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When Children Disclose Sexual Abuse
By Jane Lefkowitz, LICSW

Many parents and caregivers (and some professionals) may still be in the dark about how to respond to a child’s disclosure of being sexually abused. This article is intended for professionals to share with parents who may need resources after their child has disclosed sexual abuse.

A child’s disclosure of sexual abuse is daunting. As a parent, try and remain calm. Don’t “overquestion” the child, demand details, minimize information, overreact to the disclosure, criticize, or place blame on the child. Listen to the child and respect his or her privacy. Support the child and his or her decision to disclose the sexual abuse, no matter what the child says. Express support because a child needs to know he or she has done nothing wrong, that the situation was the offender’s fault, not the child’s.

Immediately seek appropriate medical care for the child, including a physical exam. Notify law enforcement and appropriate authorities and social services organizations, such as child protective services, as soon as possible. Seek counseling for the child and the family.

Posttraumatic Stress
Symptoms of posttraumatic stress disorder (PTSD) in sexually abused children include difficulty sleeping, irritability or becoming easily angered, being easily startled at noises, difficulty concentrating, and recurring physical symptoms such as headaches or stomach aches.

Children who have been sexually abused often struggle to distinguish new, safer situations from traumatic ones they have already endured. Some children “keep going back to the trauma” and some also overreact to what has happened to them.

Some children may avoid anything that reminds them of the sexual abuse, as they fight to keep negative thoughts, feelings, and images from returning. Children “forget” some of the worst parts of sexual abuse while still reacting to reminders of those very moments. Some children’s bodies remain “on alert.”

Posttraumatic stress reactions are influenced by age, developmental maturity, and experience. Very young children who have been sexually abused often are passive and quiet, easily alarmed, and less secure when they experience the failure of being protected from such abuse. They may be more fearful, especially with regard to separations and new situations. If a parent sexually abused the child, the child becomes confused as to where to find protection and where there is a threat.

Fear quickly interferes with recent learning. A child may start wetting the bed or revert to baby talk.

Children often keep going over what could have stopped the sexual abuse from happening and how the situation could have been different. They can develop fears connected to the original danger and may have fears of the sexual abuse recurring, which results in the children avoiding activities in which they would like to participate.

Children may alternate between shy or withdrawn behavior and unusually aggressive behavior. Thoughts of revenge are at times unresolvable. Sleep patterns may be disrupted. Children may move around restlessly in their sleep, talk, call out, and wake up tired. The lack of restful sleep interferes with mood, daytime concentration, and attention. Studying may become difficult because they may be on high alert for any perception of danger, real or not.

Adolescents are particularly challenged by posttraumatic stress reactions from sexual abuse. They are embarrassed by bouts of fear and exaggerated physiological responses. They believe they are unique in their pain and suffering. These reactions can result in isolation.

 Adolescents try to get rid of unwanted emotions and physical responses by using alcohol and drugs. Sleep disturbances can remain hidden in late-night studying, television watching, and partying. Thoughts of revenge added to adolescents’ usual feelings of invulnerability are a dangerous mix.  

Brain Changes
The brain initiates major hormonal changes in puberty. Some of these changes begin earlier in children who are sexually abused during preadolescence. An important set of hormones helps us deal with danger and stress. In a way, the brain and the body talk with each other through these hormones to help prepare us to act in the face of danger and return to normal behavior when the danger is over.

Sexual abuse interferes with emotional maturity. Very young children are learning to identify feelings and emotions with the help of their parents. During sexual abuse, intense fear easily overwhelms young children’s beginning efforts to manage emotions.

Children are learning to differentiate and manage more difficult emotions. Children learn to distinguish being a little scared and angry from being very scared and angry. The intensity and speeding up of emotions blur these differences and intensity of emotions. Children clamp down on their emotional lives, fearing everyday emotions will get the best of them.

Children are aware of the difference between what they feel inside and what they feel they can say. Shame and guilt may lead adolescents to secretiveness about their feelings. Feelings of revenge interfere with efforts to manage aggressive feelings in a constructive, rule-abiding way.

Adolescents are very aware of the social stigma attached to their experience of sexual abuse. Adolescents may thrust themselves into altruistic activities, draw back into an emotional shell, or sometimes do both.

Why Self-Destruction?
If children feel comfortable enough to come forward with the abuse, aren’t they already showing signs of being confident enough to get the help they need and move forward? Yes and no. Revealing the abuse is a huge step. How the child is allowed to express the confusion, sadness, anger, and other emotions tied to the event determines what kind of emotional health they will have in the future.

Research shows that most victims are abused by someone they know, which only makes a bad situation worse. The closer the relationship between the perpetrator(s) and the victim(s) and group memberships (e.g., the abuser is a family member, fellow churchgoer, an authority figure, someone of the same gender), the more likely they are to face conditions of divided loyalty. A child’s situation will lead to self-protective strategies such as silence, secrecy, and denial.

Let children know they owe absolutely no loyalty to someone who has hurt them. Reassure them that what happened was not their fault, you believe them, you are proud of them for telling you (or another person), and you are there to keep them safe. Stressing how much you love them and how nothing can change that will go a long way toward giving children a feeling of stability.

Contacting the police and department of social services is easier said than done if the perpetrator is a family member, but a parent’s responsibility is to their minor child. Does this open up the possibility of your family being broken? Since the abuse has already occurred, the family is already torn apart. Keeping the issue under wraps does not change that and only allows for more abuse to occur (whether in the family or with a victim outside the family) and tells your child that you just can’t bear to see the abuser punished.

Starting to Heal
Healthy activities normalize children’s daily routine following a sexual abuse disclosure. Physical activity, sensory awareness, getting a pet, reconnecting with friends, joining religious and social groups, and participating in neighborhood and community events are helpful.

Fear becomes a self-fulfilling prophecy when professional help isn’t received. This is known as complex PTSD. Potential friends and mates are kept at bay, and relationships aren’t fully realized. Survivors go through life disconnected from people and feeling isolated. The more extensive the trauma and the earlier it takes place, the more severe the effects can be.

The National Association of Social Workers has a chapter in each state with a social worker referral service, which can help you to find a local social worker/therapist. The American Psychological Association will do the same for psychologists, along with the American Mental Health Counselor’s Association for licensed mental health counselors.

The best methods of healing for any sexual abuse survivor are based on mending the victim from the inside out, and this is done in many ways with some methods that are traditional (one-on-one psychotherapy) and others that might be more alternative.

Traumatized children need extra support and help identifying their feelings. Toddlers and preschoolers have trouble using words expressing emotions such as frustration, sadness, and anger. Activities in therapy help this age group identify these feelings and emotions. Soon, they identify two or three feelings at once and use them all in a sentence.

These children do well in play therapy, a technique therapists use to communicate with children using children’s toys and games. Usually it’s much easier for a child to open up when distracted and/or feeling safe in the context of another activity. Older children do better talking with a therapist in a dynamic setting, such as going for a walk, playing basketball, or going fishing rather than sitting in an office.

Self-soothing techniques help quiet children. Children respond to proven evidence-based strategies called sensory integration. Sensory integration techniques engage different senses and encourage the processing of sensory information. Swinging, riding a bicycle, or rocking in a rocking chair are techniques for helping children to develop self-soothing methods. Yoga, creative arts, journaling, aromatherapy, and light therapy are other sensory integration methods.

Biofeedback teaches children how their body works. If children know their triggers for anxiety attacks, they may be able to prevent those attacks. By learning to recognize personal triggers, a child can help prevent a panic attack by adjusting his or her breathing, learning mediation, or focusing on a single object in the room until the anxiety subsides.

Natural supports include neighbors and friends and getting involved in sports or hobbies based on the child’s strengths and talents, such as pottery, horseback riding, writing, singing, or mechanics.

Lastly, preparation and reconnection is at least partly achieved by bringing the perpetrator to justice. Police are mandated to file charges against the abuser, so minor victims never have to make that tough choice or feel their voice was not heard by seeing their abuser not held accountable for his or her actions.

There is hope that survivors of sexual abuse will go on to have healthy and productive lives. The key is accessing the right kind of help.

— Jane Lefkowitz, LICSW, is a case manager in the children’s division of the Massachusetts Department of Mental Health.