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The impact of child sexual abuse on preschoolers

Children who have been sexually abused may display a range of emotional and behavioral reactions, many of which are characteristic of children who have experienced other types of trauma. A number of factors influence how a child reacts to a specific traumatic event including:

• Severity of the trauma
• Extent of exposure to the event
• History of or presence of other stressors
• Multiple episodes of abuse or exposure to violence
• Proximity to the trauma
• Preexisting mental health issues
• Personal significance of the trauma
• Separation from a caregiver during the trauma
• Extent of disruption in support systems during and after the trauma
• Parental mental health issues and parent distress
• Support available from family members
• Presence of supportive role models in the child’s life
• There is a growing amount of literature suggesting that genetic factors may influence the strength of an individual’s response to any given traumaticevent, producing more extreme responses in some children.
• Although many children who have experienced sexual abuse show behavioral and emotional changes, many others do not.

Preschoolers often have a particularly difficult time adjusting to change and loss. They often feel helpless, powerless and unable to protect themselves. Children in this age range are still developing the skills necessary to cope with stressful situations. They are dependent on the protection and support of caregiving adults. Preschool children tend to be strongly affected by the reactions of their parents to a traumatic event. The more severely their parents react to the event, the more likely children are to show traumatic stress-related difficulties. It is common for traumatized preschool children to show regressive behaviors. This means they might lose skills or behaviors they had already mastered, like the loss of bladder control, or that they might fall back to behaviors they had outgrown, like thumb sucking. Similarly, traumatized preschoolers often become clingy and may be unwilling to separate from familiar adults, including teachers. They may also resist leaving places where they feel safe, like their home or classroom, or be fearful of going to places that trigger a memory of a frightening experience. Furthermore, they may show significant changes in their eating and sleeping habits, like refusing to eat or waking up repeatedly during the night. It is also common for young children who have experienced traumatic events to report physical aches and pains, like stomachaches or headaches, that have no medical basis. It is believed that these physical complaints are one way in which young children express emotions, as they often do not have the necessary verbal skills to describe them.

In a very young child, you might see traumatic play in which the child re-enacts some aspect of the experience. For example, a child may act out running away from a bad man over and over again. The play may or may not be specific to the sexual abuse. You might see other signs of stress, an increase in oppositional or withdrawn behavior, tantrums, or nightmares. The child might engage in ageinappropriate sexual behavior such as trying to engage another child in oral-genital contact or simulated intercourse. The child might talk about her body as being hurt or dirty. Of course, children may have these problems for other reasons, so you cannot assume they mean the child has been abused.

It is important to note that children and adults often times view events differently. Something that an adult may view as very traumatic can be seen very differently by the child. For instance, a grandpa “tickling” a 3 year old child’s private parts may be seen by the child as game and may not understand the implications of what is happening. Even though this is very traumatic for the parent the child may not feel traumatized and show any symptoms.

A list of other behaviors that traumatized preschool children may show includes:

• Fear of separation from parents
• Crying, whimpering or screaming
• Appearing to be frozen or moving aimlessly
• Trembling
• Speech difficulties
• Fear of the dark
• Irritability
• Inappropriate sexual behavior
• Fearful avoidance and phobic reactions