We received a question from a parent who was concerned about the possibility that her 6-year-old daughter had been sexually abused. The following is her question and our answer. We anticipate that our response in this particular situation will be of assistance to parents who have similar concerns.

Q. My six year-old daughter was doing fine until around three months ago when she suddenly became very clingy with me. Around the same time, she also began having sleeping problems, and experiencing times when she seems preoccupied or sad. Is it possible that she has been sexually abused?

A. We are sorry that your daughter is having difficulties, and that you are worried that something awful has happened to her. We will try to sort through this complicated issue for you.

Typical symptoms of abused children: Sexually abused children show a wide range of behaviors or emotional symptoms. However, most of these behaviors or symptoms are non-specific, because they also occur for different reasons as well. These non-specific symptoms are indicated in the following list with a (). Some symptoms, marked with a (), are more often associated with the occurrence of sexual abuse, although they too may result from other causes. The following is a list of many of the behaviors and symptoms that we find in children who have been sexually abused:

·        Depression and withdrawal

·        Mood swings

·        Loss of appetite, or difficulty swallowing or eating

·        Regressive symptoms such as bed-wetting, thumb sucking, clinging

·        Sleep problems including nightmares or bedwetting

·        Fears of being away from parents including going to school

·        Aggression or self-abusive behaviors

·        Negative comments about own body

·        Fears, perhaps of monsters, or a particular person or place

·        Unexplainable physical complaints, particularly stomachaches

·        Spacing out

➢        Seductive behaviors
➢        Sexually explicit behaviors including compulsive masturbation, use of sexual language including new words
➢        Fearful reactions to physical affection between child and parent, or between parents
➢        Games, fantasies, or drawing with direct sexual elements
➢        Physical complaints about genital areas, possibly with bruises or sores, redness, or bleeding of the child's genitals, anus, or mouth, milky fluids in girl's genital area.

Making a judgment: An experienced professional weighs many factors when assessing the likelihood that a child has been sexual abused. The sudden onset of symptoms suggests the possibility that the child is responding to a specific event. However, children can be impacted strongly by many life events. Children will commonly react with symptoms to the death of a grandparent, move of home, discomfort with a teacher, their illness, or parental illness. Children whose parents are divorced will generally respond to the entry or leaving of a parent's significant other or change in custody or physical arrangements. Sometime the cause is less obvious, such as a peer problem at school, a death of a pet, or a change in parents including marital problems or depression.  

Children who are abused will often have multiple symptoms. However, multiple symptoms also occur for many other reasons. So, this too must also be weighed in the context of all the information.

Symptoms of specific and unusual sexual behaviors, indicated in the above list with a (), are more strongly associated with the occurrence of sexual abuse, especially the more that they are outside normal developmental patterns in being graphic, unusual, fear-laden, or repetitive and compulsive. However, even the presence of sexual thoughts and behaviors in children must be thought about in a larger context, which is what we mean by referring to normal developmental patterns. Children age three and older have natural sexual feelings, impulses, and curiosities. Often, as part of healthy development, children engage in sexual explorations, play, and discussions that can be very surprising to adults. In addition, some of these sexual symptoms can arise when children are prematurely exposed to direct sexual matters through media, observations of sexual relations, and many other profoundly undesirable events that do not involve sexual abuse in the usual way of thinking about it.

What should you do?: We recommend that parents talk with their children about any sudden and unexplainable symptoms. This is just good support and communication. You might say, "Have you noticed that you used to run into Janie's house and wave good-bye to me. Now you hold onto my leg and seem worried. Have you also noticed that you have been having many bad dreams - you almost never used to have bad dreams. You also just don't seem happy a lot of the time. Are you worried about something?" Please don't say this all at once, but work it in to the dialogue you develop with your daughter.

We recommend starting in this general way, without leading your daughter in a particular direction. Just showing that you are concerned may enable her to reveal what is bothering her - although it is possible that she does not know herself! If she cannot respond to this effort, you might repeat your concerns in a few days, adding "Sometimes scary or confusing things happen to children, and that's why they start having worries like you are having. Did something happen that has upset you?" The more difficult dilemma is whether be more specific if this effort does not bear fruit, such as asking if someone has touched her in an uncomfortable way or made her touch or do anything to them. We cannot advise you about taking this step on the basis of the limited information you have provided. We would point out that just asking these questions has a risk, as it may introduce a little bit of anxiety into your daughter's life. However this is a risk that is justified when there is sufficient concern that something may really have happened.  

Next steps: In your particular situation, the likelihood that your child has been sexually abused is small if she in not having other symptoms and you do not have reason to be suspicious about any adults or older children in her life. Nevertheless, children should have a professional evaluation when they are having significant symptoms that are present for three months without significant signs of improvement. Choose an experienced mental health professional who has a balanced view about sexual abuse. We have buried our heads in the sand for a long time about sexual abuse, but sometimes mental health professionals have over-compensated for past errors and put many children and families through unnecessary and detrimental questioning and investigation. So, no reason to panic, but please take further action and begin the process of getting your child back on a successful developmental path.

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