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THE PSYCHOLOGICAL IMPACT OF CHILD SEXUAL ABUSE

THE PSYCHOLOGICAL IMPACT OF CHILD SEXUAL ABUSE. Which symptoms or “behavioral indicators” serve as proof that a child was sexually abused?. Symptoms or “behavioral indicators” alone can not be relied on to prove or to disprove that a particular child was sexually abused .

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THE PSYCHOLOGICAL IMPACT OF CHILD SEXUAL ABUSE

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  1. THE PSYCHOLOGICAL IMPACT OF CHILD SEXUAL ABUSE

  2. Which symptoms or “behavioral indicators” serve as proof that a child was sexually abused?

  3. Symptoms or “behavioral indicators” alone can not be relied on to prove or to disprove that a particular child was sexually abused

  4. The following factors preclude relying on symptoms to determine whether a child was sexually abused: 1. SYMPTOM VARIABILITY AMONG VICTIMS OF CSA; 2. SYMPTOM OVERLAPAMONG ABUSED AND NON-ABUSED CHILDREN, AND; 3. THE BASE RATE PHENOMENON

  5. SYMPTOM VARIABILITY AMONG VICTIMS OF CSAPRECLUDES THE USE OF SYMPTOMS TO DETERMINE WHETHER A CHILD WAS SEXUALLY ABUSED

  6. SYMPTOM VARIABILITY • There is nouniversalresponse to child sexual abuse. • The effects of child sexual abuse are extremely variablefrom one victim to the next. • Some victims are highly symptomatic whereas others are asymptomatic

  7. Psychological outcomes are determined by the interaction of“Risk Factors” and “Protective Factors” • “Risk factors” include such things as severe abuse, unhealthy parent-child attachment, lack of parental su pport, and a vulnerable genotype • “Protective factors” include such things as healthy parent-child attachment, stable and supportive parent, and a protective genotype

  8. ABUSE SEVERITY • ‘Sexual abuse’ comes in different “doses” • A brief and gentle one-time fondling of a child’s genitals through his/her clothing by an unfamiliar adult is “sexual abuse” • A child whose father rapes them on a nightly basis for years is also “sexual abuse” • The more ‘severe’ the abuse, the more it serves as a ‘risk factor’ for the development of psychological problems

  9. “ABUSE-SPECIFIC” Factors Associated With Greater Severity and Greater Trauma • The use of force and “fear activation” (vs. non-coercive sexual contact) [Anxiety disorders including PTSD] • Sexual acts involving oral, vaginal or anal penetration (vs. non-penetrating acts) [Sexual behavior problems; sexual anxiety] • Greater frequency and/or duration of the abuse [Learned helplessness; depression; PTSD] • Greater emotional closeness between the perpetrator and the child. [Betrayal & trust issues; relationship problems; depression]

  10. OTHER VARIABLES THAT INFLUENCE THE IMPACT OF CSA

  11. FAMILY VARIABLES THAT SERVE AS “PROTECTIVE FACTORS” • Healthy parent-child attachments and parental support are the most potent “protective factors” for sexually abused children • Secure Attachment (preceding, during and after the abuse) • Parent believes the child • Does not blame the child • Is able to speak openly with the child about the abuse • Ensures that the child obtains necessary external support, i.e., therapy, school remediation

  12. FAMILY VARIABLES THAT SERVE AS “RISK FACTORS” • Discontinuity of parenting (disruptions/losses) • Parental alcoholism/psychiatric disorders • Unresolved CSA (or other trauma) in parent(s) • Marital Discord, i.e., conflict, separation, divorce • Parent’s pregnancy before age 18 • Rejection, physical abuse, emotional abuse, neglect of child • Domestic violence • Educational problems in parent (s) • Employment problems in parents/poverty • Criminal history in either parent • Parents’ inability/failure to use effective child management skills

  13. RESILIENCY • Resiliency is characterized by positive adaptation despite exposure to considerable challenges, traumas and threats to development • Both “environmental” and “genetic” mechanisms underlie resiliency in children

  14. CULTURAL VARIABLES • Research on the impact of Cultural & Ethnic Variables is in its INFANCY • Preliminary Findings: • Oppressed minorities tend to be less trusting of governmental agencies, i.e., social services and law enforcement • African American CSA victims were found to be more trusting and revealing when interviewed by an African American investigator

  15. CULTURAL VARIABLES • Cultural attitudes and practices vary about who to go to for help: • Therapists • Religious authorities • Keep it within the family

  16. CULTURAL VARIABLES: • Attitudes and practices vary regarding: • The family hierarchy and the value of children: “Honor thy father” “Children are to be seen and not heard” • Gender roles (status of males/females) • Virginity/sex out of wedlock • Homosexuality; “sinfulness” • Loss of ‘honor’

  17. SYMPTOM PATTERNS AMONG SEXUALLY ABUSED CHILDREN

  18. Posttraumatic Stress DisorderandDevelopmentally Abnormal Sexual Behaviorsare consistently observed more often among sexually abused children than among non-sexually abused childrenin both clinical and non-clinical samples

  19. Prevalence of PTSD Among Sexually Abused Children • Only about 1/3 of sexually abused children meet full diagnostic criteria for PTSD • About half of sexually abused children exhibit someof the diagnostic criteria for PTSD

  20. COMMON PTSD PRESENTATIONS IN YOUNGER CHILDREN • Re-experiencingthe trauma: • Trauma-specific reenactment and repetitive play are far more common than flashbacks • The repetitive play is not necessarily ‘distressing’ for the child • Increased Nightmares – within weeks, trauma-related nightmares may transform into ‘generic’ nightmares, i.e., monsters or unrecognizable content

  21. COMMON PTSD PRESENTATIONS IN YOUNGER CHILDREN • Avoidance symptoms: • Constriction of play • Social withdrawal • Loss of developmental skills • Avoidance of abuse-related conversations • Dissociative (psychogenic) amnesia—particularly when the abuse was severe, painful, terrifying and repetitive

  22. COMMON PTSD PRESENTATIONS IN YOUNGER CHILDREN • Hyperarousal, New Fears & Aggression • Hypervigilance, i.e., checking all the doors and windows in the house to be sure they are locked; sleeping with the light; exaggerated startle response • Stress-related physical symptoms, i.e., stomachaches, headaches • New separation anxiety • New aggression, temper tantrums • Sleep disturbance

  23. SEXUAL BEHAVIOR PROBLEMS

  24. ALTHOUGH CSA CAN NOT BE PROVED OR DISPROVED BY THE PRESENCE OR ABSENCE OF SYMPTOMS, DEVELOPMENTALLY ABNORMAL SEXUAL BEHAVIORS ARE THE SYPMPTOMS THAT ARE MOST SPECIFICTO CSA AND SHOULD ALWAYS BE CAREFULLY EXAMINED

  25. Young children are not born with detailed knowledge about adult-like sexual behaviors, e.g., , intercourse, oral sex, ejaculation, use of lubricants, sex toys,

  26. Generally, young kids don’t have detailed knowledge about adult-like sexual behavior (i.e., intercourse, oral sex, use of lubricants, ejaculation, etc) unless: • They were sexually abused OR • They learned about it vicariously, i.e., observing others engaging in sex in ‘real life,’ videos, magazines, someone describing it to them

  27. How do we determine which sexual behaviors are developmentally abnormal?

  28. The Child Sexual Behavior Inventory(The “CSBI”)

  29. Description of the CSBI • The CSBI was developed to distinguish between normal and abnormal sexual behaviors in children ages 2 to 12 years old. • The CSBI consists of 38 items relating to a broad range of affectional and sexual behaviors. • The CSBI is typically completed by the child’s primary caregiver.

  30. FINDINGS REGARDING THE OBSERVED SEXUAL BEHAVIOR OF NON-ABUSED CHILDREN AGES 2-12

  31. Sexual behaviors are more commonly observed in young children, ages 2 to 5. Sexual behavior does not cease as children age; it merely goes underground. “Modesty training” accounts for much of the decline in observed sexual behavior. Children are taught to avoid “inappropriate” displays of nudity, self-stimulation, and other sexual behaviors in public.

  32. It is not unusual for non-sexually-abused young children to touch their own genitals-especially at home

  33. “Touches sex parts at home” (#12) Non-abused Boys 2 to 5 years old 60% Non-abused Girls 2 to 5 years old 44%

  34. “Touches sex parts in public (#4) Non-abused Boys 2 to 5 years old 27% Non-abused Girls 2 to 5 years old 15%

  35. “Masturbates with hand” (#5) Non-abused Boys 2 to 5 years old 17% Non-abused Girls 2 to 5 years old 16%

  36. Indicators Of“Abnormal” Masturbation • The behavior is engaged in compulsively and is preferred over normal play activities. • The behavior persists despite attempts at redirection, admonishment and punishment. • Objects are inserted insidethe vagina • The child masturbates to the point of causing physical harm to their genitals.

  37. “Touching Mothers or other women’s Breasts” (#7) is common among young non-abused children Non-abused Boys 2 to 5 years old 43% Non-abused Girls 2 to 5 years old 44%

  38. Sexual Behavior Of Non-abused Children With Anatomical Dolls (Boat & Everson) • Touching, exploring, and inserting fingers in doll’s genitals and anus occurred in over 50% of non-abused 2-5 year olds. • But, demonstrations of vaginal, oral, or anal intercourse occurred in only 2-6% of 2-5 year olds overall. However, over 20% of the small sample of 4- and 5-year-old poorer males showed this behavior. (Vicarious exposure)

  39. Anatomical Dolls and other props can serve as “Distracters” • This is especially true for children under 5 years old and for older children who tend to be distractible.

  40. Dolls of any sort should not be used by very young children for demonstration purposes • Children younger than approximately 3½ years old have not yet mastered “symbolic representation” and are therefore unable to use dolls and other props to accurately depict what they have experienced. • They can be used for body parts identification.

  41. “ABNORMAL”SEXUAL BEHAVIORS IN CHILDREN

  42. The following behaviors were observed in less than 2% of the Non-sexually-abused 2 -12 year-olds: • Puts mouth on another child’s or adult’s sex parts [Only two children out of 1,114! ] (#11) • Tries to have sexual intercourse with another child or adult (#10) • Asks others to engage in sex acts (#16) • Tries to French kiss others (#31) • Puts objects in vagina or rectum (#18) • Touches animals’ sex parts (#14) • Pretends toys are having sex (#20)

  43. EXPLANATIONS FOR INCREASED AND ABNORMAL SEXUAL BEHAVIOR IN NON-SEXUALLY ABUSED CHILDREN

  44. Home Environments associated with Increased Self-stimulation and Sexual Preoccupation in Non-Sexually-Abused Children: • Observing parents or other adults naked • Bathing and sleeping with parents • Viewing adults having sex on TV, in videos • Having magazines at home with nude adults in them • Anxiety (self-stimulation as a ‘self-soothing’ behavior)

  45. Observing parents engaging in intercourse is highly correlated with Sexually Intrusive Behaviors in NON-sexually abused children • Sexually intrusive behavior involves the violation of another’s sexual boundaries: • Touches another’s sex parts • Touches an adult’s sex parts • Tries to have intercourse with another child • Puts mouth on another child’s/adult’s sex parts • Touches animals’ sex parts • Asks others to engage in sex acts with him/her • Tries to undress adults or children against their will • French kissing • Kissing/hugging other children they don’t know well

  46. FINDINGS REGARDING THE OBSERVED SEXUAL BEHAVIOR OF SEXUALLY ABUSED CHILDREN AGES 2 TO 12

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