Meeting Child Victims' Needs After Sexual Abuse

Guests

Mitru Ciarlante, Youth Initiative director, National Center for Victims of Crime
Teresa Huizar, executive director, National Children's Alliance

In the wake of high-profile child sex abuse scandals, the public often focuses on the accused. Victims and their needs often draw far less attention. Experts who work with young victims explain how children respond to abuse, and what treatment options can help them cope with the aftermath.

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BRIAN NAYLOR, HOST:

This is TALK OF THE NATION. I'm Brian Naylor in Washington. Neal Conan is away. The investigations into allegations of sexual abuse at Penn State continue. Jerry Sandusky, the former defensive coordinator, faces 40 counts of abusing young boys. Nearly 10 additional suspected victims have reportedly come forward since his arrest.

Last night on NBC's "Rock Center," Sandusky declared he is innocent. He said that he did shower with several boys and take part in what he called horseplay, but he insists he is not a pedophile. A jury will ultimately decide the facts of this case, but the latest allegations focus attention on the many victims of childhood sexual abuse - how they respond, and the treatment options available to them. And we should note that this segment may include graphic language and descriptions.

If you've been a victim of childhood sexual abuse, what helped you overcome the incidence? Our number is 800-989-8255. Our email address is talk@npr.org, and you can join the conversation at our website. Go to npr.org, and click on TALK OF THE NATION.

Later in the program, Matt Continetti of The Weekly Standard joins us, to argue that it's important for Republicans to reclaim the high ground on income inequality.

But first, Mitru Ciarlante joins us from the studios of Oregon Public Broadcasting in Portland. She's director of the Youth Initiative at the National Center for Victims of Crime. Welcome to the program.

MITRU CIARLANTE: Thank you.

NAYLOR: And did I get your last name pretty close? Ciarlante?

CIARLANTE: Excellent. Good job.

NAYLOR: Thanks. Mitru, let me ask first. How do children tend to respond to abuse?

CIARLANTE: Well, the way children respond to sexual abuse depends greatly on their life situation at the time the abuse occurs; the relationship to the offender. And probably one of the biggest factors is their age and developmental stage at the time of abuse. But, you know, I can tell you some general things about how children respond.

NAYLOR: Please. How does it vary in terms of age?

CIARLANTE: Well, a child's understanding of what is happening to them will vary depending on their age. For some young children, you know, they may not identify what's happening. They may not have the vocabulary to identify it as something actually sexual. It may or may not feel physically bad, depending on how it's perpetrated. And just their understanding of the whole thing varies, depending on, you know, where they're at in their developmental process cognitively, emotionally.

But I think what it does for all children who are abused sexually, it's a great betrayal of the trust that they had. Most of the time, the abuser is someone known and trusted by the child and the family. So one effect that sexual abuse has on children is to betray that trust that they had, that adults are here to take care of children and look out for children and help keep them safe.

NAYLOR: And the symptoms - I guess there are physical ones as well as emotional symptoms.

CIARLANTE: Sure. Younger children may develop a generalized anxiety or fear that, you know, gets externalized to many parts of their environment. In victims of all ages, it's not uncommon to see depression, eating problems. Younger children might complain of tummy aches as their anxiety comes out that way. And sleeping problems are also common.

With the older youths, sometimes it's harder for adults to have that compassion and identify what's happening with teens as a potential problem that needs intervention because with adolescents, we may see more acting out, behavior that gets labeled defiance, as some of their emotional reactions come out as anger.

NAYLOR: Hard to tell, sometimes, the difference between what might be considered the normal actions of a teenager.

CIARLANTE: That's so true. And it's really hard to tell, when we see changes in children, how much of that are changes that are just because of development or changing grades, changing schools. So what we would really encourage parents and other adults to understand is that when we're seeing any of these changes in children and teens, it may not be sexual abuse or victimization. But it's certainly a time to get closer to that child, inquire more in a non-pressuring way, to try to be that trusted adult that's available so that the process of disclosure could begin.

NAYLOR: Now for, you know, I guess you might say the grooming process, how a predator develops his prey, it usually is - it's over a period of time, right? It's not right away. They try to work on gaining the trust of children that they want to prey on?

CIARLANTE: Yes. Child sexual abuse is often a process of that abuser carefully gaining and then abusing the trust of the child and their parents, or the other adult caregivers in their world. So, you know, the relationship may be developed gradually in a very non-threatening way. And that's important if a predator's going to be successful. They need to not exhibit any red-flag behavior or, you know, boundary violations that might warn the parents.

Usually, you know, those behaviors that we would consider inappropriate and intrusive will be introduced more slowly and gradually, not to alarm the child. At the same time, there's an emotional conditioning that's happening, whether it's making promises to the child or giving their family benefits that the child, you know, realizes that this person helps our family. Mommy and Daddy like and trust this person. You know, it's a complex process.

NAYLOR: Do – does abuse - is sexual abuse always physical?

CIARLANTE: I'm glad you brought that up because children and teens experience a wide range of sexually abusive behaviors, and not all of them involve touching. And today, you know - well, exposure to pornography is age-old, but we also have the electronic exposure to inappropriate material, or what's called sexting; or adults exposing themselves to the children. So there is a range of behavior that may not get to the point of touching, but it still has, you know, a psychological effect on the child.

NAYLOR: And do children - I think sometimes they feel like they have done something that has brought the abuse on, that they've kind of invited the abuse. And how is that - make it - I guess that makes it more difficult for children to tell an adult that something's happened.

CIARLANTE: Yes, Neal. That is part of the difficulty for children in disclosing, as well as one of the hurdles survivors have to overcome. The self-blame, blame, the feeling that victims were somehow complicit with the abuse. And for the rest of us, you know, looking at these situations, it's helpful for us to understand how powerful the conditioning is that the abuser uses. It may be spoken. It may be very overt - as in, you know, telling a child, you make me do these things. I know you want this. Or even telling a child there's something about them that makes an abuser touch them in these ways.

But even if it's not said out loud, the victims often internalize that - you know, we look around the world and say, why me? Why is it happening to me? I must be bad, or there's something wrong with me. I think that's one of the really heartbreaking things to hear in counseling adult and child survivors of victimization, that self-blame and feeling that all along, they were dirty or bad in some way, and that's why this happened.

NAYLOR: We're speaking with Mitru Ciarlante. She is the director of the Youth Initiative at the National Center for Victims of Crime. And we'd also like to hear from you via emails, or you can give us a call at 800-989-8255.

Let's take a call now from Laura(ph). Laura, you're on the line from Worcester, Massachusetts. Welcome to TALK OF THE NATION.

LAURA: Hi.

NAYLOR: Hi.

LAURA: I guess I was asked if I'd tell a little bit more. I'm middle-aged now, and it's been a whole lifetime of recovering. I was abused by family members as well as several other boys, when I was a child. It went on for years. I was told later, when I saw a psychiatrist, that - I actually developed psychotic symptoms - and he said, you know, it's no wonder because you don't really know what's real. And I didn't.

I had no support, and I have endured a lifetime of shame and family still hiding or not talking about it or, in a sense, elevating the person - one of the persons who did it, because he died. And I've had so many treatments now. And one of the things I've done is just admit to myself what is real. You know, I've been really honest with people with whom I can be honest. As I said, it's been a lifetime. I feel really weird saying it, but a lifetime. And I've had treatments as different as Suboxone, which is taken as an opioid. I have had - I think it's called electrical magnetic stimulation of the brain.

And I've been told that things are forever changed, that your amygdale is, and your hippocampus is - and the whole axis - I think it's called HPA axis. And I've met some survivors, and they've experienced the same things and yet, you know, when you compare yourself to other people, you have to be wary that they are in recovery far enough so that you don't become a victim of the retelling, which can really be problematic if you want to move on with your life.

NAYLOR: All right. Well, thank you. Thank you, Laura, for sharing that with us. Mitru, I'm just wondering if that is something that you hear often - that it's just completely life- altering.

CIARLANTE: Absolutely. I mean, physically, the alterations in the brain that Laura referred to, that's accurate. And I do want to also thank Laura for telling her story and helping to break the stigma because that's part of what keeps child sexual abuse flourishing. And it's helpful for survivors to know that you're not alone because the surviving - some people don't say they're survivors; they say they're surviving child sexual abuse because it can be a lifelong process.

When children and adolescents are developing, the actual physical structures in their brain are developing much like a house - the wiring, the plumbing, the foundations - and when trauma happens during those crucial developmental times, it's like a wrecking ball. It knocks out those structures and, you know, this is all part of the healing process that Laura was helping to describe.

What's amazing is that our minds do some pretty amazing things to help us cope and survive.

NAYLOR: We're talking about victims of childhood sexual abuse, the lasting effects and the treatment options available to help. If you've been a victim of childhood sexual abuse, what helped you overcome the incident - 800-989-8255 or by email, the address is TALK@NPR.org.

I'm Brian Naylor. This is TALK OF THE NATION from NPR News.

(SOUNDBITE OF MUSIC)

NAYLOR: This is TALK OF THE NATION from NPR News. I'm Brian Naylor. Some 80,000 children report cases of sexual abuse every year. That's not counting the children who never report what happened to them.

We're talking today about what happens to victims after they're abused - the effects that linger for a lifetime, and the treatment options that are available to help them understand what happened.

If you've been a victim of childhood sexual abuse, what helped you overcome the incident? Our number is 800-989-8255. Our email address is talk@npr.org, and you can join the conversation at our website. Go to npr.org, and click on TALK OF THE NATION.

Our guest is Mitru Ciarlante. She's director of the Youth Initiative at the National Center for Victims of Crime, and she joins us from Oregon Public Broadcasting. And here in Studio 3A is Teresa Huizar. She's the executive director of the National Children's Alliance. Thanks very much for coming in today.

TERESA HUIZAR: Thank you for having me.

NAYLOR: Teresa, let me ask. To begin with, how do you help a victim understand what happened to them?

HUIZAR: Well, I think, obviously, that's going to vary some by age, but part of it is having the child's disclosure in and of itself. You know, hearing that, a part of evidence-supported mental health treatment includes having kids tell their story. We call that a trauma narrative. And one of the reasons we have them do that is so that we can try to correct the sort of cognitive distortions your prior caller was talking about - the sense that it's their fault, the sense that they've done something wrong.

And so having them talk about it in that way provides an opportunity to have them re-evaluate and think about - is that really possible that it's their fault? Is that really true? And it's an opportunity for the professional to correct those myths.

NAYLOR: So that's a treatment that works. Do we know what treatments don't work or things that have been tried over the years?

HUIZAR: I am really glad you asked that because I have a feeling that many of the callers today will be adults who, at the time of their victimization, unfortunately did not have evidence-supported mental health treatments available to them.

The research around what actually works in this field is quite recent and, more or less, over the last 15 years, we've learned a tremendous amount about the types of treatments that work, and a whole list of treatments that don't work.

I think, if callers are interested in learning about treatments that work with kids, the National Child Traumatic Stress Network at NCTSN.org has an entire list of evidence-supported mental health treatments where research says these treatments work for kids.

NAYLOR: I want to read a couple of emails that we've received. Francis(ph) from Harrisburg, Pennsylvania, writes: I was a teenager when I was abused by a man who is a serial sexual predator. What helped me heal was a healthy and loving sexual relationship with my next girlfriend, my first true love. To know that I could give myself physically to someone who truly loved me, and who was not manipulating me and taking advantage of me for his own selfish purposes, was very affirming.

How does abuse of a child affect one's later love life?

HUIZAR: Well, I think you raise a really important point, and that is that when somebody has been sexually abused, aside from simply losing the ability to trust - which is an enormous part of that, and all effective treatment tries to deal with that issue. The other thing is that there are trauma triggers, things that remind us about the trauma that we've had or in which we may re-experience that trauma. And you can imagine that physical intimacy is one of those things that may very well prompt a flashback sort of experience, where you can have this experience of feeling the sensations again - all over again - of having been sexually abused, even though right in the moment, you're with somebody that you trust and you have a loving relationship with.

And I think that having an opportunity to talk about one's sexual abuse history, and to talk about those reactions in the moment and how to cope with those, is a really important thing to help victims throughout their life develop healthy relationships and loving relationships.

NAYLOR: Another email, from Michelle(ph) in Fort Thomas, Kentucky. She writes: I have a very close family member who was abused for about a year by someone when she was about 7. She didn't tell anyone until she was 17 and, after repressing it for that long, it took a huge toll on her psychologically. She ended up being admitted nine times into different hospitals because of the psychological damage.

What happens when abuse is not reported for a long time?

HUIZAR: Well, the effects, as you can hear there, are very often compounded because the good news about effective mental health treatment is that if children disclose and people believe their disclosure and intervene and get them help, they really can have hope and healing. And that's the great news.

And the sad news is that for kids who may not feel that there's a safe person to disclose to or often the person that they disclose to, at first, doesn't believe them, in the intervening time before they finally get treatment, there's a lot of opportunity for risk-taking behavior, for self-harm, cutting themselves, suicidal thoughts, depression, anxiety. When all of those things go untreated, you can imagine the kind of long-term mental health effects of that.

NAYLOR: Let's take a call now. Mike, you're on the line with us from Madison, Wisconsin. Thanks for calling TALK OF THE NATION.

MIKE: Yes, good afternoon. Excellent topic, and I appreciate the work that your guests are doing with this because there isn't enough that can be done for children that are victims of abuse. Having been a victim of abuse myself as a pre-teenager, we were very - my family was very involved religiously - in the church. The minister of that church had his own camp during the summertime that he encouraged boys to participate in and, of course, my family and my mother and father believing that - and him being a very strong person in the community, a very upstanding person in the community, I attended this camp and it wasn't after - until a couple of years into this camp that the sexual abuse started taking place.

And when I disclosed this to my parents, one of the hardest hurdles, initially, was the fact that my parents didn't believe me, either. And my mother did. My mother was supportive. My dad was, you know, you realize what you're going to do to this family? You know, why would you do this? Why are you making this stuff up?

And, finally, when we did go to the police department, that was the attitude that was - and, of course, this was quite a while ago - but that was the attitude that was solidified by members of the police department as well; that this is a very reputable man in the community. It was a smaller community. He said, you know what? Your family's not going to want this kind of press. Nobody's going to believe this child, you know.

And we started to pursue it until that same idea was – again, was reinforced by not only the officers, by the investigators,by social workers at the time, but by the courts as well; that this can't possibly be the person that would do this. And it was becoming so devastating to our family. And I remember the arguments late at night between my mother and father, and the tear that it was causing, and my father leaving for a short period of time and...

NAYLOR: Did you - I mean, so eventually, though, you prevailed? You continued to press this?

MIKE: Well, what caused that is what was touched on slightly - is the fact that we withdrew our complaint against him, and it wasn't until several years later, when several other victims came forward, and we had the support of those other families and those other victims so that people started believing that this person actually did this. And we were all there to support each other.

And the system changed. The people started realizing that this was going on. And then we were not looked at as the terrible person who tried to ruin this man's life but as another victim - and were treated that way.

NAYLOR: Thanks, Mike.

MIKE: And that was tremendous.

NAYLOR: Thank you very much. And that raises a question I wanted to ask, and let me bring Mitru back into the conversation. Are communities - are police departments better equipped to deal with these charges now, with these cases of abuse?

CIARLANTE: Better than in the past, certainly, and you know, there are many of us - including the Children's Alliance and the National Center for Victims of Crime - a lot of our work is about equipping those police departments and local child protective services workers to be better prepared for helping children in cases like this. But I want to help people understand that when a child is sexually abused, it is a violation for their parents as well. It's a betrayal experienced by the whole, entire community when it's someone who was trusted by that community and children were put in their care.

And it's not uncommon for the family and the community to go through their own process of grief and anger and also, unfortunately for the children, denial in the beginning. And that's also why we keep talking about disclosure of sexual abuse as a process.

Many adults or children whom people think did not tell for several years actually had many incidents of trying to let someone - let an adult know what was happening to them. So we really need public awareness like this so that we can all remove some of those filters that keep us from seeing something that's so abhorrent, it's really hard to accept about our own community members and family members.

NAYLOR: Another email, from Kate(ph) in Manchester, New Hampshire: I'm a victim of childhood abuse and am aware of my coping mechanism, and have sought therapy to deal with these issues. My boyfriend is also a victim, and he refuses to seek a therapist based on bad experiences with them.

And she asks, are there signs that men tend to exhibit that are different from - men? And this is a good question. I mean, do men and women respond to - react to abuse - or boys and girls react to abuse differently?

HUIZAR: Well, one of the things that I would say about that is, the way that depression acts out in men can be somewhat different than with women. You may see more anger as a part of that than you typically may see with women. Having said that, every individual reacts somewhat differently. But when it comes to children, basic responses to child traumatic stress tend to be fairly consistent.

That is, it's not at all uncommon to have a response of hyperarousal; that is - sort of a hypervigilance, an anxiety, an increase in your startle response, to have this re-experiencing piece of it where your sleep may be disturbed, or whether you have traumatic memories intruding on your thought during the day or flashbacks to that. And then I would say the other piece of that is avoidance - that because we want to try to move away from those trauma triggers and trauma reminders, you have victims of abuse who may isolate themselves very significantly because of that.

And all of those reactions are very amenable to treatment. And so, you know, I would encourage this boyfriend to get into treatment because there certainly are some effective treatments that are available.

NAYLOR: And I want to ask, if it's a boy, a young man that's been abused, is it more difficult for him to deal with if it's another male or if it's a female? Does that, you know, change - does it make harder if he's a...

HUIZAR: I think what it may do, for some boys especially, is that they begin to question their own sexuality. I mean, if you think about it developmentally at the time that they're sexually abused, their own sexually may be formative. And so there is, I think, some additional questioning that goes along with that when it's a same-gender offense versus a cross-gender. Having said that, all sexual abuse is traumatic in nature, and all of it has significant impact on the victims that are involved.

NAYLOR: Let me ask - let's go to a call. Fred, you're on the line, joining us now from Margaret, New York. Is that right?

FRED: Margaretville, New York. Yes.

NAYLOR: Margaretville, New York. Thanks for calling us.

FRED: This is a great topic, and I wish it had been more in the public mind years ago. I'm 68, but this took place when I was 11 and 12 in summer camp. And the issue of sexual identity was what profoundly affected me. It was the most popular counselor in camp, so I felt blessed that he had chosen me. And that's what messed my mind up for many years. It wasn't until I realized that it wasn't so much a sexual thing - because the guy was not gay, and neither am I - it was a power struggle.

It was him exhibiting dominion over selected kids. And when I realized that, it freed me. And I also realized that homosexuality is not a choice. You either are or are not and - but it was difficult for me to understand that as an 11-, 12-, 13-year-old. It wasn't until I was in my late 20s that I began to really understand this.

NAYLOR: Well, thank you very much, Fred...

FRED: The point is that it's power sometimes, not so much the sexual aspect.

NAYLOR: Thanks, Fred, for calling. You're listening to TALK OF THE NATION from NPR News. And let me just ask you to - if you might for a moment - to respond to what Fred said. Is it often a power issue, or it seems that way to a child?

HUIZAR: Well, I think that certainly people abuse children for a variety of reasons. And while professionals have tried to create different typologies for sexual-abuse offenders, the truth is there are many motivations, and those vary. And in this case, it may have been power, and in others it may be sexual, and in others it may be something else. I think the important message is whatever the reason behind it, it's certainly not the victim's fault and clearly, the entire responsibility of the offender.

But certainly, the messages that are given by the offender to the child create myths in their head. I mean, what your caller just described is basically, spending a lifetime dispelling the myths in his head about why he was selected. And those cognitive distortions are precisely what high-quality mental health care can directly address.

NAYLOR: I want to read from another email, from Kate. I was a victim of abuse from the age of 9 to 15 by an older stepbrother who did not live in the house. I never revealed what happened. The recent events in the news have made me realize I need to make public what happened, and to confront this individual. So Kate is now revealing this, I guess, because of the news. How bad - or is it bad, worse when it's a brother, a stepbrother?

HUIZAR: Well, certainly it's an increased betrayal of trust. And the other complicator here is that over the course of her lifetime, this individual is going to run into that family member over and over and over again. So you can imagine how stressful this is. We have the holidays coming up. Well, imagine you're going to be thrown in at the Thanksgiving table and at family reunions, and at every wedding and other family event. And so having some coping mechanisms, and some ability to deal with the sensations of anxiety that come up when you're repeatedly exposed to someone who's harmed you in that way, I think, is critically important.

NAYLOR: Is it a coping mechanism kind of thing? Or do you need to move beyond coping with it; you need to report it.

HUIZAR: Well, certainly, I think it's important to report abuse, all abuse. That should go, you know, in my opinion, without saying; that individuals, if they have been abused, should report it. And you know, states vary in terms of the statutes of limitations, in terms of what can be criminally pursued about that. But I think there's value to reporting that, in case that individual has harmed others, and to prevent future harm of others as a part of that. I think to the extent that you can have the support of your family in directly addressing that and not sweeping it under the rug, that's also important.

But these things should be done hand and hand with a professional. I do have some concern about a caller that may say, well, I'm going to go and confront that individual. I mean, let's make sure that the caller is also safe in the doing so, and is prepared emotionally to handle what that confrontation might look like. And so I would just encourage her to reach out to a mental health professional as she plans on what her contact will be.

NAYLOR: We have received over 100 calls and emails, and we haven't been able to get to them all throughout this segment. But thanks very much for everyone, for listening and for responding. Teresa Huizar - I'm sorry - is executive director of the National Children's Alliance. She joined us here in Studio 3A. Thank you, Teresa.

HUIZAR: Thank you.

NAYLOR: And Mitru Ciarlante is director of the Youth Initiative at the National Center for Victims of Crime. She joined us from the studios of Oregon Public Broadcasting in Portland. Thank you, Mitru.

CIARLANTE: Thank you very much.

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