4.5 Caring for Children who have been Sexually Abused

RELEVANT READING

Recognising and Treating Abuse Guidance (which provides guidance on the definition of Significant Harm and recognising Significant Harm)

Children who have Suffered Sexual Abuse are Survivors
Definition
Behaviours which might be Associated with Sexual Abuse
“Day Landmarks”
Health Issues
Self Image
Relationships
What Forms can Child Sexual Abuse Take
Who can I tell?
Self Protection
Realisation
Family Ties
Sexual Abuse doesn’t Stop

1. Children who have Suffered Sexual Abuse are Survivors

Children who have suffered sexual abuse are survivors; not only have they experienced family, society, adult/child relationships being breached, but every taboo this society holds as a basic right to be safe.

Survivors should not be treated as ‘victims of sexual abuse’ but people and children in their own right. It is important to ‘look past’ any label which might have been placed on them.

That said, sexual abuse can be very psychologically damaging, as can any form of child abuse. Child sexual abuse is often linked and involved the suffering of physical, emotional abuse and neglect too.

2. Definition

The involvement of dependent, developmentally immature children and adolescents in sexual activities they do not truly comprehend, to which they are unable to give informed consent, or which violate the social taboos of family roles.

3. Behaviours which might be Associated with Sexual Abuse

Mistrust of adults (either gender).
Sexually promiscuousness.
Sexually precociousness.
Withdrawn.
Eating disorders.
Violence.
Offending.
Fire lighting (Helen Kenwood made this association).
Poor educational performance.
Absconding (from care / Home / school etc.)
Exhibitionism.
Preoccupation with cleanliness.
Poor personal hygiene.
Disturbed sleep pattern.
Rocking (rhythmic swaying either during night or day time).
Self harm.
Poor self image.
Attention needing behaviour.
Delayed speech or poor vocabulary.
Destruction of belongings / environment.
Hiding clothes especially underwear.
Hiding food.
Stealing food.
Encopresis (incontinence of faeces)
Enuresis (involuntary passing of urine)
Constipation

Indeed, many more behaviours can also be connected to sexually abused children, some of which involve stimulation of genitalia for self gratification or solace (often not age appropriate).

4. ‘Day Landmarks’

Areas of the day such as meal times, evenings, bedtimes etc. may be associated with the time abuse was suffered. It is important to be sensitive to this and emphasize that their environment is now safe. Much reassurance might be required.

5. Health Issues

Children can often be very worried about their physical health, not only in their genital region.

Children who have been sexually abused might suffer from:

H.I.V.
Venereal disease.
Urinary tract infections.
Damage to genitals.
Digestive disorders.
Incontinence.
Thrush.
Other genital infections.
Hypochondria.

The above might cause the child much distress, anxiety and worry. A medical to prove ‘everything’s O.K.’ is often ignored and should not be assumed happened at investigation or disclosure stage.

6. Self Image

Children often suffer from a ‘used goods syndrome’. They feel worthless, unwanted, unloved, cheap etc. Staff should praise and help children ‘find themselves’.

7. Relationships

Often the child / adult relationship has been damaged. A feeling of mistrust, in that ‘you are only be nice to me so you can abuse me’ is evident.

Children may never feel safe in an adult/s company, which can be demonstrated in anti-social behaviours e.g. violence, abusive language, panic etc.

Trust might be very hard to achieve but only time and proof of security will tell. Therefore it is very important that sexually abused children are not ‘let down’ and promises are kept etc.

8. What Forms can Child Sexual Abuse take?

Inappropriate verbal interaction.
Inappropriate non-verbal interaction.
Witnessing adults involved in sexual acts (deliberately).
Access to pornographic material (magazines, computer disks, videos, audio tapes etc.)
‘Hands on abuse’ where inappropriate touching occurs e.g. sexual intercourse, fondling etc.)
Abusive telephone calls.
Witnessing others being abused.
Incest.
Sibling abuse.
Invasion of ‘personal space’.

9. Who can I Tell?

Children who have been sexually abused may have a deep seated mistrust of adults. As a result of this their confidence to tell someone about their abuse could have been hampered if not destroyed. This can occur as a result of an initial disclosure, which can result in them being removed from their family with subsequent consequences.

It is often useful to encourage young people to compile lists of people they can tell about past abuse and any abuse they might suffer in the future e.g.

Police Officer.
Social Worker (male or female).
Residential Social Worker (male or female).
Close friend (adult).
Teacher.
Aunt.
Uncle.
Grandparent.
Parent.
Educational Welfare Officer.
Citizens Advice Bureau.
NSPCC (Provide national telephone number).
Child Line (Provide telephone number) etc.

It is important to emphasise the options available as any one of the above can be an abuser too.

10. Self Protection

It is important the child can be encouraged to protect themselves. There is no ‘standard format’ of attempting this self protection work but needs to be specific to the particular child, perhaps using examples from their own experiences/ behaviour. At some point specialist advice should be sought.

11. Realisation

Child sexual abuse doesn’t go away. The more knowledge a child obtains about sexual relationships and society values in general the more a child realises just what has happened to them. Therefore at some stage in their development it might appear not to be a big issue, whereas later difficulties may again come to the fore. Sensitivity and compassion are needed to cushion these hurtful rationalisation and honesty of reply and interaction are needed. Someone available to listen will be very valuable and specialist help should be sought.

12. Family Ties

When a child discloses it is like a balloon. If the situation is handled carefully the balloon deflates at a steady pace. Sometimes the balloon will burst and bits go everywhere. Disclosure is a traumatic experience. Would you share your most private sexual experience with someone you didn’t know very well ? in detail ? and perhaps on video ? No, but this is what children who disclose sometimes have to do.

After disclosure children can be told, often in anger, such things as:

“How could you say such a thing about your father”.
“You’re a liar, an evil person”.
“You’eve broken your family up now” etc.

Often, therefore, many children who are looked after suffer remorse, guilt etc. Not only because of seeing the traumatic consequences of their disclosure, but also being ‘cast out’ by their families, the ones who should (and perhaps still do) love them the most. Again, sensitivity and compassion to help bridge building (if possible) into broken relationships might be appropriate at some stage, but only at the child’s pace.

13. Sexual Abuse doesn’t Stop

Sexual abuse is very difficult to prove in Court. Often before disclosure children are involved in offending, excluded from school and are disruptive at Home. This can be ‘set up’ by abusers. “Oh this is the next thing s/he’s done, look how s/he behaves usually!”. Abusers organise a mantle of protection around themselves. They might appear to be very respectable people in their own community e.g. Church attendants, fund raisers, youth club helpers etc. “How could anyone say such a thing about Mr. or Mrs. Bloggs, they’re so nice!”.

Abusive families and people continue to place responsibility for disclosure on the child. Even when they are in care, in prison or even dead! The ‘mantle’ of we or I’m a safe person continues to occur and breaking this cycle of ‘closed awareness’ is often impossible. Staff should always try to actively be aware of this e.g. stopping distressing phone calls etc.

In conclusion, as in many areas of social work there are no ‘quick fixes’ in this area. The most important factor must always be to support the child, emphasise the positives and keep the child’s welfare as paramount.

This guide is just that not an answer but hopefully will provide Staff with landmarks to help children whilst they are in Continuum’s care.

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