Parenting a Child or Youth Who Has Been Sexually Abused: A Guide for Foster and Adoptive Parents

As a parent or caregiver of a child or youth who has a known or suspected history of being sexually abused, you may feel confused about the impact of the abuse and uncertain about how you can help. It may be comforting to know that most children and youth who have been abused do not go on to abuse others, and many life happy, healthy, successful lives. At the same time, all children and youth who have been abused need to feel safe and loved in nurturing homes. As a parent or caregiver, you can play a central role in your child’s healing process as well as in “building resilience,” which strengthens your child’s ability to adapt or cope with adversity.

Educating yourself about child sexual abuse, understanding the impact of the abuse, establishing guidelines for safety and privacy in your family, and seeking help if you need it, can all serve as ways to help you best help your child.

Educating Yourself

One of the most useful steps you can take to help your child is to educate yourself about both sexual abuse and healthy sexual development in children. With this information, you will more easily recognize behaviors possibly associated with past or current abuse and avoid uncertainty if your child or youth shows uncommon sexual behaviors. Most importantly, you may gain confidence in supporting your child or youth through a variety of sensitive questions or situations that may arise. Signs and behaviors that may suggest sexual abuse in children and youth (as well as common healthy sexual development behaviors) will be discussed below.

What Is Child Sexual Abuse?

Child sexual abuse can be defined as any interaction between an adult (or another child) in which the child is used for the sexual stimulation of the perpetrator or an observer. Sexual abuse can include both touching and non touching behaviors. Non-touching behaviors can include voyeurism (truing to look at a child’s naked body), exhibitionism, or exposing the child to pornography. Children of all ages, races, ethnicities, and economic backgrounds may experience sexual abuse. Child sexual abuse affects both girls and boys in all kinds of neighborhoods and communities.

Signs of Sexual Abuse

If you are parenting a child or youth who has been removed from his or her family, you may not know whether he or she has been sexually abused. Child welfare agencies are required to share all known information about a child’s history with his or her caregiver. However, past records of abuse may not exist, and young children who are nonverbal may be unable to tell you about being abused. Children and youth with disabilities, many of whom cannot interpret or articulate abusive experiences, are at significantly higher risk of sexual abuse than their peers without disabilities. Moreover, many children to not reveal past abuse until they feel safe. For these reasons, foster or adoptive parents or kinship caregivers are sometimes the first to learn that a child has been sexually abused. Therefore, knowing the signs and behaviors of abuse is critical.

Children who have been sexually abused may also act out – that is, express feelings or sexual impulses that are odd, excessive, aggressive, or explicit. Although no on specific sign or behavior proves that sexual abuse has occurred, the following section has examples of potential warning signs of abuse.

Signs and Behaviors That May suggest Sexual Abuse in Children and Youth

  • Younger Children
    • Imitation of sexual acts with toys or other objects, such as stuffed animals
    • Behavior of a much younger child, like wetting the bed or sucking a thumb
    • Refusal to take off clothing at appropriate times (e.g. bathing, going to bed)
    • Sexually transmitted infections (STIs) (especially in children who have not yet started puberty)
  • Older Children and Youth
    • Unhealthy eating patterns or unusual weight gain or weight loss
    • Anxiety or depression
    • Changes in self-care or paying less attention to hygiene
    • Self-harming behaviors or suicidal thoughts
    • Alcohol or drug use
    • Running away
    • STIs or pregnancy
    • High-risk sexual behavior
    • Suddenly having money
  • Both Children and Youth
    • Explicit sexual knowledge beyond the child’s developmental stage
    • Sexual fixation indicated by language or drawings
    • Nightmares, trouble sleeping, or fear of the dark
    • Sudden or extreme mood swings (e.g. rage, fear, anger, crying, or withdrawal)
    • References to a new, older friend
    • Unexplained avoidance of certain people, places, or activities
    • Pain, itching, or bleeding in genital areas

These red flags to not always indicate that your child or youth has experienced sexual abuse. Rather, these actions may reflect an underlying issue, such as physical or emotional abuse, or unintentional exposure to sexual content. Regardless, a trained professional who specializes in working with children who have been sexually abused should assess whether there is an underlying concern.

Healthy Sexual Development in Children and Youth

At each developmental stage, children show a range of healthy sexual behaviors and curiosity. Children’s behaviors and curiosity may develop gradually, based on their development, and may be influenced by such factors as what they observe and the guidance they receive from parents and caregivers. Understanding healthy sexual development can provide a context in which to consider signs and behaviors of possible abuse. Common behaviors considered healthy for most children and youth, according to developmental stages, are discussed below.

Common Sexual Development Behaviors in Children and Youth

  • Younger Children
    • Curiosity about their bodies, occasional masturbation in public and private
    • Consensual, playful exploration of their bodies with children of a similar age
    • Questions about sexuality, such as, “Where do babies come from?”
    • Lack of inhibition about nudity, particularly under the age of 5
    • Use of slang to describe body parts and jokes about bodily functions
  • Older Children and Youth
    • Adherence to social norms around masturbation, likely occurs in private
    • Shared sexual behaviors with peers of a similar age may take place
    • Interest in adult bodies on TV or in the media
    • Understanding of pregnancy, HIV, and other STIs
    • Capacity to learn about intimate, long-term, loving relationships and healthy versus unhealthy relationships

Understanding the Impact of Sexual Abuse

Sexual abuse violates physical and emotional boundaries. Children and youth who have been abused may see the world as unsafe and adults as manipulative and untrustworthy, or they may lack boundaries and be unaware when they are in unsafe situations. Many factors influence how children think and feel about the abuse they experienced, how it affects them, and how they develop resilience.

Factors that can contribute to the impact of abuse include the following:

  • Relationship of the abuser tot he child or youth; extent that the abuse was a betrayal of trust within an important relationship (E.g. the perpetrator is a father verses a neighbor)
  • Frequency and duration of abuse; whether penetration occurred
  • Child’s age (young children may experience more adverse consequences)
  • Child’s emotional and social development at the time of the abuse
  • Child’s ability to cope with physical responses to the abuse (e.g. fear and arousal)
  • How much responsibility the child or youth feels for the abuse (e.g. not telling an adult about it right away or stopping it somehow)
  • Response to the child when he or she reveals the abuse
  • Abuser’s use of “friendliness” and efforts to make the child a willing participant
  • Abuser’s use of threat of harm or violence, including threats to pets, siblings, or parents
  • Abuser’s use of secrecy and threats to withdraw love and affection
  • Gender of the abuser being the same as or different from the child (e.g. children and youth are less likely to report sexual activity with the same gender)

Children and youth must understand that they are not to blame for the abuse they experienced. Your family’s immediate response to and ongoing acceptance of your child’s abuse will play a critical role in your child’s ability to heal, build resilience, and lead a healthy life. If you are concerned whether your child acts out sexually with peers or younger children, respond calmly and take into account your child’s development and the trauma he or she has endured. Children are likely asking for limits to be set and may be unaware of the appropriate boundaries. Set clear limits and seek appropriate professional help for children whose behavior persists. Learning not to over- or under-respond to situations will help you care for your children with empathy and confidence in your parenting and in the healing process.

Children may respond to sexual abuse in varied ways. Some may act withdrawn and appear timid in social situations, while others may be angry and aggressive. Some may require special attention and firm limits to be set, and others may act out when situations, locations, or everyday items trigger memories of a traumatic event. Triggers occur unexpectedly by a variety of circumstances, and children may not be aware of their triggers. These may include situations as specific as seeing someone who looks like the abuser, or as general as being alone in a public restroom or other location that is a reminder of where the abuse took place.

In addition, awareness of cultural differences can offer insights regarding your child’s comfort level with physical space, physical affection, bathing and nudity practices, hygiene, and other factors that can lead to unwanted situations. For example, in cultures where parents do not discuss sexual activity directly with their children, or child sexual activity of any type are unacceptable (e.g. children touching themselves), children may carry shame and guilt about their bodies.

Resilience

Resilience is the ability to adapt or cope in a positive way to adversity, including trauma, tragedy, threats, and significant stress. It involves behaviors, thoughts, and actions that can be learned over time and nurtured through positive relationships with parents, caregivers, and other adults. Resilience in children and youth who have experienced sexual abuse enables them to thrive despite this traumatic event.

Trauma

Children who have been sexually abused may still be affected by the trauma associated with that experience when they come into care. Trauma is an emotional response to an intense event that threatens or causes harm. Understanding the effects of trauma can help you support your child’s healing and improve family dynamics.

Impact of Sexual Abuse on the Family

Parenting a child or youth who has experienced sexual abuse can be stressful to marriages and other relationships. It may require couples to be more open with each other and their children about sexuality in general and sexual issues specifically. If one parent is more involved in addressing the issue than another, the imbalance can create difficulties in the parental relationship. If issues emerge, getting professional advice may be helpful.

In addition, if one parent or caregiver was more in favor of fostering or adopting than the other, general stress may increase, especially when children or youth have a range of behaviors that require attention. Some parents become resentful toward or withdrawn from foster or adoptive children who require a lot of time and energy.

Parents can also feel stress around their child’s siblings, who may not be used to openly sexual language or behavior. If a child or youth is acting out sexually, you may need to talk with their siblings about what they see, think, and feel as well as how to respond. Children may also need guidelines about what to say to their friends about their sibling’s behaviors. If they see that you are actively managing the situation, they may feel more secure and will worry less, which could help foster open communication within the family.

When a child or youth has been sexually abused, his or her parents can often become protective of them. Parents can provide strategies to help their children protect themselves, but parents are ultimately responsible for protecting and keeping their children safe. Finding a balance between reasonable worry and over-protection is important. Useful strategies to prevent further abuse may include teaching your children or youth to stand up for themselves, talking with them about being in charge of their bodies, and encouraging open communication about anything – not just sexual abuse.

Establishing Family Guidelines for Safety and Privacy

Establishing family guidelines for safety and privacy is critical, as survivors of sexual abuse are vulnerable to later abuse. Some children and youth who have been sexually abused have heightened sensitivities to situations that involve physical contact, evoke sexual innuendo, or include implicit or explicit sexual content. Practicing some of the following guidelines may make your home a more comfortable place for children or youth who have been abused. It may also reduce your vulnerability to abuse allegations by children living with you.

  • Respect every family member’s comfort level with touching, hugging, and kissing. Encourage children and adults to respect the comfort and privacy of others.
  • Be cautious with playful touch, such as play fighting and tickling. This type of play may be uncomfortable or trigger memories of sexual abuse.
  • Be mindful that some children who have experienced sexual abuse may not have healthy boundaries. Teach your children and the entire family about healthy age-appropriate boundaries.
  • Teach children the importance of privacy. Remind children to knock before entering bathrooms and bedrooms and model privacy and respect.
  • Keep adult sexuality private. Adult caretakers need to pay special attention to intimacy and sexuality when young children with a history of sexual abuse are around.

Other family guidelines for safety and privacy include supervising and monitoring children’s play. If you know that your child has a history of sexual abuse, supervise and monitor his or her play with siblings or other children in your home. Some children require constant supervision – they cannot be left alone with younger children for even a moment. Consider placing locks or bells on bedroom doors so you can track a child’s movements at night. Other measures, such as audio and visual monitors or installing door alarms, can also help safety.

If your teen has a history of sexual abuse, maintaining open communication is advisable. Knowing who your youth is with and what he or she is doing and setting clear expectations for check-ins can enhance communication and mitigate high-risk behavior.

Practicing responses to children and youth who exhibit sexual behavior issues prepares you to help children develop self-awareness and learn to respect others. Encourage your children to talk to you or another trusted adult if they want to engage in inappropriate sexual behavior, and let them know it’s okay to talk about the feelings they’re having. For children and youth who have been abused, you can say, “Just like it was not okay for so-and-so to touch your private parts, it’s not okay for you to touch other people’s private parts.” You might also give clear directives like, “We don’t use that language in this house,” or “I’d like you to use different words so we can really hear what you’re saying. ”

  • Sexual Messages From the Media. While some children and youth who have experienced sexual abuse become overstimulated or disturbed by sexual content in various media, others use screen time to excessively watch pornography or inappropriate, sexualized internet videos. For these children or youth, limiting computer time and monitoring social media may encourage discussions on meaningful topics, such as the harmful effects of pornography, dangers of online sexual grooming, and showing respect for themselves and for others online.

If your child has demonstrated inappropriate touching or sexually aggressive behaviors, you may need to take additional steps such as creating a family safety plan, to help ensure safety for your child as well as for his or her peers. Consider how these tips may apply in your situation:

  • With friends. If your child has known issues with touching other children, you will need to ensure constant supervision by informing other caregivers when he or she is playing with friends, whether at your home or theirs. You should be able to see your child at all times when he or she is with other children. Constant supervision will help to ensure safety for all children and prevent the sexually aggressive behaviors from becoming a habit. Sleepovers may not be a good idea when children have touching issues.
  • At school. Working closely with the school to set up a safety plan for children or youth with aggressive sexual behaviors ensures an appropriate level of supervision and protects everyone involved. The plan should address concerns such as bathrooms and locker rooms, lunch, recess, transitions between classes, field trips, and other situations. Children or youth who have been sexually abused should not be left alone with one teacher. At least one additional teacher should be in the room.
  • In the community. Setting up a safety plan with coaches, camp counselors, and other adults who are monitoring your child may also be useful. Children with sexual behavior concerns should not be given authoritative roles over other children. If your child has these issues, do not ask him or her to watch over younger children at any time. If your child or youth is focused on specific individuals, make sure he or she is not alone or placed together in small groups.

Even as sexual behaviors diminish, continue to look for changes over time. These sexual behaviors can reemerge as children develop, so do not be discouraged if this occurs. Because sexual behavior may be a reaction to stress, it is also important to remove stressors from the child’s life as much as possible.

Seeking Help

Responding to the needs of a child or youth who has been sexually abused may involve the entire family and will likely affect family relationships. Mental health professionals (e.g. counselors, therapists, or social workers) can help your family cope with reactions, thoughts, and feelings about the abuse. Look for a mental health professional with a background in sexual abuse, child development, an child trauma. before agreeing to work with a particular provider, ask questions about the person’s background, experience and approach to treating children.

Counseling for Parents and Children

Working with a specialized mental health professionals as soon as issues arise can help you determine if your child’s behavior is cause for concern. Specialists can also provide guidance in responding to your child’s difficulties; offer suggestions for how to talk with him or her; and offer suggestions for creating structured, safe, and nurturing environments.

Many mental health professionals begin with a thorough assessment exploring how a child or youth functions in various areas of life. The specialist will want to know about the following:

  • Past stressors (e.g. history of abuse, frequent moves, and other losses)
  • Current stressors (e.g. a medical problem or learning disability)
  • Emotional state (e.g is the child or youth usually happy or anxious?)
  • Coping strategies (e.g. Does the child have challenges making or maintaining friends?)
  • Strengths (e.g. Is the youth creative, athletic, organized?)
  • Communication skills (e.g. Can the child communicate appropriately for his or her age?)
  • Attachments to adults in his or her life (e.g. Does the child seem comfortable around adults?)
  • Activities (e.g. time spent watching TV, using the internet, playing video games)

After thorough assessment, the professional will decide if the child and family could benefit from therapy. A child’s social worker can hep you understand your child’s assessments and select the most appropriate form of therapy. The social worker will assist you in finding a therapist with the right credentials for your child and family as well as help you understand insurance coverage and payment plans.

Not all children who have been abused require therapy. For those who do, the mental health professional will develop a plan tailored to the children and to the family’s strengths. this plan may include one or more of the following types of therapy:

  • Individual therapy. The style of therapy will depend on the child’s age and the therapist’s training. Some therapists use creative techniques (e.g. art, play, and music therapy) to help children or youth who are uncomfortable talking about their experiences.
  • Group therapy. Meeting in groups with other children or youth who have been sexually abused or who have developed sexual behavior issues can help children understand themselves; feel less alone; and learn new skills through play, role playing, discussion, and games.
  • Family therapy. Many therapists will see children and parents together to support positive parent-child communication and to guide parents in learning new skills that will help their children feel better and support healthy behaviors.

Regardless of whether therapy for the family is advised, parents should stay involved in their child’s treatment plan and therapy sessions. Skilled professionals will always seek to involve the parents by asking for and sharing information. Parents can benefit from professionals who understand the parenting needs of a child who has experienced sexual abuse.

Some forms of therapy are designed for dealing with trauma in general and post-traumatic stress disorder (PTSD) specifically.

  • Trauma-Informed Therapy. This therapy acknowledges the impact of trauma and recognizes that even a child who is not old enough to remember a traumatic event may still experience effects. Trauma-informed therapy focuses on processing traumatic memories and experiences so they become tolerable.
  • PTSD Therapy. Children and youth who are coping with symptoms of PTSD may be dealing with flashbacks and nightmares. They may be easily frightened and experience outbursts of anger and negative thoughts and disoriented feelings. Approaches such as cognitive processing therapy, eye movement desensitization and reprocessing, and group therapy, an all reduce symptoms of PTSD.

Where to Find and What to Look for in a Mental Health Professional

Finding an experienced mental health professional who specializes in treating children who have been sexually abused is key to getting to help your family needs. Some communities who have been sexually abused (e.g. child advocacy centers and child protection teams). The organizations and resources below may also provide specialists in your community.

  • Nonprofit service providers serving families of missing or exploited children
  • Hospitals with child and adolescent protection centers
  • Crime-victim assistance programs in a law enforcement agency or in a prosecutor or district attorney’s office
  • Group mental health private practices with a specialization in trauma services
  • Family court services, including court-appointed special advocate groups or guardians
  • Child advocacy centers

Therapy for children who have been sexually abused is specialized work. When selecting a mental health professional, look for the following:

  • An advanced degree in a recognized mental health specialty, such as psychiatry (M.D.), psychology (Ph.D. or Psy.D.), social work (M.S.W.), counseling (L.P.C), marriage and family therapy (M.F.T.), or psychiatric nursing (R.N.)
  • Licensure to practice as a mental health professional in your state
  • Special training in treating child sexual abuse and the dynamics of abuse, how abuse affects children and adults, and the use of goal-oriented treatment plans
  • Knowledge about the legal issues involved in child sexual abuse, especially the laws about reporting child sexual victimization, procedures used by law enforcement and protective services, evidence collection, and expert testimony in your state
  • A willingness to collaborate with other professionals involved in your family’s care

Your Child Welfare Agency

If you are a caregiver or parent, or if you are seeking to adopt a child, you may wish to talk with your social worker about what you discover about your child’s history and any behaviors that worry you. Sharing your concerns will help your social worker assist you and your family. If your child or youth exhibits sexual behavior issues toward other children, be aware that you may also be required to report these to child protective services to comply with mandated reporting laws in your jurisdiction.

Conclusion

As the parent of a child or youth who has been or may have been sexually abused, you have an opportunity to provide comfort and security as well as help him or her build resilience and effective coping strategies for the trauma they have or may have endured. Creating a structured, safe, and nurturing home is the greatest gift that you can give to all of your children. Seek help when you need it, share your success with your social worker or other community supports, and remember that a healthy relationship with your children allows them to begin and advance the healing process.

 

Source: Child Welfare: www.childwelfare.gov

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