Helping Child Survivors of Sexual Trauma: A Guidebook for Families and Loved Ones. Created by Tali Poran, MSW

Transcription

1 Helping Child Survivors of Sexual Trauma: A Guidebook for Families and Loved Ones Created by Tali Poran, MSW 2

2 Introduction Sexual abuse affects millions of boys and girls of all ages and across all social, ethnic, religious and cultural groups around the world. Although the overall rates of child sexual abuse have gone down in recent years, children and teens are still more likely than adults to experience sexual abuse. Sexual abuse is considered a trauma because it can be a deeply distressing experience that may cause emotional and physical shock, as well as long term problems. Many children who have experienced isolated instances of sexual abuse and who receive support from their loved ones develop a range of post- trauma reactions that will immediately respond to treatment. Other children, including those who have suffered multiple traumas and received little support, may experience a post- trauma response that is more harmful and lasts longer. Some of the challenges that your child might encounter include a range of psychological effects. These could include depression, anxiety, and post- traumatic stress disorder (PTSD). In turn, these psychological problems may affect your child s development, behavior and relationships with others. Your child s ability to trust that others can take care of him or her may decrease. When children do not receive adequate support and treatment, these symptoms may continue and in some cases, get worse long into the future. However, children who have the support of a loved one and effective treatment can successfully recover from the abuse without long- term effects. This guide is intended to help caregivers and loved ones of sexual abuse survivors understand some of the 3 more common post- trauma responses. In addition, we hope to provide information about the ways in which you can help support and contribute to your child s recovery following abuse. Finally, for more information on post- trauma response and recovery, you will find a list of suggested readings and resources at the end of this guide. 4

3 What Is My Child Going Through? Children may respond to sexual abuse in many different ways, which can vary depending on their age, gender, culture, personality, and family structure. In many cases, your child's behavior will show you how he or she is feeling because children often express their feelings through their actions rather than through words. This can be true for children and adolescents of all ages. In addition, the way in which these feelings are expressed will probably be different depending on your child s age. The following section identifies some common behaviors that you might see in preschoolers, school age youth, and teenagers who have experienced sexual abuse. Signs of Trauma in Preschoolers (ages 2-5) They may become anxious and clingy, not wanting to separate from their parents at day care or at the baby- sitter s house. They may seem to take a backward step in development: sucking their thumbs, wetting their beds, refusing to go to sleep, or waking up at night even though they passed these stages long ago. They may become aggressive in their play with other children, with their parents, or with their own toys. They may also act out some aspect of their abuse in their play. An example would be using toys to act out hiding from a monster. They may play the same game over and over again, like piling blocks and knocking them down, dropping toys behind furniture and retrieving them, or crashing the same two cars over and over again. 5 6 They may express magical ideas about what happened to them, which will affect their behavior. For example, bad things happen when I am too happy. Although they say they are having fun in an activity, they may look sad, angry, or intense in a way that, to an adult, does not look like they are having fun. They may engage in sexual behavior that is inappropriate for their age, such as trying to touch another child in his or her genital area. However, children who have not been sexually abused may behave in this way for other reasons as well. Signs of Trauma in School Age Children (ages 5-13) They may experience magical thinking. For example, the child may think that someone died because he or she had bad thoughts about that person. They may blame themselves for what happened in order to make up for feeling helpless during the abuse. Thinking that they caused the abuse gives children a sense of power and control, while helplessness painfully reminds them of being young and totally dependent. Their lack of control over the abuse may make them feel that their future is uncertain, which can lead some children to act in ways that you might think of as dangerous or reckless. You might see a significant change in their school performance. It s not uncommon for children to have a lot of difficulty concentrating in school following trauma. On the other hand, they may

4 become intensely focused on schoolwork as a way of distracting themselves from upsetting thoughts and feelings. They may test out rules about bedtime, homework, or chores, and generally become oppositional, withdrawn or testy. They may have problems in their friendships. They may have frequent nightmares, and/or trouble falling and staying asleep. They may engage in reckless play. While the preschool child will crash their truck a hundred times, the school age child might physically engage in dangerous games as a way of regaining a sense of control that they didn t have during the abuse. Sexualized play and behavior is also seen in this age group. Signs of Trauma in Teenagers (age 13-18) They often feel that no one can understand what they are going through and this can lead to a change in relationships with parents and peers. They may get involved in risky behaviors, such as experimenting with drugs, sexual activity, or refusing to go to school as a way of handling anxiety and avoiding feelings of helplessness. They may feel that their future is limited and that they are damaged for good by the abuse, so planning for the future is pointless. They can develop a negative opinion of themselves because they were not able to avoid or control what happened to them. They may feel that it was their fault. 7 8 They may have revenge fantasies against the person or people responsible for the abuse and then feel guilty about their bad feelings. A teenager avoiding reminders of their trauma may find that they prefer to be alone rather than risk facing people or places that remind them of what happened. Self cutting and suicidal behaviors are common in teenagers. With the right support and treatment, these problems can be overcome. (Ford, 2011) Common Trauma Symptoms In addition to these common behaviors, you may notice other symptoms of trauma. Three types of post traumatic stress disorder (PTSD) symptoms may occur across all age groups: avoidance, hyperarousal and re- experiencing. Avoidance means that a child will avoid being around anything that reminds them of the trauma, and may avoid thinking about the abuse all together. For example, if the abuse occurred in a closet, the child may avoid going in or near the closet. Avoidance of trauma reminders may become generalized: while a child may at first only avoid going in or near the closet where the trauma occurred, this may later turn into an avoidance of all closets, and even to any room that resembles the closet in appearance, smell, etc. Hyperarousal means that the child is nervous, jumpy and easily startled. The child may react more strongly than expected to any stressful situation. An example of hyperarousal is when a child constantly checks the doors

5 and the windows to make sure that they are locked, or gets up several times during the night to make sure that the caregiver is still in bed. Re- experiencing means that the child may constantly see images that relate to the abuse or relive some aspect of the abuse while awake or asleep. For example, the child may re- experience the abuse in a nightmare. Children may also have difficulty falling and/or staying asleep. For younger children, nightmares may involve general scary themes, such as being chased by monsters. For older children, nightmares may be directly related to the trauma. Re- experiencing may also involve anxious reactions to reminders of the trauma. For instance, any person, smell, sight or touch related to the abuse may lead to a fearful, angry or frozen reaction. Acting Out As a caregiver, you can help your child feel safe. This can be difficult to do; many common behaviors of sexually abused children are frustrating to caregivers. Naturally, behaviors such as aggression, anger, defiance, and poor boundaries are difficult to deal with. Children act out in these ways when they cannot openly express their feelings. This may be due to limited verbal skills or because they have been told by their abuser not to talk about what happened. As a result, traumatized children can act out their feelings in a number of ways including in anger and depression. person who abused them, or because it is safer to direct it towards someone they know will not hurt them. Depression: Sadness over what happened may lead a child to find ways to escape their feelings. Examples include risk- taking behaviors such as drugs, alcohol, or unprotected sex and isolating themselves. Remember that these examples are learned behaviors that can be replaced with safer, healthier ones. It is important to accept a child's reactions to the abuse, whatever they may be, because ignoring them can make their negative feelings and behaviors even stronger. It is normal for a child to have strong emotions related to the abuse, but you can help them find a safer way to express their feelings. The next section of this booklet will discuss ways in which you can help your child heal from the trauma of sexual abuse. Anger: Understandably, children may feel angry about what happened to them. They may take this anger out on the caregiver, either because they cannot direct it to the 9 10

6 What Can Help My Child Heal after Sexual Abuse? Are there any personal strengths that help protect your child from the negative effects of a trauma such as sexual abuse? Are there any resources in your child s environment, such as a mentor or a community center, which adds to this protection? Research on resiliency, or the ability to recover from change and challenges, looks at how individuals exposed to trauma, violence, and other events that place their physical and emotional well- being at risk are able to successfully cope with and overcome these challenges. According to the literature, the healing process begins with creating a support system and opportunities to meet your child's basic developmental needs. These needs include: your child identify lessons learned, personal strengths that were developed, or relationships that were strengthened as a result of the abuse. These basic needs are the foundation upon which resiliency is built. Children whose basic needs are met are more likely to develop the confidence and skills required to cope with trauma- related stress. In addition, your child's ability to develop healthy coping skills often begins with an adult's belief in his or her resiliency. Your role is essential in determining how quickly your child heals from the trauma. Safety: Your child generally feels safe and believes that others will protect them from danger. Belonging: Your child feels accepted, valued and cared for. Respect and self worth: Your child believes they are worthy of being loved. Autonomy and identity: Your child develops a healthy sense of independence from those around them. Your child sees her- or himself as an individual with unique abilities and characteristics. Mastery and power: Your child believes that they possess the necessary skills to meet future goals. Meaning: Your child is able to give meaning to events and experiences in their life. Creating meaning from an experience with abuse can help 11 12

7 What Should I Do if My Child Discloses Abuse? Remember that disclosure can be a scary and difficult process for children. Many kids take weeks, months, or even years to reveal what they have been through. Children may be afraid to disclose abuse for a variety of reasons: They might be afraid of what will happen if they speak up. They might be afraid that others will be mad at them. They might worry that they will be taken away from their family. They might feel shame and embarrassment about the abuse. Young children might have an especially difficult time talking about their abuse because their language skills are not fully developed. Young children may also be confused about whether the abuse was actually wrong. Because your child is probably experiencing a variety of conflicting emotions, remaining calm as you speak to them about the abuse can help make this process less stressful. You may ask them directly if anyone has touched their bodies in a way that made them scared or uncomfortable, or if anyone has forced them to do something that they did not want to do. Your child might be nervous about your response to their disclosure, and your reaction will play an important role in how they continue to cope with 13 the abuse following their confession to you. It is important that your child sees that you love and support them, regardless of what they say to you. Some ways in which you can help make this process easier for them include: Stay calm: Although hearing that your child has been sexually abused will bring up strong emotions for you, it will help them to see that you can tolerate what they are telling you without becoming angry or upset. Children can mistakenly believe that your anger or disgust is directed towards them, and this will only make it harder for them to open up to you. Anger is a normal and understandable response to abuse, and allowing yourself a safe place to express your own feelings is an important part of recovery for both your child and yourself. Let your child know that you believe them: Generally, children do not lie about sexual abuse. Still, they often worry that others will not believe them if they reveal their secret. Giving positive messages such as I know you couldn't stop it and praising them for telling you what happened are important first steps in their healing process. Seeking help: To ensure your child s safety, contact the Department of Human Services or the police to report the abuse. Arrange for a medical exam to be sure that there is no physical damage or sexually transmitted diseases as a result of the abuse. At this point, your child might feel afraid of what might happen to them if their abuser finds out that they have revealed their secret. Your child will benefit greatly from reassurance that you will protect 14

8 them from this point on. Usually, it is also helpful for your child to have the opportunity to speak with a professional who specializes in child sexual abuse. Therapy has been demonstrated to help reduce stress in both the child survivor and their families. Offer reassurance: Your child might feel embarrassed and worried about what others will think of them once they know about the abuse. Telling your child that you love and support them regardless of what they have been through is comforting and reassuring. Make sure your child understands that you continue to accept them and that you see them as an important member of the family Coping With Your Own Reactions to the Abuse As a parent, learning that your child has been sexually abused is undoubtedly a painful experience, especially if you, too, were sexually abused yourself as a child. You may feel anger, resentment, disgust, shock and disbelief. Don t be surprised if you go through an initial phase of denial following your child's disclosure, especially if the abuser was an important person in your life. If your child is older, you may wonder whether they played a role in the abuse, or you may question why it took them so long to tell you about what was happening. Although these reactions can be very painful and confusing, they are not at all unusual. Confronting and working through these feelings is an important part of your child's and your own recovery process. While these reactions are a natural response to a distressing event, don t allow them to obscure the fact that your child is never at fault. This is true regardless of their age, the amount of time it took for them to tell you about the abuse, or any other factor that may lead you to question their disclosure. Giving any signs that you doubt or question that what they are telling you is the truth can be very damaging to and devastating for the child, who is probably already struggling with self doubt and fear of rejection. If you are having these feelings, it is important that you ask yourself why. What would it mean for you to believe that your child is telling you the truth? In many cases, believing that your child has been sexually abused can lead to feeling as though you are a bad parent. You may blame yourself for not having been able to protect your child. You may feel guilty for not

9 having caught on to what was happening sooner. If the abuser was a spouse, relative or otherwise significant figure in your life, believing your child means believing that this person whom you loved and trusted has betrayed you and your family, and that much of what you believed about them initially is no longer true. Believing your child means redirecting your anger from your child to the abuser, regardless of who this person is. While this process can be painful, it is necessary for you to go through it before you can be fully available to help your child heal There is no need to judge yourself. Although you might feel as if you should have been aware of what was happening, there are many cases in which even a trained professional can miss signs that a client has been sexually abused. Even if you are feeling bad, your child needs you. Don t let these negative feelings keep you from showing your child how much you care. How Can I Support My Child At Home? Parents, caregivers, and loved ones are the most important supports that children lean on after they have experienced sexual abuse. Although therapy is useful in helping to address many of the thoughts and feelings children have following abuse, much of what they will go through will occur in their own homes, in the presence of caregivers and family. For this reason, it is important that you are aware of what to expect, as well as how you can best respond to and support your child through this difficult time. You have already read about some common feelings and behaviors that your child might be experiencing. The following suggestions will guide you in helping your child through their healing process. #1 Your child may have kept their abuse a secret for quite some time. This could be due to humiliation, fear of rejection, or pressure from their abuser to remain quiet. Now that their secret is out, make sure that your child knows that you are there to listen to them when they are ready to talk. Let them talk at their own pace; it might be a while before they are comfortable telling you what happened. Avoid telling them how to feel for example, don t say Don t feel sad. While you have good intentions, it is important that your child feels safe stating the truth, whether it is good or bad. Furthermore, children don't always need advice. Like you and I, sometimes they just need to vent. Let them use their own words, even if they are offensive. You can help them replace these offensive words with more 17 18

10 appropriate ones at a later time, when they aren t telling you their most personal secrets. Finally, don t promise not to tell anyone what they say to you, as this can lead to them feeling betrayed if it turns out that you have to file a report or take other measures to ensure their safety. Instead, you might say I won't share information unless I feel that there is someone that can help- and I will tell you who I share your information with. #2 Allow your child to talk about their feelings regarding the abuse, including feelings towards the abuser. In cases of abuse within the family, the abuser may still be very important to the child, especially if the abuser was a father figure. Avoid making negative comments about the abuser in general; this may add to your child s confusion about their relationship with this person. Instead, you can place blame on the abuse in a neutral and realistic way. For example, you might say, What so and so did was wrong. No one ever has the right to do that to you. #3 Sexually abused children often feel powerless over their situation; they probably had little control over the events that followed their disclosure. You can give your child back some of the power that they lost during the abuse. For example, you might allow them some control over what goes on in your home. This may mean involving them in making up some of the house rules, or deciding what the consequences for rule- breaking should be. #4 19 If you haven't already, develop and discuss clear household rules about touch, privacy, bathrooms, bedrooms, secrets, supervision and safety. Discuss the rule, related behavior, consequences and the reasons why. Be friendly but clear with what the rules are. Don't assume that children know these things, especially since their relationship with their abuser may have taught them otherwise. Consistency and predictability is a key aspect of supporting your child through their recovery process. Sexual abuse is often an unpredictable experience. Creating an environment in which the child can predict your response to their behavior is part of creating a safe environment. #5 Show your child with your own actions the behaviors that you want them to learn. As a caregiver, your actions and reactions are carefully watched by your child. Children often mimic the feelings and behaviors that they see their caregivers practicing. It is therefore important that you model a healthy way of expressing and coping with feelings. You can help your child feel more comfortable expressing themselves by showing them that you accept and respect what they are communicating to you. You can do this by reflecting back what you think they are trying to tell you through their actions and behaviors. For instance, if your child is crying before you go to work, you might say, You re sad because I m leaving and you want me to stay with you, or You re scared that I might not come back. Furthermore, if you are experiencing a particular emotion, you could label it out loud. For example, when you re feeling frustrated, say I m feeling frustrated. 20

11 Labeling your feelings will help your child recognize the difference between various feelings. This is also helpful to ensure that your child is not misunderstanding your behavior, which can be a common experience for abuse survivors. When you are feeling upset, stressed, or otherwise in need of a break, show your child that you know how to calm yourself down in a healthy way. For instance, take a few deep breaths while in their presence. They are likely to do the same if they see you do it. #6 Keep in mind the typical developmental milestones for children and what is typical sexual development for children. There is no single standard for determining normal sexual behavior for all children. Individual differences due to the developmental stage of a child, cultural and societal norms, the amount of exposure a child has had to adult sexuality, and family values all influence a child's behavior. Still, it may be helpful to review the following guidelines, which identify various sexual behaviors children commonly display: Common sexual behavior in preschool children (ages 4 and under): Exploring and touching private parts, in public or in private. Rubbing private parts with hands or against objects. Showing private parts to others. Trying to touch their mother's or other women's breasts. Removing clothes; wanting to be naked Attempting to see other people when they are naked. Asking questions about their own bodies or others' bodies. Talking to children their own age about bodily functions. Common sexual behavior in young children (ages 4-6): Purposefully touching private parts (masturbation), sometimes in the presence of others. Attempting to see others when naked or undressing. Mimicking dating behavior, like kissing or holding hands. Talking about private parts and using naughty words, even if they don't understand their meanings. Exploring private parts with children their own age. For example, playing doctor. Common sexual behavior in school- age children (ages 7-12): Purposefully touching private parts (masturbation), usually in private. Playing games with children their own age that involve sexual behavior for example, truth or dare. Attempting to see other people naked or undressing. Looking at pictures of naked or partially naked people.

12 Looking at or listening to sexual content in media for example, on television, in music, in video games, or on the internet. Wanting more privacy and not wanting to talk to adults about sexual issues. Beginnings of sexual attraction to and interest in peers. If you do notice your child engaging in what you believe to be sexual behavior that is not normal for their age group, you might label those behaviors that you see, rather than saying What are you doing? It is not uncommon for children to explore themselves sexually, or to engage in masturbation. However, they may need to be directed on what is appropriate in the setting that they are in. #7 One of the most important things that you can do to help your child is to make sure they understand that the abuse is not their fault. In particular, children whose abuser was a family member may be struggling with feelings of guilt over what happened as a result of their telling their secret. They may feel guilty about betraying the abuser or breaking up their family. In addition, they may be dealing with backlash from other relatives who may not believe their story. Tell your child that you believe, support, care about, and love them. Assure and reassure them of their safety. Children cope best when their family and environment are calm, caring and accepting A Note on Cultural Challenges Cultural values may make it difficult to disclose childhood sexual abuse. This topic may invoke shame, taboos (topics thought of as improper or inappropriate to talk about), sexual roles, virginity, women's status, honor, respect and patriarchy (consideration of the male, or father, as holding all or most of the power and authority). Such cultural rules or norms can make it even more difficult than it already is for a child to disclose their sexual abuse and seek help. For example, it is difficult for a child to disclose abuse in a culture that limits discussion of sexuality. Similarly, the emphasis on a girl's virginity and the shame around losing it can create a great challenge for the child who is disclosing the abuse. In addition, it may make it difficult for parents to seek professional treatment for their child. Boys who have been sexually abused may experience shame and self doubt. Boys that have been abused by a male may struggle with a commonly held misconception that this makes them gay. In cultures in which children are expected to respect their elders particularly their older male relatives a child survivor may feel that sexual abuse by a father figure is acceptable. As a result, they may be reluctant to disclose abuse and their family may be unwilling to take action against the abuser. While your cultural beliefs are important, it is equally important to take care of the physical and emotional health of your child. Regardless of which culture you come from, sexual abuse is not your fault. It does not mean that you or your family are bad people. Seek guidance from community members you can trust,

13 whether they are religious leaders, medical professionals, or other supportive figures. Moving Forward In most cases, it can be helpful for both parent and child to seek out the support of a mental health professional. Understanding the abuse and one's reactions to it is an important part of the healing process. Not every child will require or benefit from long- term, intensive treatment. However, sexual abuse is a confusing experience for a child, and allowing them a chance to talk through their feelings is important. For caregivers, discovering that your child has been sexually abused is naturally upsetting. Treatment that involves working with both parent and child together has been proven to reduce anxiety, decrease family tension, and help the family feel stronger as a unit. Learning that a child has been sexually abused is devastating for any family, but it is important to remember that children can and do recover from sexual abuse. As a loved one, you are one of the most important resources that your child has. Getting help for yourself is an important part of being able to get help and support for your child. On the following page, you will find resources for support as well as suggestions for further reading on recovery and healing from sexual abuse

14 Finding Help Children and Adolescent Support Advocacy and Resource Center (CASARC) serves children and adolescents (up to age 18) who have been sexually or physically abused or who have witnessed severe violence. Forensic medical and crisis management services are available 24 hours a day. CASARC provides trauma- focused psychotherapy for individuals, groups and families. Contact them at (415) or visit their website at The Trauma Recovery Center offers brief therapy and case management to adult survivors of sexual assault and other types of interpersonal violence. Contact them at (415) or visit The Victim Witness Assistance Program provides criminal justice advocacy and support for victims of crime and their families: If you know or suspect that a child has been sexually abused, you can contact the Child Welfare Information Gateway at , or you can visit their website at If you need immediate assistance, call 911. You can contact the Rape, Abuse and Incest National Network (RAINN) at HOPE, or visit for help finding support in your area. The California Coalition for Youth (CCY) offers support, encouragement, and referrals for youth needing assistance or in crisis situations. Their statewide toll- free number is The TALK Line Family Support Center offers a wide range of direct services for parents, caregivers and children:

15 Further Reading Websites For more information on the effects of and recovery from child sexual abuse, visit the National Child Traumatic Stress Network at You can also visit The National Center for Victims of Crime at Books Adams, C. & Faye, J. (1992). Helping your child recover from sexual abuse. Vancouver, WA: University of Washington Press. Brohl, K. & Potter, J.C. (2004). When your child has been molested: A parent's guide to healing and recovery. (Revised ed.) San Francisco: Jossey- Bass, A Wiley Imprint. Daughtery, L. (2006). Why me? Help for victims of child sexual abuse (even if they are adults now). (4th ed.). Roswell, NM: Cleanan Press Inc References Benard, Bonnie (1998). Prevention from the Inside Out: Tapping Resilience in Youth. Retrieved on June 14th, 2011 at ction.pdf Cavanagh- Johnson, T. (1998). Sexuality Curriculum for Abused Children and Young Adolescents, and Their Parents. Self- published. Cavanagh- Johnson, T. (2001). Understanding the Sexual Behavior of Children. The Child Care Worker, 13(6). Fontes, L.A. & Plummer, C. (2010). Cultural Issues in Disclosures of Child Sexual Abuse. Journal of Child Sexual Abuse, 19(5) Ford, Charlie (2011). National Center on Sexual Behavior Youth Fact Sheet. Sexually Abused Child Trauma Response by Age Group. Retrieved on June 6th, 2011 at exually- abused- child- trauma- response- by- age- group/ Hunter, S.V. (2010). Childhood Sexual Experiences: NarResilience Resliience. Oxen, United Kingdom: Radcliffe Publishing Ltd. Merrick, M.V. & Allen, B. Parent Support for Child Sexual Abuse. Parenting Children Surviving Sexual Abuse. Retrieved on June 23rd, 2011 at nthelp.aspx National Child Traumatic Stress Network. Child Sexual Abuse Fact Sheet: for Parents, Teachers and other Caregivers. Retrieved on June 19th, 2011 at hildsexualabusefactsheetfinal_10_2_07.pdf

16 National Child Traumatic Stress Network. Questions and Answers about Child Sexual Abuse. Retrieved on June 19th, 2011 at hildsexualabuse_qa.pdf National Child Traumatic Stress Network. What to Do if Your ChildDiscloses Sexual Abuse. Retrieved on June 19th, 2011 at isclosure.pdf National Child Traumatic Stress Network. Coping with the Shock of Intrafamilial Abuse. Retrieved on June 19th, 2011 at ntrafamilialabuse.pdf National Child Traumatic Stress Network. Sexual Development and Behavior in Children. Retrieved on June 19th, 2011 at exualdevelopmentandbehavior.pdf

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