Indicators of Child Sexual Abuse = DHHS vs Psychology Expert

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falselyaccused2010
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Indicators of Child Sexual Abuse = DHHS vs Psychology Expert

Postby falselyaccused2010 » Sun Feb 20, 2011 12:07 pm

This is per DHHs manual:

Psychosocial Indicators of Child Sexual Abuse
Comparable efforts to identify the psychosocial indicators of child sexual abuse have been made by mental health professionals. In 1985, 100 national experts in sexual abuse met to develop criteria for the "Sexually Abused Child Disorder," in the hope that it would be included in the Diagnostic and Statistical Manual Three-Revised (DSMIII-R). It was not, but the effort remains important. The criteria of the "Sexually Abused Child Disorder" differentiate three levels of certainty (high, medium, and low) and vary by developmental stage. These criteria include both sexual and nonsexual indicators.61

The work of Friedrich focuses on sexualized behavior, indicators unlikely to be found in other traumatized or normal populations. His Child Sexual Behavior Inventory has been field-tested on 260 children between 2 to 12 years of age, who were alleged to have been sexually abused and 880 children not alleged to have been sexually abused. It was found to reliably differentiate the two types of children. However, a substantial proportion of children in Friedrich's research, determined sexually abused, are not reported to engage in sexualized behavior. Moreover, children who learn about sex from nonabusive experiences may engage in sexualized behavior.

In this manual, a two-category typology of behavioral indicators is proposed:

sexual indicators, generally being higher probability indicators; and
nonsexual behavioral indicators, usually considered lower probability.
Sexual Indicators
Sexual indicators vary somewhat depending on the child's age. The discussion of these indicators will be divided into those likely to be found in younger sexually abused children (aged 10 or younger) and those likely to be found in older sexually abused children (older than age 10). However, this distinction is somewhat arbitrary, and within these two groups there are children at very different developmental stages. Finally, indicators that are important for children of all ages are noted.

Sexual Indicators Found in Younger Children
These behaviors are high-probability indicators because they represent sexual knowledge not ordinarily possessed by young children.

Statements indicating precocious sexual knowledge, often made inadvertently.
A child observes a couple kissing on television and says that "the man is going to put his finger in her wee wee."
A child comments, "You know snot comes out of Uncle Joe's ding dong."
Sexually explicit drawings (not open to interpretation).
A child draws a picture of fellatio.
Sexual interaction with other people.
Sexual aggression toward younger or more naive children (represents an identification with the abuser).
Sexual activity with peers (indicates the child probably experienced a degree of pleasure from the abusive activity).
Sexual invitations or gestures to older persons (suggests the child expects and accepts sexual activity as a way of relating to adults).
Sexual interactions involving animals or toys.
A child may be observed sucking a dog's penis.
A child makes "Barbie™* dolls" engage in oral sex.
The reason sexual knowledge is more compelling when demonstrated by younger children than older ones is that the latter may acquire sexual knowledge from other sources, for example, from classes on sex education or from discussions with peers or older children. Even younger children may obtain knowledge from sources other than abuse. However, children are not likely to learn the intimate details of sexual activity nor for example, what semen tastes like and penetration feels like without direct experience.

Another indicator often cited is excessive masturbation. A limitation of this as an index of sexual abuse is that most children (and adults) masturbate at some time. Thus, it is developmentally normal behavior, which is only considered indicative of sexual abuse when "excessive." However, a determination that the masturbation is excessive may be highly subjective. The following guidelines may be helpful.

Masturbation is indicative of possible sexual abuse if:
Child masturbates to the point of injury.
Child masturbates numerous times a day.
Child cannot stop masturbating.
Child inserts objects into vagina or anus.
Child makes groaning or moaning sounds while masturbating.
Child engages in thrusting motions while masturbating.
Sexual Indicators Found in Older Children
As children mature, they become aware of societal responses to their sexual activity, and therefore overt sexual interactions of the type cited above are less common. Moreover, some level of sexual activity is considered normal for adolescents. However, there are three sexual indicators that may signal sexual abuse.

sexual promiscuity among girls,
being sexually victimized by peers or nonfamily members among girls, and
adolescent prostitution.
Of these three indicators, the last is most compelling. One study found that 90 percent of female adolescent prostitutes were sexually abused.62 Although there has not been comparable research on male adolescent prostitutes, there are clinical observations that they become involved in prostitution because of sexual abuse.63

A High-Probability Sexual Indicator for All Children
Finally, when children report to anyone they are being or have been sexually abused, there is a high probability they are telling the truth. Only in rare circumstances do children have any interest in making false accusations. False allegations by children represent between 1 and 5 percent of reports.64 Therefore, unless there is substantial evidence that the statement is false, it should be interpreted as a good indication that the child has, in fact, been sexually abused.

Nonsexual Behavioral Indicators of Possible Sexual Abuse
The reason that nonsexual behavioral symptoms are lower probability indicators of sexual abuse is because they can also be indicators of other types of trauma. For example, these symptoms can be a consequence of physical maltreatment, marital discord, emotional maltreatment, or familial substance abuse. Nonsexual behavioral indicators can arise because of the birth of a sibling, the death of a loved one, or parental loss of employment. Moreover, natural disasters such as floods or earthquakes can result in such symptomatic behavior.

As with sexual behaviors, it is useful to divide symptoms into those more characteristic of younger children and those found primarily in older children. However, there are also some symptoms found in both age groups.

Nonsexual Behavioral Indicators in Young Children
The following symptoms may be found in younger children:

sleep disturbances;
enuresis;
encopresis;
other regressive behavior (e.g., needing to take transitional object to school);
self-destructive or risk-taking behavior;
impulsivity, distractibility, difficulty concentrating (without a history of nonabusive etiology);
refusal to be left alone;
fear of the alleged offender;
fear of people of a specific type or gender;
firesetting (more characteristic of boy victims);
cruelty to animals (more characteristic of boy victims); and
role reversal in the family or pseudomaturity.
Nonsexual Behavioral Indicators in Older Children
eating disturbances (bulimia and anorexia);
running away;
substance abuse;
self-destructive behavior, e.g.,
suicidal gestures, attempts, and successes and
self-mutilation;
incorrigibility;
criminal activity; and
depression and social withdrawal.
Nonsexual Behavioral Indicators in All Children
Three types of problems may be found in children of all ages:

problems relating to peers,
school difficulties, and
sudden noticeable changes in behavior.


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The above guideline is not accurate, according to psychology experts:

Mental health professionals may testify about behavioral characteristics of a particular child that are "typical" of sexually abused children. Such behavioral indicators include a wide variety of symptoms such as regression, withdrawal, aggression, nightmares, bed wetting, fears, masturbation, and tantrums but are completely nonspecific (Wakefield and Underwager, 1991b). They appear in many different situations, including conflict between parents, divorce, economic stress, wartime separations, father absence, natural disaster, and physical, emotional, but nonsexual abuse (Emery, 1982; Hughes and Barad, 1983; Jaffe et al., 1986; Porter and O'Leary, 1980; Wallerstein and Kelly, 1980; Wolman, 1983). There are no behaviors that occur only in victims of sexual abuse. With the exception of sexualized behavior, the majority of symptoms shown in sexually abused children characterize child clinical samples in general (Beitchman et al., 1991).

Even sexualized behavior cannot be used as proof of abuse. What children normally do sexually is more involved than most people believe (Best, 1983; Gundersen et al., 1981; Langfeldt, 1981; Leung and Robson, 1993; Martinson, 1981; Okami, 1992). Friedrich et al. (1991) asked mothers of 880 nonabused two- to twelve-year-old children to complete questionnaires concerning sexual behavior. Although behaviors imitative of adult sexual behaviors were rare, the children exhibited a wide variety of sexual behaviors at relatively high frequencies. Mannarino et al. (1991) report no differences in sexual behavior between abused girls and a clinical control group, although both scored higher than did the normal controls. Gordon et al. (1990) found no differences in sexual knowledge between their samples of sexually abused and nonabused children. Haugaard and Tilly (1988) found that approximately 28% of male and female undergraduates reported having engaged in sexual play with another child when they were children. Lamb and Coakley (1993) report that 85% of their sample of female undergraduates described a childhood sexual game experience. A third of these experiences, which the respondents rated as "normal," involved genital fondling with or without clothing and some reported oral-genital contact and attempts at sexual intercourse.

In addition, since many sexually abused children do not suffer significant trauma (Browne and Finkelhor, 1986; Finkelhor, 1990; Gomes-Schwartz et al., 1990; Kendall-Tackett et al., 1993; Wakefield and Underwager, 1988a), an abused child may fail to exhibit any behavioral signs. It is a mistake to use the absence of behavioral signs as support for an allegation being false.

Using behavioral indicators to assess sexual abuse may result in a mistake in either direction. Besharov (1990) observes that behavioral indicators, by themselves, are not a sufficient basis for a report. Levine and Battistoni (1991) state that none of these indicators, in any combination, are valid without a direct statement by the child about sexual involvement or sexual knowledge. A statement representing the consensus of a group of international, interdisciplinary experts in child sexual abuse (Lamb, 1994b) concluded:

No specific behavioral syndromes characterize victims of sexual abuse. Sexual abuse involves a wide range of possible behaviors which appear to have widely varying effects on its victims. The absence of any sexualized behavior does not confirm that sexual abuse did hot take place any more than the presence of sexualized behavior conclusively demonstrates that sexual abuse occurred; rather, both pieces of information affect the level of suspicion concerning the child's possible experiences and should to serve to promote careful and nonsuggestive investigation. (p. 154)


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Another articlethat discusses the inaccuracies of DHHS' manual:

At this point it seems that nearly every problem behavior ever detected in children has been offered by someone as a sign of child sexual abuse. The problem is the high probability that any normal child might at some point in childhood exhibit one or more of these behaviors and thereby risk being perceived as an abuse victim. To spread these lists of behavioral indicators without appropriate cautions and information about their limitations can generate mistakes, confusion, over-reaction, and over-interpretation.

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