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CBT for Survivors of Childhood Sexual Abuse
6 CEUs It Wasn't Your Fault- Diagnosis & Treatment of Sexual Abuse in Children & Adults

Manual of Articles Introduction & Sections 8 - 18
Diagnosing - Sexual Abuse of a Child
The Symptoms of Sexual Disturbance Among Children

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| Child Abuse CEU Courses
Social Worker CEU, Psychologist CE, Counselor CEU, & MFT CEU

The Symptoms of Sexual Disturbances Among Children
Parents, teachers, and guardians may find it difficult to distinguish between normal, healthy childhood sexual experimentation and sexual deviance resulting from exposure to pornography. The following guidelines, established by mental health and law enforcement officials, are useful in assessing sexual disturbances among children. These guidelines can also help to identify the symptoms of psychological damage resulting from exposure to sexual material on the Internet.
Sexual Preoccupation
Children who have been harmed by viewing pornography may be excessively curious about or overly preoccupied with sexuality. Some children expose their genitals to others or engage in a sudden, unusually high level of masturbation.
Age-Inappropriate Sexualized Behavior
Some children may display sexual knowledge and behavior beyond what is appropriate for their ages. According to the American Psychiatric Press, this is one of the few reliable and distinguishing characteristics that identifies sexually abused children. Very young children may enact adult sexual scenarios and behaviors in their play with other children or with their dolls and stuffed animals.
Age-Inappropriate Partners
Having learned the message that sexual overtures are acceptable ways to get attention and rewards, children may enter into unhealthy relationships, particularly with older, age-inappropriate partners. Additionally, believing the myth generated by pornography that their bodies are for the use of others, young girls may become promiscuous. Children preoccupied with sex may attempt to engage younger children in sexual behavior because younger and smaller children are easier to manipulate and often more cooperative.
Aggressive attempts to undress, sexually touch, or engage in intercourse with others are not uncommon among sexually preoccupied children. When a tendency toward secretive play combines with intense sexual preoccupation, a child may be vulnerable to repeating his or her abuse with other children in ways that can create chaos and further victimization. Such a child requires extensive parental supervision and therapeutic help.

Signs of Sexual Abuse
There are various possible physical and behavioral indicators of child sexual abuse, including: 
- Waking up during the night sweating, screaming or shaking with nightmares.
- Masturbating excessively.
- Showing unusually aggressive behavior toward family members, friends, toys, and pets.
- Complaining of pain while urinating or having a bowel movement, or exhibiting symptoms of genital infections such as offensive odors, or symptoms of a sexually transmitted disease.
- Having symptoms indicating evidence of physical traumas to the genital or anal area.
- Beginning to wet the bed.
- Experiencing a loss of appetite or other eating problems, including inexplicable gagging.
- Showing unusual fear of a certain place or location.
- Developing frequent, inexplicable health problems.
- Engaging in persistent sexual play with friends, toys or pets.
- Having inexplicable periods of panic, which may be flashbacks from the abuse.
- Regressing to behaviors too young for the stage of development they have already achieved.
- Initiating sophisticated sexual behaviors.
- Indicating a sudden reluctance to be alone with a certain person.
- Engaging in self-mutilations, such as sticking themselves with pins or cutting themselves.
- Withdrawing from previously enjoyable activities, like school, or a sudden change in academic performance.
- Asking an unusual amount of questions about human sexuality.
(By Kathy Smedley, Licensed Professional Counselor, a Licensed Marriage, Family Therapist, and Program Director for the Northeast Texas Children's Advocacy Center.)

Helping Children Deal with the Trauma of Online Sexual Exploitation
The best way to reduce the suffering of a child traumatized by pornography or sexual predators on the Internet (or by any other medium) is prevention. If your child tells you that he or she has seen or read something on the Internet of a sexual nature, or has had contact with a sexual predator and appears to be experiencing some trauma from that experience, talk with your child about it and, if necessary, seek professional help. Identifying, and sometimes discussing the signs and symptoms of psychological damage is a first step to relieving the child's suffering. Try to provide opportunities to talk about feelings. When hearing and accepting that a child's feelings are difficult, therapy involving the child and the family is often necessary. The following is a recommended strategy if you think your child has been abused, traumatized, or sexually exploited while on the Internet:
- Believe your child! Children rarely lie about sexual abuse or trauma.
- Commend your child for telling you about his or her experience.
- Convey your support for your child. Your child may fear that he or she is at fault and responsible for viewing the pornography or interacting with a sexual predator. Try to alleviate this self-blame.
- Temper your own reaction. Recognize that your response sends a critical message to your child. Your greatest challenge may be suppressing your own horror.
- Report the suspected illegal online activity to your local police. In some communities, the local police department is equipped to investigate computer crimes, such as online solicitation of a minor. Also report such incidences to the CyberTipline: 800-843-5678 (www.missingkids.com).
- Locate a specialized agency that evaluates sexual abuse or trauma victims - a hospital, a community mental health therapy group, or a child advocate agency.
- If your child has been physically abused as a result of contact with an online predator, contact a physician with experience and training in detecting sexual abuse.
- Talk with your child's teachers, baby-sitters, other parents, and adults who have supervised your child while he or she has been online.
- Hughes, Donna Rice, "Child Sexual Abuse", http://www.protectkids.com/abuse/, 2001

Recognizing Child Abuse
The following signs may signal the presence of child abuse or neglect.
The Child:
- Shows sudden changes in behavior or academic performance.
- Has not received help for physical or medical problems brought to the parents' attention.
- Has learning problems (or difficulty concentrating) that cannot be attributed to specific physical or psychological causes.
- Is always watchful, as though preparing for something bad to happen.
- Lacks adult supervision.
- Is overly compliant, passive, or withdrawn.
- Comes to school or other activities early, stays late, and does not want to go home.
The Parent:
- Shows little concern for the child.
- Denies the existence of—or blames the child for—the child's problems in school or at home.
- Asks teachers or other caretakers to use harsh physical discipline if the child misbehaves.
- Sees the child as entirely bad, worthless, or burdensome.
- Demands a level of physical or academic performance that the child cannot achieve.
- Looks primarily to the child for care, attention, and satisfaction of emotional needs.
Signs of Sexual Abuse
Consider the possibility of sexual abuse when the child:
- Has difficulty walking or sitting.
- Suddenly refuses to change for gym or to participate in physical activities.
- Reports nightmares or bedwetting.
- Experiences a sudden change in appetite.
- Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior.  
- Becomes pregnant or contracts a venereal disease, particularly if under age 14.
- Runs away.
- Reports sexual abuse by a parent or another adult caregiver.
Consider the possibility of sexual abuse when the parent or other adult caregiver:
- Is unduly protective of the child or severely limits the child's contact with other children, especially of the opposite sex.
- Is secretive and isolated.
- Is jealous or controlling with family members.

- National Clearinghouse on Child Abuse and Neglect Information. (2003). Recognizing Child Abuse: What Parents Should Know. Prevent Child Abuse America. Retrieved from http://nccanch.acf.hhs.gov/pubs/factsheets/signs.cfm

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