Child with ADHD
This handbook comprises difficulties of children related to hyperactivity and offers answers to most frequent questions asked by parents and professionals who suspect the child might be hyperactive.
SIGNS AND CONSEQUENCES OF CHILD SEXUAL ABUSE
Early detection and appropriate intervention may alleviate the consequences of sexual abuse and ensure child recovery.
How to identify a sexually abused child?
Many parents expect that the child who has experienced abuse will open up to them or some other person to whom s/he trusts. However, the abuser often threatens the child or bribes him/her, convincing the child that s/he should not tell anybody about the abuse. Parents can start suspecting the abuse because of the child’s behaviour. It is important to know that none of the signs is the final confirmation that an abuse has happened, but suspicions have to be explored.
Signs which may be detected depend on the child’s age, the intensity and duration of the abuse, the level of closeness with the abuser and how the child copes with the abuse. They depend on the support the child has, as well as on the consequences of a disclosure.
Some of the possible signs are:
• Physical signs; unusual health problems (soreness, infections, sexually transmitted diseases, signs of bruising in the genital and/or anal area)
• Sleeping difficulties, nightmares
• Eating problems
• Regressing to behaviours too young for the age, e.g. wetting the bed, thumb sucking
• Frequent masturbation
• Organising sexual play with friends, toys, pets
• Frequent sexualised behaviour (interest for own and others’ genitals), swear words
• Sexualised content in drawings, stories, games
• Asking too many questions about human sexuality, more than expected for the age
• Showing fear from close contacts
• Unusually aggressive behaviour towards family members, friends, toys, pets
• Unusual fear from certain space or place, closed doors, darkness
• Refusal to be alone with certain person/s
• Panic attacks, which may involve flashbacks from the abuse
• Covering body with clothes, disgust, loathing their own body
• Refusing to maintain hygiene of private parts
• Risky behaviours, e.g. self-mutilations, running away from home
• Losing interest for activities enjoyed before, truancy
• Unexplained gifts and money
Sexual abuse is strong traumatic experience for most children. Recovery does not happen ‘by itself’, by growing up, the child needs appropriate help and support. In the absence of help, short-term consequences of sexual abuse and traumatic experience are possible, but also the long-term ones, to the whole child development.
• Health problems: e.g. sexually transmitted diseases, pregnancy and/or physical injury
• Emotional difficulties: e.g. feeling of guilt, anger, sadness, hostility, anxiety, fear, phobias, shame, low self-confidence
• Behaviour problems or behaviour control problems – aggression, delinquency, sleeping and/or eating disturbance, sudden withdrawal, auto aggressive behaviour
• Difficulties at school, truancy
• Low self-esteem
• Promiscuous behaviour
• Embarrassment and difficulties in intimate relationships
• Alcohol an drug addiction
• Academic failure
• Suicide attempts
• Posttraumatic stress disorder
• Eating disorder
Sexual disfunctionality later in life, refusal or phobic reactions to sexual intimacy
MYTHS AND FACTS ABOUT SEXUAL ABUSE AND SEXUAL ABUSERS
It is necessary to make a difference between myths and facts about sexual abuse and sexual abusers in order to provide the best possible protection for the child.
The most wide-spread myth is that parents and adults should be able to identify a sexually abused child. The fact is, however, that children show many different signs and that the majority of parents and adults are not familiar with them and with what they mean.
This and many other myths contrary to facts limit knowledge and prevent early detection of abuse.
MYTH: Child sexual abuse is not frequent.
FACT: Child sexual abuse has been happening for centuries, but nowadays an increasing number of cases is being revealed and reported. Since some children never disclose a sexual abuse or it is never reported to relevant institutions, it undoubtedly more frequently happens than it is disclosed.
MYTH: Sexual abuse happens only to certain children.
FACT: Sexual abuse is not related with the socio-economic status, education, neither with the characteristics of the child in general.
MYTH: Sexual abusers are unknown to children.
FACT: In the majority of cases the child, and often the family, know the abuser.
MYTH: It is not difficult to identify child sex abusers.
FACT: The truth is quite the opposite. Sexual abusers are often kind and caring people. They often beguile parents in order to reach their goal and approach the child more easily.
MYTH: Children are sexually abused by individuals who were sexually abused themselves.
FACT: Many sexual abusers have never been sexually abused.
MYTH: Boys are homosexually abused only by homosexuals.
FACT: Sexual orientation is most frequently not related to the abused child gender.
MYTH: Only men are sexual abusers.
FACT: According to some studies, women are sexual abusers in 20-25% of cases.
MYTH: Preschool children are not in danger of being sexually abused.
FACT: It has been estimated that approximately one third of the victims are below six years of age, those below five being exposed to a greater risk of being sexually abused by a female.
MYTH: Child sexual abuse is always violent.
FACT: Child sexual abuse can be violent, but it is often not. During sexual abuse children can experience sexual excitement and pleasure, which is natural in the context of physiological stimulation and which by no means implies that the child enjoyed or wanted to be abused.
MYTH: If the child gives consent to sexual activity with an older person, it is not sexual abuse.
FACT: the child is incapable of giving informed/mature consent to sexual activity.
MYTH: Children are sexual beings and draw sexual attention.
FACT: Responsibility for sexual abuse always lies on the adult – the abuser, regardless of the child’s behaviour.
MYTH: Children lie about sexual abuse.
FACT: Children most often do not have sufficient knowledge about sex, they do not have the vocabulary nor the experience so as to lie about sexual abuse.
MYTH: The child recovers from sexual abuse by growing up.
FACT: Recovery does not come by itself, by growing up. Consequences can be short and long-term. That is why it is necessary to seek professional help.
MYTH: Sexually abused child will disclose it to an adult.
FACT: The child does not necessarily know that s/he has been experiencing something which is “wrong” and which should be disclosed to an adult. Besides, sex abusers often threaten children who then “keep the secret” about the abuse.
MYTH: Children should not be intimidated by talking to them about sexual abuse.
FACT: It is important to teach children about sexuality appropriate to their age so that they can protect themselves. By not doing it, we let someone else teach them, against the child’s interest and protection.
FAMILY SUPPORT OF THE SEXUALLY ABUSED CHILD
Once the abuse has been disclosed and stopped, some children return to their usual behaviour. Support and protection provided by close persons, especially by the family, are extremely important for the normalisation of children’s reactions.
Signs of the experienced trauma in some children persist after the abuse has been stopped. Such children are included in the treatment and their parents are in counselling. The majority will heal from the sexual abuse experience, especially if they have parents’ support.
Family members (parents) may show a series of reactions if their child has been abused: shame, denial that the abuse has happened, changed worldview, difficulties in seeking and giving support, feeling of helplessness, sadness, anger, fear…
All these reactions may be strong, but they are not unusual.
Some questions many parents ask themselves:
– Could we have prevented the abuse?
– Should we have seen what was happening?
– What now?
Sexual abuse can lead to objective changes in the family: severed marital or family ties, financial difficulties, loss of self-respect and support, change of residence… These changes may be a source of more stress in the family.
IF THIS IS SO, BESIDES PROVIDING HELP AND SUPPORT FOR YOUR CHILD, SEEK HELP AND SUPPORT FOR YOURSELF!
The parent or the family member will probably need help in:
– obtaining all relevant information about abuse
– providing for and satisfying her/his own needs
– recognising support for him/herself (among other close persons or in institutions)
– becoming aware of her/his importance in the child’s recovery
It is as bad to require that the child forgets what happened as it is to ‘push’ the child to open up more than s/he is ready to do.
How to provide family support to the abused child:
– Be open for her/his questions.
– Try to understand his/her feelings. Recall how heavy your feelings are when you think of the abuse.
– Try to restore family routines.
– Do not be afraid of showing feelings in the family. If overwhelmed, seek help.
– It is important that the child understands that you still feel the same for her/him, regardless of what has happened. If you feel that it is too difficult for you to explain, or that you cannot talk about your feelings, take professional counselling.
It is of utmost importance that the parent or a family member never makes unrealistic promises (e.g. that something will remain a secret, or that the perpetrator will not go to prison).
It is also important to stay calm without expressing anger, although it is sometimes difficult. If it happens, the child has to know that you are not angry with the child.
If the child discloses abuse to you, it is necessary to:
• trust the child
• be non-judgemental, regardless of the circumstances
• show that you believe it is difficult to talk about what has happened
• show that you approve of and that you like the fact the child has disclosed abuse to you
• reassure the child that adults think that nobody has the right to abuse children
Discrepancy between how much parents want and can talk about the abuse and how much the child needs and is willing to talk about it causes immense difficulty in giving and receiving support
How to show the child acceptance by words?
You are not guilty of what has happened. The perpetrator is an adult and the only one to blame.
I love you and I will always love you regardless of what has happened.
I understand how difficult it is for you now, but I know that in time you will certainly feel better.
I am here for you when you need to talk with me. There will be days when you do not want it, and that is all right, too. There will be days when you want it, and I will be here for you.
I am not angry with you for what happened.
How to start talking with the child?
Tell me what has happened. I know it is hard to talk about it, but it can make you feel better.
It must have been intimidating.
What happened then? (when the child hesitates)
What were you afraid of when it happened?
Children are worried that they may be blamed for what happened to them? Are you worried, too?
Were you afraid that something bad might happen if you told an adult what had been happening?
How to respond in situations which remind of the experienced abuse?
I presume that this film reminded you of what you went through and I’m sorry for that. Do you want to talk about it with me?
Everybody who experienced abuse is sometimes scared and angry especially when something reminds them of that. When did you last feel like that?
I wonder if some situations make you think about the abuse?
What NOT to tell the child who experienced sexual abuse:
You should have thought about what would happen. (The child is never responsible for the abuse).
Why didn’t you tell before? (It is better to explore if the child was afraid of telling)
It’s terrible, the worst thing that might happen to us!!! (Try to control hard feelings, your child needs to be reassured that you will be all right, that you are not “losing your mind”).
Didn’t I tell you that you should never let anyone touch you. (It makes the child feel shame and imposes a feeling of guilt).
Do NOT EVER again talk to strangers. (First, sexual abusers are most often familiar to the child, second, it is totally unrealistic that the child will NOT EVER talk to strangers – s/he will have a new teacher, a co-passenger on the train… Such messages lead to a child who will not ask for help when necessary).
Children are sensitive to their parents´ emotional reactions. They want to see their parents as responsible adults who know what their children need.
TREATMENT OF THE SEXUALLY ABUSED CHILD
After a sexual abuse has happened in the family, all its members encounter many different and intense feelings and questions. The first question parents frequently ask themselves is: What will be the consequences, or, will my child be able to continue “normal” life?
The treatment of a sexually abused child and his/her family is exactly one of the ways in which we help children cope with what has happened to them.
Why a treatment? – How can a treatment help?
First reaction of many adults and children to abuse or to some other traumatic event is a wish to forget everything as soon as possible. That is a very usual and expected way in which we are trying to protect ourselves from pain, fear and other intense feelings. It may be very efficient at the beginning. However, coping with the traumatic event is proven to be much more useful. That way we learn how to accept what has happened and continue with normal life.
What is achieved with the treatment?
The aim of the treatment of a sexually abused child is gradual exposure and ‘going through’ traumatic events s/he has experienced by using various structured techniques in a safe environment and with support. This way the child is enabled to express, understand and make feelings related to the abuse and the abuser meaningful. S/he learns how to cope with many reactions which can be associated with the abuse.
The aim of the child treatment is not forgetting the abuse, but incorporating the traumatic event into his/her life experience so that s/he is not pushed off balance.
It is important to mention that an exacerbation during treatment is possible, i.e. the child starts to show various symptoms (again), e.g. agitation, sadness, fear, anger, regressive behaviour, etc. This is expected and happens because during treatment the child is, in a way, exposed to difficult experience s/he has had before. This is important to tell the person who conducts the treatment of the child, counsel about the ways of showing support and understanding and, especially, to keep in mind that it is a phase the child is undergoing, not a permanent change.
What is it like?
Treatment is most often individual, which means that the child comes to pre-arranged appointments with the professional. Sometimes group treatment of children with similar experience may be useful.
It is conducted by mental health professionals (e.g. psychologists, psychiatrists).
How much time does it take?
Treatment is most often conducted during 10 to 15 sessions, but may be shorter, or considerably longer. The child who has completed a treatment can, after some time, take it again. It depends on many factors related to: abuse circumstances, child’s age, family functionality and the support the child receives apart from the treatment, possible involvement of the child in court proceedings, other (additional) traumatic experience, etc.
Who is it intended for?
Talking about the sexually abused child treatment, the focus is, primarily on the child. However, non-offending parents are also included in the treatment in two ways:
• Through counselling with a professional, regarding the behaviour of the child and the behaviour towards the child during individual treatment phases
• Through counselling related to them individually and to the feelings they have associated with child sexual abuse. The parent can be indirectly traumatised by the experience the child has had.
A professional can assess that the non-offending parent has a difficulty in coping with events and suggest to the parent/s an additional treatment with their therapist.
Parental integration in the child treatment depends on the child’s age: the younger the child, the more emphasis is on working with the parent and empowering the parent as the primary helper.
When to start?
The child is usually taken into treatment after the investigation and court proceedings have been completed.
However, when the child shows strong traumatic reactions, professional’s approach is focused on the recovery of the child and on his/her best interest so that the symptoms of the trauma do not take root. In such a case it is possible that the child is taken into treatment before the investigation and court proceedings have been completed in order that s/he receives what s/he needs. The professional conducting such a treatment is obliged to confidentiality, except for the information important in further court proceedings.
MOST FREQUENT QUESTIONS PARENTS ASK
• May the police interview children in the absence of parents?
The police may not interview children in the absence of non-offending parents. If the parent is not available, a social worker or other professional of the Social welfare service has to be present at the interview. Regardless of who is present, the parent or a professional, the police officer is in charge of interviewing the child, possibly assisted by other professionals.
• Does the child have to testify in the court of law?
If the child is subpoenaed, s/he has to testify in the court of law. If the child is younger than 16, parents receive the court order for the child to appear at the trial. The child comes to the court of law with parents, a carer or an educator if placed in an institution. These persons can testify in property claims cases on behalf of the child younger than 16, as well as till the child is 18 if s/he has not required otherwise. If the parent receives the court order for the child to appear at the trial, but the child, due to health issues, is not capable of testifying, or cannot come to the court, the parent is obliged to inform the judge or the court assistant in order to learn about the rights and obligations and about what is in his/her child’s best interest.
The judge, who will obtain the data about the child with the help of the court assistant, decides about the time and method of hearing the child.
The judge will relate to the child thoughtfully having his/her age, personality characteristics, education and living conditions in mind, in order to avoid harmful effects on the child’s development.
• Who conducts the child hearing in the court of law?
If the child is younger than 16, psychologist, special educator or some other professional will conduct the hearing. In this case, the hearing will be conducted without the presence of the judge and the parties in the same room with the child. The hearing will be audio visually recorded and simultaneously transferred online in real time, so that the parties can ask questions via the judge, the psychologist or other professional.
If, during the trial, the child/young person older than 16 cannot testify truthfully because of the fear of the present defendant, the judge may decide to remove the defendant during the child court hearing.
• Does the parent have to testify at the trial?
In cases of the child or youth victim, the parent, if court ordered, has to testify at the trial. Even when the spouse has to testify about the defendant, or if the parent has to testify about a family member, the parent does not have the privilege of refusing to testify if the victim is a child or a youth.
Parent is always obliged to testify in the court of law if s/he has to talk about the circumstances of the child’s life or give additional information about the child.
• Does the child have to be gynaecologicaly examined?
Medical examination required by the police or the judge is performed with the consent of the parent. It is important to keep in mind that gynaecological examination is often required within the investigation of child sexual abuse. Such examination may provide additional evidence, which is, among other things, in the child’s interest. Medical examination of the child is also important in these cases because of the child’s health protection.
• Does the parent/child have the right to know the court ruling?
The parent, on behalf of the child victim, has the right to access to the court file and to receive the final verdict. If the verdict has not been sent, the parent has the right to require that the court sends it.
• Why is the Social welfare service involved if the child has been sexually abused by a person outside the family?
Everybody is obliged to inform the Social welfare service about any violations of the child’s rights. After that, the Centre contacts the child and the child’s family. Social workers’ activities are directed towards helping the victim within their jurisdiction. They: collect family data, inform them about their legal rights, refer them to the appropriate institution and undertake measures to protect the child’s rights.
• Why is it necessary to inform the Social welfare service in cases of their peers’ developmentally inappropriate sexualised activities in the kindergarten or at school?
Involving the Social welfare service is important in order to collect family data about the child/children with sexual behaviour problems (developmentally inappropriate sexual behaviour), as well as the data about the circumstances around the case. These data are used in further proceedings aiming at protecting and supporting the children who have participated in these activities.
• Does the school/kindergarten have to be informed that the child was sexually abused?
It is recommendable that a professional in the kindergarten or at school which the child attends is informed about what the child has experienced. It is primarily important so that the child receives additional support, if necessary. Besides, the kindergarten and school professionals can more easily and more appropriately respond to some of the possible consequences manifest at school or in the kindergarten.
However, the parent/child is not obliged to give such information.
• With whom to talk in the kindergarten/school?
If the parent decides to talk with some of the school/kindergarten professionals, it is best to choose the person s/he trusts most. It can be the teacher or some other professional, like the pedagogue, the psychologist, or the special educator. It is not necessary to talk to all of them, but only with one person. It is not necessary to give details of what the child has experienced, but only the information relevant for the child’s functioning in the kindergarten/school.
• Is it desirable to talk about the sexual abuse which has happened with the media?
Retelling the experience in the media is often additional trauma for the child. This is why it is not recommendable to give the media information about that. It is especially against the child’s interest to give information which might reveal her/his identity, like information about the child, the child’s family, school, city and similar.
Although the media largely contributed to sensitising the public about the protection of children’s rights, journalists who report about crimes against children are obliged to respect the ethical principles of their profession and protect the children.