1. Child Sexual Abuse: Prevention, Identification and Action

2. Agenda What is child sexual abuse (CSA) Dynamics of CSA
How children experience CSA
Perpetrator risks and dynamics
Cultural considerations
Responding

3. What is CSA?
Any interaction when the child is being used for sexual stimulation of the child or the perpetrator or observer.
Contact sexual abuse
Non-contact sexual abuse
Care and/or custody of the child (CPS)

4. Sexual Assault/Statutory Rape
Assault of a sexual nature or sexual act without consent.
Statutory Rape:
Sexual activity where the child is below the legal age of consent.
Different term, age differentials and particulars for charging across states.

6. Sexual Trafficking
Child sex trafficking includes any child involved in commercial sex (Polaris Project)
Florida, Illinois, Connecticut and Maryland
State regulations governing Social Services Departments to provide services to victims of Human Sex Trafficking
Check with your local jurisdictions about mandated reporting.

7. CSA History Exploded into awareness in the 1980s.
322% increase in reports (National Center on Child Abuse and Neglect, 1988).
Credibility of reports questioned.
Complaints of false allegations and brain-washing.
Nationwide agencies develop methods and protocols for investigating CSA allegations.

8. Dynamics of CSA Unique crime with unique behaviors and dynamics
Rarely third-party witness or medical evidence
Only 4-5% of children who give a credible history of sexual abuse have a specific finding on medical exam.
94-95% of all children who give a history of sexual abuse have a normal or nonspecific medical exam.

9. Dynamics of CSA: Myths Denials of the extent of CSA
Perpetrator stereotypes
Minimizations or exaggerations of the extent of harm CSA poses on the child
Diffusions of perpetrator blame

10. Extent of CSA: How common is it?
High incidence and prevalence
1 in 4 girls
1 in 6 to 7 boys
…Will be sexually abused before the
age of 18.
Elevated risk for younger children and children with disabilities.

11. Extent of CSA: How common is it?
300,000 cases reported in United States
Only reported cases; unknown how many cases actually exist
Only 10% of children report their abuse

12. Extent of CSA: How common is it?
Myth:
Only happens in poor, uneducated communities…
Fact:
Inconsistent and scarce findings that race or socioeconomic status are risks
Unlike physical abuse

13. Perpetrator Stereotypes
Myths
Stranger danger
Media focus
All CSA perpetrators are male
Dirty, perverted men
Men who sexual abuse boys are homosexual

14. Perpetrator Stereotypes
70-90% of alleged abusers are people the child knows and trusts
90% of alleged offenders are male; however, there are documented cases of female perpetrators
Highly under-reported and not recognized
CSA alleged offenders tend to be married, employed and heterosexual

15. How Children Experience Abuse
Child Sexual Abuse Accommodation Syndrome (CSAAS)
Roland C. Summit, M.D. (1983)
Widely known theory for understanding dynamics of child sexual victimization
However, merely a clinical opinion, not scientific instrument
Anecdotal, not backed by research

16. Child Sexual Abuse Accommodation Syndrome (CSAAS)
Five categories:
Secrecy
Helplessness
Entrapment and Accommodation
Delayed, unconvincing disclosure
Retraction and Recantation

17. Secrecy Happens when child is alone with their abuser.
“This is our secret.”
“Don’t tell anyone, or else.”
“Nobody will believe you.”
Both the source of fear and the promise of safety.

18. Helplessness Authoritarian relationship
No child has equal power to say no to a parental figure or to anticipate the consequences of sexual involvement with an adult caretaker.
Expectation for child to cry out and run away
Almost every child fails.
Fight, flight, freeze.
Difficult for courts and law-enforcement to understand
Disbelief and rejection by non-offending caregiver = self-blame, self-hate, guilt for allowing the acts to occur.

19. Entrapment and Accommodation
Abuse is not usually a one-time occurrence.
Multiple incidents
Grooming
Accommodating to escalating sexual demands.
Child faced with continued helpless victimization must learn to somehow achieve a sense of power and control.
Child prepares for the sexual act before it happens:
Undresses and places themselves in a position for their perpetrator.
Child initiates the sexual act.

20. How Children Experience Abuse
Usually happens under the disguise of love or attention:
Bath time
Bedtime
While watching TV on the couch
Wresting and tickling
Games
Abusers use these and physical contact opportunities to sexually touch children.

21. Natural reactions of healthy child to profoundly unnatural and unhealthy caregiver environment.
Coach on your soccer team always tells you what a great job you’re doing on the field; he couldn’t get along without you; if he had his way, you’d be voted most valuable player. Everyone loves coach, so it makes you feel good that you have his attention.
Then while he’s driving you home, he starts saying things like how during showers he noticed you were really developing into a man. He begins commenting on the size of your penis and how some day you’re going to make a girl really happy. All of a sudden the good feeling goes away and you feel embarrassed, confused, maybe frightened.

22. How Children Experience Abuse
Is this really abuse?
Confusing emotions:
Ordinary, non-sexual interactions when not being abused.
Way the community views the abuser – good citizen.
He didn’t mean it – It must have been an accident.
Victim thinks he/she is weird for having a bad reaction to what happened.

23. How Children Experience Abuse
This must be love
Grooming – abuse is concealed by love and attention
Kids respond to loving attention. Like to have people spend time with them, give them treats and make them feel loved.
Some kids enjoy the physical closeness and physical feelings that can happen in the abuse situation. They seek out the abuser for attention.

24. How Children Experience Abuse
“It felt good to me and I wanted it.”
15y/o abused by older brother
“It was my mom’s boyfriend and he treated me like his girlfriend – holding my hand when we went to the mall, telling me I was so good-looking. I felt special.”
14y/o abused by mother’s boyfriend
“I liked it in a way. I kind of felt loved. He’d always be there for me.”
16y/o abused by biological father

25. How Children Experience Abuse
I deserve this.
Perpetrator tell you, “you seduced me.”
Adults are never do wrong.

26. How Children Experience Abuse: Disclosure and Discovery
Accidental vs. Purposeful Disclosure
Majority of cases are accidental discovery (74%)
More likely in pre-schoolers
Sexualized behavior or inappropriate statements
Exposure to an alleged suspect
Share with a friend who did not keep the secret
Child has Sexually Transmitted Infection
Child is pregnant

27. How Children Experience Abuse: Disclosure and Discovery
Purposeful disclosure:
Educational awareness (school prevention programs)
Influence of peers (predominantly young teens)
Proximity to perpetrator
Departure of perpetrator or threat of return of perpetrator
Timely disclosure
Anger (adolescent group)

28. How Children Experience Abuse: Disclosure and Discovery
Disclosure is a process not and event.
Most on-going sexual abuse is never disclosed (retrospective adult studies) or there is a significant time lag between abuse and disclosure.
Most adults delayed disclosure or failed to disclose in childhood
55-69% of adults never told
Treated, reported or investigated cases are the exception, not the norm.

29. How Children Experience Abuse: Disclosure and Discovery
“Nobody would believe me.”
“I would never tell. This would kill my mother.”
“Not a chance! They would put me in some foster home or take me away from my family.”
“If I tell, I’d have to go to court and then everyone would know about it.”

30. How Children Experience Abuse: Disclosure and Discovery
116 confirmed cases (Sorenson & Snow, 1991)
Denial
3/4th of children denied having been sexually abused
Active Disclosure - Personal admission by the child
Only 7% that initially denied, then moved into active disclosure.
Only 11% were able to provide a disclosure without denying or demonstrating tentative features.
Tentative Disclosure - Partial, vague or vacillating
78% - common middle step from denial to active disclosure
“I forgot”
“It happened a long time ago”
“He tried to touch me, but I hit him and ran away”

31. How Children Experience Abuse: Disclosure and Discovery
Delayed disclosure risks:
Some data indicate that males are more reluctant to disclose than females
Younger children may not have linguistic or cognitive abilities
Relationship to perpetrator: longer delays among familial
Support from non-offending caregiver (protective factor)

32. How Children Experience Abuse: Disclosure and Discovery
Disclosure does not always mean safety for the child.
Majority of offenders have kinship and trusted relationship; therefore, child is put on defensive for attacking credibility of a trusted adult.
Risks of family separation.
Threats from the alleged offender for telling.
Disbelief from authorities and non-offending caregivers
Delinquent/acting-out child
Well-adjusted child
Child does well in school and all other social aspects – not showing any kind of distress; how could the allegations be true?

33. How Children Experience Abuse: Recantation
Retraction of a previous allegation of abuse that was formally made and maintained.
Pressure/threats from perpetrator
Pressure from family, coaching
Disbelief
Fragmentation of family (child bears responsibility)
Negative personal consequences
Investigative process

34. How Children Experience Abuse: Recantation
Percentage rates vary across studies from high to low numbers:
23.1% recantation rate (Malloy, L.S., Lyon, T.D., & Quas, J.A; 2007)
Abuse victims more vulnerable to familial adult influences
Young children
Abuse by parent figure
Lack of support by non-offending caregiver
Maternal reactions are protective factor

35. How Children Experience Abuse: Reaffirmation
Reassertion of the validity of a previous statement of CSA.
Of those recanted, 92% reaffirmed their abuse over time.
Disclosure is a process.

36. False Allegations “Why didn’t my child tell me sooner?”
If child was really being harmed, would have spoken up.
When child is frozen in fear and does not fight back.
Viewed as consensual.
Child was angry for being punished.
Child has delinquency and/or mental health issues.
Promiscuous adolescent.
Diffusion of blame from perpetrator to child.

37. False Allegations Majority of investigated accusations prove valid.
Based on review of studies, only 4-8% of allegations were fabricated.
Sloppy assessments could lead to false positives or false negatives
Need researched-based investigative protocols

38. Emotional Coping Techniques
Avoidance:
“As soon as”…
the abuse stops, I will be fine.
I go to college, everything will be different.
she finds a new husband, everything will be back to normal.
Minimizing:
“It’s not that bad”…
Lots of kids have it worse.
He didn’t mean it, he was drunk.
Denial:
“It happened, but I’m fine. No big deal.”
Forgetting:
Helps on surface, but deeper level impact.

39. Emotional Coping Techniques
Splitting/Dissociation:
Out of body experience
“I was about nine or ten; my father and I were driving in the car. I can’t remember what he said to me or did to me, but I was definitely not in my body. I mean, my whole visual memory is of the back of his head, the back of my head, the back of the front seat of the car and that’s because I was literally on the ceiling at the back of the car. So all I can remember is how things looked from the back seat – but my body was in the front seat!”
- Richie, 15y/o abused by biological father

40. Emotional Coping Techniques
Olga Trujillo: The Sum of My Parts
Dissociation
“Dissociating is like watching your life from 50 feet off the ground” – Olga Trujillo
“The problem was, I dissociated automatically and had been doing so for decades. It seemed like I couldn’t stop and I wasn’t sure I wanted to. I liked feeling numb and calm. The fuzziness in my head felt addictive.” – Olga Trujillo
“DID, or Dissociative Identity Disorder, is a separated sense of consciousness. Consider it like a spectrum, with normal dissociation one on end. On the other end is a fractured consciousness with distinct personality states that are not aware of each other: a condition formerly known as multiple personality disorder, or MPD.” 

41. Physical Coping Techniques
Eating Disorders
Drugs and Alcohol
Self-Mutilation
Sexual promiscuity (self abuse)
Suicide
Being Perfect

42. Psychological and Medical Impacts
HOWEVER: Some survivors do not exhibit any negative consequences associated with the abuse.
Positively correlated to satisfaction in current social roles and one’s community.
Negatively correlated to additional trauma exposure.
Myths on how a victim should react.

43. Sexual Behavior Problems
Do all children that have been sexually abused act out sexually?
Belief that all sexually abused children will have significant, long-term problems is not supported by research.
Kaufman and Zigler (1987) – 70% of abused children did not offend in adulthood
Widom and Ames (1994) – childhood sexual abuse did not account for increased risks for violent sex crimes.

44. Sexual Behavior Problems
Do all sexual behavior problems in children indicate that the child has been sexually abused?
Myth in 1980s and 1990s
There may be other psychosocial difficulties causing the child to display sexualized behaviors.
Physical abuse, neglect, family violence, etc.
However, suspicion of exposure in children who display age-inappropriate sexual behaviors.
May be exposed to unhealthy sexual, emotional and physical boundaries in the home environment.

45. Sexual Behavior Problems
Sexual exploration and sexual play are a natural component of children’s development.
Similar age, size and developmental status
Voluntary basis
Light-hearted and spontaneous
Embarrassment, but no shame, guilt or fear
Child’s interest in sex and sexuality is balanced by curiosity about other aspects of his or her life.

46. Sexual Behavior Problems
Continuum:
Natural/healthy → Molestation of other children
Sexual Behavior Problems:
Sexually Reactive
Confusion about sex – trying to work through their confusion by enacting behaviors
Extensive, Mutual Sexual Behavior
Sexual behaviors as a way of coping with feelings of abandonment, loss and fear
Molestation of Other Children
Use some type of coercion.

47. Sexual Behavior Problems
How should we react?
Remain non-judgmental and non-punitive
Caregiver’s reactions influence child’s sexual self-esteem, sexual identity and sexual judgment.
Often becomes main focus for caregivers – forget to look at child’s positive behaviors.
Do not discuss act as “sexual” with children.
Address the actual behavior
“Touching your penis”

48. Sexual Behavior Problems
Children who molest should not be compared to adults who sexually offend.
Adult sex offenders have established sexual arousal problems.
Pedophilic offenders’ primary sexual attraction is to children.
Most children who molest are acting out their hurt and angry feelings in a disorganized and chaotic manner using sex as a vehicle.
Sexual behaviors in children do not represent sexual gratification.

49. Sexual Behavior Problems: Sibling Sexual Offending
Most common form of familial sexual abuse
Pervasive underreporting
Approximately half of all adolescent-perpetrated offenses involve a sibling.
Correlated with family violence and dysfunction histories
Sexual abuse, domestic violence history and exposure to pornography
Implications for juvenile justice and mental health.
Family-based interventions

50. Creating Healthy Sexual Environment
Children with sexual behavioral problems may need to be supervised while with other children.
Should not sleep in same bed with other children or adults
Over-stimulating for child
Child who molests should not sleep in the same room with any other children.
Motion detectors
Should not be left to care for other children, even for a short time.
All bathroom activities should be done separately.
Children and adults should not walk around without clothes on.
Overwhelming memories or encourage unhealthy sexual behavior
Other children in the home should know about the sexual behavioral problems for the child with a history of molesting. Child with sexual problems should be made aware that, for everyone’s safety, it is important for everyone to know.
Family meeting
Clinician’s role
Work with molesting child
Ask other children, in private, on a regular basis if other child has tried to touch them (older children only).

51. Sexual Abuse Offenders
Does not excuse the abuser. Abuser is fully responsible for the abuse.
Fixated Offenders
Sexual attraction toward children (pedophilia)
Regressed Offenders
Abuses children within easy reach – stressors
Turns to child in misguided attempt to cope
Children give affection freely, idolize parents, taught they cannot say no to a parent.

52. Sexual Abuse Offenders: Why do they abuse?
Abused themselves as children
Lack abilities to relate to people, express love and affection, express anger and disappointment.
Trying to feel loved and important
Feeling intimate with children makes them feel secure.
Looking for power and control
Not looking for love or sexual pleasure, but satisfaction of being in control of another.
Think love and sex are synonymous
When child shows affection, think child is looking for sex. In turn, they think they are showing affection by being sexual.
Acting out their rage
Take pleasure in seeing children hurt and in pain.
Was a victim, but instead of becoming a survivor, became an abuser.

53. Cultural and Ethnic Considerations
No culture is defined solely by one value, nor is any particular value held by one culture exclusively.
Be culturally competent, but avoid stereotyping.
Cultural background appear most associated with psychological symptoms.

54. Cultural and Ethnic Considerations
Correlation between acculturation level and reporting.
Knowledge of legal systems
Immigration fears
Shame
Predictor of post-abuse adjustment
Honor, respect and patriarchy
Asian cultures
Familism (family harmony and stoicism)
Filial piety (honoring older male relatives)
Taboos and Modesty
Sexual discussion and education taboos
Religious
Sexual Scripts
Male-female interaction
Gender struggle model
Virginity
Less valuable brides
Loss of prestige for the family or disgrace (Honor Killings)
Virginity tests
Obligatory violence
Retaliation by family members (child may delay disclosing to protect family)

55. Responding
Acceptance and validation are crucial to the psychological survival of the victim.
Mothers typically react to allegations with disbelief and protective denial.
How could I not have known?
Why didn’t my child tell me sooner?
How could my husband, who I’ve known for years, do such a thing?
Without professional intervention, most parents are not prepared to believe their child in the face of convincing denials from a responsible and trusted adult.

56. Responding MINIMAL FACTS8
Children are at risk of experiencing secondary trauma in the process of discovery.
MINIMAL FACTS

57. Reporting: Minimal Facts
Suspicion is sufficient for reporting!
List of basic information needed for reporting.
Name and DOB/age of child
Name of mother/caregiver
Where child resides/contact information
Where incident occurred (jurisdiction)
What happened?
Child stated that their private part was hurting because Uncle Tony touched him there.

58. Reporting
Contact local Child Protective Services and/or law enforcement (911)
Sexual Trafficking – FBI involvement
Check jurisdiction for mandated reporting to protective services.
Even if you are not sure if CPS should be involved (care/custody)
14y/o X went to a party with another 14y/o Y. They left the party with the Y’s uncle and went to another person’s home. Y’s uncle raped X. CPS took the case because established that the uncle was in a position of care and custody at the time of the incident.

59. Responding Child Advocacy Centers One Stop Family Focused
BCAC
Child Advocacy Centers
One Stop
Family Focused
Reducing Trauma
Neutral
MDT
Forensic Interviews

60. How can we support the family through the investigative process?
CPS safety plan (contact with alleged suspect)
Encourage cooperation with law enforcement and court processes.
Is there a victim/family advocate available at the local CAC or court?

61. Court – Risks for Recantation
Can the case be prosecuted?
Child’s age – not a reliable witness
Prominence of alleged suspect in community
Inconsistencies in evidence
Must prove beyond a reasonable doubt
Preliminary or Grand Jury Hearing – should criminal trial be held?
Child required to testify
Accommodations available depend on jurisdiction.
Closed-circuit television

62. National Children’s Advocacy Center
National Children’s Alliance

63. References
Ahern, E.C., Lyon, T.D., & Quas, J.A. (2011). Young children’s emerging ability to make false statements. Developmental Psychology, 47,
Cavanagh Johnson, Toni (2009). Helping Children With Sexual Behavioral Problems: A Guidebook for Professionals and Caregivers. Institute on Violence, Abuse and Trauma. San Diego, CA.
Cromer, L. D, & Goldsmith, R.E. (2010). Child Sexual Abuse Myths: Attitudes, Beliefs and Individual Differences. Journal of Child Sexual Abuse. 19,
Finklehor, D. (1994). Current Information on the Scope and Nature of Child Sexual Abuse. Sexual Abuse of Children, 4(2), 31-53
Fontes, L.A., & Plummer, C. (2010). Cultural Issues in Disclosures of Child Sexual Abuse. Journal of Child Sexual Abuse, 19,
Lipian, M.S., Mills, M.J., & Brantman, A. (2004). Assessing the verity of children’s allegations of abuse: A psychiatric overview. International Journal of Law and Psychiatry, 27(3),
London, K., Bruck, M., Wright, D.B, Ceci, S.J. (2008). Review of the contemporary literature on how children report sexual abuse to others: Finding, methodological issues, and implication for forensic interviewers. Memory, 16(1),
Malloy, L.C., Lyon, T.D., & Quas, J.A. (2007). Filial dependency and recantation of child sexual abuse allegations. Journal of the Academy of Child and Adolescent Psychiatry, 46(2),
Malloy, L.C., & Lyon, T.D. (2006). Caregiver support and child sexual abuse: Why does it matter? Journal of Child Sexual Abuse, 15(4),
Mather, Cynthia L., & Debye, Kristina E. (1994). How Long Does it Hurt? A guide to recovering from incest and sexual abuse for teenagers, their friends and their families. Jossey-Bass. San Francisco, CA.
Sorensen, T., Snow, B. (1991). How Children Tell: The Process of Disclosure in Child Sexual Abuse. Child Welfare League of America, 3-15.
Summit, R.C. (1983). The child sexual abuse accommodation syndrome. Child Abuse and Neglect, 7,

64. THANK YOU! Maria del Socorro Vernetti Bi-lingual Forensic Interviewer
Baltimore Child Abuse Center