1. The Facts

Developing a Foundation for Understanding the Problem

Stacy looked away to hide her shock and to make her face as supportive as possible. Then she turned back toward Mary Jones, the mother of Timmy and Tammy, the seven-year-old twins in her Sunday school class.

"Well, I'm glad you told me, Mary," she said, stalling for time while thinking of a more appropriate response. "Knowing that the twins just told you about being molested by their Uncle Jimmy will certainly be important for me and the rest of the teaching team."

"Can you tell me how they understand what happened to them, or what to expect at their age as a response?" Mary asked, "I'm embarrassed at how ignorant I really am on the topic. I guess you just don't want to believe that it could happen in your home, so you don't really pay attention. I don't even know how common child sexual abuse is or how to help the kids. Maybe I would even have spotted it sooner if I had known what to look for."

"Don't blame yourself," Stacy replied. "Most people really don't know much about the topic." (Myself included, she thought.)

How well would you be able to respond to a situation like this? Or if you have responsibility for a Sunday school class or other ministry that touches the lives of young people, how well equipped is your staff to help parents, those who care for children and the young people themselves deal with the complex emotional, physical and spiritual needs of children who have been sexually abused and their families? Could you or your staff respond to the questions Mary asks about basic information? Do you know the frequency or warning signs of child sexual abuse, how children of different ages might understand what happened to them, and how best to help them deal with their experiences?

This chapter builds a foundation of knowledge for those who may have to deal with this issue in ministry situations. First we will focus on an overview of the definition and prevalence of child sexual abuse and how to recognize when it may be occurring. Subsequent chapters deal with specific questions relating to the many ways child sexual abuse impacts children and families and how best to respond in ministry situations.

What Is Child Sexual Abuse?

Any discussion needs to begin with definitions, no matter how difficult they may be. While it is painful to hear from a child that she or he may have been abused, it is next to impossible to know that reality unless we acknowledge its existence and understand what the problem is. The first and most important step in understanding child sexual abuse is admitting to ourselves that this kind of thing occurs in the towns in which we live, in the churches we attend, and in families we know and love. Child sexual abuse is hard to think about, hard to talk about and may even be hard to read about. Yet it must be discussed frankly in order to increase understanding, to help build better protection for children and to train those seeking to help persons impacted by its horror. If the following reading becomes too difficult, take a break and come back later if you need to do so. But we must learn to talk about child sexual abuse because the silence that surrounds it is the molester's greatest ally.

Child sexual abuse may include any kind of sexual act between a child and an adult or between an infant or young child and a significantly older child. Exact definitions may vary slightly from state to state, but the sexual acts may include touching the other's genitalia (by the abuser or victim or both); exposure of the perpetrator's or child's genitalia, including photography or videotaping; requiring a child to view or participate in adult sexual activity; masturbation in front of a child or by rubbing against a child; oral sex by a child to the perpetrator or the perpetrator to a child; and any type of penetration of a child's vagina or anus by a penis, finger or other object. Descriptions such as these conjure up images that evoke a response—anger at perpetrators, fear for children we love, disgust that such events occurs, disappointment in God who allows this to happen, and pain evoked by memories of hurtful sexual experiences. Yet adults who work with children must be willing to face whatever response is engendered within themselves in order to help the children and their families. For some readers, the material discussed in this chapter may bring up powerful emotions or memories. If this is the case for you, please seek the help of a friend, pastor or professional counselor to talk through your response. We cannot effectively help the children we seek to serve if we are still raw from our own pain.

Sexual activities between peers may also be upsetting, but sexual acts are not generally considered child sexual abuse unless there is a significant age difference between the children involved. (The specific legal definitions vary from jurisdiction to jurisdiction, but five years difference is a common yardstick.) Sexualized play that features adult sexual activities (simulating intercourse, for example, as opposed to "Show me yours and I'll show you mine" curiosity), is often a warning sign that one or more of the children involved has been abused. Such play should be taken seriously even if the children are of the same age. Violent, angry or repetitive sex play between peers or children who are nearly the same age, whether entered into willingly or involving coercion of one child by another, should always be taken seriously. Play between the offending children should be stopped or at least closely monitored, and the reason behind such play investigated—even when the play itself does not meet the legal definitions of child sexual abuse.

The vast majority of child sexual abuse occurs in the context of ongoing relationships. It does not require the use of physical force for the coercive abuse of an adult's emotional power over a child to occur. Bribery, playing on fears, trickery and threats of consequences are more typically utilized by an abuser to ensure compliance and silence. These are confusing to children. Telling children that something bad will happen to them if they tell about the touching game or trying to buy them off with gifts may get them to go along with the abuse and to keep quiet for a while, but these techniques can lead to emotional confusion. The violation of trust and innocence often causes more harm than the physical aspects of the abusive experience. This frequently leads to a difficulty in knowing who to trust Damaged relationships with peers, adults and God become a part of what will have to be addressed by caring adults in the healing process. Knowing how to help can be difficult, since all too often interventions intended to be caring replicate the emotional dynamics of the abusive situation and cause more harm. Later chapters address the specifics of what to consider and how to proceed.

The Scope of the Problem

The sexual abuse of children is not rare. Estimates range from fifty thousand to over a million instances per year in the United States alone. Studies of different groups have come up with a range of figures for the incidence of child sexual abuse, but it is generally agreed that one out of every four females and one out of every seven males has been sexually abused prior to age eighteen. In any group of adults gathered together for ministry or another purpose, 15 to 20 percent of the people present may have been sexually abused by an adult before the age of eighteen. Look around the next time you are at your church for the worship service and think of what these statistics mean to your community.

Most studies show children to be at risk no matter what their ethnic, religious, socioeconomic or family background may be. Children are most often abused by someone they know, and molesters usually increase the severity of their acts against children over time and have more than one victim. No evidence suggests that children who attend church or are reared in Christian homes are immune to the problem. In fact, some aspects of typical Christian child rearing may place these children at higher risk due to having been taught to "be nice"—to respect authority, to trust and obey adults, or to believe that children should be seen and not heard.

Nearly all child advocates, legal authorities and clinical specialists agree that the reported number of instances of child sexual abuse is only the tip of the iceberg, with many more adult-child sexual contacts occurring than those of which authorities are aware. Boys appear to be at less risk of child sexual abuse than girls, but this may be because of the number of incidents that are not reported by boys and their families. Boys may hesitate to tell others for several reasons.

Parents of all children—whatever their age, sex, race, socioeconomic status, religion or location—must take the threat of child sexual abuse seriously and educate themselves on identification, intervention and prevention techniques whatever the age or sex of their children.

Warning Signs

Often, when parents find out that their children have been or are being abused, they feel guilty that they did not know what signs might have warned them of the danger. Hindsight is always perfect—as any Monday morning quarterback can tell you, after the pressure is over and the rush of the responsibilities of a real-life situation are lifted, it is much easier to see what was not so obvious in the midst of crisis.

If you are looking back now, wondering why you did not see what was happening, remember that even armed with the list of warning signs given below, you might not have discovered what was happening due to efforts that were being made to keep it secret. If you are currently wondering about but have not had confirmation of abuse, the following list may help you to focus your concerns. But be careful not to jump to conclusions. The presence of any—or even most—of these indicators is not conclusive evidence that abuse is occurring. They may be pointing to some problem or concern in a child's life other than child sexual abuse. The definitive answer, unless a child discloses specific details of an abusive experience, is usually best left to a professional—and even the professional may not know for sure. But the presence of the following symptoms may alert you to the need to monitor a child's activities more closely, to pay more attention to his or her relationships with adults or to talk to the child about your concerns. For staff or volunteers working with children, this list may help highlight areas of concern to be discussed with the supervising team in your setting to deal with child abuse situations.

The discussion that follows is organized into physical warning signs, behavioral warning signs, emotional/relational warning signs, physical warning signs and spiritual warning signs. Each section begins with a vignette illustrating the sort of situation that might cause an adult concern about possible child sexual abuse. This is followed by a discussion of warning signs of a particular type. Where different patterns occur for different age groups, they will be highlighted.

Physical Warning Signs

Cheryl opened a can of cat food for Shadrach and sat down for a much-deserved cup of tea. Nursery care had been hectic at Silver Hill Church this morning, and if Mr. Jones hadn't shown up with his daughter and volunteered to stay and help, she didn't know how she would have made it through. Grabbing for the phone with one hand while she poured the hot water with the other, she heard the voice of Lorraine Highly, the mother of two-and-a-half-year-old Kelly.

"Cheryl, I'm glad I caught you at home," Lorraine started. "Kelly was really upset after church today. She told me that her 'wee-wee' hurts and that the 'new man' in the nursery hurt her. I checked her vagina and it's red, like it was rubbed or something. She says it hurts to go to the bathroom too. I hope it's nothing, but I thought you should know."

"I'm glad you called me," Cheryl responded, her cup of tea forgotten. "I'll give Mr. Jones a call and see what might have happened. I'll get back to you with whatever I find out."

Could this be a case of child sexual abuse waiting to be discovered, or has Mr. Jones picked up Kelly by the suspenders of her pants in a misguided effort to play with her and irritated her genital areas innocently? Cheryl knew enough about the physical warning signs of child sexual abuse to know that questions needed to be asked in this situation. The examples that follow will highlight these and other areas of concern.

While the physical signs may seem like the most obvious signs of child sexual abuse, they are often overlooked by parents or caretakers who may not want to be confronted with the unpleasant reality that someone is hurting their child or who may jump to a more mundane conclusion about the source of the problem. These signs are not proof positive, but they should not be overlooked, especially when present in tandem with some of the other categories of signs discussed below.

Torn, stained or bloody underwear may indicate injury or trauma.

Pain, swelling or itching in the genital area, sometimes including a vaginal or penile discharge, may be indicative of infection, irritation or abuse.

Pain in urination or defecation, or urinary or anal bleeding, may indicate an injury secondary to child sexual abuse.

Sphincter control problems may be due to physical damage to muscles in the anal or vaginal areas or may be anxiety-related due to abuse.

Pregnancy and venereal disease, especially among preteens less likely to be involved in consensual sex with peers, obviously may be signs.

Increase in physical complaints such as headaches, stomachaches or abdominal pain may be related to infection or to anxiety symptoms.

Behavioral Warning Signs

"Mrs. Smith," Ricky said, "I like the bathrooms here at the church more than the ones at my daddy's house."

Being an experienced second-grade Sunday school teacher, Karen thought she was ready for just about any answer when she followed up with the question, "Why are they better?"

"Because there are no bathtubs, and no one has to play the slide game. It hurts when my brother and I have to play that."

"What's the slide game?" Karen asked, thinking maybe there was a new toy out there she hadn't heard of yet.

"It's when my daddy takes a bath with us, and we slide down his legs and hit the stick at the bottom. Sometimes he puts that into our bottoms, and it hurts. I wasn't supposed to tell. Can you keep this a secret?"

What started as an innocent conversation has led down a road that suggests abuse. This boy's comments illustrate both age-inappropriate sexual behavior and the issue of secrecy—common signs of child sexual abuse. (And this underlines why the examples in this section need to be explicit The children will be explicit when they talk to us about their abuse experiences, and we need to be prepared to listen.)

Behavioral signs that may be indicative of child sexual abuse include the following:

Age-inappropriate sexual behavior. Knowledge of words, sexual activities or role-playing adult sexual encounters may be indicative of having had such experiences. Preschool children may unselfconsciously act out sexual encounters with dolls or in other play situations. Children who are still assisted in toileting or bathing may reveal abuse in these settings by talking about what has been done to a part of their body. In addition to telling with their words, children may also disclose by seeking to initiate behaviors with which other adults have involved them in the past. These may seem "flirty" and cute or be hugely out of place. When a four-year-old girl strokes an adult man's leg and asks, "Do you like it when I touch you there, honey?" she's not trying to be funny or to "come on" to him. She is showing the confusion of intimacy and sexuality that results from other adults introducing her to words and deeds she is too young to understand. (One girl told me in treatment that she touched other men like that because "that's what you do when you like a man"—something her father had taught her.) Family members, friends and those in ministry situations with children need to remember that a child showing these behaviors is not being "promiscuous" but more likely is signaling a need for help.

Use of names for genitalia and other body parts different from those taught at home or used by family may be indicative of having been in a setting where those names were used in an abusive situation. Parents need to correct the use of vulgar or inappropriate language but also need to be on the alert to where their children are learning it and what else may also be happening. This can be done calmly and quietly—"Johnny, you just called your private parts by a different name than we usually use in our family. We usually call a boy's private part his 'pee-pee' but you just used 'wiener.' It's OK to use lots of different names (or 'That's a name I don't like to hear you use,' depending on how you feel about the particular name), but I'm just wondering where you learned that one." This can be easy to overlook, and many adults feel asking questions like the one suggested above is just looking for trouble. But when asked in a quiet and supportive way, such a question may open a door for a child to talk about sexual abuse.

Changes in performance at school These may be related to wandering thoughts that keep replaying the abusive experience, difficulty concentrating, daydreaming about how to escape from abusive situations, or lack of sleep due to being kept awake at night. A school phobia—sudden dislike or refusal to attend school, or fear of a teacher—likely indicates some sort of dissatisfaction with what is happening there. Being upset when picked up from school may reflect what is happening at home. Either may be indicative of abuse.

Delinquency or running away. For some children this is the only solution to an intolerable home life that includes sexual abuse.

Sleep disturbances. Nightmares, fears of "monsters," bedwetting and difficulty with going to bed may be indicative of sexual abuse. This may be because the abuse occurred in a bedroom or similar setting. Other times it is because memories return and become overwhelming as the child begins to relax and wind down from the daily routine, which allowed him or her to focus attention elsewhere. Sometimes children initially report their experiences of child sexual abuse as dreams or nightmares because they believe that they dreamed them or because they were told by the abuser that the events were not real but only a dream. Parents should listen to the content of dreams that their children talk about with one ear tuned to the possibility that a real event may be being discussed.

Changes in eating patterns. Either a decrease or an increase in food consumption may be a sign. Some people "eat their feelings" when upset, and others are unable to eat at all when worried, frightened or emotionally troubled. A sexually abused child may exhibit either pattern. Trouble with chewing or swallowing (with no apparent physical cause) may be related to replication of the physical motions of a sexual act, recalling the memories.

Emotional and Relational Signs

Ryan always seemed down on himself, distant from the other kids in his middle-school youth fellowship and sickly with frequent headaches and stomachaches. His one good friend was Joe, a popular, self-assured young man who had reached out to him and drawn him into youth group activities. But now Joe was confused; Ryan had told him they couldn't befriends anymore because there were things Ryan was afraid he might tell Joe that would get them all in trouble. Ryan stopped coming to the youth group, and Joe went to his youth group leaders wondering what to do.

Joe knew enough to verify his feeling that something was probably wrong in Ryan's life. Isolation, worry about revealing secrets and sudden withdrawal from emotional intimacy can all be signs of child sexual abuse.

Poor peer relationships. Aggressive acting out or protective withdrawal may be the result of having been sexually abused. Children may become overly assertive to keep potential abusers at a distance, or they may distance themselves from relationships in order not to become close to someone and run the risk of telling the secret that they are not supposed to mention. Some relationships with peers, adults or younger children may become sexualized because intimacy is confused with sexuality due to previous sexualized relationships. Or anger at being abused may be sexualized and acted out toward other children.

Fear of certain formerly comfortable people or places. This fear may arise because of threats made about keeping abuse secret or fear of a repetition of abuse should the child return to that person or place.

Regression. Acting like a younger child or losing recent gains (like toilet training or the ability to sleep the night through in his or her own bed) is one of the ways that a child could signal some sort of emotional trauma, including sexual abuse.

Anxiety-related illnesses. Brought on by the stress of the abuse or the impact of having to keep a secret, some anxiety-related illnesses may include headaches, gastric disturbances, sleep disorders, eating problems and the like.

Secretive talk in relationships. Telling parents or other significant adults that there are secrets that cannot be discussed with them or starting to talk about an issue, then stopping, saying, "I can't tell you about that," may be a sign. Adults can help a child understand the difference between a secret—some fact, idea or action that cannot be shared with anyone, and a surprise—a planned event where part of the fun is not telling anyone until the moment when they get to find out. Surprises are fun, and the whole point is the eventual disclosure of the planned event; secrets often involve activities of questionable legal or moral standing, and children should not be made to carry the weight of them. Talk about this in real-life situations, buying presents for Mommy's birthday, for instance, where the adult doing the shopping can emphasize the fun of not telling Mommy for now and surprising her with the gifts later. This can be contrasted with secrets, which often involve breaking rules or doing something wrong that we may be told not to tell others but which children should be sure they do tell their parents, for protection and so that healing and forgiveness may be brought into the situation.

Poor self-concept. Seeing one's self as bad may be a sign of sexual abuse. Sometimes the offender has prompted the child to violate his or her own sense of what is right and wrong. Or the offender may have told the child that what he or she did was wrong and that the child must not tell anyone about it since he or she would get in trouble for being bad. Children (and adult survivors of child sexual abuse too, for that matter) often have a sense that the problem is deeper than doing something bad. They believe that in some sense they have become bad by virtue of participation in a forbidden act. Forgiveness rituals appropriate to the child's religious community (prayer, Bible reading, confession and absolution, communion) often help by bringing the reality of God's forgiving grace to bear on the problem.

Depression. Depression may be brought on by child sexual abuse. In addition to feeling bad about oneself, symptoms may include a change in appetite, sleep disturbances, loss of interest in previously enjoyed activities, a feeling of emptiness or sadness, loss of energy, isolating and a wish to avoid life—even, in extreme cases, a desire to be dead. For some children this is related to a feeling of being trapped in the abusive situation and not seeing any way out. These children may feel relief when the story is told. For others, who believe that they are bad and all they do is wrong (perhaps they have been helped to this conclusion by the abuser), telling may create even more problems. It may make them see themselves as someone who can't even be trusted to keep a secret and who gets family or friends in trouble by talking about what should never be voiced.

Signs of decompensation. Children in severe situations may seem to be falling apart psychologically. Symptoms may include inability to function at home or school, suicide attempts and psychotic episodes in which contact with reality is lost. These symptoms are always warning signs that something is seriously wrong in a child's life, and professional help should be found quickly. Sexual abuse is not, however, always the cause. Piecing together the puzzle to determine what the symptoms mean, where they came from and how best to help can be a very difficult task. The assistance of a trained mental health professional is often needed.

Spiritual Signs

"No! Mommy, I won't pray for Uncle Tommy anymore. I don't care if God never helps him to find another job! Besides, prayers don't work anyway. God lets bad things happen, and I don't think he really cares about me anymore!"

Frustration and anger with God can come from many sources; one that is often overlooked is child sexual abuse. When children who have known and loved God begin to turn away from him, the following warning signs should be considered to assess the possibility that abuse has occurred.

Anger at God for "letting bad things happen" is a frequent post-abuse symptom for both children and their families. In children this may be manifest by changes in the way that they talk about God or by refusal to participate in formerly significant religious observances.

Refusal to pray for a specific person. Perhaps the person is the abuser or someone whom the child feels has not been protective. Or the child may respond to the idea of praying for safety or protection with the objection that God doesn't really keep people safe. That can also be a sign. Ask why the child thinks so in order to find out what the concern is, rather than shutting off communication with theological reassurances that God in fact does care. The issue may or may not be child sexual abuse, but the impact on a child's developing faith, in such instances, is serious and should be explored.

"Flight into religion." A child who has been abused may become extremely concerned about the details of religious rites and practices and seek to please God by "getting it right" (excessive time devoted to prayer or Bible study, overly zealous attendance at church functions and so on). While there can and should be solace and healing for an abuse victim in the presence of God and God's people, this is not a healthy drawing near to God but rather a desperate attempt to be perfect so that God will stop the abuse.

Belief that one is uniquely and specially sinful. This is the theological twin of the psychological self-image issue mentioned above. Children who have been abused may see themselves as the most bad, most dirty and most sinful of all people. Biblical verses that offer comfort to people aware of their own sinfulness only elicit an argument that it was not written for them, who are more sinful than even the biblical author could imagine. Such children may believe that they are forever separated from God because of what they did. Instruction, prayer and consistent love are necessary as a response. More about dealing with this reaction to abuse will be detailed in another chapter; for now it suffices to say that this pattern should be recognized as a potential symptom of abuse and not merely treated as a theological error.

Misconstrued theology. A molester may attempt to justify his actions biblically. Because most people abusing children sexually are known to them as respected adults who are a part of their lives, the teachings that they impart have impact. If, for instance, an abuser tells his young victim that God wants fathers (or uncles or teachers) to show kids how special parts of the body can make them feel good, most children would not know that what is presented to them in this way is not God's will. They might go on to conclude that sexual contact between a caring adult and a child is what God has ordained and be quite surprised and resistant when another norm is taught in Sunday school class. Or they might feel rejected when another adult with whom they feel emotionally close is not sexually active with them. The false understandings of God and God's ways need to be corrected gently but firmly, and the root sources of error require careful understanding so that the correction does not cause additional damage.

While all of these signs and symptoms should serve as red flags to warn of the possibility of abuse, none of them in and of themselves is sufficient to give certainty to a parent or caregiver's fears that a child may be in danger. They are listed here to increase awareness of the fact of child sexual abuse and as indicators that may be present in children that we know and love. Like Mary, the mother in the vignette at the opening of this chapter, we may miss the signs of abuse in children in our lives—and when we do, we need to remember the powerful forces at work keeping the abuse a secret and not blame ourselves. But when we, armed with this and other knowledge we may acquire, begin to suspect that a child may be in trouble, we can offer a sanctuary to the children by inviting them to talk about anything that may be on their minds and prepare ourselves and our ministries for the impact of a disclosure. The next chapter will look at the issue of disclosure and what to do to handle the child's needs, the family's needs and the needs of a church or ministry involved with them.