An Ugly Truth

You have accessThe ASHA LeaderFrom My Perspective1 Jan 2016An Ugly TruthKnow the signs of sexual abuse of children. It affects all areas of their lives, including language development. Rebecca MooreMS, CCC-SLP Rebecca Moore Google Scholar , MS, CCC-SLP https://doi.org/10.1044/leader.FMP.21012016.4 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Katie failed her community preschool screening. Like so many kids who came through our preschool doors, this 5-year-old didn’t know her letters, numbers or colors. She couldn’t talk about anything that was not presently occurring or answer “wh” questions. So we began. She came to our school and we developed goals to build her skills. We used evidenced-based intervention techniques. We provided an ideal learning environment. But in targeting our efforts to her language goals, we were missing a key piece. In reality, we were treating the symptoms of something far more complicated than just a developmental delay. In my naiveté, fresh out of graduate school, I began in earnest to address her language deficit. When I asked Katie simple object-function questions or questions about the plot of a children’s book, her responses were highly unrelated to the topic at hand. I assumed that like many of the children on my caseload, she just didn’t understand the question form. I continued to use all the treatment strategies I had been taught to try to connect the dots for her. Then one day, Katie wasn’t at school. A week went by. Then another. And finally I pulled her teacher aside and asked, “Where’s Katie?” She stepped out of the room, shut the door and gave me the ugly truth. Katie was in the hospital because of trauma she had suffered secondary to being raped by her stepfather. This rape was not a one-time thing but rather a recurring problem. Her little sister was also a victim. Hearing this news, I lost my breath. I sat down and cried. Who does something like that to an innocent child? Shortly after, Katie returned to school. Sometimes she would come straight from counseling and would have difficulty integrating back into her classroom. After these appointments, I would see her sitting off by herself, watching the other kids play, so I would take her down the hall to speech to help her ease back into play via a less stimulating environment. I would notice how she put the daddy in the little girl’s bed in the doll house or how she constantly fidgeted with her underwear. I wondered how I hadn’t noticed before. As the weeks went by, a remarkable thing happened. Katie almost magically knew her letters, numbers and colors. She could answer any decontextual question and all traces of a language disorder vanished. We were treating the symptoms of a much more unpleasant truth, and once that source was eliminated, so were her delays. Her failure to answer adult questions or demonstrate early academic skills may have merely been a way to cope with the trauma at home. We may not like to think or talk about childhood sexual abuse but the harsh reality is that we must. Approximately one in six boys and one in four girls are sexually abused before the age of 18, according to research conducted by the Centers for Disease Control and Prevention. Children with disabilities are 2.9 times more likely than children without disabilities to be sexually abused (). And childhood sexual abuse is associated with a decrease in receptive language learning, according to research presented in 2010 at the biennial meeting of the Society for Research on Adolescence (see sources). What to look for Stop It Now!offers a list of behaviors that may be warning signs of sexual abuse. These behaviors don’t necessarily mean a child was abused, and they could emerge at other stressful times, such as divorce or death. If, however, you note several of the indicators, you may want to begin asking questions and to think about seeking help. Young children may: Behave like an even younger child (wetting the bed or sucking a thumb). Have new words for private body parts. Resist removing clothes at appropriate times. Ask other children to behave sexually or play sexual games. Mimic adult-like sexual behaviors with toys or stuffed animals. Have wetting and soiling accidents unrelated to toilet training. A child or adolescent may: Have unexplained nightmares or other sleep problems. Seem distracted or distant at odd times. Have a sudden change in eating habits, refuse to eat or have trouble swallowing. Display sudden mood swings. Provoke a discussion about sexual issues. Write, draw, play or dream of sexual or frightening images. Develop new or unusual fears of certain people or places. Refuse to talk about a secret shared with an adult or older child. Talk about a new friend who is older. Have money, toys or other gifts without reason. Think of self or body as repulsive, dirty or bad. Exhibit adult-like sexual behaviors, language and knowledge. An adolescent may display: Self-injury (cutting, burning). Inadequate personal hygiene. Drug and alcohol abuse. Sexual promiscuity. Running away from home. Depression, anxiety or suicide attempts. Fear of intimacy or closeness. Compulsive eating or dieting. Physical warning signs are rare, but if you see them, the child needs to be seen by a doctor as soon as possible: pain, discoloration, bleeding or discharges in genitals, anus or mouth; persistent or recurring pain during urination and bowel movements; frequent yeast infections. What to do Of course we want to protect children in our care, but we also fear the ramifications of reporting something—bathroom accidents and some unusual tantrums, for example—that could mean nothing related to abuse. If you suspect possible abuse, try these strategies. Take notes. If you notice an increase or notably new presence of any of the symptoms above, write it down. Keep a journal of your observations with dates and times. Talk to your supervisor. Share your concerns or observations. After talking with your supervisor, talk to the parents or caregiver, if appropriate. Ask about any big life changes. Comment about behaviors you see and ask if parents have noticed behaviors at home (but remember that family members are the abusers of about 30 percent of abused children). Don’t make accusations—ask questions. Talk to the child. Visit for information on how to have this conversation. Report to Child Protective Services. You don’t need to wait until you have hard facts to report, but you should have some details. Examples of situations that require reporting include numerous and consistent warning signs; a child stating that he or she is being abused by an adult or that another child has been engaging in sexually harmful behaviors with him or her; a child or adult says he or she has sexually harmed a child; an individual has become aware of online child pornography or knows someone who is viewing it. For a list of organizations that offer information and assistance related to abuse, see the sidebar in the online version of this article. Sexual abuse is an all-too-real issue for children and could likely include those on our caseloads. Five years later, I still think about Katie. I am more observant. I am quicker to report, because sometimes a language delay is not just a language delay, but a far uglier truth. Where to Go for Help A number of organizations offer information and assistance to people experiencing abuse or who suspect someone else is being abused. Child Help National Child Abuse Hotline 800-4-A-CHILD Darkness to Light 866-367-5444. Toll-free helpline for individuals living in the United States who need local information and resources about sexual abuse. National Center for Missing & Exploited Children 800-843-5678. Available 24 hours a day, this toll-free line is for reporting any information about missing or sexually exploited children to the police. This number is available throughout the United States, Mexico, and Canada. The TDD Hotline is (800) 826-7653. www.missingkids.com/CybertipLine National Center for Victims of Crime 800-394-2255. Tollfree helpline for supportive counseling, practical information about crime and victimization, referrals to local community resources, and skilled advocacy in the criminal justice and social service systems. Rape, Abuse & Incest National Network 800-656-4673. Toll-free National Sexual Assault Hotline is available 24 hours a day, 7 days a week, and offers secure, anonymous, confidential crisis support for victims of sexual assault and their friends and families. www.rainn.org/get-help/national-sexual-assault-onlinehotline Take preventive action As a clinician working with children, you can help yourself and colleagues by advocating for more training about child sexual abuse. You can ask, for example, that your work place complete sexual abuse training (available from several sources, including StopItNow.org, NSVRC.org or childsafeeducation.com). You can also educate yourself on age-appropriate sexual behaviors. We can also help our clients protect themselves. Children with disabilities need open and honest discussions and rules about what is—and what is not—appropriate for support staff and those assisting the child with activities of daily living. How can you help the child preserve privacy? What rules are in place? Label body parts and be explicit about who can and cannot see or touch a child. Talk with families and encourage them to create a plan (for details, click on “Prevention Tools” at StopItNow.org). Source Noll, J. G., Barnes, J., & Trickett, P. K. (March 2010). Sexual and physical (re) victimization of sexually abused females: The plausible role of global dysregulation. Paper presented at the Society for Research on Adolescence Biennial Meeting; Philadelphia, PA. Author Notes Rebecca Moore, MS, CCC-SLP, is a pediatric clinician at the Blick Clinic in Akron, Ohio, a nonprofit specializing in enhancing the lives of individuals with disabilities. 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