Safe for Them and Safe for Me
By June Bond and Amy Paul
The fear of children who sexually act out is a major topic of concern for families considering foster parenting and or adopting an older child. It is estimated that one out of four girls and one out of eight boys experience sexual abuse before the age of eighteen years old. Statistics indicate that that the rate of sexual abuse for children in foster care may be as high as an astounding 75%! With these saddening statistics, we realize that caseworkers in the field are tasked with the enormous job of helping families understand this delicate issue, keeping all of the children in the home safe, and preventing false accusations of adults in the home. This article attempts to provide some basic information about children who may sexually act out and how foster families, adoptive families, and caseworkers can design and implement safety plans and therapeutic interventions for the child who is sexually acting out.
Caseworkers and foster families need to establish a precise definition of sexually acting out. A standard definition can alleviate confusion and potential wrongful allegations against the child that follow him or her for years to come. When children are designated as “sexually acting out” falsely, their options for foster care placement and adoption are dramatically reduced. An understanding of what is age appropriate sexual behavior as compared with non- appropriate sexual behavior is key in the definition. Joan and Bernard McNamara, foster parents and authors, have developed a list of behaviors (green light behaviors) that are considered normal and expected, as compared to behaviors that may illicit concern (yellow light behaviors) and behaviors that required adult supervision, confrontation and possible therapeutic intervention (red light behaviors). Green light behaviors include playing doctor or house, occasional masturbation, mutual showing of body parts to peers, the use of sexual words, and/or conversations with peers about reproduction and genitals. Yellow light behaviors move into more explicit behaviors that may become a preoccupation. These behaviors can include preoccupation with sexual themes, sexually explicit conversation with peers, sexual harassment of other children, attempting to expose another child’s genitals, simulating foreplay with toys, mutual masturbation and /or interest in pornographic materials. Red light behaviors can include touching other children, using force to expose body parts, using bulling to coerce sexual acts, compulsive masturbation, simulation of intercourse with dolls or toys, and/or penetration of other children, dolls, or pets.
Therapists state that these age inappropriate behaviors regarding sexual issues are often the result of sexual abuse. The sexual acting out can be toward self, other children, adults, or animals. The more severe forms of sexual acting out involve coercion and manipulation of others. The most common sexual acting out behaviors seen in children include: masturbation, sexual play with toys, sexualized behaviors and inappropriate boundaries to adults and other children, sexual play with animals, sexual language and knowledge that is beyond an age appropriate level, interest in looking at and/or touching genitalia, and sometimes play with feces.
It is commonly believed that children who have been sexually abused themselves are at highest risk for acting out behaviors. Children who have been sexually abused will often manifest their feelings of helplessness and anger in the very types of sexual behaviors that hurt them. It is very common for children who have recently entered therapy for sexual abuse to exhibit acting out behaviors. As many therapists recount to the chagrin of parents, therapy may initially make the behaviors worse before the behaviors get better. Recounting painful settings and the accompanying anger and anxiety can trigger sexual acting out in some children.
It is also important to note, however, some children that are not defined or diagnosed as being sexually abused also exhibit the acting out behaviors. The authors of this paper think that it is important to understand that the precise definition of sexual abuse of a child may need to be broadened. We all live in a highly sexualized world. A child does not have to go far to see sexual content on television, videos, and games. Likewise, a child does not have to venture far to hear highly sexually-tinged musical lyrics. Some children may be reacting to the highly sexually explicit world that surrounds them.
Some children who have impaired impulse responses and do not understand consequences are also at higher risks for sexually acting out behaviors. This is particularly true of children who are diagnosed with ADHD, FAS or FASE. Impulse control, combined with hormonal changes, can trigger behaviors that are considered sexual acting out. One notable work in the area of sexual abuse by Toni Cavanaugh Johnson discovered that many children who are sexually aggressive come from single parent homes that include substance abuse, domestic violence, and poor physical boundaries between family members.
Johnson has developed a scale that helps to identify behaviors in a progressing order in a continuum of sexual behaviors in children. This continuum assists in identifying behaviors as being developmentally normal to increasingly negative behaviors. The continuum ranges from Group One – Normal Sexual Exploration to Group Four – Children Who Molest. As any parent will attest, all children progress through sexual exploration stages. This will usually take a predictable pattern that ranges from playing doctor or using sexual words to the more advanced stages of exploration. The normal sexual exploration has several characteristics that include exploration with their peers that is usually based in fun and child-like innocence. The exploration is not the results of coercion and is usually voluntary. Looking at the next three stages in the continuum of sexually behaviors, there is an increasing amount of guilt and anxiety expressed or internalized by the child.
Group Two includes sexually reactive behaviors. These behaviors may be the result of sexual abuse or founded in confusion about sexual encounters and appropriate boundaries. While these reactive behaviors usually occur with peers, without force or coercion, the child will harbor guilt and shame over the event. Children in this category respond well to therapy for their sexually acting out behaviors. As the continuum progresses to Group Three, Extensive Mutual Sexual Behaviors, children may view sexual behaviors as a “typical way to relate to peers,” thus requiring extensive supervision, as well as intensive counseling to learn how to make appropriate contacts with peers. Group Four, Children Who Molest, may exhibit a full range of sexual behaviors that are on younger, small, and vulnerable children. Children in this category express their anger through sexual acts. As one might surmise, children in this category need intensive therapy, strong supervision, and the possibly of other interventions to break the cycle of sexual molestation.
While foster parents and adoptive families are equipped with training on the issues of sexual acting out, many parents confess that training is lost, when they are in the midst of an incident. The question most often asked is, “When do I know to be concerned that my child’s behavior is going beyond the normal sexual exploitation?” Some general guidelines include:
The child is preoccupied with sexual issues for an extended period of time
The child goes beyond the mutually playful stage of exploration with peers into an angry or forceful mode of exploration
The child desires to constantly be with children that are much younger or venerable in an unsupervised setting
The child seems unduly secretive about being with other children, exhibiting some degree of guilt and anxiety when questioned about the activities.
Foster parents may be asked to make a safety plan for foster children who have had a history of sexual abuse. It should be noted, however, that a foster family and a caseworker may not be aware of past sexual abuses. These abuses may be hidden deep within a child’s young mind and only surface when counseling is instituted. Consequently, we recommend the following ideas with all foster children. (Remember that some studies suggest that as high as 75% of all children in foster care may have been sexually abused.)
The suggestions are divided into two sections: 1) Structuring the environment for talking and listening and 2) Structuring the home for safety issues and the prevention of false allegations:
As stated before, children may have been sexually abused, but have not made a disclosure. The disclosure may come as a result of counseling and/or the feeling that they are now safe enough to disclose information about the abuse. Use these ideas when a child discloses abuse:
Communicate your willingness to talk
Do not be too harsh or too condoning when the child discloses information.
Assist the child with any terminology that they may need to provide accurate information
Do not “cross examine” the child. This can intimidate the child and inhibit the child’s ability to disclose information in a forensic interview.
Notify the child’s caseworker or counselor immediately when a disclosure has been made in order that the child can get services by a professional. (Remember that the disclosure may reveal information about a perpetrator who may still be abusing other child.) Remember that you are the support person, but a professional is needed to assist the child in working through the aftermath of abuse, no matter how long ago it happened.
Communicate positively on a verbal level, as well as in your body language when the child is talking to you about the abuse.
There are also suggestions for a safety plan that can prevent or reduce sexual acting out by children, as well as lessening the possibility of false accusations.
Read as much information as possible about the child before a placement is made. But remember that the child may not have disclosed abuse to their caseworker.
Use the “Rule of Three” Do not leave two children alone together. Likewise, try not to be alone with a child who has a history of sexual acting out or a history of false accusations.
Allow each child, if possible, to have their own bedroom. Make certain that doors are left open, unless the child is dressing. Children should not be allowed to visit in each other’s bedrooms.
Address small issues when they happen. Be clear and concise about the rules so that small infractions do not escalate. From close monitoring, the foster parent may be able to see a pattern of when small infractions occur, thus structuring the physical, verbal or emotional environment to circumvent inappropriate behaviors.
Have clear rules about dressing, bathing, and touching. Make certain that all residents of your home know and abide by clear boundaries.
Avoid physical horseplay. Horseplay can be arousing and can be misinterpreted by a child who has been sexually abused.
Record any sexual acting out in writing. Make certain that the therapist, caseworker, and you have a detailed copy of any acting out episodes. Pinpoint when and where the episodes have occurred so you can possibly predict trouble spots before they happen.
Do not allow children to sleep with pets.
Explore the use of baby monitors, house alarm systems, hall motion detectors, and/or portable door alarms if needed.
If a child has sexually acted out, restrict their visits to other homes that may not have a safety plan in place.
Provide a wide variety of healthy activities for a child that can provide alternative ways to vent anger and anxiety in an acceptable manner.
Make certain that all adults in the home are above reproach in their behavior so that a child does not receive mixed signals about boundary rules.
Being a foster parent is one of the most rewarding, yet difficult endeavors, that any family can do. Fostering children who have been the victims of sexual abuse adds a layer of new stressors to the already daunting task of fostering. Yet, with proper training, a structured physical environment, an open and listening heart, and access to good intervention models/counseling, foster parents can successfully parent children who have been abused and/or have a history of sexually acting out. The reward to the foster parent is knowing that they have made a difference in the life of a child. The reward to the child is the ability to overcome the effects of sexual abuse and sexual acting…thus regaining their life and dignity.
Sexualized Children Assessment and Treatment of Sexualized Children and Children Who Molest – Toni Cavanaugh Johnson and Eliana Gill, Launch Press, 1993
The Safe Team Curriculum: Preparation and Support for Families Adopting Sexually Abused Children – Bernard and Joan McNamara, Family Resources, 1990