective adult studies) or there is a significant time lag between abuse and disclosure. • Most adults delayed disclosure or failed to disclose in childhood • 55-69% of adults never told • Treated, reported or investigated cases are the exception, not the norm.

29. How Children Experience Abuse: Disclosure and Discovery • “Nobody would believe me.” • “I would never tell. This would kill my mother.” • “Not a chance! They would put me in some foster home or take me away from my family.” • “If I tell, I’d have to go to court and then everyone would know about it.”

30. How Children Experience Abuse: Disclosure and Discovery • 116 confirmed cases (Sorenson & Snow, 1991) • Denial • 3/4th of children denied having been sexually abused • Active Disclosure - Personal admission by the child • Only 7% that initially denied, then moved into active disclosure. • Only 11% were able to provide a disclosure without denying or demonstrating tentative features. • Tentative Disclosure - Partial, vague or vacillating • 78% - common middle step from denial to active disclosure • “I forgot” • “It happened a long time ago” • “He tried to touch me, but I hit him and ran away”

31. How Children Experience Abuse: Disclosure and Discovery • Delayed disclosure risks: • Some data indicate that males are more reluctant to disclose than females • Younger children may not have linguistic or cognitive abilities • Relationship to perpetrator: longer delays among familial • Support from non-offending caregiver (protective factor)

32. How Children Experience Abuse: Disclosure and Discovery • Disclosure does not always mean safety for the child. • Majority of offenders have kinship and trusted relationship; therefore, child is put on defensive for attacking credibility of a trusted adult. • Risks of family separation. • Threats from the alleged offender for telling. • Disbelief from authorities and non-offending caregivers • Delinquent/acting-out child • Well-adjusted child • Child does well in school and all other social aspects – not showing any kind of distress; how could the allegations be true?

33. How Children Experience Abuse: Recantation • Retraction of a previous allegation of abuse that was formally made and maintained. • Pressure/threats from perpetrator • Pressure from family, coaching • Disbelief • Fragmentation of family (child bears responsibility) • Negative personal consequences • Investigative process

34. How Children Experience Abuse: Recantation • Percentage rates vary across studies from high to low numbers: • 23.1% recantation rate (Malloy, L.S., Lyon, T.D., & Quas, J.A; 2007) • Abuse victims more vulnerable to familial adult influences • Young children • Abuse by parent figure • Lack of support by non-offending caregiver • Maternal reactions are protective factor

35. How Children Experience Abuse: Reaffirmation • Reaffirmation: • Reassertion of the validity of a previous statement of CSA. • Of those recanted, 92% reaffirmed their abuse over time. • Disclosure is a process.

36. False Allegations • “Why didn’t my child tell me sooner?” • If child was really being harmed, would have spoken up. • When child is frozen in fear and does not fight back. • Viewed as consensual. • Child was angry for being punished. • Child has delinquency and/or mental health issues. • Promiscuous adolescent. • Diffusion of blame from perpetrator to child.

37. False Allegations • Majority of investigated accusations prove valid. • Based on review of studies, only 4-8% of allegations were fabricated. • Sloppy assessments could lead to false positives or false negatives • Need researched-based investigative protocols

38. Emotional Coping Techniques • Avoidance: • “As soon as”… • the abuse stops, I will be fine. • I go to college, everything will be different. • she finds a new husband, everything will be back to normal. • Minimizing: • “It’s not that bad”… • Lots of kids have it worse. • He didn’t mean it, he was drunk. • Denial: • “It happened, but I’m fine. No big deal.” • Forgetting: • Helps on surface, but deeper level impact.

39. Emotional Coping Techniques • Splitting/Dissociation: • Out of body experience “I was about nine or ten; my father and I were driving in the car. I can’t remember what he said to me or did to me, but I was definitely not in my body. I mean, my whole visual memory is of the back of his head, the back of my head, the back of the front seat of the car and that’s because I was literally on the ceiling at the back of the car. So all I can remember is how things looked from the back seat – but my body was in the front seat!” - Richie, 15y/o abused by biological father

40. Emotional Coping Techniques Olga Trujillo: The Sum of My Parts • Dissociation • “Dissociating is like watching your life from 50 feet off the ground” – Olga Trujillo • “The problem was, I dissociated automatically and had been doing so for decades. It seemed like I couldn’t stop and I wasn’t sure I wanted to. I liked feeling numb and calm. The fuzziness in my head felt addictive.” – Olga Trujillo • “DID, or Dissociative Identity Disorder, is a separated sense of consciousness. Consider it like a spectrum, with normal dissociation one on end. On the other end is a fractured consciousness with distinct personality states that are not aware of each other: a condition formerly known as multiple personality disorder, or MPD.” 

41. Physical Coping Techniques • Eating Disorders • Drugs and Alcohol • Self-Mutilation • Sexual promiscuity (self abuse) • Suicide • Being Perfect

42. Psychological and Medical Impacts • HOWEVER: Some survivors do not exhibit any negative consequences associated with the abuse. • Positively correlated to satisfaction in current social roles and one’s community. • Negatively correlated to additional trauma exposure. • Myths on how a victim should react.

43. Sexual Behavior Problems • Do all children that have been sexually abused act out sexually? • Belief that all sexually abused children will have significant, long-term problems is not supported by research. • Kaufman and Zigler (1987) – 70% of abused children did not offend in adulthood • Widom and Ames (1994) – childhood sexual abuse did not account for increased risks for violent sex crimes.

44. Sexual Behavior Problems • Do all sexual behavior problems in children indicate that the child has been sexually abused? • Myth in 1980s and 1990s • There may be other psychosocial difficulties causing the child to display sexualized behaviors. • Physical abuse, neglect, family violence, etc. • However, suspicion of exposure in children who display age-inappropriate sexual behaviors. • May be exposed to unhealthy sexual, emotional and physical boundaries in the home environment.

45. Sexual Behavior Problems • Sexual exploration and sexual play are a natural component of children’s development. • Similar age, size and developmental status • Voluntary basis • Light-hearted and spontaneous • Embarrassment, but no shame, guilt or fear • Child’s interest in sex and sexuality is balanced by curiosity about other aspects of his or her life.

46. Sexual Behavior Problems • Continuum: • Natural/healthy → Molestation of other children • Sexual Behavior Problems: • Sexually Reactive • Confusion about sex – trying to work through their confusion by enacting behaviors • Extensive, Mutual Sexual Behavior • Sexual behaviors as a way of coping with feelings of abandonment, loss and fear • Molestation of Other Children • Use some type of coercion.

47. Sexual Behavior Problems • How should we react? • Remain non-judgmental and non-punitive • Caregiver’s reactions influence child’s sexual self-esteem, sexual identity and sexual judgment. • Often becomes main focus for caregivers – forget to look at child’s positive behaviors. • Do not discuss act as “sexual” with children. • Address the actual behavior • “Touching your penis”

48. Sexual Behavior Problems • Children who molest should not be compared to adults who sexually offend. • Adult sex offenders have established sexual arousal problems. • Pedophilic offenders’ primary sexual attraction is to children. • Most children who molest are acting out their hurt and angry feelings in a disorganized and chaotic manner using sex as a vehicle. • Sexual behaviors in children do not represent sexual gratification.

49. Sexual Behavior Problems: Sibling Sexual Offending • Most common form of familial sexual abuse • Pervasive underreporting • Approximately half of all adolescent-perpetrated offenses involve a sibling. • Correlated with family violence and dysfunction histories • Sexual abuse, domestic violence history and exposure to pornography • Implications for juvenile justice and mental health. • Family-based interventions

50. Creating Healthy Sexual Environment • Children with sexual behavioral problems may need to be supervised while with other children. • Should not sleep in same bed with other children or adults • Over-stimulating for child • Child who molests should not sleep in the same room with any other children. • Motion detectors • Should not be left to care for other children, even for a short time. • All bathroom activities should be done separately. • Children and adults should not walk around without clothes on. • Overwhelming memories or encourage unhealthy sexual behavior • Other children in the home should know about the sexual behavioral problems for the child with a history of molesting. Child with sexual problems should be made aware that, for everyone’s safety, it is important for everyone to know. • Family meeting • Clinician’s role • Work with molesting child • Ask other children, in private, on a regular basis if other child has tried to touch them (older children only).