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Approximately two million children in the United States experience physical or sexual abuse every year. Millions of children are also affected every year around the world. Traumatic experiences usually result in devastating impacts on child victims by changing their cognitive, physical, social, and emotional development (DiLillo et al., 2006). The impacts of sexual assault on children also spill over their immediate families and the community in general. Traumatic experiences in childhood stages usually increase the child’s risk for social problems such as anti-social behavior, teenage drug abuse, failure in school and victimization (Perry, 2002). It also leads into neuropsychiatric challenges like stress disorder, conduct and dissociative disorders as well as physical health problems, because of the injuries inflicted during the abuse. The current deterioration of human ethics, the decline of public education, increase of urban violence, and the distressing social breakdown experienced in most societies of the world are associated with the rising cycles of assault and neglect of the children (DiLillo et al., 2006). For juveniles traumatized by physical or sexual abuse, intimacy in most cases brings about confusion, pain, and fear.
Children’s Drawings and Sexual Assault
Child sexual abuse is an action where older, stronger, and more informed individuals exploit children for their own sexual and emotional fulfillment and occasionally for financial benefits. Child sexual abuse is both a physical act that involves touch and non-touch actions and a psychological act since the perpetrators fulfill their emotional and sexual needs while the children are hurt and confused (Children's Bureau Karageorge, 2008). Sexual abuse may comprise caressing a child's genitals, making the child caress the adult's genitals, having intercourse, incest, sodomy, exhibitionism, rape, sexual exploitation, or exposure to pornography (Library sources, 2011). This can be committed by any person even younger than18 years old, as long as the perpetrator is significantly older than the victim is. Sexual assault in most cases is perpetrated by the most trusted people such as the family members, known family friends like the parents’ boyfriend or girlfriend, contrary to the usual notion that sexual assault is committed mostly by strangers. The assaulters are usually well known to the children and have good relationships with them (Children's Bureau Karageorge, 2008).
This paper looks at how children’s drawings can be used to assess and help sexually assaulted children by discussing the impacts and the indicators that can help one suspect the possibility of an assault on a child. This can be through monitoring the emotional, psychological, physical, and behavioral indicators. The paper discusses how to use the picture diagrams drawn by the children to detect sexual assault, how to stimulate the children to generate diagrams that can in turn be used to assess if the child has been a victim of sexual abuse or not. The paper also looks at how the anatomical pictures can be used to identify the children who have experienced traumatic experiences in the past and how the children can be assisted.
Impacts and Indicators of Child Sexual assault
The impact of sexual assault on a child is dependent on a number of factors such as the identity of the perpetrator, duration of abuse, frequency of the exploitation, cruelty of the act or betrayal involved and the age of the kid and personality (Perry, 2002). Children are usually more traumatized especially when they know the perpetrator, making the feelings of betrayal by the people they trusted more disturbing and traumatizing than the assault itself. Boys are also susceptible to sexual abuse just as girls, though they are less probable to report the abuse (Children's Bureau Karageorge, 2008).
There are several physical indicators of sexual abuse. They include experiencing difficulty or pain while sitting, walking or running, persistent infections of the urinary tract, pain when urinating, recurrent yeast infections, venereal diseases, show of bruises or mutilation, pain, itching, bleeding or discharges in the genital areas, mysterious silence and presence of torn, strained, or bloody underwear (Library sources, 2011).
Some of the behavioral signs that may indicate likelihood of sexual assault include, exceptional secrecy, obsessive and sudden interest in sexual activities including uncommon sexual knowledge or relation with peers that is developmentally unsuitable, being involved in self-destructive conducts and being excessively submissive or withdrawn. The child may also show excessive fear on the abuser or a dreadful response when in presence of a particular gender. The victim may also show some sudden degenerating behaviors such as soiling, bedwetting and thumb sucking, sudden sleep problems like having nightmares or fear and resistance at sleeping time (Library sources, 2011). Sexually assaulted children may reveal the abuse by acting sexually or imitating what they saw done to them. This can be seen being practiced on other peers or even younger children. Occasionally, some children may approach adults in this way while innocently thinking that this is what all adults need from them (Library sources, 2011).
The psychological and emotional indicators that are common exhibited among sexually assaulted children, which parents and the care givers need to investigate include the child appearing confused, depressed, withdrawn and fearful (Children's Bureau Karageorge, 2008). They may also complain of psychosomatic symptoms such as lack of appetite, headaches, and stomachaches and may display extreme mood variations and lack of energy to participate in the normal activities with their peers or show signs of being overwhelmed in handling their duties. Children's Bureau Karageorge (2008) stresses that these symptoms are very important for the parents and psychologists to be able to assess and determine the possibility of sexual assault of the children who may not be willing to talk about the ordeal. Children who have faced traumatic experiences usually exhibit unusual and mostly inappropriate styles of socialization inconsistencies such as attachment problems. Caregivers need to handle the children with care not to kill the spirit of the child (Perry, 2002). For example, in a case a child walks over and touches the care provider, they need to respond in a kind manner to play with them and even sway the child. Alternatively, the caregiver needs to avoid interrupting the child’s play, or instantly grabbing a child since they may associate such disturbance with the historic traumatizing experience.
Equally, parents and children’s caregivers should be aware of other indicators of probable sexual abuse. One major indicator is the use of the children’s drawings that may include unusual images comprising children with blocked mouths, no hands, and drawings with obvious genitalia or sexual acts (Perry, 2002). This is because the sexually assaulted children may keep the abuse undisclosed for several reasons. Some young victims such as the infants and toddlers may not have verbal skills to be able to communicate the ordeal or at times may not comprehend what is happening. Slightly older children who can express themselves may fail to reveal the abuse because of being afraid of the repercussions, based on the threats given by the perpetrators. It may also be a result of being confused, or lack of trust whom to tell or what to say the truth owing to the fact that the perpetrators are in most cases the most trusted family members or friends (Library sources, 2011). This leaves the victims with worries whether they can be believed and sometimes fear they can be blamed for the occurrence.
Drawing is a natural communication tool of expression especially for children who have been traumatized or experienced substantial loss of either friends or family members such as in accidents. Self-expression through drawing is one means used by many including adults to convey the complexities of the crisis individuals have gone through, suppressed memories, or unspoken feelings (Library sources, 2011). Drawings conveniently reveal pertinent disturbing post-trauma experiences, thus making it possible for the professionals in case of any sexual assault to timely intervene and improve the therapist-child relationship efficiently (Library sources, 2011). It is worth noting that it is easier for the abused children to reveal the ordeal through diagrams than verbal communications making it a vital tool to initiate further investigation and plan recovery procedures of the assaulted. This therefore means that the use of children's drawing is a vital method to assess probable sexual abuse (Malchiodi, 2001).
The underlying assumption in the use of this method is based on the belief that emotionally distressed children reveal their problems through drawings whether at school or at home (DiLeo, 1996; Handler, 1996). In a close examination, the drawings from children who have been traumatized through physical beating, car accident, or have been sexually abused will mostly differ from those diagrams of children who have not been assaulted. According to Malchiodi (2001), free drawings such as those categorized as the House-Tree-Person, Draw-A-Person, and Kinetic Family Drawings are commonly used. Features of the pictures, like the sizes and details of body parts, colors used, and the shape of the pictures may be inferred in relation to have the presence or absence of sexual abuse. For example, in a diagram one below: the child drew the face of a child having shaggy hair, who is crying while the mouth remains closed. In the analysis, this may mean that the child was traumatized and silently suffered the psychological, emotional, and physical effects of an assault (DiLillo et al., 2006). A professional may interpret this diagram inclined towards assault to mean that the child passed through a disturbing ordeal where the child was ruffed up, making the child shaggy. This inference then prompts the caregiver to investigate further, what could have transpired (Perry, 2002).
According to Burgess, McCausland, and Wolbert (1981), drawings where a child displays a change from age-appropriate diagrams to more jumbled objects or drawings with recurrent stylized and sexualized figures usually indicate the possibility of a sexual abuse. The use of drawings should therefore be recommended to be part of evaluative interview for the suspected sexually abused victims and further review of several illustrations of drawings that reveal abuse histories. The children drawings involving human figures are emotional and psychological indicators that need to be analyzed deeply to reveal the traumatizing experiences of the young children that they are incapable of talking about.
Acoording to Cantlay (1996), distress and trauma represented in children’s drawings as a result of sexual abuse are usually reflected through signs such as large heads, large hands, large and empty eyes, shaded clouds, abundant and shaggy hair and knotholes in trees. Other signs include large pointed teeth, eyes minus pupils, unusually tiny eyes, crossed eyes, box-shaped bodies, poorly joined body parts, lack of gender distinction, long hair hanging from the sides, circles, and large smoke emanating from the chimney. Cantlay (1996), however, cautions that the presence of trauma can only be confirmed from a sequence of similar drawings, which encompass several signs. This therefore means that a single indicator in one diagram is not enough to determine that the child was sexually assaulted.
The manifestation of genitalia in the drawings is usually considered to be strong indicator of sexual abuse, because it is taken to be unusual for a normal, non-abused child to contain genitals in their drawings if they have not experienced or known what it is, and therefore reflects a strong possibility of sexual abuse (Di Leo, 1996; Cantlay, 1996). This is because incest victims who have been assaulted by their family members are known to either embellish or understate sexual features in their drawings. It is worth noting that children, who have the courage to draw sexualized figures and have sexual knowledge beyond their abilities, should thoroughly be investigated on where they saw and obtained such information. Similarly, professionals and care providers should not erroneously interpret children’s diagrams that will lead into wrong conclusion of sexual abuse that may in turn act as a revelation to the children (Perry, 2002).
A diagram 2 above shows some of the features mentioned by De Leo (1996), clearly manifested. The diagram explicitly represents a child at the bottom being sexually assaulted by another big person on top. The choice of red coloring used expresses bleeding to prove the force and the possible mutilation that occurred because of the difference in size of the two. At the top of the diagram, there is another bigger man that can be interpreted in two ways. The first can be representing the man’s long genital (penis) before the rape with an arrow pointing at the perpetrator to give it a direct link. On the contrary, the man on the top can also be interpreted to be a police officer who rescued the victim by shooting at him leading to bleeding at the back of the assaulter. This diagram also indicates that the assault took place outside the house or probably by an abductor. One fact that remains constant is that the child must have been assaulted and without the diagram, the interviewer may have not realized this.
After a close observation by clinicians on the drawings characteristics representing sexually abuse in children, exploration of the content has not been systematic and up to standard, even though most of the pictures are helpful. Drawings are mostly helpful in diagnostics for possible defilement of the children. Diagrams drawn by children aged 3 to 4 produce beneficial drawings and the diverse features in the drawing are marked and descriptions given on the drawing (Attorney General, 2007). Some teenagers may prefer drawing an illustration of what transpired rather than describing verbally. Drawings can be used for several purposes other than gathering information concerning likelihood of sexual abuse. The drawings are usually employed to diminish tension, to evaluate the child's general functioning, and to comprehend issues not related to sexual abuse (Handler, 1996).
To get the pictures for direct or indirect information gathering and assessing possible child's victimization, the care provider, the psychiatrist, and the interviewer can ask the children to draw such pictures to indirectly lead in findings; (1) a drawing of yourself, (2) a drawing of anything, (3) a drawing of family, (4) a drawing of somebody, (5) a drawing of family actions, and (6) a drawing of the possible perpetrator. Out of these questions, sexual content such as sexual acts or genitalia occasionally appear in the drawings. In case such drawings appear, the interviewer need to seek clarifications by asking more questions about the content to provide explicit information about the sexual abuse (Library sources, 2011). For example, by asking a five-year-old child about a picture she drew that contained a naked child and a naked man, she said that it was she and the uncle in her bedroom.
In case the child cannot give further information concerning sexual assault in reaction to questions about drawings, the interviewer must be cautious during interpretation. In as much as the pictures specifics may clearly suggest an abuse, more information should be sought to give clarity, since pictures with genitalia may not certainly mean that the kid has been sexually assaulted, but may refer to an experience with a younger brother, while sad drawing where one weeps could have a widespread significance range. For example, when a 5 year old girl was asked to explain who was the naked person lying on bed on the back, she explained that was her younger brother after taking a bath before being dressed up by the mother. Clearly, if this information was not sought, the interviewer could easily error in the interpretation of having sexually abused just because of the exposed genitals.
In case the kid has vaguely indicated that there is a possibility that an assault took place, the interviewer may advance to ask questions such as draw an image of the perpetrator, of the place the assault took place, of the actions the offender did and of the body part among others. This will help the interviewer narrow down to a specific person and the circumstances under which the abuse occurred, especially when the child is experiencing difficulty in revealing. The interviewer needs to substantiate the revelations as demonstrated by the diagrams or further ask to draw the instruments that were used in the assault (Malchiodi, 2001).
A Diagram 3 above explicitly reveals an ordeal that the child experienced because of the clearly protruding male genitals. The diagram indicates a huge harsh man with shaggy hair and large protruding genital, and appears to be holding an object in the hands. There is a child lying down on the ground weeping, appearing gagged, and a red coloring that indicates bleeding around the waist area. When asked to explain what the diagram meant, the child confirmed that the man standing was their gardener who ‘did to me the bad thing’, to mean the perpetrator who assaulted her. The man threatened her not to reveal it to anyone, because in case she does, he would punish her again when the parents are not around. She explains that the man locked the door and the windows, then gagged her mouth using a piece of cloth to ensure she is not heard when screaming. When asked what the red coloring meant, she explained that it was painful and she bled. This is a clear indication that in most cases children’s drawings have meanings attached to them and that the diagrams that contain genitals should be an alert to prompt further investigation (Malchiodi, 2001).
Children’s anatomical pictures can become part of case records and produced as evidence in court. It is therefore important that the assessor has the kid define various features of the pictures and if possible write related comments on the diagram (Attorney General, 2007). In case the victim of abuse is incapable to do that because of undeveloped writing skills, the investigator should categorize the drawings according the child’s identification. The labeling should include the name of the perpetrator the specific drawing denotes; and the assessor needs to encourage the assaulted child to inscribe or draw any thing on the pictures or diagrams to illuminate the different aspects of the assault (Malchiodi, 2001). For example, if the victim specifies that the perpetrator used the penis to hurt her vagina, the assessor should let the child mark or circle the part and then encourage the victim to write besides the penis explaining that it is the part, which hurt her. In case the child cannot write, the professional interviewer needs to write the child’s response plus the question asked. This detailed information is very necessary when handling such cases in a court of law (Faller, 1993).
Anatomical drawings are readily produced pictures of children and adults both male and female at distinct developmental stages including elderly people, adults, latency age, adolescence, and preschool levels presented without clothing and explicit primary and secondary sex features (Attorney General, 2007). The drawings may show an anterior sides presented on one side of the page and the posterior shown on the other page for the sexual assault victim to be able to identify the age and gender of the perpetrator.
In many cases, anatomical drawings are used concurrently with the anatomically obvious dolls and are effective when used with the same age range of children as the dolls. This combination is predominantly successful with very young children, but is as well applicable in older children assessment. During the interview, the appropriate pictures are selected among the others by either the child or the interviewer, and the assaulted child may be requested to mark the drawing or directly point to the feature appearing on the drawing (Attorney General, 2007). The children are also encouraged to use the dolls to demonstrate what actually transpired starting from how the undressing took place and using two dolls or pictures representing an adult and a child to show how the intercourse took place. This can be demonstrated by rubbing the drawings against each other. Equally, anatomical drawings can be used as visual records and are admissible in court (Attorney General, 2007). For example, an anatomic picture below shows several children being physical abused in an enclosed corner, some tied up, their mouths gagged and labeled funnily. Any child who was beaten up by an adult teacher, kidnapper, or guardian will explicitly select this picture to explain what happened.
In addition, the interviewer needs not to use the drawings in a suggestive way and not to selectively reinforce the child's explanation of the picture. This means that it is inappropriate to ask a child who has not revealed anything concerning an assault to draw a diagram of what daddy or uncles did him/her. This will be limiting and confining the child’s thinking towards a particular problem that may not be and makes the outcome not to be objective. Any beneficial information about likelihood of assault will freely be inferred from the child's clarifications of the drawing and the impulsive narratives that this elicits. Details and indicators in the drawings cannot be interpreted without the description from the victim.
Once the assessment has been done and interpretations made that the child was sexually assaulted, an intervention team that involves various professionals directly concerned with the case such as medical consultants, security forces, courts, and the parents begin the investigation and treatment activities. According to Faller (1993), the composition and operation of intervention teams differ depending on the locality and the participation level of team members also vary based on the stage of the intervention. In an interfamilial scenario, the intervening professionals at treatment stage typically include Child Protective Services (CPS), the medical therapists treating and counseling the victim and the affected various members of the family, and a representative from the state prosecutor’s office. The victim should be separated from the perpetrator (Grant & Lundeberg, 2009).
The treatment model that can be used is the Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), which comprises all components and is used in training the victims in psycho-education skills to deal with anxiety and fear, cognitive survival skills, emotional skills, stress management and control skills, and training both the victim and the affected parents on behavioral management (Grant & Lundeberg, 2009).
Traumatic experiences from physical and sexual abuse usually result into devastating cognitive, physical, social, and emotional development impacts on children (Perry, 2002). The impacts of sexual assault on children usually spill over to have deep consequences on the immediate family members and the community in general. It involves both physical acts and psychological experiences.
The impact of sexual assault on a child depends on several factors such as the identity of the perpetrator, the period and the frequency of the exploitation, the cruelty of the act or betrayal involved and the age of the child. There are several physical, psychological, and behavioral indicators of sexual abuse (DiLillo et al., 2006). The physical indicators include difficulty, pain while sitting, walking, or running and persistent genital infections among others. The behavioral indicators may include exceptional secrecy, obsessive and sudden interest in sexual activities including uncommon sexual knowledge or relation with peers that is developmentally unsuitable, being involved in self-destructive conducts and being excessively submissive or withdrawn (Children's Bureau Karageorge, 2008). Psychological signs may involve the victim always appearing confused, depressed, withdrawn and fearful. This paper has extensively discussed the use of diagrams drawn by children to assess the possibility of an assault. Many children fear talking about the traumatic experiences but are comfortable drawing what transpired. Interviewer should however not make interpretation from the diagrams and the anatomical drawings before seeking explanations from the children on what they mean by each feature. In most cases, children’s diagrams that explicitly reveal the genitals point to the possibility of sexual assault (Malchiodi, 2001; McCausland & Wolbert, 1981).