Advice for Professionals

Introduction

  • Sexual abuse is largely hidden and can be difficult to uncover.
  • In 2011, nearly a quarter of young adults had experienced sexual abused by an adult or peer during childhood (Radford et al 2011).
  • Disabled children can be particularly vulnerable to sexual abuse.
  • Sexually abused children can suffer a range of psychological and emotional problems, especially if the abuse is never uncovered.
  • Sometimes the only chance of uncovering sexual abuse is when a child makes a disclosure and many victims wait years before telling anybody.
  • Child sexual exploitation, which has received an increased focus over the last two years, should be seen as part of a wider problem of child sexual abuse.

 

Identifying CSA and CSE

Signs and Symptoms

Unlike with physical abuse or neglect, there are often no clear physical signs that a child is being sexually abused.

Changes to the way a child behaves can indicate a possible trauma and there are several factors which, when found in conjunction with one another, may indicate child sexual abuse.

Sudden emotional or behavioural changes especially a fear of being alone or sleep disturbances and nightmares could be a result of sexual abuse. New problems at school such as difficulty learning, poor concentration and declining grades can also signify that something has happened to upset a child.

Other signs that a child may be suffering sexual abuse include:

  • Social withdrawal.
  • Depression and suicidal ideation.
  • Eating disorders.
  • Anxiety.
  • Risk taking behaviour, such as running away, self-harming, drug and alcohol misuse.
  • Expensive gifts.
  • Reluctance to spend time with specific individuals.
  • Using sexually explicit language that is not usual for a child their age.

 

A young person may exhibit a range of types of behaviour or warning signs that might indicate that they’re a victim or at risk of child sexual exploitation. If you know a young person who is showing some of these signs and you’re worried about them please report it now.

 

Appearance and behaviour

  • Physical symptoms (bruising suggestive of physical or sexual assault).
  • Evidence of drug, alcohol or substance misuse.
  • Volatile behaviour/mood swings/use of abusive language.
  • Truancy/disengagement with education or a change in performance at school/college.
  • Low self-image, low self-esteem, self-harming behaviour, e.g. cutting, overdosing, eating disorder, promiscuity.
  • Physical aggression towards others.
  • Change in appearance/always tired.

Sexual

  • Sexually transmitted infections/pregnancy/seeking an abortion.
  • Sexually risky behaviour.
  • Sexual/unexplained relationships with older people.
  • History of abuse or neglect.
  • Domestic violence/parental difficulties.
  • Clothing inappropriate for age, borrowing clothing from others.
  • Reports that the child has been seen in places known to be used for sexual exploitation.

Relationships

  • Entering or leaving vehicles driven by unknown adults.
  • Hostility in relationship with parents/carers and other family members.
  • Reports to suggest the likelihood of involvement in sexual exploitation.
  • Associating with other young people who are known to be sexually exploited.
  • Inappropriate use of internet and forming of online relationships with adults.
  • Phone calls, text messages or letters from unknown adults.
  • Adults or older youths loitering outside the child’s usual place of residence.

Missing/homelessness

  • Truancy.
  • Placement breakdown.
  • Persistently missing, staying out overnight or returning late.
  • Returning after having been missing, looking well cared for in spite of having no known home base.
  • Missing for long periods, with no known home base.
  • Going missing and being found in areas where the child or young person has no known links.

Financial

  • Petty crime e.g. shoplifting, stealing.
  • Having keys to other premises.
  • Expensive clothes, mobile phones or other possessions without explanation.
  • Accounts of social activities requiring money.
  • Possession of large amounts of money with no plausible explanation.

 

Effects of abuse and exploitation

Victims of sexual abuse can show a range of symptoms during and for years after the abuse has occurred. Physical signs and symptoms are still given precedence in the literature but often it is the emotional and psychological effects that do more long term damage to victims.

Alexander (2011) calls sexual abuse a chronic neurologic disease and goes on to discuss how the effects create decades of negative consequences for victims. The consequences of child sexual abuse can include depression, eating disorders, post-traumatic stress and an impaired ability to cope with stress or emotions (Allnock et al 2009). However, up to 40% of victims of sexual abuse exhibit no long-term negative consequences of their experience (Finkelhor and Berliner 1995).

Self-blame, self-harm and suicide are commonly mentioned as consequences of sexual abuse. Children who are sexually abused can be manipulated by their abuser to believe that the abuse is their fault. The feelings of shame and guilt that come from the abuse can reduce the likelihood of that child making a disclosure (Allnock 2010). A study by Calder (2010) also found that participants sexually abused in childhood were more than twice as likely to consider committing suicide in later life.

Child sexual abuse can have a more fundamental effect on brain functioning, where a child’s brain becomes damaged by the abuse they have suffered (Mizenberg et al 2008). The effects of sexual abuse can include dissociation, memory impairment and reduced social functioning (Whitehead 2011).

Being sexually abused as a child, especially where that abuse is not discovered, can lead to confused ideas about appropriate relationships and behaviour. It can lead some victims to block out the abuse so that they do not remember parts of their childhood. It can also lead to post traumatic stress symptoms. Where the abuse is not disclosed or discovered or where the children do not receive adequate help and support following a disclosure, the damage and negative effects can be life-long (Goodyear-Brown 2012).

Sexual abuse can also have physical consequences for victims from sexually transmitted diseases to pregnancy. These physical consequences compound the significant emotional and psychological damage inflicted by the abuse (Whitehead 2010).

 

Prevalence of sexual abuse

Estimating the prevalence of child sexual abuse has been difficult because of the number of instances that go unreported.

Dagon (2012) and Pemberton (2011) both use three distinct models for abuser-victim relationships.

  • Inappropriate relationships where an older abuser has a measure of power over their victim. This could be physical, emotional or financial and in many cases the victim will believe that they have a sincere or loving relationship with their abuser.
  • Cases under the Boyfriend Model often involve the abuser and victim entering into an almost conventional relationship with the exchange of gifts and other dating activities. This model can lead the abuser to manipulate the victim into undertaking sexual acts with other people. This is a common model for abuse by peers.
  • Organised exploitation and trafficking: Children are abused by more than one adult as part of a network that may involve the movement of victims into and across the country as well as the exchanging of images of abuse.

An NSPCC study (Radford et al 2011) found that nearly a quarter of young adults (24.1%) had experienced sexual abuse (contact and non-contact), by an adult or peer during childhood. Around 11% of young adults said that they had experienced contact sexual abuse during their childhood.

Perpetrators of sexual abuse are more likely to be a family friend or acquainted with the child rather than being a parent or stranger. Girls are at a greater risk than boys of being abused by a family member, while boys are at a higher risk than girls of being abused by a stranger (Maikovich-Fong and Jafee 2010).

The majority of reported abuse is carried out by male abusers but there is some discussion as to whether abuse by female abusers is underreported. An analysis of the calls to ChildLine where children talked about being sexually abused found that 17% of the calls concerned a female abuser. Where the victim of the abuse was a boy then the proportion of male and female abusers was roughly the same. For girls, over two thirds of the perpetrators were male (Mariathasan 2009).

 

Risk factors

Sexual abuse can happen to any child but there may be certain circumstances that can increase a child’s vulnerability.

Experiencing other forms of abuse, especially previous sexual abuse or a disrupted home life can lead to a child being more susceptible to being sexually abused. Some abusers target children who are neglected by their parents or children who don’t have many friends as they are more likely to be receptive to the attentions of an adult (Elliot et al 1995).

A disrupted home life can make children particularly vulnerable to sexual abuse. Domestic violence can push children out of the home and make them susceptible to people who seem kind and show them affection (Goodyear-Brown 2012).

Children of parents who misuse substances may have homes where lots of adults are coming and going or they may be left alone for long periods of time while their parents are out. This can leave those children vulnerable, especially when the adults in the house may be under the influence of drugs or alcohol (Goodyear-Brown 2012).

Children with disabilities are particularly vulnerable to sexual abuse. Sullivan and Knutson (2000) found that disabled children were up to three times more likely to be abused than non-disabled children. This can be because there are fewer people to tell, fewer ways to tell someone or that some disabled children may find it difficult to make themselves understood.

Children can also be at risk when using the internet. Social media, chat rooms and web forums are places where children could be groomed, persuaded to meet an abuser in person or persuaded to send pictures of themselves or perform sexual acts in front of webcams. However, it should be recognised that the internet has also brought huge benefits for children (Leonard 2010).

 

Dealing with disclosures

Stopping sexual abuse relies primarily on children making a disclosure to an adult who can act to protect them.

Unlike with physical abuse or neglect, there are often no clear signs that a child is being sexually abused so detection often relies on a child being brave enough to tell someone (Goodyear-Brown 2012; Allnock 2010). Child sexual abuse remains largely hidden with many victims waiting years before telling anyone (Cawson 2000). Research suggests that one in three children who have been sexually abused do not report it at the time (Radford et al 2011).

In order to make a disclosure a child has to find someone they can trust and who they feel safe telling. Victims of sexual abuse can be reluctant to tell anyone because their abuser may have told them that they will not be believed (Allnock 2010). Much of the control an abuser has over their victim can be based on this fear that they will not be believed, that the abuse is their fault or a fear of what their abuser may do if the child tells. Providing a safe space for a child to talk can be key to preventing further abuse.

If you work with or come into contact with young people, it is your responsibility to make sure that you:

  • Understand what child sexual exploitation is.
  • Can recognise the warning signs.
  • Know who to contact and how to report any concerns.

 

Make sure you know who the child protection / safeguarding lead in your agency is and be aware of the procedure to follow if you have concerns about a young person. If you are worried or in any doubt, get help.

 

Information and resources

The NSPCC website hosts a range of resources for professionals about child abuse and neglect, including research, statistics, factsheets and briefings. They also provide expert training and consultancy services to professionals as well as freely accessible library and information services. Visit the NSPCC website

Anyone wanting to keep up-to-date on developments in child protection can sign-up for weekly email alerts or follow Caspar News @NSPCCpro on Twitter.

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References

  1. Alexander, R. (2011) Introduction to the special section: medical advances in child sexual abuse, part 2. Journal of Child Sexual Abuse, 20(6): 607-611.
  2. Allnock, D, Bunting, L, Price, A, Morgan-Klein, N, Ellis, J, Radford, L and Stafford, A (2009) Sexual abuse and therapeutic services for children and young people: the gap between provision and need: full report. London: NSPCC. pp 165.
  3. Allnock, D. (2010) Children and young people disclosing sexual abuse: an introduction to the research. London: NSPCC.
  4. Calder, J., McVean, A. and Yang, W. (2010) History of abuse and current suicidal ideation: results from a population based survey. Journal of Family Violence, 25(2): 205-214.
  5. Cawson, P., Wattam, C., Brooker, S. and Kelly, G. (2000) Child maltreatment in the United Kingdom. London: NSPCC.
  6. Dagon, D. (2012) Preventing sexual exploitation. Children and Young People Now, 6-19 March: 36.
  7. Elliot, M., Browne, K. and Kilcoyne, J. (1995). Child sexual abuse prevention: what offenders tell us. Child Abuse and Neglect, 19(5): 579-594.
  8. Finkelhor, D and Berliner, L (1995) Research on the treatment of sexually abused children: a review and recommendations. Child Adolescent Psychiatry 34(11): 1408-1423.
  9. Goodyear-Brown, P. (ed.) (2012) Handbook of child sexual abuse: identification, assessment and treatment. Hoboken, New Jersey: Wiley.
  10. Leonard, M. (2010) ‘I did what I was directed to do but he didn’t touch me’: the impact of being a victim of internet offending. Journal of Sexual Aggression, 16(2): 249-256.
  11. Maikovich-Fong, A. and Jaffee, S. (2010) Sex differences in childhood sexual abuse characteristics and victims’ emotional and behavioural problems: findings from a national sample of youth. Child Abuse and Neglect, 34(6): 429–437.
  12. Mariathasan, J. (2009) Children talking to ChildLine about sexual abuse. London: NSPCC.
  13. Minzenberg, Michael J., Poole, John H. and Vinogradov, Sophia (2008) A neurocognitive model of borderline personality disorder: effects of childhood sexual abuse and relationship to adult social attachment disturbance. Development and Psychopathology 20(1): 341-68.
  14. Pemberton, C. (2011) Disturbing signs. Community Care, 1870: 16-17.
  15. Radford, L. et al. (2011) Child abuse and neglect in the UK today. London: NSPCC.
  16. Sullivan, P. and Knutson, J. (2000) Maltreatment and disabilities: a population-based epidemiological study. Child abuse and Neglect, 24(10): 1257–1273.
  17. Whitehead, J. (2011) How do children cope with sexual abuse? Protecting Children Update, 84: 9-10.
  18. Whitehead, J. (2010) Back to basics: sexual abuse. Protecting Children Update, 71: 8-9