Children disclosing sexual abuse

The potential impact of a disclosure of sexual assault by a child or adolescent is immense, particularly if the alleged offender is in the immediate or extended family. Such a disclosure is often followed by a period of crisis, disruption and strong emotions for the many people whose lives may be affected.

Often, it is the GP that a parent comes to when a child has some questionable symptoms, and/or has indicated sexual abuse. What is often not acknowledged is that a presentation such as this in the surgery may precipitate a crisis for the GP as well, particularly in rural communities.

Whilst the law is clear about our responsibilities to notify, it doesn't answer or solve the complexities that inevitably accompany the disclosure. One difficulty often encountered is that a child may give an unclear, contradictory or vacillating account of what has happened. Whilst it is not the role of the GP to investigate allegations of child sexual abuse, the following information may assist our understanding of a child's behaviour at the time of disclosure.

Sorensen & Snow* (1991) analysed the disclosures of 116 children aged between 3 & 17. They found that 74% of those disclosures were accidental, ie. revealed by chance rather than a deliberate effort on the part of the child; and 25% were purposeful, ie. when a child consciously decides to tell an outsider. However, for all children, disclosure was a process, not a single event - involving denial, tentative disclosure, active disclosure, recanting and reaffirming.

72% of all children denied having been sexually abused - for example, when questioned by a concerned parent/carer or when identified as potential victims and formally questioned. Only 7% of children who denied then moved directly to active disclosure - with tentative disclosure becoming the common middle step for the majority of the children (78%). The characteristics of this stage are

Forgetting (I forgot);
Distancing (It happened to Joe / or a long time ago );
Minimising (It only happened once);
Empowerment (He tried but I hit him and ran away);
Dissociation (When he does that I go to the pink forest);
Discounting (I was only kidding).

Understandably, this stage is concerning as, with children appearing confused, inaccurate and uncertain, potentially protective adults may cease further investigation and protective action.

Active disclosure was eventually made by 96% - meaning they could give detailed, coherent, first-person accounts of the abuse. 22% of children then recanted their allegations - with pressure from perpetrator or family being amongst the major reasons. Of those who recanted, 92% went on to reaffirm their allegations. The time frame for this progression of disclosure ranged from within a single session to several months.

The common presumption that children will be able to give a detailed and coherent account of the abuse in a single investigative interview is not supported by these findings, which showed that only 11% were in active disclosure at the time of the initial interview. Sorensen & Snow's work challenges all health & welfare professionals to review how we listen to children, how we respond to disclosures that appear vague, oscillating and/or a bit unbelievable, and what protective action we take in response to disclosure.

This research implies that our response to children may be critical to how the process of disclosure unfolds. Some key reminders are:

listen to the child's story
be, and act, calmly
let the child know s/he is believed
explain what you are going to do
make the child comfortable whilst you organise things.Ensure s/he is not left in a situation where s/he is pressured to change her/his story
notify the Department of Community Services
consult with Richmond Sexual Assault Service if needed.