The Complexity of Investigating Possible Sexual Abuse of a Child
Ludwig.F. Lowenstein Ph.D
Southern England Psychological Services
The author attempts to deal with three important issues in relation to child sex abuse allegations. These are 1) some potential signs in the behaviour of children who might have suffered sexual abuse; 2) how an evaluation of an allegedly sex abused child can be carried out; 3) the possible long term affects on a child who has suffered from being sexually abused. The complexity of drawing the right conclusions are considered when there are false positives due to the overlap of evidence between sexually abused and non abused children.
The Complexity of Investigating Possible Sexual Abuse of a Child
Sexual abuse of children is a serious matter and it is intended in what follows to provide information that may be of value to professionals in various situations. I am often asked to appear in courtrooms to provide evidence for or against whether child sex abuse has occurred.
We will consider the following three aspects;
- Some of the potential signs of behaviour of children that possibly have been sexually abused, but could also constitute normal non abuse behaviour.
- The evaluation of children who may have been sexually abused. To carry this out there is a need for skill, and unbiased, independent thinking.
- The possible long term effects of a child who has been sexually abused.
1. Some potential signs of behaviour of children who may have been sexually abused
There are a number of signs that sexual abuse may have occurred but these are not necessarily always to do with a child having been sexually abused. Some of the behaviour may well be normal but if it is consistently based on the signs which follow then some form of assessment may be required. The first differentiation will be based on the age of the child. We will therefore consider a child of age 2-6, followed by middle childhood of 7-10 and 11-12.
A child aged 2-6
- Kisses non family members voluntarily.
- Tries to look at people undressing or the tendency to look at such an act surreptitiously.
- Undresses in front of others without feeling shame.
- Sits with crotch exposed and is aware of doing so.
- Touches sex parts at home.
- Masturbates or stimulates self even when company is present.
- Touches sex parts in public without feeling shame.
- Shows sex parts to adults regularly.
- Shows sex organs to another child regularly.
- Sexual play with dolls noted.
- Placing objects in anus or vagina.
- Requesting sexual stimulation from adults or from other children.
Middle childhood 7-10 and 11-12
- Tries to look at people undressing in the nude.
- Touches sex parts at home and when away from home.
- Masturbates regularly.
- Fondles non genital areas e.g. back, stomach.
- Shows sex parts to another child to invite a reaction.
- Is interested in engaging in sexual activities.
- Has age inappropriate sexual knowledge.
- There is overt sexual behaviour.
2. The evaluation of children who may have been sexually abused
One of the more difficult tasks for psychologists and others is to carry out a comprehensive yet sensitive, impartial procedure in order to identify the possibility of the child having been sexually abuse (Kuehnle, 2003). There is always an element, albeit reduced by the skill of a conscientious assessor as to having reached a valid conclusion. Wrong conclusions are doubly harmful: firstly to the child who may be provided with unnecessary therapy if sexual abuse has not really occurred; it is also harmful and unjust for an alleged perpetrator who is totally innocent of such behaviour. The US Department of Health and Human Services (1992) defines sexual abuse as follows:
“Fondling a child’s genitals, intercourse, incest, sodomy, exhibitionism, and sexual exploitation to be considered child abuse, these have to be committed by a person responsible for the care of the child (for example a parent, baby sitter or day-care provider). If a stranger commits these acts, it would be considered sexual assault and handles solely by the police and criminal courts.”
The evaluation of children where child sex abuse has been alleged and/or suspected requires a combination of ethics, sensitivity and scientific knowledge combined with the experience in analyzing extremely complex signs (Koocher, 2009). All the parties involved, (alleged victim and alleged perpetrator) are vulnerable individuals due to the uncertainty that exists. One must therefore adopt a stance of being totally neutral and independent in one’s thinking with having no prejudices in one direction or another as one begins the investigation.
There is some controversy as to whether structured or unstructured interviewing is preferable (Herman, 2009). Some investigators prefer a structured interview claiming it to be freer of potential bias. It has also been recommended that no more than three interviews of the child should be carried out and this should always be done by the same interviewer.
It is also recommended that different individuals could carry out the function of independent unbiased evaluator of sexual abuse and the carrying out of therapy once it has been shown to exist. It must be accepted, that in most cases no sexual abuse has occurred despite the allegations made. This is due to individuals who are mentally ill, or obsessed in some way, or are eager to alienate the child (and incidentally the court) against a parent in order to prevent that parent having contact with the child (Lowenstein, 2007; Kuehnle, 2006).
Repeated interviews combined with other evaluations such as tests, can provide more valid information when the child is able to verify early facts with later repetition of these facts (La Rooy et al., 2009).It will also reveal inaccurate, inconsistent and contradictory statements made by the child. A child who subsequently recants about sex abuse having taken place could still have been abused (Malloy & Quas, 2009).
A number of assessment techniques when used on their own have been found to be flawed (Pipe & Salmon, 2009). There are a number of ways that children may have been assessed indirectly or indirectly. Included here are play therapy, and observing behaviour, observation of the child interacting with toys especially in playing with dolls, the dolls having genitals, projective techniques such as drawing pictures and the use of a number of other assessment procedures. It is wise to consider the most important thing which is to use as many procedures as possible which can be used in order to verify other procedures used. Hence these approaches should be simultaneous and in combination in order to indicate which way the evidence points in regard to child sex abuse having taken place or not having taken place.
Psychologist must ever be on their guard not to make judgements based on potentially flawed evidence. Psychologists therefore need to rely on scientifically supported evidence, preferably supported by empirical evidence (Murrie et al., 2009).
3. The possible long term effect of a child who has been sexually abused
It must be stated from the start that most sexually abused children do not present sexual behaviour problems or any problems for that matter. At the same time, a large number of male children who have never been sexually abused tend to have sexual behaviour problems and may even become abusers.
The effect on the child who has been sexually abused depends on several important aspects:
a) Whether the child is coerced and aggression and force is used.
b) Whether the child has been penetrated vaginally or anally.
c) Who the person is who carries out the abuse. Is it a stranger or a member of the family and hence trusted?
When the perpetrator is close to a child such as a member of the family, or a close friend, the affect of abuse perpetrated is much worse. Much depends also on the length of the abuse and the frequency of the abuse. The type of sexual act is also an important factor, with penetration leading to more serious symptoms in the child. Another important aspect is whether the child is able to confide in the mother or other family member and is believed. The situation can be worsened if the child who has been abused is not believed. Also important are the number of perpetrators of sexual abuse involved with a child.
The most commons symptoms have already been delineated in part 1. They include early sexualised behaviour. In addition young children frequently become anxious and suffer from nightmares, bedwetting and sometimes PTSD. Some children become aggressive or withdrawn or regress to a more infantile level (Kendall-Tackett et al., 1993).
In the case of older children, including adolescents, depression, self-harming, educational problems, hyperactivity and suicidal ideations can occur. Such children are also likely to suffer from psychosomatic complaints such as headaches and stomach aches for which there is not organic explanation. Some older children run away from home, truant or abuse substances such as alcohol or drugs. In the extreme cases they can develop a serious mental illness for a lifetime.
Sometimes disclosure of sexual abuse is delayed and this is often due to feelings of guilt, self-blame, helplessness, and being closely attached to the perpetrator. The result of such experience is that the child or adolescent will distrust others. They are unlikely to confide in others what has occurred (Somer & Szwarcberg, 2001). Sometimes the victim of sex abuse is confused and feels, although wrongly, that they themselves are responsible for the abuse having taken place. It usually takes longer for a child to reveal sex abuse when it occurs within the family, especially in the older child. Fear of undesirable consequences can also lead to a delay in revealing abuse (Goodman et al, 2003). The same can be said when the perpetrator threatens the child not to reveal the abuse, and when a parent does not believe a child who reveals the abuse (Veltcamp & Miller, 1995).
Time sometimes helps in the healing process in dealing with the abuse. At other times, time does not make any difference and may even make it worse. Dedicated treatment is likely to be most helpful. It appears to be less harmful to the child when testimony can be given via close circuit television than having to testify in open court. In some cases the effect of child sex abuse improves individuals and in other cases it worsens them. This can lead to sexual difficulties as already mentioned (Feiring et al., 2009).
As adults, sexually abused women report less satisfaction with sexual activities than women who have not been abused (Sexton et al., 1990). Abused women, as already stated are more likely to have eating disorders and may lack the ability to trust other adults. They may also suffer from degrees of anxiety, depression and become self-harmers. Some can suffer from borderline personality disorder and commit suicide (Polusny & Follette, 1995; Briere & Runtz, 1993).
Women who have been abused are also more likely to suffer from postpartum depression, diminished maternal attachment disorder than women who have not suffered abuse (Buist & Janson, 2001). Abused children are also susceptible to being abused repeatedly (Polusny & Follette, 1995).
It should be stated that some children who have been sexually abused become paradoxically stronger as a result. They are also more likely as adults to protect their own children from being sexually abused, as a direct result of their own experience (McMillen et al., 1995). Finally, it must be said as a cautionary note that many of the symptoms of sexual abuse occur in non abused children. Hence, there is a need for considerable care, attention and skill when drawing conclusions from the evaluation of alleged victims of child sexual abuse.
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