Parenting a Child Who Has Been Sexually Abused: a Guide for Foster and Adoptive Parents

FACTSHEET FOR FAMILIES

April 2008

Parenting a Child Who Has Been Sexually Abused: A Guide for Foster and Adoptive Parents

You may be a foster or adoptive parent of a child who was sexually abused before coming to your home. In some cases, you will not be certain What’s Inside: that abuse has occurred, but you may suspect it. • Educating yourself You may even be exploring becoming a foster or • Establishing family guidelines adoptive parent to a child in the foster care system; for safety and privacy many of these children have been abused or • Seeking help neglected—physically, emotionally, or sexually— before coming into care.

Child Welfare Information Gateway Children’s Bureau/ACYF U.S. Department of Health and Human Services 1250 Maryland Avenue, SW Administration for Children and Families Eighth Floor Washington, DC 20024 Administration on Children, Youth and Families 703.385.7565 or 800.394.3366 Children’s Bureau Email: [email protected] www.childwelfare.gov Parenting a Child Who Has Been Sexually Abused: A Guide for Foster and Adoptive Parents www.childwelfare.gov

You may feel confused, frightened, and “… the employment, use, persuasion, unsure of the impact the sexual abuse of a inducement, enticement, or coercion of child may have on your child and family. It any child to engage in, or assist any other is important for you to understand that the person to engage in, any sexually explicit term “sexual abuse” describes a wide range conduct or simulation of such conduct for of experiences. Many factors—including the the purpose of producing a visual depiction severity of abuse as well as others discussed of such conduct; or the rape, and in cases later in this factsheet—affect how children of caretaker or inter-familial relationships, react to sexual abuse and how they recover. statutory rape, molestation, prostitution, Most children who have been abused do or other form of sexual exploitation of not go on to abuse others, and many go on children, or incest with children.” to live happy, healthy, successful lives. As Within this Federal guideline, each State is parents, you will play an important role in responsible for establishing its own legal your child’s recovery from childhood abuse.1 defi nition of child sexual abuse. For more This factsheet discusses how you can help information, see the Child Sexual Abuse children in your care by educating yourself section of the Child Welfare Information about sexual abuse, establishing guidelines Gateway website: for safety and privacy in your family, and www.childwelfare.gov/can/types/sexualabuse understanding when and how to seek help For legal defi nitions in each State, see if you need it. Information Gateway’s Definitions of Child Abuse and Neglect: www.childwelfare.gov/systemwide/laws_ Educating Yourself policies/statutes/defi ne.cfm

The fi rst step to helping a child who may Signs of Sexual Abuse have been a victim of sexual abuse is to If you are a foster or adoptive parent to understand more about how sexual abuse is a child from the foster care system, you defi ned, behaviors that may indicate abuse may not know whether he or she has been has occurred, how these behaviors may differ sexually abused. Child welfare agencies from typical sexual behaviors in children, usually share all known information about and how sexual abuse may affect children. your child’s history with you; however, many children do not disclose past abuse What is Child Sexual Abuse? until they feel safe. For this reason, foster or Child sexual abuse is defi ned in Federal adoptive parents are sometimes the fi rst to law by the Child Abuse Prevention and learn that sexual abuse has occurred. Even Treatment Act (42 U.S.C. sec. 5106g(4)) as: when there is no documentation of prior abuse, you may suspect abuse because of the child’s behavior. 1 Although the term “parents” is used throughout this factsheet, the information and strategies provided may be Determining whether a child has been equally helpful for kinship care providers, guardians, and abused requires a careful evaluation by a other caregivers.

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 2 Information Gateway. Available online at www.childwelfare.gov/pubs/f_abused/index.cfm Parenting a Child Who Has Been Sexually Abused: A Guide for Foster and Adoptive Parents www.childwelfare.gov

trained professional. While it is normal • An older child behaving like a much for all children to have and express sexual younger child: wetting the bed or sucking curiosity, children who have been sexually a thumb, for example abused may demonstrate behaviors that • Suddenly having money are outside of the range of what might be considered normal. (See table on the Again, these are only signs of a potential following page.) There is no one specifi c problem; they must be evaluated by a sign or behavior that can be considered professional along with other information. proof that sexual abuse has occurred. The following organizations contributed to However, many professionals and the above list and offer more information organizations agree that you might consider about behavioral signs of sexual abuse on the possibility of sexual abuse when one or their websites: several of the following signs or behaviors • Stop It Now! are present: www.stopitnow.com/warnings. • Sexual knowledge, interest, or language html#behavioral that is unusual for the child’s age • Childhelp® • Sexual activities with toys or other www.childhelp.org children that seem unusual, aggressive, or • National Center for Missing & Exploited unresponsive to limits or redirection Children • Excessive masturbation, sometimes in www.missingkids.com public, not responsive to redirection or limits Healthy Sexual Development in • Pain, itching, redness, or bleeding in the Children genital areas Children’s sexual interest, curiosity, and • Nightmares, trouble sleeping, or fear of behaviors develop gradually over time and may be influenced by many factors, the dark including what children see and experience. • Sudden or extreme mood swings: Sexual behavior is not in and of itself a sign rage, fear, anger, excessive crying, or that abuse has occurred. The table on the withdrawal next page lists some of the sexual behaviors common among children of different age • “Spacing out” at odd times groups, as well as some behaviors that might • Loss of appetite, or diffi culty eating be considered less common or unhealthy.2 or swallowing • Cutting, burning, or other self-mutilating

behaviors as an adolescent 2 The list is adapted from the Stop It Now! publication, Prevent • Talking about a new, older friend Child Sexual Abuse: Facts About Those Who Might Commit It (2005). Additional information was provided by Eliana Gil, • Unexplained avoidance of certain people, Ph.D., RPT-S, ATR, specialist, trainer, and consultant in working with children who have been abused and their families. See the places, or activities website: www.elianagil.com

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Sexual Behaviors in Children Preschool (0 to 5 years)

Common: Uncommon: • Sexual language relating to differences in body • Discussion of sexual acts parts, bathroom talk, pregnancy, and birth • Sexual contact experiences with other • Self-fondling at home and in public children • Showing and looking at private body parts • Masturbation unresponsive to redirection or limits • Inserting objects in genital openings School Age (6 to 12 years) Common: Uncommon: • Questions about menstruation, pregnancy, • Discussion of explicit sexual acts sexual behavior • Asking adults or peers to participate in explicit • “Experimenting” with same-age children, sexual acts including kissing, fondling, exhibitionism, and role-playing • Masturbation at home or other private places

Adolescence (13 to 16 years) Common: Uncommon: • Questions about decision-making, social • Sexual interest in much younger children relationships, and sexual customs • Aggression in touching others’ genitals • Masturbation in private • Asking adults to participate in explicit • Experimenting between adolescents of the sexual acts same age, including open-mouth kissing, fondling, and body rubbing • Voyeuristic behaviors • Sexual intercourse occurs in approximately one-third of this age group • Oral sex has been found to occur in 50 percent of teens ages 15 and older.

For a more complete list, or if you have any questions or concerns about your child’s sexual behaviors, call the Stop It Now! toll-free helpline at 1.888.PREVENT (1.888.773.8368).

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 4 Information Gateway. Available online at www.childwelfare.gov/pubs/f_abused/index.cfm Parenting a Child Who Has Been Sexually Abused: A Guide for Foster and Adoptive Parents www.childwelfare.gov

Factors Affecting the Impact of • The age (developmental level) of the Sexual Abuse child at the time of the abuse (younger children are more vulnerable) If you suspect, or a professional has deter mined, that a child in your care has been • The child’s emotional development at the a victim of sexual abuse, it is important to time of the abuse understand how children may be affected. • The child’s ability to cope with his or her All children who have been sexually abused emotional and physical responses to the have had their physical and emotional abuse (for example, fear and arousal) boundaries violated and crossed. With • How much responsibility the child feels this violation often comes a breach of the for the abuse child’s sense of security and trust. Abused children may come to believe that the world It is very important for children to under is not a safe place and that adults are not stand that they are not to blame for the trustworthy. abuse they experienced. Your family’s immediate response to learning about the However, children who have experienced sexual abuse and ongoing acceptance of sexual abuse are not all affected the same what the child has told you will play a way. As with other types of abuse, many critical role in your child’s ability to recover factors inﬂuence how children think and and go back to a healthy life. (See the last feel about the abuse, how the abuse affects section of this factsheet, Seeking Help, for them, and how their recovery progresses. more information about healing from abuse.) Some factors that can affect the impact of abuse include: • The relationship of the abuser to the Establishing Family child and how much the abuse caused a betrayal of trust Guidelines for Safety • The abuser’s use of “friendliness” or and Privacy seduction There are things you can do to help ensure • The abuser’s use of threats of harm that any child visiting or living in your or violence, including threats to pets, home experiences a structured, safe, and siblings, or parents nurturing environment. Some sexually • The abuser’s use of secrecy abused children may have a heightened sensitivity to certain situations. Making • How long the abuse occurred your home a comfortable place for children • Gender of the abuser being the same as or who have been sexually abused can mean different from the child changing some habits or patterns of family life. Incorporating some of these guidelines may also help reduce foster or adoptive parents’ vulnerability to abuse allegations

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by children living with them. Consider need to take additional steps to help ensure whether the following tips may be helpful safety for your child as well as his or her in your family’s situation: peers. Consider how these tips may apply to your own situation: • Make sure every family member’s comfort level with touching, hugging, • With friends. If your child has issues and kissing is respected. Do not with touching other children, you may force touching on children who seem want to ensure supervision when he or uncomfortable being touched. Encourage she is playing with friends, whether at children to respect the comfort and your home or theirs. Sleepovers may privacy of others. not be a good idea when children have touching problems. • Be cautious with playful touch, such as play fighting and tickling. These may • At school. You may wish to inform your be uncomfortable or scary reminders of child’s school of any inappropriate sexual sexual abuse to some children. behavior, to ensure an appropriate level of supervision. Often this information • Help children learn the importance of can be kept confidential by a school privacy. Remind children to knock before counselor or other personnel. entering bathrooms and bedrooms, and encourage children to dress and • In the community. Supervision becomes bathe themselves if they are able. Teach critical any time children with sexual children about privacy and respect. behavior problems are with groups of children, for example at day camp or • Keep adult sexuality private. Teenage after-school programs. siblings may need reminders about what is permitted in your home when In any case, keep the lines of communication boyfriends and girlfriends are present. open, so children feel more comfortable turning to you with problems and talking • Be aware of and limit sexual messages with you about anything—not just sexual received through the media. Children abuse. Remember however, that sexual abuse who have experienced sexual abuse can is difficult for most children to disclose even fi nd sexual content overstimulating to a trusted adult. or disturbing. It may be helpful to monitor music and music videos, as well For more information about developing a as television programs, video games, safety plan for your family, see: and movies containing nudity, sexual • Create a Family Safety Plan activity, or sexual language. Limit access Stop It Now! to grown-up magazines and monitor www.stopitnow.org/downloads/ children’s Internet use. SafetyPlan.pdf If your child has touching problems (or any sexually aggressive behaviors), you may

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are actively managing the problem, they Seeking Help will feel more secure and will worry less. When one child has been sexually abused, Responding to the needs of a child who parents often become very protective of has been sexually abused may involve the their other children. It is important to fi nd whole family and will likely have an impact a balance between reasonable worry and on all family relationships. Mental health overprotectiveness. Useful strategies to professionals (for example, counselors, prevent further abuse may include teaching therapists, or social workers) can help children to stand up for themselves, talking you and your family cope with reactions, with them about being in charge of their thoughts, and feelings about the abuse. bodies, and fostering open communication with your children. Impact of Sexual Abuse on the Family Counseling for Parents and Children Being an adoptive or foster parent to sexually abused children can be stressful to Talking with a mental health professional marriages and relationships. Parenting in who specializes in child sexual abuse as these situations may require some couples soon as problems arise can help parents to be more open with each other and their determine if their children’s behavior is children about sexuality than in the past. If cause for concern. Specialists can also provide one parent is more involved in addressing parents with guidance in responding to their the issue than another, the imbalance children’s difficulties and offer suggestions can create difficulties in the parental for how to talk with their children. A mental relationship. A couple’s sexual relationship health professional may suggest special areas can also be affected, if sex begins to feel like of attention in family life and offer specifi c a troubled area of the family’s life. When suggestions for creating structured, safe, and these problems emerge, it is often helpful to nurturing environments. get professional advice.3 To help a child who has been abused, many Your child’s siblings (birth, foster, or mental health professionals will begin with adoptive) may be exposed to new or a thorough assessment to explore how focused attention on sexuality that can be the child functions in all areas of life. The challenging for them. If one child is acting specialist will want to know about: out sexually, you may need to talk with • Past stressors (e.g., history of abuse, siblings about what they see, think, and feel, frequent moves and other losses) as well as how to respond. Children may also need to be coached on what (and how • Current stressors (e.g., a medical problem much) to say about their sibling’s problems or learning disability) to their friends. If your children see that you • Emotional state (e.g., Is the child usually happy or anxious?) 3 For more information about sustaining a healthy marriage, visit the National Healthy Marriage Resource Center website: www.healthymarriageinfo.org

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• Coping strategies (e.g., Does the child to guide parents in learning new skills withdraw or act out when angry or sad?) that will help their children feel better and behave appropriately. • The child’s friendships Whether or not family therapy is advised, it • The child’s strengths (e.g., Is the child is vital for parents to stay involved in their creative, athletic, organized?) child’s therapy or other kinds of treatment. • The child’s communication skills Skilled mental health professionals will always seek to involve the parents by asking • The child’s attachments to adults in his for and sharing information. or her life After a thorough assessment, the mental Your Child Welfare Agency health professional will decide if the child If you are a foster parent or seeking to adopt and family could benefit from therapy. a child, you may wish to talk with your Not all abused children require therapy. social worker about what you discover about For those who do, the mental health your child’s history and any behaviors that professional will develop a plan tailored to worry you. Sharing your concerns will help the child and family’s strengths and needs. your social worker help you and your family. This plan may include one or more of the If your child exhibits problematic sexual following types of therapy: behaviors, be aware that you may also be • Individual therapy. The frequency required to report these to child protective and duration of therapy can vary services in order to comply with mandated tremendously. The style of therapy reporting laws in your jurisdiction.4 will depend on the child’s age and the Many adoptive parents also call their local therapist’s training. Some therapists use child welfare agency to seek advice if their creative techniques (for example, art, child shows troubling behaviors. Child play, and music therapy) to help children welfare workers are often good sources who are uncomfortable talking about of information, can offer advice, and their experiences. Other therapists use are familiar with community resources. traditional talk therapy or a combination Adoption agencies may also be able to of approaches. provide additional postadoption services or • Group therapy. Meeting in groups with support to adoptive parents who fi nd out other children who have been sexually about their child’s history of sexual abuse abused can help children understand after the adoption is finalized. For more themselves; feel less alone (by interacting information about postadoption services, with others who have had similar see the Information Gateway web section: experiences); and learn new skills through www.childwelfare.gov/adoption/ role plays, discussion, games, and play. postadoption/ • Family therapy. Many therapists will see 4 See Information Gateway’s Mandatory Reporters of Child children and parents together to support Abuse and Neglect at www.childwelfare.gov/systemwide/laws_ positive parent-child communication and policies/statutes/manda.cfm

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What to Look for in a Mental Health Therapy for children who have been Professional5 sexually abused is specialized work. When selecting a mental health professional, look Finding a knowledgeable and experienced for the following: mental health professional is key to getting the help your family needs. Some • An advanced degree in a recognized communities have special programs for mental health specialty such as treating children who have been sexually psychiatry (M.D.), psychology (Ph.D. or abused, such as child protection teams and Psy.D.), social work (M.S.W.), counseling child advocacy centers. You may also fi nd (L.P.C.), or psychiatric nursing (R.N.) qualified specialists in your community • Licensure to practice as a mental health through the organizations noted below. professional in your State (Some mental • Child advocacy centers health services are provided by students under the supervision of licensed • Rape crisis or sexual assault centers professionals.) • Local psychological or psychiatric • Special training in child sexual abuse, association referral services including the dynamics of abuse, how it • Child abuse hotlines (See the Infor affects children and adults, and the use of mation Gateway publication, Child Abuse goal-oriented treatment plans Reporting Numbers: • Knowledge about the legal issues www.childwelfare.gov/pubs/reslist/rl_dsp. involved in child sexual abuse, especially cfm?rs_id=5&rate_chno=11-11172) the laws about reporting child sexual • Child protective services (CPS) agencies victimization, procedures used by law enforcement and protective services, • Nonprofit service providers serving evidence collection, and expert testimony families of missing or exploited children in your State • University departments of social work, psychology, or psychiatry • Crime victim assistance programs in the Conclusion law enforcement agency, prosecutor’s, or district attorney’s offi ce Many people want to help children who have been sexually abused, but many • Family court services, including court struggle with feelings of anger and disgust appointed special advocate (CASA) groups as they learn more about the abuse. You or guardians ad litem may need help to resolve these struggles and to move toward acceptance of your child’s background.

5 The following information is adapted from the National If you were (or suspect you may have been) Center for Missing & Exploited Children’s Parental Guidelines in Case Your Child Might Someday Be the Victim of Sexual sexually abused as a child, dealing with your Exploitation: www.missingkids.com

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own child’s difficulties may be particularly to all of your children. Seek help when challenging, and reading this factsheet you need it, share your successes with your may have brought up diffi cult thoughts social worker, and remember that a healthy and feelings. Your courage in facing these relationship with your children allows them issues and tackling a personally diffi cult to begin the recovery process. It is in the and painful subject can actually be helpful parent-child relationship that your child to your children by demonstrating to learns trust and respect, two important them that sexual abuse experiences can be building blocks of your children’s safety managed and overcome. and well-being. Creating a structured, safe, and nurturing home is the greatest gift that you can give

Acknowledgment: Child Welfare Information Gateway would like to acknowledge the contributions of Eliana Gil, Ph.D., Director of Clinical Services for Childhelp® and a nationally known lecturer, author, and clinician specializing in working with children who have been abused and their families; and Susan A. Rich, Ph.D., a psychologist in private practice in Canada who specializes in working with children who have been abused and those with sexual behavior problems and offers consultation and training to child welfare agencies and foster and adoptive parents. Suggested Citation: Child Welfare Information Gateway. (2008). Parenting a child who has been sexually abused: A guide for foster and adoptive parents. Washington, DC: U.S. Department of Health and Human Services.

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 10 Information Gateway. Available online at www.childwelfare.gov/pubs/f_abused/index.cfm