INTRODUCTION
posttraumatic stress disorder meets the psychological manifestations, immediate or delayed, which can follow exposure to high-level stressors and thus reflects the effects of these stressors in the lives of people.
Detailed studies of the responses observed in extreme situations (natural disasters, wars) have provided important evidence about the consequences of participation in these events.
not yet know a lot of parameters that define the stress traumatic, or clinical course and treatment, but it is essential to explore the interaction between biological, psychological and social aspects of the victim and the characteristics of the traumatic event.
This has been studied in adults than in children, these have been difficult to assess symptoms such as amnesia and numbness, and flashbacks were not found.
In the new DSM-IV, is included as a traumatic event in children, inappropriate sexual experiences for their stage of development, without being accompanied by threats, violence or injury.
DEFINITION OF STRESS POST-TRAUMATIC
Diagnostic criteria
The person has experienced a traumatic event which was attended by the following two items :
- Events leading death or the threat of death, serious injury or threat to physical integrity
- The response of the person involved intense fear, helplessness or horror. Note in young children can be expressed by disorganized or agitated behavior.
- unpleasant memories, recurrent and
- invasive and recurring unpleasant dreams about the event
- sudden behaviors or feelings as if the traumatic event from happening again (flashbacks).
- intense psychological distress at exposure to internal or external signals that symbolize or resemble an aspect of the traumatic event.
- physiological reactivity when exposed to these signals.
- Efforts to avoid these thoughts.
- Efforts to avoid activities or places that arouse recollections of the trauma
- Inability to recall some aspects of the trauma
- marked decline of interest or participation in activities.
- feeling of detachment or estrangement from others.
- restricted range of affect.
- Sensation of shortened future.
- or difficulty maintaining sleep
- Irritability or outbursts of anger.
- Difficulty concentrating.
- Hypervigilance.
- exaggerated startle response.
The disorder causes significant distress or impairment in social functioning .
Specify other:
definition of child sexual abuse
called child sexual abuse is the involvement of a child or adolescent (under 18 years old) in sexual activities that are not yet fully understood, to which it has no capacity to consent or that violate social taboos of family roles.
Prevalence of child sexual abuse
exact prevalence is unknown but is estimated between 6 and 62% in women and 3 and 31% in men. In Spain it is around 22.5% in women and 15.2% in men, using the 16 years age limit.
Characteristics of abused child's family.
No differences were found in As to socioeconomic status, but as negative factors that have proved relevant and add to the traumatic experience are:
in which there has been domestic abuse, families are described as entangled or chaotic
and common factors that experience has been within or outside the family are: low levels of cohesion, poor personal growth stimulation of children, with little encouragement of independent thought, moral and ethical development and leisure activities; little organization in terms of responsibilities mutual activities and family rules.
study in detail the familial risk factors for sexual abuse as well as it is a difficult task to design treatments and prevention programs.
mediate the effects of child sexual abuse
negative factors related to abuse characteristics
The effects of sexual abuse can be difficult to distinguish from the consequences of emotional abuse, physical or experience of a dysfunctional family.
The characteristics of the child before the abuse, are also important. Personal problems that predate the abuse can be triggered or exacerbated by it. Also consider the responsibility of the child and his family attributed to abuse. This last factor, together with support, has a special significance because, unlike others, can be modified by treatment.
Factors that protect against the negative effects of abuse
are associated with resistance to adversity: the presence of a mother's warm, it being believed or supported, have a high IQ, ability to solve problems, not make biased attributions, hope, fantasy and good self-esteem emerge as strong predictors of adjustment in adulthood.
effects of child sexual abuse
Short-term effects
To increase experimental control of these studies is be taken into account: that children usually do not report what happened to them, some lack the language skills and that in cases of incest on the whole episode is usually not sudden.
This effect has been studied using standardized questionnaires are completed by parents, teachers, social workers and the children themselves.
-effects has been observed that these children show antisocial behavior, aggression, fear, ambivalence toward both parents, anxiety, phobias, sleep problems, nightmares, alarm reactions, hypervigilance, withdrawal from normal activities, nervousness and poor cognitive development . It has also been observed more frequently in boys than girls, physical complaints, regressive behavior and self-destructive behavior, while girls may appear enuresis and encopresis. In addition to those other symptoms such as compulsive, hyperactive, withdrawn, guilt, mood swings, suicidal thoughts, fatigue, loss of appetite, change in eating habits, distrust and school problems.
Despite being very different symptoms, many authors agree that present: onset of sexual misconduct, public masturbation, sex require adults or other children or inappropriate sexual play. In addition to dissociative symptoms understood as avoidance responses.
Some authors have found that after an experience of child sexual abuse, increased social competence and greater sympathy for girls, to strangers, which has been interpreted as an adaptation to an abnormal situation has been termed inescapable this form of pseudo-sophistication interaction.
The variety of reactions makes it difficult to detect the existence of sexual abuse at home. Then as indicators arise: the presence of physical signs of shock or penetration (anal or vaginal) that can be accompanied by pain. And appearance in the child afraid of men or their families, loss of sphincter control, changes in hygiene. Of particular relevance last appearance of sympathy toward strangers or the presence of sexual misconduct for his age that can be observed in games, verbal expressions, drawings or compulsive masturbation. In adolescents will have to show special attention to the fleeing from home, to the intake of alcohol or other drugs.
term effects
not found a direct relationship between child sexual abuse and a single disease in adulthood. The most frequently studied, depression, anxiety, eating disorders, sexual, dissociative and certainly stress disorder disorder.
Given the wide range of problems that may have a person who has been abused should not be overlooked in the evaluation of any patient, the possibility that these events have occurred in its infancy, but be careful not to create false memories.
Explanatory models of the effects of child sexual abuse
Specify other:
- Acute: duration of symptoms less than three months
- Chronic: duration is three months or more.
- delayed start: if the onset of symptoms occurred at least six months after the stressor.
definition of child sexual abuse
called child sexual abuse is the involvement of a child or adolescent (under 18 years old) in sexual activities that are not yet fully understood, to which it has no capacity to consent or that violate social taboos of family roles.
Prevalence of child sexual abuse
exact prevalence is unknown but is estimated between 6 and 62% in women and 3 and 31% in men. In Spain it is around 22.5% in women and 15.2% in men, using the 16 years age limit.
Characteristics of abused child's family.
No differences were found in As to socioeconomic status, but as negative factors that have proved relevant and add to the traumatic experience are:
in which there has been domestic abuse, families are described as entangled or chaotic
and common factors that experience has been within or outside the family are: low levels of cohesion, poor personal growth stimulation of children, with little encouragement of independent thought, moral and ethical development and leisure activities; little organization in terms of responsibilities mutual activities and family rules.
study in detail the familial risk factors for sexual abuse as well as it is a difficult task to design treatments and prevention programs.
mediate the effects of child sexual abuse
negative factors related to abuse characteristics
- The type of sexual behavior, the more intimate carries a greater impact.
- The relationship with the abusante, here is reflected as the most important variable, the existence of a good emotional relationship between the victim and the aggressor, rather than whether it has been in the family.
- The use of coercion, has a weak but significant, and there are no neglect the importance of more subtle psychological tricks or he have received awards and benefits, which can increase the feeling of guilt on the victim.
- The duration and frequency of abuse, given that every abuse of the victim is a test of learning.
- The child's age, there is no clear relationship between age and gives the victim further trauma.
- Breaking the silence without support, since this is an extremely stressful time, so the adult should not only try to resolve the conflict, but seek professional help.
- not forget that the child may have contracted a sexually transmitted disease sex, AIDS or becoming pregnant, being therefore appropriate medical examination, which is essential not blame the victim.
The effects of sexual abuse can be difficult to distinguish from the consequences of emotional abuse, physical or experience of a dysfunctional family.
The characteristics of the child before the abuse, are also important. Personal problems that predate the abuse can be triggered or exacerbated by it. Also consider the responsibility of the child and his family attributed to abuse. This last factor, together with support, has a special significance because, unlike others, can be modified by treatment.
Factors that protect against the negative effects of abuse
are associated with resistance to adversity: the presence of a mother's warm, it being believed or supported, have a high IQ, ability to solve problems, not make biased attributions, hope, fantasy and good self-esteem emerge as strong predictors of adjustment in adulthood.
effects of child sexual abuse
Short-term effects
To increase experimental control of these studies is be taken into account: that children usually do not report what happened to them, some lack the language skills and that in cases of incest on the whole episode is usually not sudden.
This effect has been studied using standardized questionnaires are completed by parents, teachers, social workers and the children themselves.
-effects has been observed that these children show antisocial behavior, aggression, fear, ambivalence toward both parents, anxiety, phobias, sleep problems, nightmares, alarm reactions, hypervigilance, withdrawal from normal activities, nervousness and poor cognitive development . It has also been observed more frequently in boys than girls, physical complaints, regressive behavior and self-destructive behavior, while girls may appear enuresis and encopresis. In addition to those other symptoms such as compulsive, hyperactive, withdrawn, guilt, mood swings, suicidal thoughts, fatigue, loss of appetite, change in eating habits, distrust and school problems.
Despite being very different symptoms, many authors agree that present: onset of sexual misconduct, public masturbation, sex require adults or other children or inappropriate sexual play. In addition to dissociative symptoms understood as avoidance responses.
Some authors have found that after an experience of child sexual abuse, increased social competence and greater sympathy for girls, to strangers, which has been interpreted as an adaptation to an abnormal situation has been termed inescapable this form of pseudo-sophistication interaction.
The variety of reactions makes it difficult to detect the existence of sexual abuse at home. Then as indicators arise: the presence of physical signs of shock or penetration (anal or vaginal) that can be accompanied by pain. And appearance in the child afraid of men or their families, loss of sphincter control, changes in hygiene. Of particular relevance last appearance of sympathy toward strangers or the presence of sexual misconduct for his age that can be observed in games, verbal expressions, drawings or compulsive masturbation. In adolescents will have to show special attention to the fleeing from home, to the intake of alcohol or other drugs.
term effects
not found a direct relationship between child sexual abuse and a single disease in adulthood. The most frequently studied, depression, anxiety, eating disorders, sexual, dissociative and certainly stress disorder disorder.
Given the wide range of problems that may have a person who has been abused should not be overlooked in the evaluation of any patient, the possibility that these events have occurred in its infancy, but be careful not to create false memories.
Explanatory models of the effects of child sexual abuse
To explain the rise of the conditioned response in the absence of a new traumatic experience.
ASSESSMENT OF THE EFFECTS OF CHILD SEXUAL ABUSE
Initial assessment
- Two Factor Theory of Mower .- The neutral stimuli present in the abusive situation (smells, clothing, place, thoughts) are conditioned to fear and anxiety that occur during the same (EI) and generalize to other stimuli.
- associative Other possibilities would be:
- Subsequent changes in the value of unconditional stimulus
- brief contact with the conditional status (Flashbacks)
- The learned helplessness model of Seligman
- social learning principles .- In this sense, modeling, instructions, reinforcement and punishment inadequate and forge a code determined unintended consequences for behavior.
- The conceptualization of Foa and Kozak .- in it together proposals on the stimuli and responses, with proposals of meaning or interpretation of danger, forming a node or fear structure, conceived as a program to perform the escape or avoidance response. And according to this model, the traumatic event breaks the basic security concept and the world becomes less predictable.
- traumatic learning model or cognitive-behavioral model Hoier. For these emotional responses would learn by classical conditioning, whereas negative reinforcement account for the acquisition and maintenance of avoidance responses.
ASSESSMENT OF THE EFFECTS OF CHILD SEXUAL ABUSE
Initial assessment
The first priority is to ensure that neither he nor his siblings or other children at risk of further abuse or consequences of having spoken . Sometimes the child will have to find another home, and others that will be the offender. Suffice it to say that the longer children are away from home more difficult it will reunite again. As will be better leave the adult.
The therapist must be prepared to initiate legal action (21/87 Law on Adoption and foster care).
Then you have to assess their current world, if the child receives the necessary support of the family, we must banish the belief that abuse only happens in special environments (poverty, overcrowding) and the mentally ill abusantes with serious diseases. Guilt, jealousy, fear of losing emotional and economic support, fear of making mistakes in reporting or poor family relationships can stoke doubts to believe the child, in which case parents should start their own therapy.
At the same time to study other family needs can be met and that other stressors are also present.
must be known as was the abuse and all mediating factors previously mentioned, this information may be obtained from adults with the child we can communicate either verbally or through drawings, games or the use of anatomical dolls.
Assessment should be idiographic, targeting both the child and family and should collect information from different people and situations.
Instruments for assessing general aspects
have to study the consequences, avoidance responses, beliefs and responsibilities about the abuse. Also the list of child behavior (Achenback) Depression Inventory for Children (Kovacs) and the State Anxiety Inventory-Trait for children (Spielberg), may also be used.
Tools for assessing specific aspects
The scale of impact of traumatic events in children (CITES-R) (Wolfe) consists of 11 subscales across four dimensions: posttraumatic stress syndrome (intrusive thoughts, avoidance and sexual anxiety), social reactions (negative reactions to others, social support), attributions about the abuse (guilt, control, vulnerability, dangerous world) and eroticism.
relations between stimuli and conditioned responses, unconditional and active and controlling variables must be examined very carefully, because these are crucial to detect patterns of response and all related stimuli. The stimuli can be private or come from external, the latter of various modalities (olfactory, thermal). To identify relevant conditioned stimuli are: sexual issues, body, small details (a pubic hair) and the dates and places where they had the experience also nightmares can be used to detect anxiogenic stimuli.
Finally do not forget to evaluate the positive aspects of child and family, to teach them to recognize and then empower them.
Evaluation during the treatment phase
This should continue throughout the operation, which will allow flexibility in the operation, outline the functional analysis, knowing the course and impact of the intervention and identify at what point should end.
As the records will be subjective, we can use the little smiley faces, angry, sad or normal)
TREATMENT OF THE EFFECTS OF CHILD SEXUAL ABUSE
key action areas are
This relationship should promote: respect, trust, unity and mutual feelings of empathy.
As always no complaint is to have suffered sexual abuse, if this is the case, the therapist must know how to react, without judging and without embarrassment to show it. Finally it
to be open and willing to seek a sex therapist, at least at the beginning of treatment, to facilitate the intervention. Intervention
emotional processing
For patients diagnosed with PTSD, behavioral techniques have led to exposure of the subject to stimuli (gradual or abrupt (systematic desensitization, flooding, negative practice) in imagination or in vivo, participatory modeling), the control of physiological arousal (eg relaxation, coping skills instruction, stress inoculation) and the proper handling of contingencies; to what has joined a training aimed at changing the perception of coping effectiveness (assertiveness training, cognitive restructuring).
With the smallest of the game can be incorporated into the chosen techniques, with the highest a good strategy is to speak, write or write about what concerns them, using diaries, biographies, letters. The therapist must constantly helping your child not to feel overwhelmed by the intensity of memories or feelings, not to exceed their coping capabilities.
may remember experiences appear fragmented, a good technique to bring them together is the use of imagination tour. Through the evocation of images of the trauma and the exploration of its meaning can rearrange the content.
There are times when it is convenient to provide the patient with the necessary skills to deal with intrusive memories and dissociative, they are to teach them to concentrate on the here and now, describing the immediate environment, touching nearby objects, or talking to someone . Another possibility is to teach and perform in conduct incompatible distractors.
There is considerable controversy with the use of techniques of flooding. Kilpatrick has said that a problem of this intervention is to focus only on reducing anxiety to the exclusion of other symptoms, but decreases anxiety get a major therapeutic achievement as this is accompanied by a decrease in negative irrational cognitions. The Foa and Kozak model explains how an activation of fear memories in the absence of situations involving risk, changes the meaning of memory. In addition, once anxiety has been reduced it is possible to start another type of training specific to the deficiencies that prevail.
Fear and anxiety need to neutralize the stimuli that cause, then it is important to expose all of the traumatic stimulus and the feelings caused by them. As since the start of treatment is impossible to know all these peculiarities treatment may be timely but not progressive. Intervention
fears related to going to bed
is one of the fears that often appear in the abuse, for this we must take the necessary measures for the environment is safe, remove all the details that help to elicit or maintain anxiety and distribute objects that help the child to have control over their environment (eg night lamp if you wake up, posters favorites).
Parents and caregivers need to train them to extinguish the fear of inappropriate behavior.
At the time of going to sleep is to institute a reassuring ritual (bath warm glass of milk), both to go to bed as if startled awake at night. If anxiety starts to go to bed is necessary for the child to engage in conduct incompatible at the time it begins to have anxiety, without waiting for increased anxiety. Regarding
nightmares may have a role to decrease the anxiety that prolonged or intense exposure to the feared stimuli appearing in them to reduce the physiological responses associated with them. Waking up in the middle of a nightmare just to exposure and may explain its recurrence. Then it should give the child the option to count or draw their dreams and transform their content so that it loses its ability terrifying. Has also been used systematic desensitization coupled with training in self-control and implosive therapy. Intervention
other emotions
emotional reactions such as anger, grief and sadness are common in abused children. The child must learn to recognize their intensity, naming them and learn how emotions are legitimate and permissible, but no contingent relation with the environment, ie not change any aspect of your situation. The fear to express them is an aspect that should be taken into account by the therapist.
The search for the events that trigger these emotions, is a step of deconditioning of abuse-related stimuli. Intervention
beliefs and rules (reference)
abusante is possible that, to win the boy and his silence has been distilling arguments that undermine their self-esteem and happiness, also the potential gains (gifts) and duration of abuse can generate ideas of guilt. The goal is for desculpabilizar the child and has to understand to prevent future abuses, which aspects of their behavior may be harmful.
The internal attributions, specific and unstable enable more adaptive coping responses, they help to foster a sense of control.
must also explain the behavior of the aggressor with the 4 points made by Finkelhor (adult interest in sex with children, ability to overcome internal inhibitions, lack of external control and withdrawal of the child's resistance.)
Avoid explanations of abuse as a form of love misunderstood or submit to abusante as a patient and increases the vulnerability of children in the future.
abuse is more traumatic when there was an affectionate relationship with the abusante. For what should be taught to discriminate on who can be trusted without extreme generalizations, for it is the ideal therapeutic relationship itself.
Cognitive training must be accompanied by acquisition of social skills, communication and assertiveness, to promote positive relationships with others and integration into the social networking environment.
Social relations are also favored the creation of a positive personal image and not stigmatized.
is appropriate to revise and influence children's academic performance, difficulties in concentrating and fatigue characteristic of PTSD, they may be hindering their academic performance. Then you need to improve by studying their feelings of efficacy and achievement. Sex education
Its objectives are: Provide
Intervention for secondary prevention of child sexual abuse
The primary and secondary prevention teaches children to recognize the aggression before it is carried out and react, but secondary prevention, as opposed to primary may be held in the school or by parents, results in a therapeutic environment, and taking great care not to trigger unwanted emotional responses.
As important points of training include: Teaching
The low correlation between what we know must be done and what is done in a given situation is encouraging the workhorse of preventive programs. Transform
programs eminently practical and not theoretical, in which there is an opportunity to shape and develop appropriate behavior will be important future contributions.
In any case he had gone through a prevention program, it places the child in a situation of complete absence of risk, and are the adults responsible for their welfare and the society itself which must ensure that these misdeeds are not repeated. Intervention
family whenever possible, should be to involve parents in the treatment, making them co-therapists, intervention can be performed continuously and natural.
Parents must show the child's verbal and nonverbal support him, not push him to talk and normalizing daily life. It is inappropriate to ask the child to forget or overcome what happened. They must also be trained in proper methods of childrearing and education, to recognize and record specific behaviors, the appropriate use of reinforcement and development of guidelines on privacy, sexuality and family boundaries. Using operant techniques (observation, contingency management and stimulus control).
Where necessary, we can advise parents perform their own therapy. Still a controversy today whether to treat or not, as goal of treatment, family reunification.
The abused child's siblings, and especially those who have been abused by a family member must not be forgotten in the intervention. CONCLUSIONS
The assessment should involve more people and situations related to the child, and must pass a general examination and extensive, detailed analysis of particular problems.
treatment, but must address the specific problems of each child, in general, will aim emotional processing of the traumatic event, not forgetting to make a proper sex education and prevent future abuses. When possible, involve the family in treatment will be an important therapeutic aid.
The therapist must be prepared to initiate legal action (21/87 Law on Adoption and foster care).
Then you have to assess their current world, if the child receives the necessary support of the family, we must banish the belief that abuse only happens in special environments (poverty, overcrowding) and the mentally ill abusantes with serious diseases. Guilt, jealousy, fear of losing emotional and economic support, fear of making mistakes in reporting or poor family relationships can stoke doubts to believe the child, in which case parents should start their own therapy.
At the same time to study other family needs can be met and that other stressors are also present.
must be known as was the abuse and all mediating factors previously mentioned, this information may be obtained from adults with the child we can communicate either verbally or through drawings, games or the use of anatomical dolls.
Assessment should be idiographic, targeting both the child and family and should collect information from different people and situations.
Instruments for assessing general aspects
have to study the consequences, avoidance responses, beliefs and responsibilities about the abuse. Also the list of child behavior (Achenback) Depression Inventory for Children (Kovacs) and the State Anxiety Inventory-Trait for children (Spielberg), may also be used.
Tools for assessing specific aspects
The scale of impact of traumatic events in children (CITES-R) (Wolfe) consists of 11 subscales across four dimensions: posttraumatic stress syndrome (intrusive thoughts, avoidance and sexual anxiety), social reactions (negative reactions to others, social support), attributions about the abuse (guilt, control, vulnerability, dangerous world) and eroticism.
relations between stimuli and conditioned responses, unconditional and active and controlling variables must be examined very carefully, because these are crucial to detect patterns of response and all related stimuli. The stimuli can be private or come from external, the latter of various modalities (olfactory, thermal). To identify relevant conditioned stimuli are: sexual issues, body, small details (a pubic hair) and the dates and places where they had the experience also nightmares can be used to detect anxiogenic stimuli.
Finally do not forget to evaluate the positive aspects of child and family, to teach them to recognize and then empower them.
Evaluation during the treatment phase
This should continue throughout the operation, which will allow flexibility in the operation, outline the functional analysis, knowing the course and impact of the intervention and identify at what point should end.
As the records will be subjective, we can use the little smiley faces, angry, sad or normal)
TREATMENT OF THE EFFECTS OF CHILD SEXUAL ABUSE
key action areas are
- The therapeutic relationship
- Intervention on anxiety-related problems
- Discussions focused on the abuse and the child's understanding of what happened
- Sex Education Prevention of future abuses
This relationship should promote: respect, trust, unity and mutual feelings of empathy.
As always no complaint is to have suffered sexual abuse, if this is the case, the therapist must know how to react, without judging and without embarrassment to show it. Finally it
to be open and willing to seek a sex therapist, at least at the beginning of treatment, to facilitate the intervention. Intervention
emotional processing
For patients diagnosed with PTSD, behavioral techniques have led to exposure of the subject to stimuli (gradual or abrupt (systematic desensitization, flooding, negative practice) in imagination or in vivo, participatory modeling), the control of physiological arousal (eg relaxation, coping skills instruction, stress inoculation) and the proper handling of contingencies; to what has joined a training aimed at changing the perception of coping effectiveness (assertiveness training, cognitive restructuring).
With the smallest of the game can be incorporated into the chosen techniques, with the highest a good strategy is to speak, write or write about what concerns them, using diaries, biographies, letters. The therapist must constantly helping your child not to feel overwhelmed by the intensity of memories or feelings, not to exceed their coping capabilities.
may remember experiences appear fragmented, a good technique to bring them together is the use of imagination tour. Through the evocation of images of the trauma and the exploration of its meaning can rearrange the content.
There are times when it is convenient to provide the patient with the necessary skills to deal with intrusive memories and dissociative, they are to teach them to concentrate on the here and now, describing the immediate environment, touching nearby objects, or talking to someone . Another possibility is to teach and perform in conduct incompatible distractors.
There is considerable controversy with the use of techniques of flooding. Kilpatrick has said that a problem of this intervention is to focus only on reducing anxiety to the exclusion of other symptoms, but decreases anxiety get a major therapeutic achievement as this is accompanied by a decrease in negative irrational cognitions. The Foa and Kozak model explains how an activation of fear memories in the absence of situations involving risk, changes the meaning of memory. In addition, once anxiety has been reduced it is possible to start another type of training specific to the deficiencies that prevail.
Fear and anxiety need to neutralize the stimuli that cause, then it is important to expose all of the traumatic stimulus and the feelings caused by them. As since the start of treatment is impossible to know all these peculiarities treatment may be timely but not progressive. Intervention
fears related to going to bed
is one of the fears that often appear in the abuse, for this we must take the necessary measures for the environment is safe, remove all the details that help to elicit or maintain anxiety and distribute objects that help the child to have control over their environment (eg night lamp if you wake up, posters favorites).
Parents and caregivers need to train them to extinguish the fear of inappropriate behavior.
At the time of going to sleep is to institute a reassuring ritual (bath warm glass of milk), both to go to bed as if startled awake at night. If anxiety starts to go to bed is necessary for the child to engage in conduct incompatible at the time it begins to have anxiety, without waiting for increased anxiety. Regarding
nightmares may have a role to decrease the anxiety that prolonged or intense exposure to the feared stimuli appearing in them to reduce the physiological responses associated with them. Waking up in the middle of a nightmare just to exposure and may explain its recurrence. Then it should give the child the option to count or draw their dreams and transform their content so that it loses its ability terrifying. Has also been used systematic desensitization coupled with training in self-control and implosive therapy. Intervention
other emotions
emotional reactions such as anger, grief and sadness are common in abused children. The child must learn to recognize their intensity, naming them and learn how emotions are legitimate and permissible, but no contingent relation with the environment, ie not change any aspect of your situation. The fear to express them is an aspect that should be taken into account by the therapist.
The search for the events that trigger these emotions, is a step of deconditioning of abuse-related stimuli. Intervention
beliefs and rules (reference)
abusante is possible that, to win the boy and his silence has been distilling arguments that undermine their self-esteem and happiness, also the potential gains (gifts) and duration of abuse can generate ideas of guilt. The goal is for desculpabilizar the child and has to understand to prevent future abuses, which aspects of their behavior may be harmful.
The internal attributions, specific and unstable enable more adaptive coping responses, they help to foster a sense of control.
must also explain the behavior of the aggressor with the 4 points made by Finkelhor (adult interest in sex with children, ability to overcome internal inhibitions, lack of external control and withdrawal of the child's resistance.)
Avoid explanations of abuse as a form of love misunderstood or submit to abusante as a patient and increases the vulnerability of children in the future.
abuse is more traumatic when there was an affectionate relationship with the abusante. For what should be taught to discriminate on who can be trusted without extreme generalizations, for it is the ideal therapeutic relationship itself.
Cognitive training must be accompanied by acquisition of social skills, communication and assertiveness, to promote positive relationships with others and integration into the social networking environment.
Social relations are also favored the creation of a positive personal image and not stigmatized.
is appropriate to revise and influence children's academic performance, difficulties in concentrating and fatigue characteristic of PTSD, they may be hindering their academic performance. Then you need to improve by studying their feelings of efficacy and achievement. Sex education
Its objectives are: Provide
- proper sex information to the child's age
- Correct distorted ideas about sexuality.
- clarify and establish social values.
- Training in managing their own feelings.
- inhibitions promote internal and external controls appropriate behavior
- make the development of healthy sexual expression and not traumatic. Foster
- contraceptive use and prevent sexually transmitted diseases, AIDS, unwanted pregnancies. This point should not ignore in adolescents.
Intervention for secondary prevention of child sexual abuse
The primary and secondary prevention teaches children to recognize the aggression before it is carried out and react, but secondary prevention, as opposed to primary may be held in the school or by parents, results in a therapeutic environment, and taking great care not to trigger unwanted emotional responses.
As important points of training include: Teaching
- the child to trust their feelings about touch.
- When a touch makes them feel bad, they should say no, run, defend, or speak to a trusted adult.
- Abuse can come from an acquaintance or a stranger.
- should not keep secrets that make you feel bad.
- There are many adults who can help.
- abuse is never child's fault.
The low correlation between what we know must be done and what is done in a given situation is encouraging the workhorse of preventive programs. Transform
programs eminently practical and not theoretical, in which there is an opportunity to shape and develop appropriate behavior will be important future contributions.
In any case he had gone through a prevention program, it places the child in a situation of complete absence of risk, and are the adults responsible for their welfare and the society itself which must ensure that these misdeeds are not repeated. Intervention
family whenever possible, should be to involve parents in the treatment, making them co-therapists, intervention can be performed continuously and natural.
Parents must show the child's verbal and nonverbal support him, not push him to talk and normalizing daily life. It is inappropriate to ask the child to forget or overcome what happened. They must also be trained in proper methods of childrearing and education, to recognize and record specific behaviors, the appropriate use of reinforcement and development of guidelines on privacy, sexuality and family boundaries. Using operant techniques (observation, contingency management and stimulus control).
Where necessary, we can advise parents perform their own therapy. Still a controversy today whether to treat or not, as goal of treatment, family reunification.
The abused child's siblings, and especially those who have been abused by a family member must not be forgotten in the intervention. CONCLUSIONS
The assessment should involve more people and situations related to the child, and must pass a general examination and extensive, detailed analysis of particular problems.
treatment, but must address the specific problems of each child, in general, will aim emotional processing of the traumatic event, not forgetting to make a proper sex education and prevent future abuses. When possible, involve the family in treatment will be an important therapeutic aid.
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