PREVENTION OF SEXUAL ABUSE IN ADOLSCENTS

PREVENTION OF SEXUAL ABUSE IN ADOLSCENTS

Sexual abuse is common in India. A national study on child sexual abuse found that almost every child is abused sexually at least once in a life including adolescents.

It is a public health problem from various studies it is concluded that child sexual abuse (CSA) does occur and it is a reality that touches at least 40-50% of children life in India. It is need of hour to prevent child sexual abuse.

The Perpetrator

• Is mostly known to adolescent (the abuser looks like any friend or family member not an ugly monster)
• Is obsessed with victim and snares every opportunity to abuse
• Has easy access to adolescents or creates opportunities for easy access
• Intend to involve adolescents repeatedly and more aggressively over time.
• Uses rewards and/or threasts
• Lives in same community, used same roads, shops, parks, buses and trains.
• Can be found at home, school, play ground and neighborhood

Adolescents and parents may known to them but way be unaware of their personal lives or interest in children and adolescents. Secrecy plays a vital role in execution and repetition of sexual abuse and is an essential dynamic.

Disclosure or failure to disclose determine the course of abuse

• Help children speak out- Children need to know what sexual abuse is, that it is never okey and that it’s never their fault.
• Our Speak out stay safe programme Visits primary school to teach children what kind of behavior are not okey and who to turn to if they are ever worried
• Childline gives children a confidential place to turn if they are worried that something isn’t right.

Child sexual abuse and exploitation

Understanding risk and Vulnerability  (2016)

(SARAH BROWN, GERALDINE BRADY, ANITA FRANKCIN, COUISE BRADLEY NATHAN KERRIGAN AND CARCOSS SEALEY)

Two indicators of increased risk of becoming a victim of CSA or CSE were found-

• Being disabled
• Being in residential care a number of potential indicators were identified including-
• Identify demographic factors
• Alcohol and drug misuse
• Going missing/running away
• Escaping from abuse
• Family difficulties
• Association with gangs/groups
• First sexual contact at a young age
• Frequent and particular types of use of social media
• A poor relationship with parents
• An isolated position

 Definition

The English Government’s definition of CSA as set out in working together to safe guard children (HM Government 2015) is-

CSA involves forcing or enticing a child or young person to take part in sexual activities not necessary involving a high level of violence, whether or not the child is aware of what is happening.

The activities way involve physical contact including assault by penetration (for eg. Rape or oral sex) or non penetrative act such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities such as involving children in looking at or in the production of sexual images,  watching sexual activities, encouraging children to behave in sexually in appropriate ways or grooming a child in preparation for abuse (incl via internet)

Prevention of Sexual abuse

Protective Indicators

Educational programmes have been designed to reduce risk of victimisation and the completion of them may be protective. These programmes aim to teach children skills such as identifying dangerous situation, refusing an abuser’s approach, breaking off interactions help seeking, promoting disclosure and/or reducing self  blame which may help protect children from becoming a victim or being  further victimized (Dale, shanbe 2immer-Gembeck, lines, pickesing  white 2015, Kenny, cabri, thakk kolor, ryon runyon 2008, walsh, Zwi, Woold gender shlo 2015, wertele 2008)

Four empirical studies encoring child and/or kerenb group education programmes were identified in their reniew (Dale it al Kenny et at -2008 walsh ebal  Wurtele 2008). These suggest that.

• Children as young as three could be taught and understood concepts of safety and self protection skills of inappropriate touch. How ever most progremmers were implemented with 6-13 yrs olds involving parents in the programme was seen to be positive and led to increased communication about this issue between child and parents.
• Children need repeated exposure/repeated learning to retrain their knowledge although there was some evidence that information was retained upto 5 months later.
• Children reported feeling safer and feeling a sense of control following the programmes

 PREVENTION

• Adolescent must be told in a very clear unambiguous terms what constitute abuse and sexual abuse
• What should they do if someone tries to abuse or assault and
• to report everything and anything that happens without their consent and that makes them uncomfortable
• Parents must be told to give credence to such complains by adolescents and they should investigate every single such reported incidents
• Children should be told to apply preventive skills in high risk situation like
• Yelling, asking for help
• Not surrendering
• Forceful physical resistance
• Trying to refuse the perpetrators
• Fleeing the scene etc.

It has been found that above methods lead to avoidance of rape and mere requesting not to harm, pleading, crying or offering no resistance at all is associated with a higher incidence of completed rape.

ROLE OF PEDIATRICIAN

• By giving careful observation to the existence of risky behavior.
• By preventing and berating risk taking behaviours.
• Helping and spoiling risk factors.
• Assist in fostering parental skills and inter personal skills.
• Educating parents and children about sexual safety at will child visits.
• During genital examination the pediatrician can inform the child that only the doctor and select adult care gives should be permitted to see their “private parts” and trusted adult should be told if anyone else attempts to do so.
• Pediatrician can tell parents how to recognize possible signs and symptoms and how t reassure child that she or he was not at fault.

PREVENTION OF SEXUAL ABUSE IN ADOLESCENTS

PARENTS GUIDELINES

• Parents must know that adolescence is a period of experimenting, experiencing and expanding, need parental and social support to safe guard and protect them.
• Parents should maintain open communication with their children.
• Parents should help adolescents to develop good assertive skills so that they are able to say “No” to anything unethical.
• As children get bib older, can give them a code word that they can use when they are feeling unsafe. This can be used at home, when there are guests in house or when they are on a play date or a sleepover.
• Tell your children they will never be in trouble if they tell you a body secret.
• Parents should become a role model to their children so that they decide to say no to drugs and sex.
• Teach them that some body parts are private- Tell them their private parts are called private because they are not for everyone to see. Explain them that mommy and daddy can see them naked but people outside home should only see them with their clothes on.
• Teach your child body boundaries tell them that no one should touch their private parts and that no one should ask them to touch somebody else’s private parts. Sexual abuse often begins with the perpetrator asking child to touch them or some one else.
• Tell the child that body secrets are not okey- Most perpetrators will ask then to keep the abuse a secret.
• Tell your child that no one should take pictures of their private parts- This is often missed, there is whole sick world out there of pedophiles who love do take and trade pictures of naked children online. This is epidemic and it puts your child at risk.
• Teach your child how do get out of scary or uncomfortable situation.
• Tell your child that a body touch night tickle or feel good- Many parents and books talk about “good touch and bad touch” but this can be confusing because often these touches do not hurt or feel bad. I prefer the term “secret touch” as it is a more accurate depiction of what might happen.
• Tell your child that these rules apply even with people they now and even with another child.

Reading a story can help you talk to children and young people about sensitive subjects such as what to do if some on touches you in appropriately or tries to pressure you into something.

Risk indicators for Perpetration of CSA or CSE
A small number of indicators of increased risk of becoming a perpetrator of CSA were identified

Sexual abuse victimisation

The  ‘cycles of abuse’ explanation, i.e., that sexual victimisation as a child increases the risk of perpetration of abuse  is commonly cited, despite there being no clear account of the pathways by which sexual victimisation might  lead to sexual perpetration and the fact that many victims of sexual abuse do not go on to perpetrate sexual  abuse.

• Adult and juvenile perpetrators of sexual offences are more likely to have been sexually abused than offenders convicted of other (noncsexual) offences
• Adult perpetrators of sexual offences are more likely to have been sexually abused than nonc offenders
• The large majority of sexually abused children do not go on to offend, so other factors must also play a role
• Not all sex offenders have a history of sexual abuse, so sexual abuse history is neither sufficient or a necessary condition for adult sexual offending.

      

Only one study was identified in the review that specifically investigated female offenders, but this study was excluded because it did not include a comparison group of non offenders.

We therefore need to identify the other factors that play a role.  Jespersen et al. (2009) argued that being male  is the ‘leading candidate’ for a vulnerability factor, since the large majority of perpetrators are male, yet a  sizeable proportion of victims are female.

• Twice as many victim abusers were abused by females than non abusers

In a UK study (Craissati, McClurg   Browne, 2002) comparing 82 individuals convicted of CSA who reported  being sexually abused as children with 96 similarly convicted individuals who did not report sexual  victimisation, it was found that those who abused males were more likely to have been sexually abused,  compared to those who abused girls.

 Other forms of abuse and neglect

Many studies examined other forms of abuse and neglect, with the findings being mixed.  In one meta analysis  (Jespersen, Lalumiere,   Seto, 2009), sexual offenders were not found to have higher rates of physical abuse  than other offenders, while the opposite was found in another (Whitaker et al., 2008).

• More victim abusers (81%) had witnessed intra familial family violence compared to the non abusers (58%)9 and the severity of the abuse was ranked as more intense by the victim abusers than the non abusers,
• Victim abusers (71%) were significantly more likely than the non abusers (42%) to have been physically neglected,10
• A higher proportion of victim abusers (67%) had experienced supervisory neglect compared to the non abusers (40%).11

                                                                

In a survey of adolescents in the USA (Morris et al., 2002) boys deemed to be at highest risk of becoming a  perpetrator of sexual abuse had been exposed to parents who had used violence, been a victim of physical  abuse, had parents who encouraged gang membership and knew a perpetrator of sexual violence.

As with sexual abuse, we know that many people who are physically abused and neglected do not go on to  perpetrate sexual abuse and many perpetrators of CSA do not report histories of such abuse, so other factors  must play a role. The causal pathways from abuse to perpetration are therefore not clear.

Atypical sexual interests/fantasies

Atypical sexual interests and sexual fantasies of sexually abusive sex (e.g., sex with children) have been  examined as a factor that is linked to perpetration of CSA; however, very little research has been conducted in  which this issue is compared between offending and non offending samples.

It should be noted that many of the studies included in the meta analysis assessed these variables when the  perpetrators were adults and it is not possible to determine when these problems began.  If these problems  began in adulthood, then they are outside the remit of this review, with its focus on factors that can be  identified during childhood.

• adolescent sex offenders reported more exposure to sex or to pornography than other juvenile offenders (small effect size)
• adolescent sex offenders reported significantly more atypical sexual fantasies, behaviours, or

interests, or were more often diagnosed with a paraphilia (medium to large effect) .

Nevertheless, this might indicate that atypical sexual interests/sexual fantasies either begin in adolescence, or  increase risk of perpetration of CSA when they occur; i.e., it is possible that atypical interests and fantasies do  not begin in some until adulthood when they then increase the risk of perpetration of CSA.

Psychological and other factors

 Summary

These findings indicate that within childhood individuals do not ‘develop’ into perpetrators of CSA.  Studies  that compare juvenile perpetrators of CSA with other juvenile offenders suggest that the characteristics of the  populations are similar, so it is not clear that it is possible to identify children who specifically are at greater  risk of perpetrating CSA. In addition, research suggests juveniles who engage in harmful sexual behaviour are in  the main a distinct population from adults who perpetrate CSA, since most adolescents who engage in harmful

sexual behaviour do not go on to become adult sexual offenders and that most adult sexual offenders do not

begin sexual offending in their adolescence. This review has not been able to find any clear indicators present  in childhood that would suggest that an individual will become a perpetrator of CSA in adulthood. Situation and  other theories and research findings (e.g., problems with adult attachment) suggest that many indicators of  risk start/develop during adulthood and that a complex array of variables play a part – many of which are not  psychosocial (e.g., access to children) and have been under researched. Caution should also be exercised since  being ‘labelled’ as a potential perpetrator of CSA could potentially be very damaging and great care would be  needed for any ‘screening’ strategies and interventions.

 

View of various preventive programmes addressed to various group of adults

	Parents/Guardian	People working with children or teacher/coaches	General Public
Goals	To educate parents and guardians on 1- How to inform their children about sexual abuse 2- How to protect them from SA 3- How to recognize signs of (Potential) sex abuse and how to stop 4- How to strengthen a healthy family  dynamic	To educate people working with children on 1- How to inform children about prevention of SA 2- How to recognize & report	To inform public about SA To change societal behavior Media based compaign

Sexual abuse/assault is  suspected  when following leature

1-         Excessive night mare

2-         Extreme fear

3-         Sudden change in personality

4-         Significant change is eating, studying, play activities and interaction with family and friend

5-         Return of bed wetting and thumb sucking.

6-         Psychosomatc symptoms like stomach ache or headache

7-         Unexplained or unusual possession of money or gift or privilage

8-         Self harm

9-         Suspicious use of mobile/internet

10-      Unexplained trauma

 

Pass Test

This test detects sexual abuse of an adolescent by an adolescent. Ask these questions during evaluation-

1-  Power – is one adolescent using tricks, threats, bribes, physical force or black maling the other adolescent

2- Ability – is one adolescent more able

3- Status – is one adolescent in a more powerful situation like owner servants term leader etc.

4- Size – is one adolescent much larger in physique, age or strength then other.

If none of these questions answer is yes, then adolescent pass  this test and sexual abuse is unlikely.

If answer is yes, adolescents should be evaluated for sexual abuse

Prevention of sexual abuse

• Primary prevention – This is the action taken for preventing the first (and subsequent too) incidence of sexual abuse Education of care givers, parents and adolescent themselves is the key to primary prevention. Ideally this education of children should begin much before adolescence begins.
• Secondary Prevention

Involves immediate response once abuse has been reported or has occured.  Appropriate actions to identify the perpertrator may act as deterrant for repeat of abuse.

Tertiary Prevention

Prevention of consequence of sexual abuse is more important when victum is an adolescent as they face greater consequence, here parents and family are important as they constitute immediate support system.

Physician along with other experts like psychologist, psychiatrist, medical, social workers, gynecologist  and  STI experts.

School & teachers are the other important components in life of adolescents and they should be taken into confidence. Ultimately concentrating on study and/or work will help adolescent in leaving behind the episode of sexual abuse and move forward in life.

References

1. How ward Dubonitz and wendity, lane Nelson Text book of pediatrics (2011- pg 145-146)
2. MKC Nair, Baki George, Karnathss Adolescent violence, Adolescent Pediatrics (2017, Pg 67, 57)
3. S. Yamuna, Dr. A. Chenthial early risk taking behavior (Mission Kishore Uday 2013 Pg. 62-65)
4. Manson W. “Keeping children safe” the child sex oftender discumin scheme in scottland 2015 journal of Sexual aggression- 2019 Pg. 43-45
5. Brain A eb al call to keep children safe from sexual abuse A study of use and effects of the stop it now UK and Ireland helpline PDF- 2014 London Nalien Social Research.