By Silvia Farag, MSW, LSW, PsyD Candidate

Today is the third post in a five-part series I’m sharing on sexual abuse. I’m honored to have an expert clinician in the field share her knowledge and experience on the topic of child sexual abuse for several posts in this series. I’m also honored that she’s a friend and my sister in Christ. You can read her first post in the series, Talking to My Children About Child Sexual Abuse, here, and her second post in the series, Parents Preventing Sexual Abuse, here. In her second post, Silvia offers a list of important tips for speaking to children about child sexual abuse. Subscribers to my email newsletter receive that list as a free download – you can get your list by subscribing here. In today’s post, Silvia explains the impact of sexual abuse on children, and what to do if a child discloses abuse. Lawyer Mark Morgan also shares important legal obligations and concerns.

The Impact of Sexual Abuse on Children

One of my clients came into my office one day for a last-minute appointment and she sounded anxious. I had been her therapist for several weeks and we had just started to delve into some deeper issues as our therapeutic alliance became stronger. It was in that session, at age 21, that she told me about multiple acts of sexual abuse that she endured when she was 10 years old, by someone she knew very well.

Therapists come to care about their clients, and the thought of her experiencing that, and keeping it silent for so long particularly struck me because my daughter had just turned 10.

She was not the first client to, as an adult in my office, disclose past sexual abuse for the first time. Adult women and some men have confided in me about sexual abuse and rape in high school and college, and I’ve had clients who are dealing with PTSD, post-traumatic stress disorder brought on by childhood sexual abuse. I have had clients who are still adolescents reeling from the impact of abuse and turning to addictive behaviors to cope with the pain from abandonment and betrayal..

This is a topic that needs to be addressed and discussed with children in a frank and open way.

As a counselor, I entered this field to become a helper and to become a part of something bigger than myself. But one thing the mental health field has shown me is that helping sometimes requires us to combat the systemic injustices and atrocities that are prevalent in our society.  I was in a counseling session with a college-age female who was displaying feelings of hopelessness, crying profusely, and asking me “Why?” She was directly asking me why — after the sexual abuse she suffered as a child, and the subsequent removal from her home. She was placed in foster care and was abused there. She then moved to 4 different foster homes till she turned 18. She was cutting all through her adolescence. She was hypersexual. She had no healthy attachments and she wasn’t sure of her sexuality.

The system failed her. Her family failed her. I was apologetic, and honestly gutted for her experience, but I found myself at a loss for words. She was correct; Why? I couldn’t think of an answer I could provide in that moment that would address her feelings of hopelessness.

I began to feel both compassion fatigue and burnout begin to take root. As I’ve mentioned, my intention as a therapist is to help, and I felt that I was not helping enough. I know trauma and its associated treatment modalities, but that didn’t mean I was doing my part to address the gaps in the system and the inequalities that were drastically affecting my client. Sadly, there are many survivors and victims that we encounter in the mental health profession, all with similar shared experiences of abuse.

Research has repeatedly shown that over the long term, child sexual abuse can have a very serious impact on physical and mental health, as well as later sexual adjustment. Depending on the severity of and number of traumas experienced, child sexual abuse can have long-lasting effects on an individual’s physical and mental health. Victims of child abuse are at risk for substance abuse, depression, anxiety, and some chronic physical conditions.

In the short term, it’s not unusual for a child to develop some post-traumatic stress reactions that will respond to treatment. Others—particularly those who have suffered multiple traumas and received little parental support—may develop post-traumatic stress disorder, depression, and anxiety. Their ability to trust adults to take care of them may also be jeopardized. Sadly, when children do not disclose sexual abuse and/or do not receive effective counseling, they can suffer difficulties long into the future. As one child expressed it, “Abuse is like a boomerang. If you don’t deal with it, it can come back to hurt you.” On the other hand, children who have the support of understanding caregivers and receive effective treatment can recover without long-term effects.

It is important that we are able to recognize the signs of post-traumatic stress reactions. These are some of them:

• Hyperarousal – which means that the child is nervous and jumpy, has a heightened startle response, and may react more strongly to any anxiety-producing situation.

• Reexperiencing – which means that the child may keep seeing mental images linked to the abuse, or relive some aspects of the experience, either while awake or during sleep in the form of nightmares. A child may have other sleep disturbances, such as insomnia or frequent awakenings. Younger children are more likely to have generalized fears or nightmares about other scary things, such as monsters chasing them. With an older child, the nightmares are more likely to be directly related to the trauma.

Reexperiencing also includes reactions to traumatic reminders: any thing, person, event, sight, smell, etc., connected to the abuse. For example, if the perpetrator had a beard, the child might start to feel frightened and uncomfortable, usually without knowing why, around any man with a beard. Even being touched by another person may become a traumatic reminder.

• Avoidance – which means that a child avoids exposure to traumatic reminders, and sometimes avoids thinking about the abuse altogether. So, for example, if the abuse occurred in the basement, the child may avoid going into any basement. Reactions to—and avoidance of, traumatic reminders—can become generalized. A child may begin with fear of one particular basement that generalizes to reactions to and avoidance of all basements, and from that to any room that in any way resembles a basement. Avoidance can seriously restrict a child’s activities–an important reason to seek help early.

Among adolescents, the basic symptoms of post-traumatic stress are similar, but as children grow up and develop more autonomy, the difficulties they can get into may be more serious. Teenagers have more access to substances, so to cope with hyperarousal and reexperiencing, they might be more likely to abuse substances. High-risk behaviors might also include indiscriminate sexual behavior. A teenager avoiding traumatic reminders may withdraw socially. Self-cutting and suicidal behaviors are also more common among adolescents. However, with parental support and effective treatment, adolescents can avoid or overcome these problems.

Disclosing Sexual Abuse

Disclosure is when a child tells another person that he or she has been sexually abused. Disclosure can be a scary and difficult process for children. Some children who have been sexually abused may take weeks, months, or even years to fully reveal what was done to them. Many children never tell anyone about the abuse. In general:

• Girls are more likely to disclose than boys
• School-aged children tend to tell a caregiver  
• Adolescents are more likely to tell friends
• Very young children tend to accidentally reveal abuse, because they don’t have as much understanding of what occurred or the words to explain it

Children are often reluctant to tell about being sexually abused. Some reasons for this reluctance may include:

• Fear that the abuser may hurt them or their families
• Fear that they will not be believed, or will be blamed and get in trouble 
• Worry that their parents will be upset or angry
• Fear that disclosing will disrupt the family, especially if the perpetrator is a family member or friend
• Fear that if they tell they will be taken away and separated from their family.

Delayed disclosures are common and are not a reflection of a poor parent-child relationship. Sometimes children will say that they didn’t want to “hurt” or “upset” their parents because they love them so much.

What should I do if my child discloses sexual abuse?

Your reaction to the disclosure will have a big effect on how your child deals with the trauma of sexual abuse. Children whose parents/caregivers are supportive heal more quickly from the abuse.

To be supportive, it is important to stay calm. Hearing that your child has been abused can bring up powerful emotions, but if you become upset, angry, or out of control, this will only make it more difficult for your child to disclose. Believe your child, and let your child know that he or she is not to blame for what happened. Praise your child for being brave and for telling about the sexual abuse. Protect your child by getting him or her away from the abuser and immediately reporting the abuse to local authorities or call 911. Call the Childhelp® National Child Abuse Hotline at 1.800.4.A.CHILD (1.800.422.4453) Many communities also have local Children’s Advocacy Centers (CACs) that offer coordinated support and services to victims of child abuse (including sexual abuse).

Get help. In addition to getting medical care to address any physical damage your child may have suffered (including sexually transmitted diseases), it is important that your child have an opportunity to talk with a mental health professional who specializes in child sexual abuse. Therapy has been shown to successfully reduce distress in families and the effects of sexual abuse on children. Consider therapy for yourself and the rest of your family as well.

Reassure your child that he or she is loved, accepted and an important family member. Let your child know that you will do everything in your power to protect him or her from harm.

Some children who disclose sexual abuse later “take it back.” This does not mean that they are lying. In fact, attempting to “take it all back”—also known as recantation—is common among children who disclose sexual abuse. Most children who recant are telling the truth when they originally disclose but may later have mixed feelings about their abuser and about what has happened as a result of the disclosure. Some children are dealing with issues of denial and are having a difficult time accepting the sexual abuse. In some families, the child is pressured to recant because the disclosure has disrupted family relationships. A delay in the prosecution of the perpetrator may also lead a child to recant in order to avoid further distressing involvement in the legal process. A very small percentage of children recant because they made a false statement.

Knowledge about our responsibilities for disclosure is important. Mark Morgan, Esq. explains:

The Coptic Orthodox Church has experienced exponential growth in the last two decades with Churches being consecrated in nearly every state throughout the United States. That growth has significantly expanded the Church’s legal risks and compliance requirements and, in particular, in the mandatory reporting of sexual abuse of children. Most states specifically impose on clergy the obligation to report sexual abuse to government authorities. The laws of Massachusetts, Connecticut, Pennsylvania, Maryland, Virginia, North Carolina, Michigan, Illinois, and California explicitly require clergy to report sexual abuse to government authorities. Many states also require that clergy report incidences of sexual abuse “immediately” to designated state offices. These reporting obligations are not limited to clergy only and, in most states, include church servants, chaperones, Sunday school teachers, day care center workers, and nearly “any” other person who knows or has reason to know that a child is being sexually abused. See e.g., https://www.rainn.org/ (Rape, Abuse & Incest National Network). 

For example, New Jersey’s law specifically requires that “[a]ny person having reasonable cause to believe that a child has been subjected to child abuse or acts of child abuse shall report the same immediately to DCF’s Child Protection and Permanency by telephone or otherwise.” N.J.S.A. 9:6-8.10 (emphasis added). Whether you are person of authority in the church, i.e., priest, deacon, Sunday school teacher, and board member or a mere congregant of the church who attends vespers and liturgical services, the obligation remains the same – you must immediately report any sexual abuse of children. If there is ever any doubt about whether to report and to whom such reports are made, consult an attorney.

Every culture has spoken and unspoken rules about sex and sexuality. These rules can make it even more difficult for children to ask for help when they have been abused. For example, in cultures that place a high value on female virginity, a girl who has been sexually abused may feel that she has been disgraced. This can lead to feelings of shame that in turn lead to further secrecy. Boys who have been sexually abused may experience shame and self-doubt. Boys who have been sexually abused by a male may struggle with a commonly held misconception that this makes them gay.

Although your cultural beliefs are important, it is necessary to focus on the physical and emotional health of your child. Remember that the sexual abuse is not the fault of the victim and does not reflect negatively on them or their family or you as a parent.

When talking to children about sexual behaviors, it’s important to ask open-ended questions as much as possible, so the children can tell what happened in their own words, rather than just answering yes or no.

Talking about sex with children will NOT encourage them to become sexually active.  In a recent survey of American teens, 9 out of 10 teens said it would be easier to delay sexual activity if they were able to have “more open, honest conversations” with their parents on these topics. When you talk honestly with your children about body safety and age appropriate sexual issues, you can give them the knowledge and skills they need to keep safe and to make good decisions about relationships and intimacy.

Have the conversation. This is where prevention begins.

Subscribe to the Being in Community email newsletter here to get your list of important tips for speaking to children about child sexual abuse.

Silvia Farag, MSW, LSW, runs the Christian Center for Counseling and works with adolescent and adult clients in individual, couples & family therapy. Her personal philosophy is that through human connection, we can foster the encouragement needed to take courageous steps toward creating positive change. She uses evidenced based and strengths-based approaches & believes in the inherent ability of each individual to overcome, when they are willing to step into their potential. Therapy illuminates the path so the client can make conscious steps towards emotional health. Her attitude is one of respect and acceptance of each client’s individuality, allowing for the creation of a safe, therapeutic space. Silvia also started the Coptic Women Fellowship, a ministry focused on enriching, supporting and strengthening the lives of Coptic Orthodox women, along with the clergy and several accomplished women of the Coptic Orthodox Archdiocese of North America. 

Mark Salah Morgan, Esq., is a trial lawyer who has assisted clients with strategies for the containment, management and resolution of legal crises occurring at the federal/state, criminal/civil and domestic/international levels, including the Supreme Court of New Jersey, U.S. Court of Appeals for the Second Circuit, U.S. District Court for the Southern District of New York, and U.S. District Court for the District of New Jersey. Mark was an adjunct professor at Seton Hall Law School from 2008 to 2012, and serves as a visiting professor at the American University in Cairo. He is the founder and former officer of the Coptic Lawyers Association. He currently serves on various civic and charitable organizations throughout New Jersey and New York, including as co-chair of the Jersey Battered Women’s Service, Battered Women’s Legal Advocacy Project and as a Board Member of Life’s WORC and The Family Center for Autism.

References:

https://www.morrissussexresourcenet.org/search/family-intervention-services/

https://www.nj.gov/dcf/families/assault/

https://www.nj.gov/dcf/policy_manuals/CPP-II-C-2-700_issuance.shtml

https://www.rainn.org/

https://preventchildabusenj.org

-Child Welfare Information Gateway. (2016). Mandatory reporters of child sexual abuse and neglect. Retrieved from https://www.childwelfare.gov/topics/systemwide/ laws-policies/statutes/manda/

-Child Welfare Information Gateway. (2018)

-Adverse Childhood Experiences Study: Data and Statistics. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Retrieved January 12, 2009 from: http://www.cdc.gov/nccdphp/ace/prevalence.htm

-U.S. Department of Health and Human Services, Administration on Children, Youth, and Families. (2017). Child Maltreatment 2005. Washington, DC: U.S. Government Printing Office. Retrieved January 12, 2009 from http://www.acf.hhs.gov/programs/cb/pubs/cm05/cm05.pdf

-Snyder, H. N. (2000). Sexual assault of young children as reported to law enforcement: Victim, incident, and offender characteristics. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Retrieved January 12, 2009 from http://www.ojp.usdoj.gov/bjs/pub/pdf/saycrle.pdf

-Felitti, V.J., Anda, R.F., Nordenberg, D.F., Williamson, D. F., Spitz, A.M., Edwards, V.J., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14, 245-258.