The sexual abuse of children impacts the most vulnerable members of society. It is widespread, affecting 1 in 7 girls by the age of 18 and 1 in 25 boys. Childhood sexual abuse (CSA) is not a new phenomenon; scientific reports date back to the mid-1800s. Nor is it limited to westernized cultures, as once believed. Yet the study of this enormously damaging public health problem is still in its infancy, public education about it is inadequate, and our children remain at grave risk.
Attention first became drawn to the problem of CSA in the 1960s and 1970s as the feminist political movement combined with the expansion of child welfare systems, allowing for the observation that sexual violence directed toward children was a large-scale problem that had been both underrecognized and undertreated. Then, during the latter half of the 20th century, the scope and nature of the problem was further highlighted by publicized incidents of child molestation, beginning with the “priest abuse” scandal that unfolded in the 1980s and extending to many high-profile cases of children sexually victimized by adult celebrities, athletes, coaches, and family members. The coverage of these incidents drew attention to the reality that our children are not at most risk from a stranger who hurts them on a single occasion as we once thought. Rather, the risk more than 75% (and many suggest as high as 90%) of the time is from an adult who knows the child and is often known to the child’s family as well—someone who uses his power, access, and trust to begin to engage in sexual abuse.
We now have to grapple with the reality that the customary warnings about “stranger danger” are woefully inadequate to protect our children. What those of us who work with children hear time and time again from victims of child sexual abuse is that the person who sexually victimized them as a child was someone they, and often their family, trusted. We also hear that the abuse happened a little at a time and in secrecy and that, looking back, their biggest regret is not being fully forewarned about the realities of childhood sexual abuse—and that no one else in their life had noticed or asked at the time.
It is the stories of all of these victims who suffered in silence that led us to join together to write this book, a book we hope will serve as a cautionary tale for children and adults alike. As mental health professionals who have worked with child and adolescent victims of CSA for more than two decades, we (Dr. Kaplan and Dr. Aguirre) are acutely aware of the toll that childhood sexual maltreatment takes on a youth’s well-being both in the short and longer term. Victims suffer from more depression, substance use, school failure, and other problems than their nonabused peers, and are significantly more likely to be revictimized as adults. More needs to be done to educate the public to recognize the signs that someone might be hurting a child and give both caregivers and youth knowledge and skills so they can identify and end sexual abuse as early as possible when it does occur.
We came together in writing this book to provide as much education as we can.
BLAISE AGUIRRE
I am a child and adolescent psychiatrist specializing in a condition known as borderline personality disorder (BPD). BPD is characterized by emotional extremes and relationship difficulties. Our research shows that nearly one-third of the patients we treat with BPD also have posttraumatic stress disorder (PTSD), and many of those are victims of childhood sexual abuse. We found that without treating the PTSD, particularly that caused by CSA, many patients, and their families, continued to suffer. Additionally, our patients often turned to self-harm in response to traumatic memories and experiences when they had no other coping skills.
Every child we treat has a parent or other adult caregiver, and part of the work we do is intended to develop the parents’ capacity to see the world through their child’s eyes and by so doing make better sense of their child’s behavior. It is essential to teach parents about trauma, its impact and its treatment, and particularly the latest knowledge about scientifically sound and compassionate therapies, and so a large part of the work we do is educational.
Then given how often parents have either felt culpable or been blamed for their child’s adversities, moving forward means ending the search for blame and fault, aiming instead to create the best lives possible for the young people we treat given the circumstances of their lives. In doing so, we empower ourselves to be better parents, caregivers, and human beings.
The privilege of working with my two coauthors has been its own reward. For the many years that I have known Cynthia Kaplan, she has been dedicated to the cause of CSA and PTSD. And I knew Kayla as a fierce competitor on the judo mat before I knew many of the details of her story. Today I know her as an even fiercer advocate for increasing awareness and reducing the stigma of CSA.
CYNTHIA KAPLAN
I am a child and adolescent psychologist who has spent my entire career working with individuals and families who have experienced trauma. Specifically my work has focused on childhood abuse and neglect and includes 25-plus years of helping CSA victims. This experience has taught me about the pain and emotional distress endured by children who are hurt by the very adults entrusted to care for them and the challenges these youth face when it comes to breaking their silence. So many times I have sat with children and teens who felt they could not speak up because they would be hurt or possibly not believed and that doing so might only “make matters worse.” For every child I have treated there are often also distraught parents or caregivers who sit with me and bemoan their own lack of awareness and preparedness and express deep regret at not having recognized and stopped their loved one’s abuse sooner.
Over the course of my career it has become increasingly clear that the solution to the problem of childhood abuse cannot come from treatment personnel alone, most of whom do not meet these victims until they are well into adolescence and adulthood and already bear the scars of their childhood trauma. Instead, those of us in this field must work together with victim advocates who have the best chance of persuading schools, communities, and legislatures about what needs to be done to stop this scourge. Kayla Harrison is just such an advocate, someone who refused to be silenced by her fear and shame and who found a way to reach out to me and Dr. Aguirre to ask if we would help tell her story in the hope that her first-person narrative would increase public awareness and prevention efforts and alert youth and adults alike to how CSA unfolds, goes unnoticed, and can be interrupted. Working with Kayla and Dr. Aguirre on this book has truly been a privilege and our collective and loving contribution to children, youth, and caregivers everywhere.
WHAT YOU CAN EXPECT FROM THIS BOOK
You may be a parent who has concerns about your own child. You could be a teacher, a school psychologist, a childcare worker, a babysitter, or a social worker. Perhaps you work in child protective services or the criminal justice system. In this book we are speaking to you, the individuals who are in close and regular contact with children and want to keep them safe. Our discussion includes children between the ages of 5 and 18, because these are the children we generally see in our practices and who are able to both recall and put words to their childhood experiences of sexual abuse. That is not to say that younger children are not traumatized, as there are certainly many corroborated reports of infants and preschool-age children being subjected to abuse that they may not themselves recall or be able to dialogue about; many of these cases come to the attention of child protective services and legal services and are beyond the scope of this book. While most of the information and advice we give applies broadly to all forms of CSA, including incest (and we have noted some additional considerations about incest), this is a complicated separate topic that we cannot do justice to in this book, and we offer additional sources of information and help in the Resources appendix.
This book would not be possible without Kayla Harrison’s brave revelations of the sexual abuse she suffered at the hands of her coach; it is these firsthand accounts that give all of us a chance to see explicitly how CSA can begin, persist, and be brought to an end. In the chapters that follow, we trace the course of Kayla’s victimization and survival, weaving her story with our professional experience with hundreds of children, teens, and families to reveal what can be done to prevent and interrupt this damaging cycle. Essentially the chapter order matches the chronology of child sexual abuse, from the point when a child is targeted by a perpetrator to the child’s ultimate recovery from being victimized in this devastating way.
It’s important to understand before you start reading, however, that the course of child sexual abuse is not entirely linear. Events and developments are often intertwined, and although we have organized these chapters to make information easy to understand and retain—and refer back to as needed—topics covered in one chapter may very well take shape and affect the child and family at the same time as those discussed in the next chapter. We strongly encourage reading the entire book to get a complete understanding of this problem and its solutions.
We hope you will emerge from reading this book with a better understanding of how perpetrators gain access to and violate children in secrecy, along with a sharper ability to recognize what may be happening to children you care about. We hope you will also learn how to respond effectively to help these victims through the difficult aftermath of disclosing their abuse and when and how to access professional mental health help as needed. Finally, we offer hope through understanding the recovery process—how children can make the transition from victim to survivor, as Kayla has, and find a path to a meaningful life.