1. Age-related signs of Abuse

2. Ages 0-3 Signs of physical injury Signs of physical injury Signs of physical illness, especially to genital or urinary systems Signs of physical illness, especially to genital or urinary systems Unusual fussiness Unusual fussiness Refuses his/her favorite food Refuses his/her favorite food Becomes extremely shy Becomes extremely shy Exhibits a sudden or unusual fear of strangers Exhibits a sudden or unusual fear of strangers

3. Ages 0-3 Shows a lack of enjoyment of his/her favorite play things Shows a lack of enjoyment of his/her favorite play things Clings to parents as if fearful Clings to parents as if fearful Experiences great difficulty getting to sleep Experiences great difficulty getting to sleep Suffers from frightening dreams Suffers from frightening dreams Regresses to an earlier pattern of behavior Regresses to an earlier pattern of behavior Regression of skills Regression of skills

4. Ages 0-3 Experiences a loss of his/her sense of security Experiences a loss of his/her sense of security Becomes unable to adjust to his/her normal schedule Becomes unable to adjust to his/her normal schedule Manifests any change from normal behavior pattern such as: Manifests any change from normal behavior pattern such as:

5. Ages 0-3 * Feeling ugly * Very concrete symptoms- hitting self in eye, etc. * Difficulty cuddling * Seeking attention from any adult

6. Ages 4-12 A sign of physical injury A sign of physical injury Signs of physical illness, with a variety of symptoms from recurrent headaches, upset stomachs, or urinary tract infections Signs of physical illness, with a variety of symptoms from recurrent headaches, upset stomachs, or urinary tract infections Exhibits sudden shyness Exhibits sudden shyness Suffers from frightening dreams Suffers from frightening dreams Experiences great difficulty getting to sleep Experiences great difficulty getting to sleep

7. Ages 4-12 Refuses his/her favorite foods Refuses his/her favorite foods Suffers from depression Suffers from depression Exhibits some loss of memory Exhibits some loss of memory Worries excessively, interrupting his/her normal life pattern Worries excessively, interrupting his/her normal life pattern Exhibits a fear of specific adults Exhibits a fear of specific adults Has a sudden and unwarranted fear of the dark Has a sudden and unwarranted fear of the dark

8. Ages 4-12 Exhibits extreme fear of being alone Exhibits extreme fear of being alone Shows regression in patterns of behavior or skills Shows regression in patterns of behavior or skills Exhibits a change in school relationships, including possible fighting and the sudden inability to adjust Exhibits a change in school relationships, including possible fighting and the sudden inability to adjust Shows lack of enjoyment in his/her favorite TV shows, movies, games, or other activities Shows lack of enjoyment in his/her favorite TV shows, movies, games, or other activities

9. Ages 4-12 Seems easily distracted as though his/her mind is wandering Seems easily distracted as though his/her mind is wandering Manifests a change in his/her attitude Manifests a change in his/her attitude Manifests a change in his/her pattern of normal behavior Manifests a change in his/her pattern of normal behavior Acts out in a sexual manner, appearing more knowledgeable about sex than his/her peers. Acts out in a sexual manner, appearing more knowledgeable about sex than his/her peers.

10. Ages 4-12 Develops a pseudomature character, taking over specific parental responsibilities in the home ( a sign predominately associated with incest) Develops a pseudomature character, taking over specific parental responsibilities in the home ( a sign predominately associated with incest) Bedwetting Bedwetting Excessive masturbation Excessive masturbation Approaching strangers for affection Approaching strangers for affection Dependency issues Dependency issues School phobia School phobia

11. Ages 4-12 Excessive lying or manipulation Excessive lying or manipulation Use of precocious sexual language Use of precocious sexual language Cruelty or excessive concern for animals Cruelty or excessive concern for animals Fear or aversion to sports Fear or aversion to sports Phobia Phobia Emotional lability Emotional lability Recurrent nightmares Recurrent nightmares Lack of joy Lack of joy

12. Ages 4-12 Shame Shame Excessive or total lack of interest in dating Excessive or total lack of interest in dating Excessive drug or alcohol use Excessive drug or alcohol use Self-injury Self-injury Eating disorders Eating disorders Problems with boundaries: Problems with boundaries: –Difficulty saying “no” –Problems with closed doors –Excessive modesty or nudity

13. Ages 4-12 Intrusive behavior with siblings, parents, or friends Intrusive behavior with siblings, parents, or friends Blocked feelings or memories Blocked feelings or memories Rejection issues are primary Rejection issues are primary Early sexual acting out Early sexual acting out

14. Ages 13-19 Manifests signs of physical injury Manifests signs of physical injury Manifests signs of physical illness, headache, stomach cramps, urinary tract infections Manifests signs of physical illness, headache, stomach cramps, urinary tract infections Suddenly refuses food Suddenly refuses food Suffers from sudden and violent dreams Suffers from sudden and violent dreams Manifests difficulty in getting to sleep Manifests difficulty in getting to sleep Seems in depths of depression Seems in depths of depression

15. Ages 13-19 Exhibits inability to concentrate Exhibits inability to concentrate Shows irritability or manifests angry outbursts toward others Shows irritability or manifests angry outbursts toward others Exhibits a sudden and unwarranted fear of the dark Exhibits a sudden and unwarranted fear of the dark Has a sudden lapse of enjoyment in dating Has a sudden lapse of enjoyment in dating Feels an unexplainable fear of being left alone Feels an unexplainable fear of being left alone

16. Ages 13-19 Worries excessively, interrupting his/her normal life patterns Worries excessively, interrupting his/her normal life patterns Experiences a loss of memory Experiences a loss of memory Exhibits fear of specific adults Exhibits fear of specific adults Exhibits a change in his/her level of scholastic achievement Exhibits a change in his/her level of scholastic achievement Acts out the sexual encounter with sibligns or friends Acts out the sexual encounter with sibligns or friends

17. Ages 13-19 Experiences a lack of enjoyment of his/her favorite activities Experiences a lack of enjoyment of his/her favorite activities Makes an attempt to run away from home Makes an attempt to run away from home Contemplates suicide Contemplates suicide Appears passive or overly compliant n behavior Appears passive or overly compliant n behavior Behaves seductively with the opposite sex Behaves seductively with the opposite sex

18. Ages 13-19 Manifests a deviation from his/her normal patterns or attitudes Manifests a deviation from his/her normal patterns or attitudes *Lack of interest in dating * Promiscuity * Excessive drug/alcohol use * Self-injury * Eating disorder ( too much or too little)

19. Ages 13-19 Problems with boundaries: Problems with boundaries: –Saying “no” to friends –Closing doors –Excessive modesty/nudity –Being intrusive with friends, parents, siblings

20. Ages 13-19 Blocked memories/feelings Blocked memories/feelings Lack of joy Lack of joy Shame Shame Rejection issues are primary Rejection issues are primary Dependency issues Dependency issues Truancy Truancy Early marriage/early pregnancy/early sexual experience Early marriage/early pregnancy/early sexual experience

21. Ages 13-19 Lying and manipulation Lying and manipulation Cruelty or excessive concern for animals Cruelty or excessive concern for animals Excessive masturbation Excessive masturbation

22. Signs of Credibility Important information to keep in mind during the interview process. What enhances and what will detract from a child’s allegation of sexual abuse

23. Credibility of Language Increase of credibility - Uses own language - Facts stay the same even if the vocabulary changes - Gives details - Tells from a child’s viewpoint Decrease of credibility - Adult terms - Rote phrases - Lack of details

24. Credibility of Affect Increase in credibility - Congruent with allegations Decrease of credibility - Inappropriate allegations

25. Credibility of Behavior Increase in Credibility - Seductive - Precocious - Regressed - Guarded - Somatic - Complaints Decrease in Credibility - No behavioral changes

26. Credibility of Cognitive Development Increase in Credibility - Differentiates fact from fantasy Decrease in Credibility - Impaired reality testing

27. Credibility of Memory Increase in Credibility - Good recall of details, including sensorimotor - Absence of denial - Idiosyncratic detail Decrease in Credibility - Vague - Evasive - Prior abuse may confuse allegation

28. Credibility of Motives Increase in Credibility - Absence of secondary gain Decrease in Credibility - Possible secondary gain - Need parent’s approval

29. Credibility of Play Increase in Credibility - Sexual Themes - May reenact trauma, exaggerates or avoids sexual features Decrease in Credibility - Sexual themes absent

30. Credibility of Drawings Increase in Credibility - Will show characteristics of sexually abused children Decrease in Credibility - Will not show characteristics of sexually abused children

31. Credibility of History Increase in Credibility - Progressive sexual activity over time - Delayed disclosure - Child threatened to keep secret - Psychological coercion - Sex rings, rituals, pornography Decrease in Credibility - Other medical history to explain heightened sexual concerns

32. Credibility of Physicality Increase in Credibility - Gonorrhea under age 14 other than newborn - Strong indicators, hymenal disruption, anal scars or relaxation, gonorrhea of rectum or vagina, other venereal diseases Decrease in Credibility - Normal physical exam in spite of history of penetration.