National Center on Sexual Behavior of Youth Fact Sheet

National Center on Sexual Behavior of Youth Fact Sheet

Sexual Development and Sexual Behavior Problems in Children Ages 2-12
This Fact Sheet provides basic information about sexual development and problematic sexual behavior in children ages 2-12. This information is important for parents and professionals who work with or provide services to children such as teachers, physicians, child welfare personnel, daycare providers, and mental health professionals. Understanding children’s typical sexual development, knowledge, and behavior is necessary to accurately identify sexual behavior problems in children. Guidelines to distinguish typical sexual behaviors from problematic sexual behaviors are described below.

Research on sexual behavior of children ages 2 to 12 has documented that:

  • sexual responses are present from birth; 1
  • a wide range of sexual behaviors for this age range are normal and non-problematic; 1, 2
  • increasing numbers of school age children are being identified with inappropriate or aggressive sexual behavior;3 it is not clear if this increase reflects an increase in the actual number of cases or an increase in identification and reporting;
  • several treatment interventions have been found to be effective in reducing problematic sexual behavior in children, such as cognitive behavioral group treatment;4, 5 and
  • sexual development and behavior are influenced by social, familial, and cultural factors, as well as genetics and biology.7

Typical sexual knowledge of children age 2 to 6 years old:

  • understand that boys and girls have different private parts;
  • know labels for sexual body parts, but use slang words such as weenie for penis; and
  • have limited information about pregnancy and childbirth.

Typical sexual knowledge of children ages 7 to 12 years old:

  •  learn the correct names for the genitals but use slang terms;
  •  have increased knowledge about masturbation, intercourse, and pregnancy; and
  •  understand the physical aspects of puberty by age 10.

Common vs. Infrequent Sexual Behaviors in Children

In the last decade, research has described typical sexual behaviors in boys and girls ages 2-12.2 The table below lists sexual behaviors that are commonly observed or reported by parents of pre-school and school age children.

AGES 2-6

  • Do not have a strong sense of modesty, enjoys own nudity
  • Use elimination words with peers
  • May explore body differences between girls and boys
  • Curious about sexual and genital parts
  • Touch their private parts, even in public
  • Exhibit sex play with peers and siblings; playing “doctor”
  • Experience pleasure from touching their genitals

AGES 7-12

Sexual play with children they know, such as playing “doctor”
Interested in sexual content in media (TV, movies, radio)
Touch own genitals at home, in private
Look at nude pictures
Interested in the opposite sex
Shy about undressing
Shy around strange men

Research has also described infrequent and uncommon sexual behaviors in boys and girls ages 2-12. 2

The table below lists sexual behaviors that are reported by parents of pre-school and school age children to be infrequent or highly unusual.

Puts mouth on sex parts
Asks to engage in sex acts
Puts objects in rectum or vagina
Imitates intercourse
Masturbates with objects
Undresses other people
Touches others’ sex parts after being told not to
Asks to watch sexually explicit television
Touches adults’ sex parts
Makes sexual sounds

Sexual Play vs. Problematic Sexual Behavior

Professionals in the field have developed a continuum of sexual behaviors that range from common sexual play to problematic sexual behavior.10 These are described below.

Sexual play

  •  is exploratory and spontaneous;
  •  occurs intermittently and by mutual agreement;
  •  occurs with children of similar age, size, or developmental level, such as siblings, cousins, or peers;
  •  is not associated with high levels of fear, anger, or anxiety;
  • decreases when told by caregivers to stop; and
  • can be controlled by increased supervision.

Problematic sexual behavior

  •  is a frequent, repeated behavior, such as compulsive masturbation;
    • Example: A six-year-old repeatedly masturbates at school or in other public places.
  • occurs between children who do not know each other well;
    • Example: An eight-year-old girl shows her private parts to a new child during an after school program.
  • occurs with high frequency and interferes with normal childhood activities;
    • Example: A seven-year-old girl has been removed from the soccer team because she continues to touch other children’s private parts.
  • is between children of different ages, size, and development level;
    • Example: An eleven-year-old boy is “playing doctor” with a three-year-old girl.
  • is aggressive, forced, or coerced;
    • Example: A ten-year-old threatens his six-year-old cousin and makes him touch his penis.
  • does not decrease after the child is told to stop the behavior;
    • Example: A nine-year-old child continues to engage other children in mutual touching after being told the behavior is not allowed and having consequences, such as being grounded.
  • causes harm to the child or others.
    • Example: A child causes physical injury, such as bruising, redness, or abrasions on themselves or another child, or causes another child to be highly upset or fearful.9

Children With Sexual Behavior Problems

Children with sexual behavior problems (SBPs) are children 12 years and under who demonstrate developmentally inappropriate or aggressive sexual behavior. This definition includes self-focused sexual behavior, such as frequent public masturbation, and intrusive or aggressive sexual behavior towards others that may include coercion or force. Although the term “sexual” is used, the children’s intentions and motivations for these behaviors may be unrelated to sexual gratification.

Some children who have been sexually abused have inappropriate sexual behaviors and others have aggressive or highly problematic sexual behavior.8 However, it should be noted that the majority of children who have been sexually abused do not have subsequent inappropriate or aggressive sexual behaviors.

Although only a small number of children develop problematic sexual behavior, professionals and parents may have concerns about (1) whether the behavior is problematic, (2) whether a child should be referred for mental health services, and (3) when an incident should be reported to the proper authorities.

Suggestions for professionals and parents are listed below:

  •  Do not overreact as most sexual behaviors in children are within the typical or expected range.
  •  Inappropriate or problematic sexual behavior in children is not a clear indicator that a child has been sexually abused.
  •  Most children will stop the behavior if they are told the rules, mildly restricted, well supervised, and praised for appropriate behavior.
  •  If the sexual behavior is problematic as defined above, referral for mental health services is recommended.
  •  It is important to remember that children with problematic sexual behavior are significantly different from adolescent and adult sex offenders.
  •  A report to Child Protective Services (CPS) and/or law enforcement may be required by law for certain behaviors such as aggressive or forced sexual behavior.

Additional information about adolescent sex offenders and children with sexual behavior problems is available from the National Center on Sexual Behavior of Youth,

1. Gordon, B. N., & Schroeder, C. S. (1995). Sexuality: A developmental approach to problems. New York: Plenum Press.
2. Friedrich, W. N., Grambsch, P., Broughton, D., Kuiper, J., & Beilke, R. L. (1991). Normative sexual behavior in children. Pediatrics, 88, 456-464.
3. Araji, S. K. (1997). Sexually aggressive children: Coming to understand them. Thousand Oaks, CA: Sage.
4. Bonner, B. L., Walker, C. E., & Berliner, L. (1999). Children with sexual behavior problems: Assessment and treatment (Final Report, Grant No. 90-CA-1469). Washington, DC: Administration of Children, Youth, and Families, Department of Health and Human Services.
5. Pithers, W. D., Gray, A., Busconi, A., & Houchens, P. (1998). Children with sexual behavior problems: Identification of five distinct child type and related treatment considerations. Child Maltreatment, 3, 384-406.
6. DeLamater, J., & Friedrich, W. N. (2002). Human sexual development. The Journal of Sex Research, 39, 10-14.
7. Silovsky, J. F., & Bonner, B. L. (2003). Children with sexual behavior problems. In T.H. Ollendick, & C.S. Schroeder (Eds.), Encyclopedia of Clinical Child and Pediatric Psychology (pp.589-591). New York: Kluwer Press.
8. Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993). Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113, 164-180.
9. Hall, D. H., Matthews, F., Pearce, J., Sarlo-McGarvey, N., & Gavin, D. (1996). The development of sexual behavior problems in children and youth. Ontario, Canada: Central Toronto Youth Services.
10. Johnson, T. C. (1998). Understanding children’s sexual behaviors: What is natural and healthy. Order information

The University of Oklahoma is an equal opportunity institution.

Opinions in this document are those of the authors and do not necessarily represent the official positions or policies of the US. Department of Justice/Office of Juvenile Justice and Delinquency Prevention.

This Fact Sheet was prepared through the National Center on Sexual Behavior of Youth at the Center on Child Abuse and Neglect, University of Oklahoma Health Sciences Center and was authored by Jane F. Silovsky, PhD and Barbara L. Bonner, PhD. This project is funded by grant number 01-JR-BX-K002 from the Office of Juvenile Justice and Delinquency Prevention (OJJDP), US Department of Justice.

Possible Life Span Signs and Symptoms Associated with Victims of Childhood Sexual Abuse

Infancy and Early Childhood Under 4 Years
• Night terrors Loneliness
• Shame
• Clinging behavior
Developmental delay
• Suspicious physical findings
• Staring blankly
• Mood swings
• Cruelty to others
• Whining
• Secretive
• Daydreaming
• Sexual preoccupation

Middle and Late Childhood 5 – 10 Years
• Sudden onset of anxiety
• Depression
• Insomnia
• Conversion hysteria
• Weight gain/loss
• Sudden school failure
• Truancy
• Run-away
• Sudden irritability
• Excessive bathing
• Psychosomatic problems
• Suspicious physical findings
• Staring blankly
• Cruelty to others
• Mood swings
• Withdrawn
• Lying
• Cheating
• Secretive
• Daydreaming
• Sexual preoccupation
• Seductiveness

Early Adolescence 11 – 14 Years
• Guilt
Low self-esteem
• Isolation
• Poor body image
• Staring blankly
• Cruelty to others
• Mood swings
• Withdrawn
• Lying
• Cheating
• Aggression
• Secretive
• Daydreaming
• Sexual preoccupation
• Low sexual self-esteem
• Fear of homosexuality
Sexual abuse of younger children

Late Adolescence 15 – 17 Years
• Self-depreciation
• Prostitution
• Promiscuity
• Depression
Social isolation
• High rebellion
• Pregnancy
Venereal disease
Drug abuse
• Acting out
• Anorexia
• Aggression
• Seductiveness
• Sexual preoccupation
• Low sexual self-esteem
• Sexual abuse of younger children

Adult 18 Years +
• Figidity
• Conversion hysteria
• Promiscuity
• Prostitution
• Phobias
• Suicide attempt
• Psychotic behavior
• Low self-confidence
• Low self-esteem
• Guilty feelings of defenselessness
• Feelings of worthlessness
• Seductiveness
• Sexual preoccupation
• Sexual abuse of others

Remember that lists such as these should be carefully regarded. You will note that many of the behaviors might be associated with many other causes and in some instances can be associated with “normal” behavior. It is critical to carefully consider the full range of information about any case.

From: Dr. Pamela Langelier, Vermont Family Forensic Institute, 1989

Effects of Domestic Violence on Children

Effects of Domestic Violence on Children

The tragic reality is that any time a mother is abused by her partner; the children are also affected in both overt and subtle ways. What hurts the mother hurts the children. Children do not have to be physically or verbally abused to be injured by domestic violence. Hearing or seeing the abuse of one parent by the other takes a huge toll on the children. Even if they don’t see the beating, they see the bruises, broken bones, and abrasions. In homes where domestic violence occurs, fear, instability, and confusion replace the love, comfort, and nurturing the children need. These children live in constant fear of physical harm from the person who is supposed to care for and protect them.

While many children experience difficulties resulting from their exposure to violence, many children appear to cope with the experiences and show fewer problems than in comparison to other children. This is likely because the level of violence in families and children’s exposure to it can vary greatly. Further research is needed in order to draw blanket conclusions about the effects of domestic violence on children.

Children who witness domestic violence display various emotional, physical, and behavioral disturbances.

  • Witnessing parental abuse produces feelings of anger, fear, guilt, shame, confusion, and helplessness. When the community fails to offer protection and support, children also feel undervalued and worthless.
  • Children may express these emotions as withdrawal, low self-esteem, nightmares, regressive behavior, or aggression against peers, family members, and property.
  • Child witnesses to domestic violence often suffer physical problems, such as bed-wetting, insomnia, colds and diarrhea.
  • Children often suffer developmental delays in verbal, cognitive, and motor abilities when they live in homes with domestic violence. Learning disabilities are common.

Domestic violence disrupts children’s lives.

  • Children’s living arrangements are often disrupted when a parent is fleeing the abuser. Moving to unfamiliar surroundings can add to the stress.
  • Children and their mother may suffer financially when they flee the abusive parent.
  • School performance may suffer if the child is distracted or tries to remain at home to protect the mother.
  • Many children in families where domestic violence has occurred appear to be “parentified” or “spousified.” They are forced to grow up faster than peers, often taking on the responsibility of cooking, cleaning, and caring for younger children while the mother attempts to deal with the trauma.
  • Children may also be isolated. Typical activities such as having friends over to their house may not be possible due to the chaotic atmosphere. However, school performance is not always obviously affected. Children may respond by being overachievers.

Symptomology of Domestic Violence on Children

Symptomology of Domestic Violence on Children

Ongoing parental conflict and violence in childhood were significant predictors of serious personal crimes in adulthood, including assault, rape, murder, and kidnapping.


0-1 Years

  • Withdrawn
  • Sleep disturbances
  • Hyperactive
  • Failure to thrive
  • Eating disorders
  • Physical injuries


2-5 Years


6-9 Years

  • Suicidal ideation/attempts
  • Cruelty to animals
  • Fire setting
  • Running away
  • Depression
  • Low self esteem
  • Poor social skills


10-12 Years


13-17 Years

  • Poor impulse control
  • Confrontational
  • Engage in pecking order battering with mothers or siblings
  • Align with abuser to avoid being a victim
  • Dating violence


As they grow, children form assumptions about the world in which they live. Is their world consistent and predictable or chaotic and unsafe?

Domestic violence creates inordinate stresses in a child’s life.


Every child responds differently to witnessing or directly experiencing domestic violence. This is dependent on their temperament, usual coping mechanisms, developmental stage, and support systems. Some children may respond with internalized symptoms such as regression and social isolation. Others may develop externalized negative behaviors that include nightmares, hyperactivity, aggression, and delinquency.


  • Studies suggest that between 3.3 – 10 million children witness domestic violence a year.
  • Children in homes with domestic violence are 15 times more likely to experience child abuse.
  • 50-70% of children exposed to domestic violence suffer from PTSD – more than Vietnam Veterans
  • Children who witness domestic violence are more likely to exhibit behavioral and physical health problems including depression, anxiety, and violence toward peers. They are also more likely to attempt suicide, abuse drugs and alcohol, run away from home, engage in teenage prostitution, and commit sexual assault crimes.
  • Children in homes with domestic violence may “indirectly” receive injuries. They may be hurt when household items are thrown or weapons are used. Infants may be injured if being held by the mother when the batterer strikes out.
  • As children grow into teenagers, they exhibit higher levels of delinquency and violent behavior than those in non-violent homes.
  • Because of the shame of shelter living, moving, changing schools, fitting in with peers, and making new friends, teens face unique challenges. This can result in never learning to form trusting, lasting relationships, or ending up in violent relationships themselves.

Sexually Abused Child Trauma Response by Age Group

Sexually Abused Child Trauma Response by Age Group

It can often be very difficult to recognize whether or not a child is being abused, both for parents and for professionals.

Children respond to sexual assault in many different ways according to their age, gender, personality and family circumstances. Their behavior will always reflect how they feel as children tend to communicate through their behavior. Children frequently find it extremely hard to talk about what is happening to them, especially when they’ve been told to keep it a secret or have been subjected to coercion, bribery or threats. Children very rarely lie about sexual abuse. They may underplay the effects of the abuse or change the identity of the perpetrator in an attempt to protect the family, but they have not been found to lie about the occurrence of the abuse itself.

Generally speaking there are two main behavioral indicators of trauma following sexual abuse. Regression to an earlier developmental stage or loss of developmental tasks previously achieved and failure to learn or distortion of new developmental tasks.

Signs of Trauma Responses in Preschoolers (age 2-5)

  • They may become anxious and clingy, not wanting to separate from their parents at day care or the baby-sitter’s house.
  • They may seem to take a backward step in development (regression), sucking their thumbs, wetting their beds, refusing to go to sleep, or waking at night when they passed those stages long ago.
  • They may become aggressive in their play with other children, with their parents, or with their own toys.
  • They may play the same game over and over, like piling blocks and knocking them down, dropping toys behind furniture and retrieving them, or crashing the same two cars over and over again.
  • They may express ‘magical’ ideas about what happened to them which alters their behavior (ex: “Bad things happen when I get too happy”).
  • Though they say they are having fun in an activity they may look sullen, angry, or intense in a way that to an adult it doesn’t look like they are having fun.

Signs of Trauma Responses in School Age Children (age 5-13)

  • They may revert to developmentally earlier coping mechanisms, such as an ego-centered view (i.e. thinking that someone died because they had bad thoughts about the person).
  • They may compensate for feeling helpless during the crisis of the abuse by blaming themselves for what happened. Thinking that thtey caused the event gives children a sense of power and control while helplessness painfully reminds them of being young and totally dependent.
  • Their lack of control over the abuse may make them feel that their future is unsure, which can lead some children to act recklessly.
  • They may experience a significant change in school performance. It’s not uncommon for children to have great difficulty concentrating and performing in school following trauma. On the other hand, they may become intensely focused on schoolwork to the exclusion of other activities in an effort to cope.
  • They may test out rules about bedtime, homework, or chores. School age children believe in rules. When something bad happens, even if they obeyed the rules, they become oppositional and testy.
  • They may have interruptions in their friendships.
  • They may experience sleep disturbances, nightmares, and difficulty falling asleep.
  • They may engage in reckless play. Where the preschool child will crash their truck a hundred times, the school age child might physically engage in dangerous games as a way of exhibiting a sense of control that was lost during the abuse.


Signs of Trauma Responses in Teenagers (age 13-18)

  • They often feel that no one can understand what they are going through and there is a marked shift in relationships with parents and peers.
  • They may get involved in risky behaviors, such as experimenting with drugs, sexual activity, or refusing to go to school as a way of handling anxiety and countering feelings of helplessness. They feel their future is limited and may believe they are damaged for good by the abuse so planning for the future is pointless.
  • They develop a negative self image because they were not able to avoid or alter what happened to them.
  • They are likely to engage in revenge fantasies against the person or people responsible for the abuse and then feel guilty about their vengeful feelings.
  • They may experience a shift (either an intensification or withdrawal) in the normal developmental tasks of their age, such as dating, friendships, or sense of autonomy. They may isolate themselves, be depressed and at risk of suicide.


Some More Specific Behaviors Of Children Following Sexual Assault.


Many young children lose bladder/bowel control following sexual assault. It can be frustrating for parents and cause extra work. It can be humiliating and embarrassing for children. It is easy for adults and children to focus on the consequences of wetting and soiling e.g. changing sheets/clothes, washing, rather than the reasons why it happens.

All children bed wet from time to time when they are sick, stressed or anxious. Children who have been sexually assaulted will often bed wet every night and sometimes more than once a night. Bedwetting can be linked to feelings and may be a result of nightmares. Extreme fear can cause loss of bladder control and may serve the purpose of waking a child from a terrifying dream.

Bedwetting can also result from feelings of helplessness when children feel a loss of ownership and power over their body when it has been used by someone more powerful than they are. Bedwetting can be a reflection of children regressing in many ways, following sexual assault, when they lose a number of skills they previously had. Children may regress to a younger state to try and get their needs met. Bedwetting and soiling may also occur because a child separates from their genital/urinary/anal areas. They may lose the ability to respond to their body cues and therefore become less able to regulate their toilet habits. Sometimes children may be scared to actually go to the toilet. They may have experienced sexual assault in a bathroom or their fears may focus on the toilet itself.



All children have bad dreams from time to time but children who have experienced sexual assault often have nightmares every night sometimes more than once. They may have recurring dreams which are all the more frightening because they know what is coming. Nightmares can make children terrified of the dark and bed time.

Their dreams are likely to reflect their fears and their sense of lack of control. Looking at the content of their dreams can help them to talk about what has happened.


Persistent Pains

Lots of children develop aches and pains that have no physical cause. These will often have a connection to an aspect of the assault. Sometimes if a child has experienced physical pain during the assault, their body can retain the memory of this pain. Children may also think that something is broken inside of them. Repeated pain can also be a way for children to gain the extra love and attention they need at the time. Sometimes emotions manifest themselves physically for children because they do not have the ability to put it in to words.



A clingy child can test the patience of a saint! This behavior which is so common after sexual assault is a communication of a real need to be reassured of being lovable and of being secure. Children are attempting to rebuild a sense of safety and trust through their relationships with close adults. They are trying to restore a sense of good touch by demanding affection and cuddles. In essence, they are trying to heal their wounds. Constant physical and verbal demands can be difficult for parents but can be modified by identifying what the child needs and putting limits on when and how they are met. Clinginess can also reflect fears which can be reduced by talking about them.



Aggression in children after sexual assault tends to be related to fear and anger. It can be a direct communication that states “I am never going to be hurt again”. Anger is a healthy response and a necessary part of the recovery process from any trauma. It needs to be expressed in a safe and constructive way with firm limits against hurting yourself or others. To do this, anger needs to be acknowledged and recognized by the child and the adult. A child needs opportunities to discharge their anger. If this, for whatever reason, does not happen then anger is likely to come out through aggression. This causes the child more problems as their aggression prevents other people seeing or understanding the child’s needs.

Aggression also stems from fear and a need to protect themselves from further hurt.

Being aggressive can also cause a child to punish themselves and confirm their low self esteem because they have no friends and are always in trouble.


Sexualized Behavior

When children are sexually assaulted their sense of what is right and wrong becomes distorted. What they had previously learned about bodies and sexual activity becomes invalid. If a child was shown how to light a fire, for example, it is likely that the child will attempt to repeat what they saw. If children have learned that they get attention by being sexual with one person they may well repeat the behavior with another person. If children have experienced sexual feelings, which are common in children who have been sexually assaulted, they are likely to try and recreate those reactions. They may begin to sexually act out with other children to try and make sense of what has happened to them. Their curiosity about sexual matters may have been activated years before they develop the intellectual ability to understand. Children may want to sexually act out on other children to make them feel less vulnerable in the same way they may be aggressive. The trouble they may get into as a result of this behavior then confirms their view of themselves as dirty and bad.

Sexual acting out by children needs to be distinct from what is natural curiosity. Sexual acting out usually involves a difference in power between the children and may involve coercion/force or blackmail and a repetition of an adult sexual activity.

Normal sexual activity between children is about exploration not gratification (Martinson 1991 in Hunter 1996). Up to the age of 5, children are interested in touching their private parts and looking and touching the private parts of others if they have the opportunity. From 6 to 10 children have learned that sexual activity should be hidden and will masturbate secretly. They may create situations with their peers that involve looking and possibly touching. (Attempted or actual penetration and activities using force are not normal). They are likely to be curious about adult bodies. Early adolescents will masturbate and begin to develop relationships that involve a range of touching.

Sexual acting out in children who have been assaulted will involve either the child repeating what has been done to them on other children or getting other children to do to them what the offender did. It can also involve children approaching adults in a sexual way. It does not mean that the child automatically becomes an offender but it is an indication that professional help is needed.


Triggers & Recovery

Everyone who has suffered a trauma will react when they are reminded of it. The things that remind us can be called ‘triggers’ and they cause similar feelings to those experienced during the trauma. Very often these ‘triggers’ are not known to the adult because they relate to an aspect of the assault the parent may not know about. Some examples include the smell of beer or smoke; the feel of a beard; the color of a car; someone resembling the offender; a song or a game. Some are obvious, others are not. Often children can be triggered by unrelated things going wrong because that triggers their feelings of helplessness.

When children are triggered then their behavior tends to reflect the fact that they are experiencing similar feelings to the ones they felt during the assaults. Parents should be encouraged to discuss with the child what sort of things trigger them, so they are all aware of situations when it may occur.

The behaviors that children exhibit after sexual assault do tend to pass in time as children regain a sense of safety and self control. When the feelings that drive the behavior are explored, they become less powerful and the behavior becomes more manageable. Establishing a link between the feeling and the behavior is important as it gives you an understanding of what is happening.

Children can and do recover from sexual assault. The long term effects of sexual assault are often caused by secrecy, fear and denial of feelings. The more open and honest you can be about what happened the easier it is for children to be the same and the quicker the recovery.


Psychological Effects of Child Sexual Assault


Child sexual assault can have a number of effects both physical and psychological that last both in the short term and the long term. Outline below are some common effects which can occur as a result of childhood sexual assault.


Psychological Effects:

  • Fear. The offender may swear the child to secrecy and say something bad will happen if they tell. Coercion, bribery, or threats usually accompany sexual abuse. Overwhelmingly, the child is afraid to tell be cause of what the consequences might be, such as punishment, blame, not being believed, and ultimate rejection or abandonment.
  • Helplessness/Powerlessness. Children in this situation often feel that they have no control over their own lives or even over their own bodies. They feel that they have no choices available to them.
  • Guilt and Shame. The child knows something is wrong, but blames him or herself, not others. The offender will often encourage the child to feel that the abuse is his or her fault and as a consequence, is a “bad” person.
  • Responsibility. The offender coerces the child to feel responsible for concealing the abuse. The child then believes they are responsible for preserving the secret in order to keep their family together and to maintain appearances at all costs. The burden of this responsibility interferes with all normal childhood development and experiences.
  • Isolation. Incest victims feel different from other children. They must usually be secretive. This further isolates them from non-offending parents and brothers and sisters. This isolation often leads to the child being labeled as “different,” “a problem,” or in some way different from their siblings.
  • Betrayal. Children feel betrayed because they are dependent upon adults for nurturing and protection and the offender is someone who they should be able to love and trust. They may also feel betrayed by a non-offending parent who they believe has failed to protect them.
  • Anger. Children most often direct their feelings of anger in several ways.

1.      They may direct it outward at perceived “little things.”

2.      They may direct it inward, affirming their feelings of low self worth/value.

3.      Almost never direct their anger towards the abuser while still in a relationship with them. Anger is most often dealt with as an adult.

  • Sadness. Children may feel grief due to a sense of loss, especially if the perpetrator was loved and trusted by the child.
  • Flashbacks. These can be like nightmares which happen while the child is awake. They are a re-experience of the sexual assault as it occurred at that time. As an adult, a survivor may experience the same type of omnipotent fear that they experienced as a child. Flashbacks can be triggered by many things. By a smell, a mannerism, a phrase, a place, or a wealth of other environmental factors that may have significance.





Adult Survivors of Childhood Sexual Assault

There are many reactions that survivors of rape and sexual assault can have. But for adult survivors of childhood abuse there are reactions that may either be different or stronger than for other survivors. These include:

Setting Limits/Boundaries
  • Because your personal boundaries were invaded when you were young by someone you trusted and depended on, you may have trouble understanding that you have the right to control what happens to you.
  • Like many survivors, you may experience flashbacks.
  • This is often the most difficult emotion for an adult survivor of childhood sexual abuse to get in touch with.
  • As a child your anger was powerless and had little to no effect on the actions of your abuser. For this reason you may not feel confident that your anger will be useful or helpful.
  • Being abused as a child means the loss of many things- childhood experiences, trust, innocence, normal relationship with family members
    • You must be allowed to name those losses, grieve, and then bury them.
Guilt, Shame, and Blame
  • You may carry a lot of guilt because you may have experienced pleasure or because you did not try to stop the abuse.
  • There may have been silence surrounding the abuse that led to feelings of shame.
  • It is important for you to understand that it was the adult who abused his/her position of authority and should be held accountable, not you.
  • Learning to trust again may be very difficult for you.
  • You may go from one extreme to the other, not trusting at all to trusting too much.
Coping Skills
  • You have undoubtedly developed skills in order to cope with the trauma.
    • Some of these are healthy (possibly separating yourself from family members, seeking out counseling, etc.)
    • Some are not (drinking or drug abuse, promiscuous sexual activity, etc.)
  • Low self-esteem is a result of all of the negative messages you received and internalized from your abusers.
  • Because entering into an intimate relationship involves trust, respect, love, and the ability to share, you may flee from intimacy or hold on too tightly for fear of losing the relationship.
  • Your first initiation into sex may have been nonconsensual.
  • You may experience the return of body memories while engaging in a sexual activity with another person. Such memories may interfere in your ability to engage in sexual relationships which may leave you feeling frightened, frustrated, or ashamed.


Signs of Child Sexual Abuse

Signs of Child Sexual Abuse


Child sexual abuse is the exploitation of a child for the gratification or profit of an adult. Sexual abuse can range from exhibitionism and fondling to intercourse or use of a child in the production of pornographic materials. Sexual abuse also may result in physical injury or be accompanied by other signs of abuse or neglect. Sexual abuse generally is perpetrated by someone known to the child and frequently continues over a prolonged period of time. Often it does not involve sexual intercourse or physical force. The incidence is estimated at 100,000 to 250,000 cases per year; however this type of abuse is difficult to detect and confirm.





Any of the following physical signs may indicate abuse:

  • Difficulty in walking or sitting
  • Thickening and/or hyperpigmentation of the labial skin (especially when it resolves during out-of-home placement)
  • Horizontal diameter of vaginal opening that exceeds 4mm in prepubescent girls
  • Torn, stained, or bloody underclothing
  • Bruises or bleeding of the genitalia, perineum, or perianal area
  • Vaginal discharge and/or pruritus
  • Recurrent urinary tract infections
  • Gonococcal infection – Pharynx, Urethra, Rectum, Vagina
  • Syphilis
  • Genital herpes
  • Trichomonas
  • Chlamydial infection when resent beyond first six months of life (may be present at birth up to 6 months)
  • Lymphogranuloma venereum
  • Nonspecific vaginitis
  • Candidiasis
  • Pregnancy
  • Sperm or acid phosphatase on body or clothes; sperm in the urine of a female child
  • Lax rectal tone




Children may display a wide range of psychological reactions to sexual abuse. Reactions depend on the age of the child, emotional maturity, nature of the incident, duration of sexual abuse, and the child’s relationship to the offender. The child may:

  • Confide in a relative, friend, or teacher; the disclosure may either be overt or subtle and indirect
  • Become withdrawn and daydream excessively
  • Evidence poor peer relationships
  • Experience poor self-esteem
  • Seem frightened or phobic, especially of adults
  • Experience distortion of body image
  • Express general feelings of shame or guilt
  • Exhibit a sudden deterioration in academic performance
  • Show pseudomature personality development
  • Attempt suicide
  • Exhibit a positive relationship toward the offender
  • Display regressive behavior
  • Display enuresis (wetting self) and/or encopresis (soiling self)
  • Engage in excessive masturbation
  • Engage in highly sexualized play
  • Become sexually promiscuous
  • Have a sexually abused sibling.

Children Witnessing Violence Fact Sheet

Witnessing Violence Fact Sheet
Joanne Davis, Ph.D. and Ernestine Briggs, Ph.D
National Violence Against Women Prevention Research Center
Medical University of South Carolina

Society has become increasingly aware of the negative impact of child abuse on children’s’ behavioral, emotional, and social functioning. Research has shown that children do not have to be the direct targets of violence to be affected by it. Indeed, the research on negative outcomes associated with exposure to violence has grown exponentially. Children may be exposed to various types of violence including violence in the media (e.g., television or movies), in the school or in the community, and between adults at home.

This fact sheet will focus primarily on children’s experiences of witnessing domestic violence.

What Kinds of Violent Activities do Children Witness?
The violence that children are exposed to in their homes can vary in frequency, duration, degree of reciprocity, and severity (Wolak & Finkelhor, 1998). Although domestic violence is typically thought of in terms of a physical assault, it includes verbal and emotional abuse, sexual assaults, and murder.

Edleson (1999) discussed the different ways in which children can witness or be a part of domestic violence (see also Ganley & Schechter, 1996). These include witnessing the actual violent events occurring, hearing the fight, being physically assaulted while near the mother during a violent incident, being taken hostage in order to force the mother’s situation, and being forced to participate in the violence.

Also, some children ribe coping with the aftermath of domestic violence as particularly stressful. After a violent t, a child may have to aid an injured parent, call the police, witness the arrest or removal of the offending parent, relocate to a shelter and/or cope with a host of persistent family stressors (e.g., poverty, substance abuse, mental and physical illness).

How Many Children are Affected?
Prevalence estimates of children who witness domestic violence vary widely. Some commonly cited figures suggest that 3.3 million children and 10 million teenagers are exposed to domestic violence each year (Carlson, 1984; Straus, 1992). Other studies suggest that approximately 20% to 41% of adults recalled observing domestic violence when they were younger (Henning, Leitenberg, Coffey, Turner, & Bennett, 1996; Silvern 1995). Differences in prevalence rates are a function of several methodological issues including age and geographic location of participants sampled, and retrospective versus prospective nature of the studies examined. Despite the variation in the prevalence
estimates, most researchers would agree that a substantial number of children are exposed to violence in their homes.

Correlates of Witnessing Violence
Children who witness domestic violence (i.e., violence between parents, guardians, or caregivers) are often referred to as the “forgotten” victims since interventions generally target the adult victim or perpetrator (Groves, Zukerman, Marans, & Cohen, 1993). Most of the research in this area sugge that children exposed to domestic violence are at increased risk for emotional, behavior, academic, and social problems (Kolbo, Blakely, & Engelman, 1996; Pfouts et. al., 1982). More specifically, children exposed to domestic violence may exhibit immediate and long-term problems with anxiety, depression, anger, self-esteem, aggression, delinquency, interpersonal relationships, and substance abuse (Carlson,1990; Jouriles, Murphy, O’Leary, 1989; Silvern, et al., 1995; Sternberg, et al., 1993). Moreover, children who are exposed to domestic violence may react in ways that fur augment their risk for negative outcomes. For example, some children run away from violent homes, which increases the risk of substance use, prostitution, homelessness, physical illness or injury, and victimization.

The Association Between Child Abuse and Witnessing Domestic Violence
Children in violent homes are at higher risk for being abused than children in non-violent homes. McKibben, DeVos, and Newberger (1989) found that 40-60% of mothers of abused children were abused themselves by their partner, compared to 13% of mothers of unabused children. In a study investigating the effects of witnessing domestic violence, Hughes et al. (1989) compared children who had ‘only’ witnessed violence, children who were abused and witnessed violence, and those who experienced neither. The investigators found that children who experience both direct abuse and witnessed violence exhibited the most symptoms, and the group that did not experience either exhibited the least.

Revictimization and Other Long-Term Correlates
Women who witnessed domestic violence as children may be at higher risk for being victimized in their own relationships. Experiencing revictimization may also lead to greater difficulties in the women’s functioning (i.e., post traumatic stress disorder, depression) as adults. In a study of 201 battered women, Sonnleitner, Basil, and Van Hasselt (1999) found that women who also experienced or witnessed violence in their families of origin reported greater depression and hopelessness. Silvern et al. (1995) found that witnessing domestic violence was associated with depression, low self-esteem, and trauma symptoms in adult women and trauma symptoms in adult men. Henning et al. (1996) surveyed adult women in the community and found that those who reported witnessing domestic violence as children reported higher psychological distress and lower social adjustment than those who had not witnessed violence.

Limitations of Research and Future Directions
Although the research on exposure to domestic violence is steadily improving, there are limitations and methodological shortcomings that must be addressed:

  • Frequency, severity, recency, type of violence, and other important characteristics associated with a child’s exposure to violence are rarely assessed and reported by researchers.
  • Child abuse and neglect often are not assessed despite the high risk in this population.
  • Most studies have included children residing in shelters. Although this is an important group to study, the chronicity and severity of the violence they witness may not accurately represent the range of experiences and symptoms reported by children exposed to less severe forms of domestic violence. Also, many of these studies fail to differentiate between children who witness violence and those who experience it.
  • Little attention has been paid to the demographic characteristics and the differential developmental needs of children exposed to domestic violence.
  • Most studies have relied on the reports of the primary caregiver rather than assessing the child’s response directly.
  • Few studies have differentiated between the effects of observing domestic violence and the impact of negotiating multiple transitions and family disruptions that are secondary to leaving an unsafe environment.
  • Few assessment tools have been designed specifically to address the impact of witnessing violence.
  • To date, there are virtually no follow-up, prospective, or longitudinal studies that examine the effects of witnessing violence.

When domestic violence comes to the attention of others, interventions are typically focused on the adults. In the past, law enforcement and other social service agencies have not been equipped to deal with the diverse needs of children exposed to domestic violence (Wolak & Finkelhor, 1998).

According to Wolak and Finkelhor (1998), professionals serving the needs of children exposed to domestic violence should be prepared to provide: (1) crisis intervention (i.e., assess for safety; develop a safety plan; file an abuse report; and provide crisis counseling); (2) assessment (i.e., assess current functioning, suicide risk); (3) short and long-term therapy (i.e., gradual exposure, trauma processing, reduction of feelings of responsibility and self-blame).

Carlson, B.E. (1990). Adolescent observers of marital violence. Journal of Family Violence, 5 (4), 285-299.

Carlson, B.E. (1984). Children’s observations of interparental violence. In A.R. Roberts (Ed.), Battered women and their families (pp. 147-167). New York: Springer.

Edleson, J.L. (1999). Children’s witnessing of adult domestic violence. Journal of Interpersonal Violence, 14 (8), 839-870.

Ganley, A.L., & Schecter, S. (1996). Domestic violence: A national curriculum for children’s protective services. San Francisco: Family Violence Prevention Fund.

Henning, K., Leitenberg, H., Coffey, P., Turner, T., & Bennett, R.T. (1996). Long-term psychological and social impact of witnessing physical conflict between parents. Journal of Interpersonal Violence, 11 (1), 35-51.

Hughes, H.M., Parkinson, D., & Vargo, M. (1989). Witnessing spouse abuse and experiencing physical abuse: A “double whammy?” Journal of Family Violence, 4, 197-209.

Jouriles, E.N., Murphy, C.M., & O’Leary, D. (1989). Interpersonal aggression, marital discord, and child problems. Journal of Consulting and Clinical Psychology, 57(3), 453-455.

Kolbo, J.R., Blakely, E.H., & Engelman, D. (1996). Children who witness domestic violence: A review of empirical literature. Journal of Interpersonal Violence, 11(2), 281-293.

McKibben, L. DeVos, E., & Newberger, E. (1989). Victimization of mothers of abused children: A controlled study. Pediatrics, 84, 531-535.

Pfouts, J., Schopler, J., & Henley, H. (1982). Forgotten victims of family violence. Social Work, 367-368.

Silvern, L., Karyl, J., Waede, L. Hodges, W.F., Starek, J., Heidt, E., & Min, K. (1995). Retrospective reports of parental partner abuse: Relationships to depression, trauma symptoms, and self-esteem among college students. Journal of Family Violence 10(2), 177-202.

Sonnleitner, M.R., Basil, V.M., & Van Hasselt, V.B. (1999, August). Impact of early exposure to violence on battered women. Paper presented at the annual meeting of the American Psychological Association, Boston, MA.

Sternberg, K. J., Lamb, M.E., Greenbaum, C., Cicchetti, D., Dawud, S., Cortes, R.M., Krispin, O., & Lorey, F. (1993). Effects of domestic violence on children’s behavioral problems and depression. Developmental Psychology, 29(1), 44-52.

Straus, M.A. (1992). Children as witnesses to marital violence: A risk factor for lifelong problems among a nationally representative sample of American men and women. Report of the Twenty-Third Ross Roundtable. Columbus, OH: Ross Laboratories.

Wolak, J. & Finkelhor, D. (1998). Children exposed to partner violence. In J.L. Jasinski & L. Williams (Eds.) Partner Violence: A Comprehensive Review of 20 Years of Research. Thousand Oaks, CA: Sage.