Impact of Child Sexual Abuse

Abstract

Child sexual abuse is one of the most devastating traumas a person can endure. Thousands of sexual abuse cases have been recorded over the years and even more have gone unreported. As research continues the range of what is considered sexual abuse has broadened.  The effects of child sexual abuse manifest differently in each individual and are treated through different interventions. Although the victim of sexual abuse has been traumatized their immediate family-members are affected as well.  

Introduction

 American Psychological Association defines sexual abuse as: unwanted sexual activity, with perpetrators using force, making threats or taking advantage of victims not able to give consent (2018). Child sexual abuse eludes to the sexual exploitation of a minor child for gratification or financial gain. In other cases, the abuser uses sexual abuse to gain power over their victim. Acts of rape, incest, child, and sex trafficking are not the only components of child sexual abuse. Actions such a take pornography pictures, showing minors inappropriate pictures or videos, groping a minor, and touch or exposing oneself in a sexual manner is form are other forms sexual abuse. It is an agonizing and traumatic experience to the child and is punishable by law. Age can also play a factor in what is considered child sexual abuse. Instances, where a youth violates a child younger than them, is also considered sexual abuse. Depending on the age of the children criminal actions can be taken youth violator as well.

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 Child abuse is reported daily, 8.3 % of reported child abuse involves sexual abuse (American SPCC, 2018). On average, child abusers are a part of the child’s family (Mental Health Effects of Sexual Assault, 2018).. Up to 93% of the children who have been sexually abused know their attacker (Mental Health Effects of Sexual Assault, 2018).  Child sexual abuse can be one of the most traumatic forms of abuse to endure. The abuse can alter the child’s cognition, trust, and developmental progress. Some children regress and began to bed wetting or become fearful and have anxiety before bedtime.

Social workers facilitate in locating services to help children who have been sexually abused trauma cope form their abuse. It is also important that the child’s parents are involved in services to cope with the secondary-trauma. Social workers become involved with these children after the abuse has been reported to the proper authorities. Screenings complete through the Children Justice Department and Children Advocacy Center are important assessments when determining the extent of the abuse as well as the longevity of the abuse. Agencies such as law enforcement, National Center for Missing and Exploited Children, children services organization and educational groups have created awareness of the problem and identifying strategies that parents, children, educators, and others can use to prevent and respond to effectively to child sexual abuse (Dove, Miller, 2007).

Child sexual abuse has proven to have short-term and long-term effects. Although it is not guaranteed that a child will experience significant negative consequences in adolescence or adulthood; common longer-term effects include the development of a physical, interpersonal, social, education, mental health and sexual problems (Dove, Miller, 2007). Each effect if not treated or coped with properly can develop or evolve negatively and be detrimental to a victim. 

Review of Literature

According to scholarly literature, sexual abuse is common in the United States. Child sexual abuse accounts for approximately 44% of reported sexual abuse (Mental Health Effects of Sexual Assault, 2018). One in four women and one in five men will experience sexual assault by the age of 18.  More than 20% of children are sexually abused before the age of 8 (Fafalleo, 2010).  The true number of sexual abuse may be higher due to under-reporting. Just as adults, children are ashamed or afraid to report sexual misconduct out of fear of harm from their abuser, disbelief,  exile from their family, and even discrimination.

Childhood trauma, particularly in the form of interpersonal victimization like sexual abuse, has been found to be associated with a host of difficulties ranging from emotional and psychological reactions such as depression, low self-esteem, and suicidal ideation; psychiatric problems such as anxiety/panic, borderline, post-traumatic stress, and dissociative identity disorders; and behavioral problems including substance abuse, eating disorders, domestic violence, and self-injury (Knight 2014). These behavior and symptoms affect the day to day lives of these abused children. They tend to be isolated from peers and lack appropriate social skills, feel worthless and over all damaging their sense of self.

When building therapeutic relationships with children who have been sexually abused the social worker must be knowledgeable about childhood trauma and its difficulties faced by the current client. Several studies reveal that survivors of trauma are likely to have been in treatment multiple times and to report having experiences with professionals that were not helpful and often counterproductive (Knight, 2014). The social worker should be competent in trauma-informed care related to sexual abuse with children. As well as have the ability to convey compassion, empathy and normalize the client’s feelings about their experiences.

 Clinicians should avoid using techniques or strategies that have little to or no evidence of effectiveness in treatment.  Evidence-based practice (EBP) is the use of the best available scientific knowledge derived from randomized controlled outcome studies and meta-analyses of existing outcome studied, as one basis for guiding professional interventions and effectiveness of therapy, combined with professional ethical standards, clinical judgment and practiced wisdom (Baker, 2003).  Children who have suffered from child sexual abuse are often diagnosed with emotional and behavioral problems, and one common diagnosis is Post Traumatic Stress Disorder. Evident based practices that are used as a treatment for PTSD are Cognitive Based Therapy (CBT)  Trauma-Focused Cognitive Based Therapy (TF-CBT), and Child-Centered Therapy.

 A study completed by the Cohen, Dedlinge, Mannarino, and Steel  revealed children who receive Trauma-Focused Cognitive Based Therapy experienced significantly greater improvement in PTSD symptoms (2005). During the study, parents reported improvement in children’s overall behaviors and sexual behaviors. TF-CBT is offered to parents of sexually abusing children to help them cope and normalize the feeling and reaction of the abused child.

Child-Centered Therapy is another avenue of treatment for sexually abused children and their parents. It focused on establishing trust therapeutic relationship which is self–affirming empowering, and validated for the child and parent (Cohen, Dedlinge, Mannarino, and Steel, 2005). The overall bases of this form of therapy are to reverse the difficulties of trauma endured by the child and their patents. It promotes empowerment and allows the child and parent to determine when they want to share their feelings about the sexual abuse. The therapist provides active listening, reflection, and encouragement. Therefore allowing the family to develop proper coping skills to address difficulties related to the abuse.  However, children who receive Child-Centered Therapy have a lowered success rate of improvement in PTSD symptoms than Therapeutic- Focused Cognitive Behavioral Therapy.

Reporting suspicion of child abuse is mandated for a number of professions, law enforcement, doctors, teacher, and other stakeholders. Education stakeholders on the sign and symptoms are important. Children  have been abused frequently demonstrate symptoms in the following category: physical, emotional, behavioral, and sexual and no symptoms at all (Dove & Miller, 2007). Physical symptoms can range from swelling and rashes to sexually transmitted infections. Other symptoms can be associated with anxiety which includes headaches or chronic stomach pain. Emotional symptoms include suicidal attempts, rebellion, and anger. And the behavioral include nightmares, irritability, and masturbation. None of the symptoms are tailored to strictly to sexual abuse, however, the response varies according to the age of the child, relation to the abuser or overall time of the abuse. Not all victims report their abuse immediately and many never report. As many as 60-75% of reported child abuse and neglect cases include a sexual element (Dove, Miller, 2007).

Harmful side effects of child sexual abuse include adverse development of interpersonal social skills, mental health, educational and sexual problems. The adverse symptoms can carry over into adulthood if not handled properly. As adults, they suffer from low self-esteem, insecure and disorganized attachment in adult relationships, instability, lower levels of satisfaction in intimate relationships, and higher rates of separation and divorce (Dove, Miller, 2007). During their childhood, they are more likely to become delinquent children, have conduct issues, and academic problems. Some children resort to risky behavior such as self-mutilation or sexual misconduct. Although all noted behaviors are common, they are not always portrayed.

People with disabilities are not excluded from sexual abuse. They are more vulnerable and face an even higher rate of sexual abuse. Children with disabilities are often times not educated about sexual issues and may not be aware of what is happening. Due to their disabilities, some children are cognizant of what is happening and are not able to properly communicate the assault. Others may be aware they are being assaulted but unaware it is illegal. More than 90% of people with developmental disabilities will experience sexual abuse at some point in their lives (Sobsey & Doe, 1991). Studies suggest that 49% of people with intellectual disabilities will experience ten or more sexually abusive incidents (Sobsey & Doe, 1991).

 Children with disabilities that have been sexually abused share common reason for not reporting as nondisabled children; shame, fear and personal blame. Their abusers are also family members authority figures and outside persons who care for them on a daily bases. However, the risk of sexual abuse increases according to the environmental factors. Children with developmental disabilities who are in residential settings are taught to comply with authority figures thus increasing their risk of abuse (McEachern, 2012).  If the child doesn’t have the ability to discern the assault, they are unable to determine what is appropriate and inappropriate.

Data collected from a study completed by Adriana McEachern reflect sexually abused children with disabilities in Omaha, Nebraska. The Omaha Police Department and Douglass County Sheriff Department identify over 4,000 child abuse reports made, 1,012 reports involved children with disabilities.  The study reflects that children with speech and language disabilities had 3 times more risk of being sexually abused (Mceachern, 2012). The children’s speech impairment increased their vulnerability by impeding on the disclosure and detection of sexual abuse.

Sometimes it is assumed that disabilities safeguards someone from sexual abuse and the signs of abuse goes unnoticed. It is important that family members and caregiver are aware of the warning signs and protect the victim. Education about sexual abuse in children with disabilities should begin early with parents and caregivers. Training targeting sexual abuse in people with disabilities is one approach in prevention strategies (McEachern, 2012)  This training provides information on sexuality, building relationships, personal rights, and steps to take if a victim is abused.  Another strategy in preventing sexual abuse is tailoring the possibility of sexual abuse to the nature of the disability and the person’s physical cognitive and emotional ability (McEachern, 2012). The information should be presented to the client in a simplistic manner to accommodate the disability. Techniques such as role-playing, rehearsal, and reinforcement are recommended. Other techniques to accommodate children with communication barriers are pictures, computerized communication sign language, and photographs. Children with disabilities are more likely to disclose sexual abuse to someone they have built a positive relationship with and it is important that they are aware of these signs and how to help the child properly communicate the abuse.

Research on child sexual abuse has grown over the years, however, the studies have focused on the victimization of females versus males. Although the studies don’t have excluded males are not excluded, it is believed that the research numbers are low in male sexual abuse because it is unreported. Boys are more likely than girls to be victimized outside of the home than girls, therefore, supporting lower numbers of report sexual abuse in boys (Cermak, Moildor, 1996). With the disproportion numbers involving sexual abuse in boys, it poses two discrepancies: less attention in the area and insignificant care in treatment for boys.

Boys are more reluctant to report sexual abuse than girls ( Romo, Anderson & Gallo-Silver, 2014). The under-reporting of male sexual abuse carries the same factors as any other reason for not reporting sexual abuse. However, more societal and imaging reasons support the reluctance of reporting. The socialization process that encourages males to take on multiple females experiences would make it less likely that sexual experiences with older females would be recognized as abuse and therefore is less likely to be reported. In the case of abuse by another man, the fear of being labeled a queer, or a wimp might discourage reporting (Cermak, Moildor, 1996). Boys are also reluctant to disclose sexual abuse for fear of loss of freedom and independence. Many of these reasons implead of the child developmental growth.

The possibility of women sexually abusing children seems difficult to accept. The object of the denial is that “women being viewed as sexually harmless to children: what harm can they do with no penis” (Cermak, Moildor, 1996).  However, studies show that women have been shown to be the abuser, either jointly, in polyincestous activities, alone between 5% and 15% of the time. Since this study, the act of sexual abuse had gained a wider range of aspect when what behaviors are involved. It no longer only refers to penial-virginal contact and because women are the primary caregiver they have more access to the child. Women typically dress, bathe, and change their children, society seems to accept the son’s sleep in the bed with their mother. On the other hand, society doesn’t imply the same level of acceptance with fathers sharing the bed with their daughters.

The male reaction to sexual abuse may manifest differently from a female. Some female victims internalize their emotions and it’s displayed through depression and anxiety, whereas males are more externalized and participate in disruptive behaviors. Male victims exhibit other behaviors such as withdrawn-aggression, acting out sexually towards peers, and report difficulty sleeping/ nightmares (Cermak, Moildor, 1996). Behaviors such as regression to enuresis, being fearful of bathing, changing clothes, or even fearful of someone they were not previously fearful of, are viewed as potential indicators of sexual abuse. A few other alarming behaviors noted males sexual abuse include, soliciting sexual play from peers, attempting to insert toys or other objects into his own rectum or that of pets (Cermak, Moildor, 1996). Complaints of red/ swollen genitals, bruising and concerns with his anus much be referred to a physician for expert results. 

When considering the impact of trauma imposed on victims of sexual abuse, the secondary-trauma endured by the non-offending parent or caregiver is overlooked. Although they have not been directly violated they are impacted by sexual abuse, with the non-offending caregivers overwhelmed with grief. Research reveals non-offending caregivers identify the grieving process as death without someone dying (Grant, 2006). With child sexual abuse, more often perpetrators have a relationship with their victims. When the offender is a significant other, friend or relative most caregivers feel betrayal, loss of relationships, and distrust in their community.

The dynamics in the household of a family changes with child sexual abuse. After disclosure, caregiver’s ability to support the child and family may be compromised. While processing the betrayal and mistrust they are expected corporate with and to put their trust in unknown professionals. Non-violated children in the home also feel the impact of the abuse. They may become jealous and resentful of the abused child the parent’s attention has shifted. Other research alludes other children in the home may be subjected to physical or emotional neglect surrounding the caregiver’s immobilization and focus on the victim (Grant, 2004). Their inability to parent properly can be devastating on the entire family.

Child sexual abuse is a difficult issue to face. Non-offending caregivers know they are not responsible for the abuse itself but are left with many feeling of responsibilities (Grant, 2006). Non-offending caregivers are responsible for the safety of the children in the care and second guess their caregiving abilities. Caregivers battle with the question such as “Why didn’t I see this situation? How did this happen in my own home? – Am I a bad parent because I couldn’t protect my own child (Grant, 2009). Having to disclose sexual abuse to family member and friends can be tough to endure. Caregivers may seek guidance from social services and counselors in navigating the conversation with the family about the abuse. In best practice, caregivers should be encouraged to shew the information with family members who will be supportive and encouraging. Caregivers must also be made aware that the issue will be difficult to mask particularly if the perpetrator is a family who has to be removed from the family system (Grant. 2006).

The task of “coming clean” will be devastating and the support will be needed for the child and their immediate family. A caregiver who is survivors of childhood sexual abuse may encounter guilt and painful feeling surrounding disclosure of sexual abuse of their own child. Some caregivers will disclose their own childhood abuse for the first time their child discloses. With these memories and feelings resurfacing it is important that the caregiver is able to cope properly with their own trauma before attempting to support their child her trauma.

Interventions

There are a number of evidence-based practices to help children and adults cope with sexual abuse. In the event that a child is sexually abused their family also suffered from their trauma. Group treatment can help the entire family work through and understand their won response to the sexual abuse, deal with the strong emotions related to the abuse, form a strong network with other families who have experience with sexual abuse, learn better ways to communicate and avoid power struggles within the system (Grant, 2006). Treatment such as cognitive-behavioral therapy tailored to trauma, play therapy, and client-centered therapy provides significant evidence in successful treatment with a client when coping with sexual abuse.

Although it is important to ensure the child is able to cope with the trauma, their caregivers must be able to have an outlet to share their similar concerns, be empowered and become competent in rearing children impacted by sexual abuse.   The intervention should be culturally responsive and sensitive and taking into consideration the social environment of individuals. (McEachern, 2012). The victim and their families should aware of their basic rights such as protection, information, dignity, compassion, and reparation (Grant, 2006). They should also be aware of the expectations in regards agencies and the. It is helpful that social service agencies, family advocacy centers, and law enforcement have a roll in the interventions process and help the navigation of the legal system (Grant, 2006).

Sexual abuse itself is something that will never be eliminated but can be reduced. Being proactive in the reduction of sexual abuse is in the hand of all stakeholders. It is of the best interest facilities educate the care providers with the appropriate skills when working with children and adults with disabilities. Residential staff training should include the following: rules on maintaining healthy boundaries, sexuality education, recognizing sexually appropriate and inappropriate expressions and how to directly intervene when these are observed, recognizing signs of inappropriate sexual behaviors and sexual abuse reporting laws and procedures (McEachern, 2012). 

By providing victims and their caregiver with interventions and techniques to cope with the abuse, it increases the success of a positive outcome. Although the family will have endured the horrible trauma, they will be equipped with the tools to face the abuse and prevail. Research suggests that parent/caregiver support is associated with better emotional and behavioral outcome for children who have been victims of abuse (Grant, 2006). 

References

• American Psychological Association (2018) https://www.apa.org/topics/sexual-abuse/index.aspx 750 First St. NE, Washington, DC 20002-4242
• Les Gallo-Silver, MSW, LCSW-R; Christopher M Anderson; Jaime Romo, EdD (2014) Best Clinical Practices for Male Adult Survivors of Childhood Sexual Abuse: “Do No Harm”, The Permanente Journal, http://www.thepermanentejournal.org/issues/2017/winter/50-the-permanente-journal/commentary/5710-clinical-practices.html
• American Society for the Positive Care of Children, (2018) https://www.americanspcc.org/child-sexual-abuse
• Cermak, Pamela & Moilder Christin (1996) Male Victims of Child Sexual Abuse, Child and Adolescent Social Work Journal Volume 13
• Cohen, Judith A., Delinger, Esther, Mannarino, Anthony P., Steel, Robert (2015). A Multi-Site, Randomized Control Trial for Children With Sexual Abuse- Related PTSD, https://www.ncbi.nih.eov/pmc/articles/PMC1201422
• Dove, Marianne & Miller, Kenneth (2007), Child Sexual Abuse: What Every Educator Should Know
• Grant, Deborah (2006) Overlooked Victims: Working with non-offending Caregivers in Child Sexual Abuse Cases.
• Knight, Carolyn (2014) Trauma-Informed Social Work Practice: Practice Considerations and Challenges, Clinical Social Work Journal pages 25-37
• Rafanello, Donna (2010) Child Sexual Abuse Prevention and Reporting: It’s Everyone’s Responsibility
• Sobesy, D. & Doe, T. (1991) Patterens of Sexual Abuse of People With Developmental Disabilities. Sexuality and Disability
• McEachern, Adriana (2012) Sexual Abuse Individuals with Sexual Disabilities Preventions Strategies for Children Practice, Journal of Child Sexual Abuse, 21: 386-398
• Mental Health Effects of Sexual Assault, (2018) https://www.goodtherapy.org/leran-about-therapy.issues.sexual-abuse