Parents must be made aware of warning signs of child sexual abuse: Psychiatrists

BY Ruwan Laknath Jayakody

Given the high prevalence of child sexual abuse and the devastating psychological consequences, for the purpose of prevention and early recognition, all parents should be aware of the importance of supervision, the characteristics of perpetrators, and the common signs of child sexual abuse, child psychiatrists noted.

This concern was raised in an article on “Child sexual abuse: What parents need to know” which was authored by Y.M. Rohanachandra and was published in the Sri Lanka Journal of Child Health’s 50th Volume’s Fourth Issue in December 2021. 

Child sexual abuse is defined as the involvement of a child in sexual activity that he/she does not fully comprehend, is unable to give informed consent to, or that violates the laws or social taboos of the society, and may include the inducement or coercion of a child to engage in any unlawful sexual activity, the exploitative use of a child in prostitution or other unlawful sexual practices, or the exploitative use of children in pornographic performance and materials.

The prevalence of child sexual abuse in Sri Lanka ranges between 14%-44%% (A.S.A. Abeywardene, S.H. Atukorale, K.K.D.C.C. Abeynayaka, and T. Athauda’s original article on “A (retrospective) study on the knowledge and prevalence of sexual harassment and abuse among school boys in the Colombo District” showed a prevalence of sexual abuse among adolescents of 21.9%), with the rates of sexual harassment being as high as 78.5%. 

Even though child sexual abuse is a major public health problem, studies show that parental awareness about child sexual abuse is limited and that myths and beliefs held regarding child sexual abuse are common (parents oft believe that it is a rare phenomenon, and that most children are abused by strangers, and that in the case of delayed disclosure on the part of the child, the latter was a voluntary participant in the abuse) and that this lack of knowledge may in turn lead to the delayed recognition of the same.

In a research based letter to the editors of the Ceylon Medical Journal in January 2016, on the “Characteristics of victims of alleged child sexual abuse referred to a child guidance clinic of a children’s hospital”, which was authored by Rohanachandra, D.M.A. Dahanayake, P.A.S. Pathigoda, and G.S. Wijetunge, they referenced the findings made from a retrospective, descriptive study (with a consultant psychiatrist assessing the psychological consequences and diagnosis being carried out per the International Classification of Diseases 10th Edition) carried out on all 35 children referred through courts or the relevant judicial medical officer to a Child Guidance Clinic conducted at the Lady Ridgeway Hospital for Children, from 2010 to 2014-2015, due to alleged child sexual abuse. 

In terms of biological sex, the majority (57.1%) was female. Age wise, the commonest (nine) age group was 12-14 years. With regard to the location, the majority (60%) were from the Colombo District. In nine (25%) cases, the parents were separated and in five cases (14%), the mother was abroad. In all the cases, the perpetrator was male and the majority (29 – 83%) were known to the child (a neighbour in seven cases, the father in six cases, an uncle in four cases, a teacher in two cases, and an older child in two cases). In the majority (29), only a single perpetrator was involved. In 23 (66%) cases, the abuse occurred on several occasions at the hands of the same person. Threats or violence were used in 17 (49%) cases and rewards were given in seven (20%) cases. The commonest form of sexual abuse was non-penetrative contact (17 – 49%) (which, Rohanachandra et al. pointed out, may often go undetected by the parents due to the lack of physical evidence) while co-existing forms of child abuse such as physical abuse and neglect were present in 13 (37%). There was penetrative contact in 17 cases (genital in eight, anal in six, and oral in three). Psychological consequences were present in 24 (68%), with post-traumatic stress disorder (PTSD) being the commonest (seven – 20%), followed by adjustment reaction (in six), sexualised behaviour (in five), anxiety disorder (in three), adjustment disorder (in two), and depression (in one).

Per M. Stoltenborgh, M.H.V. Ijzendoorn, E.M. Euser, and M.J. Bakermands-Kranenburg’s “A global perspective on child sexual abuse: Meta analysis of prevalence around the world”, child sexual abuse is commoner in females. D. Glaser’s “Child sexual abuse” notes similarly that the highest rates of child sexual abuse have been reported from among adolescents. Abeywardene et al. have shown that the mother living abroad is a risk factor.

Also per Glaser, worldwide, the majority of abusers are male and known to the victims. That said, T. Dias, A. Kociejowski, S. Rathnayake, S. Kumarasiri, S. Abeykoon, and T. Padeniya’s “Sexual violence against women: A challenge” showed most perpetrators to be strangers. Most abuse occurred at the child’s home (15 – 43%) and at the perpetrator’s home (11). This, Rohanachandra observed, shows that the perpetrator is someone who has easy access to the child. S.W. Smallbone and R.K. Wortley’s “Child sexual abuse: Offender characteristics and modus operandi” shows that perpetrators gain the compliance of children by way of grooming behaviour (where the offender pays special attention to the child and gains the child’s and the caregivers’ trust by using tactics such as gift giving, flattery, gifting money, and meeting other basic needs), rather than by threats. In contrast, threats or violence had been used in 17 (48.6%) cases with rewards being given only in 20% of the cases.

Abeywardene et al. showed oral and intra-crural sex (a type of intercourse generally regarded as non-penetrative sex, in which a male partner places his penis between a male or female partner’s thighs, and thrusts to create friction and achieve orgasm) to be the commonest forms, with 10.7% being penetrative sex. In the present study, the percentage of anal penetrative sex in boys was higher (17.1%). Glaser too has reported that different forms of child abuse and neglect frequently co-exist.

Psychological consequences have been reported in up to two-thirds of victims, per Glaser while PTSD was present in 48%. In the present study, the rate of PTSD was lower (20%), which according to Rohanachandra et al., is most likely because the data included findings at the first visit following abuse, while PTSD may develop up to six months after the initial abuse.

Rohanachandra et al. also noted that the study sample was derived from referrals to a Child Guidance Clinic and, therefore, may not represent all children subjected to child sexual abuse as only some make complaints and are then referred for assessment. 

In their recommendations, Rohanachandra et al. emphasised that since a majority of the perpetrators are known to the victims, public education programmes should address the need to recognise the danger that exists at home in addition to the danger posed by strangers. They also called for clinicians to be vigilant about the fact that child sexual abuse frequently co-exists with other forms of abuse. Also, since the majority show psychological consequences, Rohanachandra et al. called for all children to be screened for psychological problems following abuse so as to minimise the adverse outcomes.

Hence, Rohanachandra reiterated and highlighted the fact that both the parental lack of supervision and neglect are risk factors for child sexual abuse.

If you’re affected by the above content or if you/someone you know may be dealing with a similar situation, the following institutions would assist you:

Police Child and Women Bureau: 011 2444444

NCPA: 1929

LEADS: 011 495 4111

Ministry of Child Development and Women’s Affairs helpline: 1938