Category — 2.4 Children with Environmental Risk Conditions: Sexual Abuse

Sexual abuse is defined as the sexual assault and/or sexual exploitation of a minor. Here are a few examples of sexual abuse (Fig. 1):

Figure 1. Sexual abuse

• Rape;
• Group rape;
• Sodomy;
• Incest;
• Penetration of a genital or anal area with a foreign object;
• Molestation and fondling;
• Forcing the child to perform sexual acts on an adult;
• Forcing the child to watch while others engage in sexual acts;
• Forcing the child to perform in front of a camera;
• Forcing the child to engage in pornography (that is, filming the child while engaged in sexual acts).

Sexual abuse has many symptoms. They include:

• Enuresis (no control over bladder);
• Encropesis (no control over bowel);
• Eating disorders (over or under eating);
• Having fears and phobias;
• Being extremely anxious;
• Being extremely sad;
• Age-inappropriate sexual behavior (for example, talking about sexual positions);
• Regression (such as bed-wetting or thumb-sucking);
• Being very curious about matters related to sex;
• Drinking alcohol and/or using illicit drugs;
• Being suicidal;
• Complaining of headaches or stomach aches (these are usually psychosomatic (see full Glossary) in nature);
• Setting fires to property;
• Being very aggressive;
• Engaging in self-mutilation (that is, hurting oneself on purpose);
• Being extremely withdrawn;
• Acting in sexually provocative ways (for example, coming on to peers and adults);
• Being tired all the time;
• Bleeding from the vaginal or anal areas;
• Refusing to dress up for sports;
• Difficulty sitting or walking due to pain in the genital or anal areas;
• Crying without provocation;
• Finding it very difficult to pay attention and concentrate (Fig. 2).

Figure 2. Difficult to concentrate

Sexual abuse affects many areas of development, especially:

• Cognitive and academic skills: some children who are sexually abused do not perform well on standardized assessments, such as IQ tests (see full Glossary). Some do not do well because they do not care. Others do not do well because the fear in which they live prevents them from thinking clearly. Some children who are sexually abused may perform less well than their peers on some academic tasks because the constant fear in which they live prevents them from performing well;
• Social/emotional skills: some children who are sexually abused really struggle with their social/emotional skills:
  • Emotional skills: some children who are sexually abused have immature emotional skills. They may react in extreme ways to regular and simple situations (such as being grounded). They may struggle when it comes to identifying emotions, both in themselves and others. Some have very negative self-esteem and very poor self-confidence;
  • Social skills: some children who are sexually abused have poor social skills. They may interrupt others and refuse to wait their turn. Others may be eager to please and may do anything that is asked of them, making it easy for others to take advantage of them. Some act in very sexually-provocative ways, that is, they try to seduce others;
• Language and communication skills: the language skills of some children who are sexually abused may be rather simplistic and very concrete. They may struggle with complex or multi-step directions (such as: please go to your room, get the book and bring it back to me). They may also struggle with certain complex and abstract terms (like justice and freedom). Also, they sometimes use language that is very sexual in nature and that most children their age do not use (for example, they may talk about orgasms);
• Mental health: most children who are sexually abused need the help of a psychotherapist. Many of them are severely depressed and may suffer from anxiety-based disorders. Others may be suicidal.

The onset of sexual abuse sometimes triggers sudden changes in behavior in the child who is being sexually abused. When a teacher (or someone else) notices that a child’s performance has changed in school in very drastic ways, this could be an indication that they are being sexually abused. Changes in behavior include a sudden drop in grades, and suddenly becoming withdrawn and shy.

Some children end up being diagnosed with a sexually transmitted disease (such as AIDS or syphilis). Some children have genital or anal areas that appear to have been the subject of trauma. The areas may have bruising, bleeding, lacerations and abrasions.

Children who are sexually abused need our help, empathy and support. Many feel dirty and many blame themselves for what has happened to them. It is crucial that a child be reassured that what has happened to them is not their fault. Some children are told that this has happened to them because of the way they act or dress. It is very important that these children be reassured that this is completely false and that they did not do anything to trigger the assault that was committed against them.

Children who are sexually abused do not usually qualify for special education services at school and most of them will not have an Individual Education Plan (IEP). But they do need help, especially from the following professionals:

• Psychotherapy: this is what most children who are sexually abused need the most.  Most of them will need regular and sometimes intensive psychotherapy from a clinical psychologist. The psychologist will help them come to terms with what has happened to them, help them understand that what happened to them was not their fault, and help them learn to trust adults again. If the child still resides with his or her biological family, family therapy may be recommended as well;
• School counseling: some children who are sexually abused  benefit from regular sessions from the school counselor in addition to the sessions that they may be getting from a clinical psychologist. The school counselor could help these children manage their behaviors and feelings at school;
• Special education services: some children who are sexually abused, especially those who are behind their peers cognitively or academically, could benefit from the help of the school’s special educator. The special educator will teach the child how to pay attention and get organized, in order to learn how to read, write and do math.

In the classroom, teachers need to be aware that children who are sexually abused often behave differently than others. They may not like it when someone touches them, even gently. These children may be unwilling to trust their teachers, at least at first, because they may be suspicious of adults, especially male teachers. It is important to note that teachers can do a lot to help these children with the healing process, as long they are not the ones committing the abuse. Many children choose to tell their teacher that they are being abused. This is because teachers are usually seen as a source of trust and safety. This is why many children go to them with their personal problems. Therefore, it is highly recommended that a teacher do everything in his or her power to reach the child who is sexually abused. Collaboration with the school counselor (and psychotherapist, if possible) is highly recommended. The teacher may be the only constant in the child’s life, and his or her role cannot be under-stated.

To learn more about sexual abuse, please visit the sexual abuse section of the birth to six course.

see References
Crosson-Tower, C. (2009). Understanding Child Abuse and Neglect (8^th Ed.). Boston, MA: Prentice Hall.
Jenny, C. (2010). Child Abuse and Neglect. New York, NY: Harper Collins.
McCoy, M. L. & Keen, S. M. (2009). Child Abuse Neglect. New York, NY: Psychology Press.
http://www.nlm.nih.gov/medlineplus/childabuse.html