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Fostering a Sexually Abused Child
Children who have been abused sexually have specific needs in foster care. Foster parents need to understand several aspects of how sexually abused children express symptoms. Though sexually abused children present some challenges that other children who have not been sexually abused do not present, they are still just children in need of love, affection, care, and guidance.
The first thing that foster parents need to understand is the child’s diagnosis. Often, children who have been sexually abused will have a diagnosis of Post Traumatic Stress Disorder. If this is the case, the foster parent should read up on this disorder in the other articles dedicated to PTSD in children in this series. Other children may not have a PTSD diagnosis, but have some other diagnosis such as Oppositional Defiant Disorder or Reactive Attachment Disorder.
Abused children express their issues of sexual abuse in a variety of ways. Some children have a cluster of behaviors that has been termed: “Child Sexual Abuse Accommodation Syndrome.” The CSAAS was developed in 1983 by Dr. Roland Summit as a descriptor of signs seen frequently in sexually abused children. This is a description of behaviors that many, but not all, sexually abuse children demonstrate. These behaviors include:
- Secrecy about the abuse, reluctance to speak about it due to possible threats by the perpetrator.
- Emotional helplessness to resist or complain about the original abuse, or subsequent re-victimization by other perpetrators.
- Entrapment and accommodation, in that the child feels that there is no way to escape the abuse, so they learn to cope with it and adapt. The child’s resolve to tell also may “fold” in the presence of the perpetrator or other persons associated with the perpetrator.
- Delayed, conflicted, and unconvincing disclosure of the abuse. This disclosure may seem exaggerated, inconsistent in detail, or simply vague.
- The child may “backpedal” or recant their allegations to restore the family structure, or to emotionally calm a parent, family member, or the perpetrator.
There are other behavioral difficulties that can occur in sexually abused children. They may have behaviors that are sexually pre-occupied: they may use vulgar language, or speak about sexual issues with other children. Some children may masturbate excessively, to self-comfort, or masturbate in public. They may behave or try to dress in ways that are seductive or amorous. Some children may make attempts at sexual contact with other children or adults. On the other hand, some children who are sexually abused may try to minimize their gender, and be highly concerned about their privacy, and reject physical affection..
Children who have behaviors that are sexually precocious need to be given firm, but non-punitive guidance about appropriateness and boundaries. For some of these children, it is not wise to allow them out of your sight for long periods of time when they are interacting with other, especially younger children. Though in most cases, no genuinely dangerous activities will take place, it is very important for the child not to engage in behaviors that can become a pattern of sexualized, clandestine and manipulative sexualized behaviors with other children.
There will be occasions when a sexually abused child will begin to “tell” a foster parent about a specific event of sexual abuse. When this occurs, the foster parent needs to keep in mind two basic things: accurate recording of what the child said, and avoiding certain types of questioning that could make the information gained essentially worthless in protecting the child. While it is therapeutically desirable for the child to verbalize about their abuse, foster parents should realize that there is a very strict set of guidelines about what can be accepted as evidence by child protection workers, and is acceptable in court as testimony. When a child’s accounts are tainted by the wrong methods of questioning, they are likely to be discarded by the legal system. Though there is only a small chance that a foster parent would ever be called to court to testify in a situation where a foster child reveals sexual abuse details, foster parents should be prepared.
Foster parents needs to know that children often reveal information about abuse in one of two ways: either they blurt it out once they gain trust in an adult, or they accidentally speak about it.
When possible, a foster parent should seek help from the child’s therapist in processing such material; there are many complexities to communications with children about sexual abuse issues. There are even many professional therapists who make common mistakes in these conversations with children. Research shows that children’s memories and accountings of sexual abuse can be quite accurate, and they generally do not make up stories about the abuse...except when the wrong approach to questioning is used by well meaning adults. But of course, the child may not be willing to speak to the therapist if there is a wait. In these cases, the foster parent should keep these guidelines in mind:
1. Remember that children want to please adults; the child may give an embellished answer to satisfy you.
2. Remember that you are a big person, and the child is small; this can be intimidating, and the child may give a made up answer just to get you to back off.
3. Never “lead” a child with questions. Here are some examples of subtle, leading questions:
“If some one has done sexual things with you, did they do (whatever)?” Or, perhaps more commonly: “Has anyone ever touched you inappropriately?”
4. Never suggest an emotion or content to the child that the child has not expressed. For example: “I’ll bet that it would be frightening if an adult tried to put their hands down your pants.”
5. If you repeat a question, the child may assume that their first answer was not ‘good enough’, and then try to embellish the answer to satisfy you.
6. Never ask “trap questions”: “Did this person do (this) or (that)? This leaves the child only two answers, either one being a positive statement about abuse.
7. Be aware that if the child begins to talk about sexual abuse, and you already know the child has been sexually abused, you may have a bias about who the perpetrator is, and what was done.
The following are better strategies if the child begins to reveal to you:
- Stay calm; hide your anxieties, fears, or anger towards the perpetrator.
- Use small encouragements to encourage the child to speak, such as: “Hmmm…” or “I see”. You can also nod your head and keep eye contact and appropriate physical proximity.
- If you must ask a question, just say: “I don’t quite understand, can you tell me more?”
- If you want to add emotional support, simply reflect an emotion that the child is giving, or, you can ask the child how they felt at the time, or how they now feel.
- If the child makes any statements that the abuse was somehow their fault, immediately correct this, telling the child sexual (or any) abuse is never a child’s fault.
- Reassure the child that you will keep them safe. Tell the child that it might be necessary for someone else to talk to the child about their statements (you need not say who just now) so that the child can remain safe, and that you will be with them when they do.
- Report the conversation as soon as possible to the child’s other treatment staff, and make a Childline report if indicated.