This is another of those topics I really wish I didn’t have to do. In this interview with Dr. Jennie Noll of Pennsylvania State University, we discuss the impacts that sexual abuse can have on a child (even many years after the event itself!), and we talk extensively about what parents can do to prevent abuse from happening in the first place.
If you want to be sure to remember this info, there’s a FREE one-page cheat sheet of the 5 key steps parents can take to prevent sexual abuse available below.
Jen: 01:26 Hello and welcome to the Your Parenting Mojo podcast. We have a pretty serious topic to cover today and it’s what I’ve been thinking about for a long time now. In 2016 the USA gymnastics sexual assault scandal broke and we learned that Dr. Larry Nassar had been sexually assaulting gymnast for years as he claimed to be providing them legitimate medical treatment. Now obviously there were failings at so many levels here. This was reported and ignored and covered up at many levels. But one thing that stuck in the back of my mind was an interview with gymnast Aly Raisman where she said she really thought this was what medical treatment was like and I want to be 100% clear that I’m not blaming Raisman or any other gymnast who had this awful experience, but I just couldn’t get my head around how and why she didn’t know she was being sexually abused.
Jen: 02:11 I realized that it’s at least partly because we live in a culture where we don’t talk about this. We don’t teach children to watch for warning signs and we don’t look out for them ourselves as parents or we pretend we don’t see them. We just stick our head in the sand. So today’s episode is probably not one you want to listen to with children around because we’re going to be very explicit and discussing sexual abuse and how to prevent it. I also want to give a shout out to listener Christine who helped me to think through some great questions to ask my guest today. I spent a really long time looking for someone to talk with us about this and finally found the right person. Dr. Jennie Noll is Professor of Human Development and Family Studies and Director of the Child Maltreatment Solutions Network at Penn State University.
Jen: 02:52 She earned her Ph.D. in Developmental Psychology and Statistical Methodology from the University of Southern California. The reason I’m so interested to talk with her about this topic is because she has active research projects on two topics that are very important to us, the long-term health outcomes for victims of child sexual abuse and programs for the prevention of that abuse. Welcome Dr. Noll.
Dr. Noll: 03:13 Thank you very much for the opportunity.
Jen: 03:16 So before we get started, I actually also want to mention that I took the training that Dr. Noll studies and it’s called Stewards of Children and it’s published by an organization called Darkness to Light. I’ve created a free one page guide to preventing sexual abuse that you can download from this episode’s page at YourParentingMojo.com/SexualAbuse. So we’re going to talk a lot more about the Stewards of Children program today I imagine. But I wonder if we can get started by looking at the mental health or the general health actually impacts of sexual abuse because I was really surprised to find out how many of these there are. Can you walk us through these and do we have any indication of how likely they are to occur in a child who is chronically abused for years versus one who experiences abuse that it’s discovered or reported fairly quickly.
Dr. Noll: 03:58 Yeah, very good. So what we’ve understood and this has been my work for the last 30 years, what we’ve understood really well as sort of the mental health and emotional health consequences of abuse. We have pretty good trauma informed treatments for mental health. These are things like persisting posttraumatic stress disorder, other anxiety disorders, depression, other sorts of attachment related disorders in terms of not being able to attach to a partner, relationship difficulties, and substance abuse. These kinds of things that we normally think about as mental health or emotional health. But what we’re learning I think in the last decade is something that surprised a lot of us and that is just how we see sort of physical health consequences that we didn’t really anticipate when we were just studying mental and emotional health and these are things like physical health disorders, these are heart attacks, obesity, strokes, stress-related diseases like inflammation, interferences with disease processes.
Dr. Noll: 05:04 These are the kinds of things that we see in chronically stressed populations like PTSD Vietnam vets, people who have endured long and chronic stressors in their lives early on. And we think about this as how does stress sort of get under the skin and impact physiology? And we’re talking about not just disease process but brain development, right? Other sorts of major organs, systems, the stress response system. So after studying survivors, which I have done for over 30 years and across generations, we’re really starting to see a strong causal influence of early sexual abuse on long-term health outcomes because of the early and chronic exposure to stress and the stress hormone cortisol and other assaults on the stress response system.
Jen: 05:57 Wow, that’s incredible. So that completely makes sense from the sort of chronically abused perspective, if the stress is ongoing for a really long period of time. Do you see similar effects in people who have this experience maybe once or twice and it’s discovered fairly quickly?
Dr. Noll: 06:13 Yeah, that’s a great question. It has two parts to the answer and my answer would be it depends. It sort of depends on what outcome you’re looking at. For example, when we look at things like, sexual development, promiscuity, teen pregnancy, sort of more sort of sexual outcomes, right? Those are not necessarily tied to physical health, but something to do with the severe sexual boundary violation that has happened in the context of sexual abuse. I actually have some papers that really show clearly that it doesn’t matter all that much if it’s happened chronically or one time or several times or at what age, but more the fact that there was a sexual boundary violation and some kind of trust that was violated early on. So I don’t like to put things on a continuum from mild to severe or one time to chronic. It’s more about the interpretation of that violation and how it happened and the context in which it happened that helps us understand the sequelae and how to treat this kind of survivor.
Jen: 07:20 Okay. So that leads me to think about, what’s the prevalence of these kinds of problems among children who are sexually abused? We actually did an episode on Intergenerational Trauma and how that’s passed down through the generations and it’s amazing. Some people can experience incredible trauma and not pass it onto the next generation and the vice versa happens as well. So I’m wondering, do most children manage these transitions to adolescence and adulthood kind of okay, kind of normally as it were or are problems really common?
Dr. Noll: 07:49 I think problems are a lot more common than we initially had thought about because of our work, not just mine, but others in the field where we follow survivors through time and we’re able to compare those to kids of a normal developmental trajectory. And what we see is as much more common in survivors than in the normal population. Things like I’ve talked about and things like sexual outcomes, depression, mental health, and also these physical health outcomes. So much more common, significantly more common than would be accounted for by chance than the general population. But you’re right, the road to resilience I think is under studied and under understood. And we are trying to look at models now of those who do not have affects. Those do not seem affected and what can we learn from those trajectories. Those are things like having a really good support system early on in life, having someone who believes in you, having some good evidence based trauma treatment early on, and also revisiting these issues as different developmental transitions happen.
Dr. Noll: 08:53 For example, getting married often triggers some effects of sexual abuse as memories or sort of clarified and uncovered and even experienced differently in the context of a new relationship or a new sexual relationship. Also the birth of a child can trigger a trauma symptoms as well. So we often suggest revisiting of treatment as survivors go through their lives. These are the kinds of success stories that we hear. In terms of intergenerational transmission, let me just say one thing quickly. We don’t see necessarily victims of sexual abuse going on to sexually abuse their children. That’s not the kind of intergenerational transmission we’re talking about. We’re talking about sexual abuse victims recreating an environment for their children were adversity persists or where other people have access to their kids who might be exploitive individuals who then pass sexual abuse on to those kids or physical abuse or neglect. So what happens with a survivor when they become a parent, if they have substance abuse issues or other mental health issues, children suffer because of those kinds of issues. Not necessarily because they are being sexually abused by a person who’s a survivor. So let me just make clear, it’s about the environment that’s recreated or abuse and neglect are allowed to persist in that environment as opposed to someone sending that perpetration per se along to their kids. Does that make sense?
Jen: 10:26 Yeah, it does. So it sort of sets up a potential problem for researchers, isn’t it? If you’re not necessarily in studying the next generation, but in the current person who’s experienced that abuse, if they are also in an environment where physical abuse is common and neglect is sort of ongoing, how do you and how do other researchers untangled these effects of the sexual abuse compared to the other co-occurring adverse child experiences that the child might be going through?
Dr. Noll: 10:51 Yeah. Another great question and I think what we have to do is look carefully at the research that’s out there and how it’s designed. I am chiefly charged with doing just what you said, how do I create models and research designs that actually parse out the impact and the causal impact of sexual abuse when accounting for all of the other adversities, other types of abuse, etc. that are happening in the lives of survivors. So our models are very, very comprehensive. We monitor and model all kinds of adversities and we do what we call statistical controls for those to see if there’s a variation above and beyond other adversities that can only be explained by the experience of sexual abuse. We indeed have long-term longitudinal studies that actually show the effects of sexual abuse being different. As always, it depends. It depends how you’re looking at. This is particularly pronounced when we’re looking at sort of sexual context outcomes like teen pregnancy, teen motherhood and sexual activities.
Jen: 11:55 Okay. So I’m wondering, are there factors that can protect children who have been sexually abused from some of these outcomes? Or is it sort of inevitable that they might happen depending obviously on the abuse and the person’s individual circumstances?
Dr. Noll: 12:11 Oh, this is far from inevitable and if that’s one message I could get through that.
Dr. Noll: 12:17 These kinds of problems persist when the environment doesn’t change. So there’s a lot of propensity toward revictimization. So that is someone who might’ve been a survivor of sexual abuse ends up in an abusive relationship when they get older or they’re raped or they’re in a domestic violence situation, etc. etc. because the basic environment never changes, right? And the basic coping mechanisms and coping skills never change. But with adequate support from caregivers, from mentors, from other strong women and men in the lives of survivors, these trajectories can change, these environments can change and as well as really good evidence based trauma treatments, right? These are all things that target exactly the mechanisms that we see complicating the lives of survivors.
Jen: 13:06 Okay. So I want to get really practical. What form does this support take? Who is this coming from? What does a parent do when their child has experienced something like this?
Dr. Noll: 13:14 Oh, the very first thing in the paramount of everything that we talk about with survival is believing the victim. This is a basic tenant of prevention as well. Being able to listen, being able to understand what abuse really is, and then being able to really listen to the survivor and make that report to the official so that it stops. Stopping it and believing, those are the important features of the road to recovery. So that’s the very first thing and then continued support, right? Continued monitoring throughout development, throughout the various developmental stages that’s the survivor might accompany like say transition to puberty, transition through adolescence, transition to adulthood. These kinds of milestones often trigger trauma symptoms and there should be supports in place at every single one of those transitions so that survivors continually feel the support. It can be a parent, a sister, an aunt, a boyfriend, a husband, a caring individual who understands and that survivors can confide in, a really good therapist, a clergy member who’s trusted. These are the kinds of support systems that often do show up regularly in success stories.
Jen: 14:30 Okay. So what these people are specifically doing is, I mean in the short term, believing that it happened and in the longer term providing empathy and a person to talk to. Are there specific things other than that sort of general, I’m here if you need to talk kind of thing that successful support systems exhibit?
Dr. Noll: 14:48 Just like in any support system, it’s sort of holding the person accountable to their treatment. Right? Going to treatment, making sure that it happens. Having the right kind of insurance coverage, those kinds of things parents can do for their children. But also making sure they go to the sessions, making sure they adhere, going with them if need be. And also looking for other ancillary systems like substance abuse, right? Problematic relationships. If these things sort of crop up at certain periods, that might mean the coping mechanisms are breaking down and that treatment should be revisited. So just looking at the lives of survivors and just loving people through. That’s what we do in a caring society.
Jen: 15:28 Okay. So I want to make a shift here because I think this is important to parents as well. Talking about the prevention of sexual abuse. So firstly, can we talk about how common it is for children to be sexually abused?
Dr. Noll: 15:40 Oh boy. It depends. I’m sorry, I keep saying depends because it’s important to understand the nuances of the question if you’re really going to understand how to prevent it. So there are two ways at looking at the incidents, let’s say. And that is sort of what do we know about confirmed cases in the US, right? So we see about (I don’t remember what the numbers are today) but we see about it is tens of thousands per year in the US where we have confirmed cases of sexual abuse that meet the criteria of substantiation in various jurisdictions. But if you look at the CDC stats and what the CDC says about the incidents of sexual abuse, they estimate that based on retrospective reports of adults looking back over their lives, that about one in 10 women will experience sexual abuse by the time they are 18 and about 1 in 5 men. So those numbers are largely, you know, there’s a large discrepancy between the cases that we know about that reach protective services and the cases that adults say happened when they were children. So somewhere in between is my guess.
Jen: 16:55 Okay. So what you’re saying here is that there are probably a lot of cases that are never reported.
Dr. Noll: 17:00 That’s what the CDC says based on the discrepant findings. And that says a lot about our society. So are people not coming forward? Are people not recognizing that they were abused until someone asks when they’re an adult? Are there not good support systems out there built in for survivors to come forward? There’s layers and layers of reasons why there might be these discrepant numbers.
Jen: 17:25 Yeah. Okay. So I think we have this sort of perception because we latch onto these sort of, you know, one of media events or things that happen in the media, latch onto them and really over report them. And we have this idea in our minds that most abuse is happening or same as kind of kidnappings that somebody snatching my child off the street. It’s somebody who I don’t know and I have no idea that this could have happened. Whereas I was shocked in the training that I took from Darkness to Light, the Stewards of Children training, that the vast, vast majority of abuse is actually perpetrated by either a family member, which is less common admittedly, but somebody that the family knows and trusts. So I’m wondering why do young children have trouble recognizing what “good people” who do “bad things” as being abusers?
Dr. Noll: 18:18 Yeah. This is sort of the biggest question and how to prevent, because if you study these cases and the Nassar cases is a good example. What perpetrators do is they gain access to kids. They need that access and in order to gain access, they have to be trusted by the parents and they have to be in the lives of the family on a regular enough basis to be able to gain at that access. It’s not just gaining access, it’s deciding which child might be, let’s call it groomable. When we study Sandusky, Nassar and priests, etc. etc., we learned that they first try to figure out who might be a likely candidate. So the grooming behaviors like who’s amenable, who will take the gifts, who’s trust can they gain, right? Those are the kinds of things, and it’s not just the child, but the parents, which parents are going to allow their kids to be seen alone by the doctor, to stay the night alone with the coach, right?
Dr. Noll: 19:20 To be left alone in the company of a babysitter who might be exploiting the children. So there’s lots of layers of access. And when that access happens, there’s a level of trust that gets built. This is how it works. They gained the trust. You listened to Aly Raisman and she talks about this was the most trusted physician in the country for this kind of injury, right? So that trust is built and when trust is built, it’s much more difficult to discern the difference between the good guys and the bad guys. When we’re taught about stranger danger, that’s easy. Strangers are the guys who offer you candy and snatch you off the street. They’re really easy to identify because they’re strangers. Well, it’s harder to identify someone who’s a bad guy, who’s not a stranger because they’re part of the family or they’re part of the trusted system. And that’s what’s so hard to identify. Why would someone whom I trust, who my parents trust, whom is familiar to me, hurt me? So this behavior must not be wrong if it’s coming from someone that I trust and someone who’s revered by my family.
Jen: 20:28 It must be incredibly confusing to be a preschooler in that position and try and wrap your head around that.
Dr. Noll: 20:33 You’re exactly right.
Jen: 20:35 Yeah. So what kinds of conversations should we be having with children to help prevent them from becoming victims of abuse?
Dr. Noll: 20:42 Yeah, I’m so glad you asked that. So the program that you talked about, Stewards of Children is a good program but it really is targeted toward community members, concerned adults who might want to go voluntarily and get trained in what is sexual abuse, what does it look like, how to recognize the signs, how to make a report, those kinds of things. But what we really need in accompanying with that is to actually train children about what this is. So another evidence based program that we are implementing here in Pennsylvania is called Safe Touches. And that’s a program specifically designed for children. And we are implementing that now in second grade. We are doing in our trial in Pennsylvania, 100% of second graders. These are concepts that are taught to kid via a puppet show that talk about, this is my swimsuit area.
Dr. Noll: 21:33 No one’s allowed to touch my swimsuit area. Someone close to me may be doing things to me that are uncomfortable. And it’s okay to say no. Always tell a safe adult who are safe adults. Identify those in your family, the right names for private parts, right? You want children to know the right names from private parts. And the reason I say this is there was one family where they talked about, the vagina as being the cookie, right? So this is your cookie, this is your cookie. And a child was having someone touching her cookie and was trying to tell the nurse, someone’s touching my cookie. Well, the nurse had no idea what that meant. Oh, you’re sharing your treats at lunch. Right? And so the nurse didn’t know that that was something to report. But if the child had known the term vagina or my swimsuit area or my private parts, that would have been communicated much more efficiently.
Dr. Noll: 22:30 And then the biggest thing that parents need to really understand is they need to let kids know that if it feels icky, it is icky. If it feels wrong, it is wrong. If there’s someone telling them to keep secrets, those are secrets that are going to hurt them and that parents should have a really nicely open dialogue with their children about things that are hard to discuss and sexual stuff is part of that, but it’s not, you know, it would be drugs, it would be friends who are bullying them. It’d be all kinds of things that are hard to talk about. If parents have a much more open dialogue about their kids in all kinds of areas, then kids will be much more readily skilled to be able to talk to their parents when something dangerous is happening.
Jen: 23:18 Yeah, and just to go back to the point that you made about correct name for body parts. Absolutely, one reason we want to do that is so that children can communicate what’s happened. I’ve read another reason to do that is because people who are grooming children for abuse, will test to see if the children know and use the correct terms because if a child uses the correct terms for their body parts, chances are they have also been spoken to about sexual abuse and what to watch out for in those kinds of things. Is that familiar to you as well?
Dr. Noll: 23:48 Yeah, that makes sense to me. It’s hard to talk to parents about talking to kids about sex. So we have a parent curriculum also that we’ve developed that specifically talks about ways to bring these things up, to talk about them, how parents can look at their own fears about talking about sex. How did they talk to us about sex with their own parents? What gets in the way? What are those barriers? What comes up for them when they start talking about it? Because most of the time it’s the parents that are afraid and not the kids.
Jen: 24:19 It’s often the way, isn’t it? So I’m wondering about when is the right time to start conversations on this topic because you’re doing your training with second graders. And I understand the reasons for that. When you’re doing research, you need to be able to sort of test what’s happening beforehand and test again afterwards and you want to make sure that it’s the child’s understanding that has changed and it helps if they’re able to verbally communicate very well. But in most of the parents who are listening to this, who are parents of preschool age children, and so I’m wondering about the research on that, some research I had found had shown that at pretesting only 38% of our sample of preschoolers had correctly recognized that a good person’s request to touch their private parts was inappropriate. And after a training, a decent chunk of them still could not recognize the inappropriateness of these requests. And that that skill does improve as they get older. But is there anything that we can do when they’re still in this young age to help them sort out, what is appropriate and what is not?
Dr. Noll: 25:15 Yeah. That’s really good. So in our parent curriculum, we sort of had a developmentally correct or appropriate curriculum as children age. So what you’re talking about, so let’s start from infancy. Why not? In infancy, you should be careful about the kinds of people that have access to your kids, right? So it’s not about training the kids, it’s about recognizing that environment, right? So is there someone who was inappropriately wanting alone time with the small kids or inappropriately having some kind of weird sort of fascination with your kids? Any age, you should pay attention to those kinds of things and the kinds of environment that your kids are in, right? So that goes for any age kids. Once they get older and they’re sort of preschoolers, it’s never too soon to talk about the names of private parts, right? It’s never too soon to say that’s your vagina, that’s your penis, right?
Dr. Noll: 26:05 It’s never too soon to talk about as soon as they can wear a swimsuit, it’s like that’s your swimsuit area that belongs to you, right? Nobody gets to touch that. Those are the kinds of things you can tell a preschooler. When they get older and they start encountering peers, they start going to sleep overs, they start doing things that are sort of outside the parents control then you can start saying things like, nobody gets to touch you there. Right? Or if someone tells you to keep a secret, you need to tell mommy or daddy about it. Right? You can start to introduce sort of more developmentally appropriate things as their experience of the world gets bigger. And then this translates even into parents with multiple siblings, right? Sometimes siblings have inappropriate touching and inappropriate stuff with their younger siblings. It’s always a good idea to monitor when siblings are mad at each other, when there might be pornography exposure in the family from an older sibling to a younger sibling and sort of monitoring those behaviors across siblings. It doesn’t matter how old they are. A younger sibling could be affected by older siblings or their friends coming around or those kinds of things. But I’m hoping that that gives you a little bit of a good idea of sort of the developmental scope of what we need to pay attention to.
Jen: 27:22 Yeah. So it seems as though you’re sort of recommending a series of conversations over time that developed because I was actually really surprised to see in the Stewards of Children program, they recommended talking with children about intercourse at age 8 and I was 7 when I got the conversation and I sort of got to, you know, do you know what happens as you get older? Well let’s get you some books kind of thing. But rather than having that, waiting for that one age and we’re going to have this one conversation, it’s going to be done. We are approaching it very differently is sort of an ongoing series of what questions do you have? Okay, let’s answer those. And then as she has more questions then we’re going to provide more information and more answers. And it’s firstly, I feel as though it’s more developmentally appropriate. And secondly, it’s so much less threatening as a parent to feel you’re holding out for this one conversation that’s going to be absolutely terrifying and instead it sort of we’re just going to talk about this right now and most of the time children don’t want to know a super detailed account of what’s going on in intercourse. So do you recommend the sort of ongoing approach then?
Dr. Noll: 28:27 Exactly. But also we teach parents to kind of look for opportunities to bring things up. So there’s a couple of layers to that. One is you want to make sure they’re not getting inaccurate information. So sometimes parents will see a book that the kids bring home or some kind of conversation they might be having with their friends that they overhear where there’s inaccurate information being perpetuated and you want to correct that when you hear it. It doesn’t have to be immediately but you can say I heard you and so and so talking about and here’s how it really is, right? Here’s how babies are really made or you know, whatever. There’s also sort of points of contact like in the car when you’re just going somewhere and a song with sexually explicit lyrics come on, you can say, you know what that means, right?
Dr. Noll: 29:09 Or what do you think that means? Or sort of touch points of what do they know, what do they believe? And then answering any question that they ever have. Just answering it straight up with factual information. And then also there are the touch points where if something happens, like if there’s a big new story, right? Or there’s something that happened to someone at school and they heard about it or there’s something horrifying that happened, like maybe a teacher got caught inappropriately touching a student or maybe there was a pornography ring or something that the kid learns about that is a time to say, has that ever happened to you? Or what would you do if, right? Or, you know, you can come to me or I will always love you and I will always believe you if anything like this would ever happen to you.
Dr. Noll: 29:54 Those are really good opportunities to say, I’m going to have this conversation, whether you like it or not, we’re going to have this conversation. But you have to understand where the kid is developmentally. You don’t want to force something on a kid they’re not ready for, but you also don’t want to put your head in the sand and pretend they’re not there yet. So individual variation, I think 8 years old is a two black and white of a, this has to happen. You know that some kids are ready, some kids aren’t. Some kids are ready at 6, some kids are ready at 7. It depends on the context. But books are good. There are age appropriate books for that age. You don’t have to make a big production of it and just put it in on their cabinet or whatever. There are ways to do this.
Jen: 30:33 Yup. Okay. And so I’m thinking about what kinds of figures in the child’s life are most likely to initiate sexual abuse? And I read one study that found that sexual abuse among participants in youth serving organizations peaks in the teenage years. And I’m wondering if you concur with that and if sort of by extension of that, that this means that parents of preschool age children should be more worried about abuse by a family and friends.
Dr. Noll: 30:58 Yeah. Well also it depends on the gender, right? So we see that boys tend to be abused younger. And girls tend to be abused older, like in more in adolescents, but we also don’t know, we have fewer boys coming forward. We have fewer teenage boys prep coming forward, so we don’t always know by the statistics, you know, when it’s most appropriate for, to talk about certain types of people. I think at every age we need to be concerned about anyone who’s obsessed with our kids, who wants inappropriate access. I think for every age it’s okay to vet your babysitter, right? Say, go ahead and look online to see if that person is in a registry. It’s okay to say things about, nobody touches each other’s private parts when we have sleepovers. That’s my rule at my house to any age, right.
Dr. Noll: 31:54 It’s okay to be able to monitor, you know, kids’ behavior when they don’t want to go with an individual or when they come back and they’re depressed or angry after they’ve been to say an uncle’s house or stepfathers house, what’s really going on there? It’s okay too if you see blood in the undies, right? To talk about or to be concerned about what’s going on there, right? These are the kinds of things, I don’t think there’s an age at which you should be doing these things more or less the principles apply. But we do know that people who have access to kids, when kids are younger might be more family members and so on or babysitters. And then when kids get older, that world expands. So you have to be a little bit more vigilant about where they’re spending their time, who they’re spending their time with, sleepovers. Other things like that that happened. Coaches, when people get older, when adolescence happens.
Jen: 32:51 Yeah. And so we’ve talked a bit about grooming behaviors and what these are and they’re kind of building up the trust with the child. And that makes perfect sense to me. But I’m wondering (how sort of an outsider to that relationship between the adults and my child) firstly, how do I even see that it’s there? And secondly, how do I talk with my child about this especially when it might involve things that the child really likes, like candy or gifts and they may be inclined not to tell me if the other person says, oh, don’t tell your mom I gave you some candy. It can just be our little secret. I can imagine my daughter keeping that secret. So how do we approach that?
Dr. Noll: 33:30 Yeah. Well, part of that is about secrets, right? What’s our family rule and what’s our culture around secrets and what do secrets really mean? And those may be some hard conversations to have. When someone wants you to keep a secret that means they don’t want you to be safe, that they don’t want me involved in your safety. And here’s some examples of how secrets have hurt. And you may have some examples in your own life, but you may have some examples that they may have seen in their books that they’re reading or on TV or social media or something that you can use as illustrations, right? And then just building that open line of communication so that they like, you know, you tell me, I’m going to reward you for telling me. So when they do tell you about a secret, say I’m so glad you told me and you know, let’s do something to sort of celebrate that you’re safe and that you can tell me and this is wonderful, you know, reinforcing that behavior.
Dr. Noll: 34:22 It doesn’t have to be around candy, it can be around anything, right? So they know that, that you don’t always come down on them, you know, when they do something that’s not perfectly right. And the other thing is sort of, you know, if there’s gifts that show up, right? Who’s this from? Where did you get this and why are you getting these things and who’s offering your kids sort of inappropriate gifts? You go right to that person. And say, that’s enough. I draw the boundary, I am the parent. I draw the boundary. Sorry, that’s not how we do things around here. And you can limit access, right? And if the kid is apprehensive at all about spending time with someone, you need to pay attention to that. I mean, if you think about the Aly Raisman story, they wanted so desperately to be treated by Larry Nassar, right?
Dr. Noll: 35:12 And when things started to get in a little weird, they were afraid to say anything because they thought they might not get that access anymore. Right? Because their parents were so invested in that relationship and the investment that the parents were making in that gymnastics career, they felt like they were disappointing their parents if they were to cause any trouble. Right? Those are the kinds of things to watch for and dispel. Like I will love you no matter what. I love you. I don’t love your softball career or your gymnastics career or the fact that you’re getting good grades because you’re having private tutoring. Right? I love you. And those are the kinds of messages just reinforce over and over and over to create that safe space.
Jen: 35:56 Yeah, and I love what you said about if someone’s asking you to keep a secret, that means that they don’t want you to be safe, that they don’t care about your safety because we do have a no secrets rule in our house. And I think the way that I found helpful to think about it is surprises are fine. Surprises have an expiration date. There’s a time when you’ve already planning that you’re going to tell the person that this thing is happening. Secrets have no expiration date. It’s something that somebody is asking you to keep private forever. And so I think that has been fairly successful for us. But I love the additional layer of, you know, this person doesn’t care about your safety if they’re asking you to keep a secret. So we’ll definitely use that. So next I’m thinking about questions about asking a club or school or activity about their abuse prevention policies. So if my daughter is thinking about getting into some activity where maybe I’m not going to be around all the time to supervise, are there state or national regulations around screening measures or policies to prevent abuse or student and staff education or anything like that?
Dr. Noll: 36:58 Yeah, in many states there’s mandatory checks and you can find out by going to your Department of Human Services or Department of Child Welfare websites for your state. But in general you still can ask. I mean I would always ask. So for example, you can ask things like, do all of your volunteers have FBI clearances and clearances, right? Because FBI clearances are clearances for any sort of past perpetration or past inappropriate behaviors and so forth. So whenever, like in Pennsylvania, whenever you volunteer for anything, you can’t be a baseball coach without clearances, right? You can’t volunteer at a church without clearances. You can’t do anything with children in a volunteer capacity or an official capacity without clearances. So you can always ask, do all of your people at this camp say, have their clearances? And if they don’t, you can ask why. And if there’s no requirements for that, you can have extra protections in place.
Dr. Noll: 37:59 The second thing is a lot of places should have a no one-on-one rule, right? So like for example, some of the really good prevention programs are at Big Brothers Big Sisters where they have a two-on-one rule all the time where there’s always another adult in the room with the child. You are never alone with the child in any activity in any way, shape or form. And that is a protection, right? You can ask about those kinds of rules. You can show up unannounced, right? Like this is a general rule of just showing up unannounced at a babysitter or a daycare facility or a camp, right? So that you can kind of see what’s happening and see what the behavior is like, see what they’re doing. These are all things that parents have the right to do. Sometimes parents don’t think they have the right to ask these questions right?
Dr. Noll: 38:45 But doing those things does two things. First of all, it allays your fears or curiosity about what the protections are and it lets the organization know that you’re a concerned parent and that you’re watching, right? And if there’s any clandestine stuff going on that you’re going to be aware. And there’s always the opportunity to have meetings beforehand of all the parents involved and saying, why don’t we all take Stewards of Children together? Or here’s some pamphlets or some education about how to keep kids safe. Parents can be in control and I don’t think all parents realize that you can be in control without being a nuisance, right? Without appearing to be a helicopter parent. These are just basic tenants of keeping kids safe.
Jen: 39:33 Yeah. And I think that’s a really powerful message that this is not being a nuisance and that you have more power than you think you do. That if you’re going to sign up your child for an activity, and especially if you’re paying money for an activity, but even if you’re not, that you have the right to ask these questions and to get good answers to them and that you’re not being a pest, being a helicopter parents. That’s a really powerful lesson. So if we think that maybe the worst comes to the worst and something does happen if the child doesn’t immediately report this abuse to the parent or caregiver, are there certain signs that parents should look forward to indicate that might indicate that some kind of abuse could have occurred?
Dr. Noll: 40:15 Yeah, and there are lots of sort of pamphlets on this on the CDC website or your state usually has some kind of child welfare resource where you can download some of these things and if you want, some of these things we will find them for you, for your listeners. But there are some basic things to look for and some of those things have to do with the actual person. Like we’ve talked about several times, people who want inappropriate access to your kids, people who are obsessed with your kids, people who are trying to separate you from your kids. Right? Look for those behaviors because those are behaviors you want to extinguish or want to understand better. The other thing is if kids are really apprehensive about going on a visit or being alone with an adult, you need to pay attention to why and what’s happening because you know if they all of a sudden sort of changed their behavior like they used to really love going with this adult and now they’re like, mmm, I’m not sure I want to go.
Dr. Noll: 41:11 There might be reasons for that that you have to understand more and the second is then, say on an return visit or when they come home for something like that, are they more withdrawn? Do they act out behaviorally? Like they get more sort of aggressive or their behavior problems get escalated upon return, right? These are the kind of basic things to look for in terms of children’s behavior and then just generally being depressed or withdrawn. Is there no real reason for why a child should be depressed if it’s not like them, right? If they’re more withdrawn than usual. If they don’t want to go to certain activities than they usually have gone to, this could be a symptom of depression, it could be just general depression that they are depressed, but if it’s tied to certain people or certain events, you might want to pay particular attention.
Dr. Noll: 41:58 And then I talked about, you know, with other types of abuse there’s bruises and so forth with physical abuse, but with sexual abuse is not always outward signs. But there are some, like we talked about blood in the underwear. We talked about soreness or redness around the genital area. Some of those things like yeast infection when they shouldn’t really be having it. Some people talk about inappropriate sexual behaviors like kids who are now more obsessed with body parts or with pornography or with masturbation, those kinds of things. And sometimes those can be signs that a kid is more sort of sexually precocious than they should be because they’re learning it from another place. But those aren’t necessarily signs of abuse. But those are signs that you should be talking to kids about what’s happening sexually with them so they understand what’s happening, whether it’s more normative developmental milestones that they’re learning or whether someone’s exploiting them. Does that make sense?
Jen: 42:56 Yeah, it does. And I think that a really important thing to know as well is you’re not always looking for it, you know, some inappropriate touching that’s happened. It could be somebody sharing your child pornography or somebody is asking your child to expose themselves to the adults or maybe the adult is exposing themselves to the child. So it’s not always physical touch that we’re looking out for. Right?
Dr. Noll: 43:16 Right. And let’s break that down just a hair, because sometimes normal sexual exploration as kids with their peers happens. We think about like playing doctor or show me yours, I’ll show you mine. Some of that is sort of normative and sort of kids are curious. So they’re going to do that or they’re going to accidentally go onto a porn site or they’re going to say, no one’s watching and I got the iPad, so I’m going to just Google boobs or something like that. And they see stuff and it’s like, oh my god, you know, they’d been exposed to things that way sort of in the normative course of life. But you have to watch out for when they’re being exploited. So even though it might be a same age peer that saying, show me yours, I’ll show you mine.
Dr. Noll: 43:56 You want to be careful that there’s not, if you don’t show me yours, I’m going to tell on you or you know, I’m forcing you to come in this closet with me when you don’t want to. Or they’re doing it a lot. Right? Those are the kinds of things to look for because a lot of professionals will say if it’s peer on peer, it’s not a big deal. Well that’s not true if it’s exploitive. So you have to kind of watch out for those kinds of things. And if kids are seeing pornography and you find out, you gotta talk to them about what pornography is and why it’s bad. I use the analogy with my kids, there dangerous places on the Internet that if you go, you’re going to see things you’re not ready for and that’s not healthy, that are meant to hurt you.
Jen: 44:33 As I think about that, I’m thinking it’s not about the age of the people involved necessarily. It’s about the power differential. One person has more power over the other, then that’s something to watch out for in a situation that could potentially lead in an undesirable direction.
Dr. Noll: 44:51 You’re exactly right. Most jurisdictions don’t prosecute sexual abuse unless there’s a four year age difference. But that doesn’t mean that there hasn’t been some trauma or there’s something that’s worth talking about with peers.
Jen: 45:03 Yeah. Okay. And so if a parent’s suspect something has happened to their child or their child is telling them something has happened, what’s the first thing that we do? We talked about believing the child, but how do you actually understand enough about what has happened to know if this is something that we need to report or not and how can we know that what we’re asking isn’t changing what our child tells people or even what they remember.
Dr. Noll: 45:30 Yeah, this is really, really tough. The first thing that parents need to understand is sort of, they need to understand what abuse is, right? They need to understand that abuse doesn’t mean that, you know, there’s some cases that I’ve heard of where someone gives the child a new pair of undies for Christmas or something and they’re like, oh, that is sexual abuse or whatever. You need to understand what is and isn’t sexual abuse and this is where Stewards of Children comes in and see these other educational programs is really talking about what that means, right? The exploitation, touching, penetration, those kinds of things need to be understood by the parent. And then if the child comes or you see something that’s happening and you suspect, your job is not to decide if it happened or not, your job is to let the officials know that something happened because they are the professionals and they will discern whether it’s happened or not.
Dr. Noll: 46:27 This is a very common misconceptualization of what it means to report child abuse, right? It doesn’t mean that you’ve decided that it’s abuse, it means that you have discovered something that matches a definition that you have learned that is sexual abuse, right? So you make the call and you let the professionals do the investigation or ask questions of you as the reporter that will help them make that decision. They’re going to have to know some basic things. They’re going to have to know who the person is. They’re going to have to know the age of the person and they’re going to have to know what you know and you don’t have to sit and ask the kid, what did he do? What did he do? You should never be asking leading questions, right? You should listen. You can say, can you tell me a little bit about what happened as opposed to, did he put his penis in your vagina?
Dr. Noll: 47:22 You don’t want to ask leading questions. You want to ask just what happened and let the child describe then you remember those things and then you make the call to, ours is Childline in Pennsylvania, but every state has their own sort of number that you can call. You can also call these numbers hypothetically and just ask questions without reporting. You can say, hey, this happened. Is this a reportable event or what should I do from here? And they can also tell you those things. There’s information only you can get from these lines as well.
Jen: 47:56 Oh, that’s super helpful. So you don’t have to feel as though if you’re calling then all hell is going to break loose necessarily. Or you could just call and say, you know, I’m not sure about this. Something doesn’t feel quite right, but I’m not sure if it crosses a threshold. And get some advice on that before you actually move forward and accusation is made.
Dr. Noll: 48:15 And some of us are mandated reporters, don’t forget, you know, teachers, therapists, etc. So you know, you have to call whether you know, you suspect or not, and that’s part of your job. And if you don’t have adequate training in that, you should ask your supervisors for more training.
Jen: 48:29 Yeah. Okay. And so I want to finish it actually with a comment from my listener Christine, who said that the threshold for abusive behavior crossing into the criminal level is actually quite high. And so I wonder if you can help us understand what that means. Are there behaviors that we might associate with the idea of sexual abuse that actually wouldn’t be considered so criminally?
Dr. Noll: 48:50 That’s such a hard question because that varies by jurisdiction as well. When I say jurisdiction, I mean like state, but it also can vary by county. It can vary by, by judge. It could vary by the legal team, right? It can vary by the amount of evidence that’s actually collected. So I would say just as a professional working in this field, that the standards are quite high for substantiating sexual abuse. That may be one of the reasons why we have just such discrepant reporting from retrospective adults and substantiated cases for children. But I would say that for every jurisdiction, for every state, you can look at the Child Welfare Code or the Child Protective Service Code and you can see what those definitions are, right? And then you can know sort of exactly what the investigators are looking for to make that determination that it’s sexual abuse.
Dr. Noll: 49:47 Some states have various levels, like sexual exploitation might be different from sexual abuse, right? So it might not be, you know, penetration or actual sexual contact, but exposure to pornography or sending of lewd pictures or paying kids for sex, those kinds of things might be in more of an exploitation category. So I think for every parents there’s sort of getting to know what those rules are and what the jurisdiction says and what the laws and statutes say is going to be helpful in understanding how you might report or what you might look for. But I do agree with the caller. This is a hard thing. The burden of proof is on the family and the kid, right? There are things locally that we have called Children’s Advocacy Centers or CACs. CACs are sort of a relatively new concept in the last decade that our agencies within jurisdictions, mostly within counties that actually facilitate the reporting of sexual abuse. So these are skilled forensic interviewers who know how to talk to children about these things, who will do a video tape recordings so children don’t have to say the story over and over again. Who know how to gather evidence, be it physical evidence, rape kits or so forth pictures or whatever needs to be taken as well as taking and documenting the child’s story and jurisdictions that have CACs do show increased conviction rates because the evidence is gathered in a way that is not a saleable in court.
Jen: 51:23 Oh wow! That’s incredible. I mean it makes logical sense, but the idea that if you just have someone there advocating for the child and doing things, collecting evidence in the right way, that you can actually increase the prosecution rate.
Dr. Noll: 51:37 Exactly. So one should look to see if there is a CAC, it’s called a CAC within their county. This is a model that’s growing around the country. The goal is to have one in every county. We are about halfway there in Pennsylvania, but these are tools that we can use as parents and mandated reporters to ensure that the child goes to the right place. And then they have mental health referrals, right? They have referrals for families for other sorts of things that might be going on in the family and so forth.
Jen: 52:05 Yeah, and I guess the depressing flip side of that is if you happen to be in a county where this isn’t in place yet, that it’s possible that the procedures involved with the collecting of evidence might be the thing that lets your child down and not that the abuse didn’t occur.
Dr. Noll: 52:21 Exactly.
Jen: 52:22 Yeah. Okay. Well, I didn’t want to end on such a negative note. I wonder, is there some kind of nugget of wisdom or piece of hope that you can leave us with that can empower parents to move forward in this area?
Dr. Noll: 52:36 Yeah. I think that we are making great strides with prevention. Parents, it’s okay to be concerned about your kids. It’s okay to want to protect your kids. It’s our chief responsibility as parents and we all want to do it. So do it and do it with pride and do it with concern and just do it with compassion and do it so that your kids know that they will never slip through the cracks. That you will always protect them, that you will do anything that you can to make sure that they’re okay, and that it’s okay for them to come talk to you. There’s remarkable stories of resilience of survivors. Even if your kid is abused or even if your kid does go through something heinous like this, there are remarkable stories of resilience and advocacy, as children grow up and become adults and then become advocates for abuse survivors, this is in no way an inevitable trajectory for kids in general or for survivors. So we are all in this together, right? There’s lots of resources out there. You should get together and ask your school for some curriculum in your school. You can organize a Darkness to Light training. You can go online and do training on your own. There are several avenues by which I think you can gain access and it always helps.
Jen: 53:53 Thank you. That feels much more hopeful and thank you so much for dedicating your professional career to helping children. I can only imagine the hundreds of thousands of lives that you must have impacted through the course of doing this work. And thank you for sharing your insights and your wisdom with us as well.
Dr. Noll: 54:10 Well, you’re welcome and thank you for devoting some time to this and if I can ever be of help, please let me know.
Jen: 54:15 Thank you very much. So listeners can find the Stewards of Children training that I took from Darkness to Light, that’s the organization and that can be found at d2l.org and a link to that as well as to the references for the show and the one page checklist of things that you can do to prevent abuse can be found at YourParentingMojo.com/SexualAbuse.
Bolen, R.M., & Scannapieco, M. (1999). Prevalence of child sexual abuse: A corrective metaanalysis. Social Service Review 73(3), 281-313.
Clark, D.B., Thatcher, D.L., & Martin, C.S. (2010). Child abuse and other traumatic experiences, alcohol use disorders, and health problems in adolescence and young adulthood. Journal of Pediatric Psychology 35(5), 499-510.
Dion, J., Matte-Gagne, C., Daigneault, I., Blackburn, M-E., Hebert, M., McDuff, P., Auclair, J., Veillette, S., & Perron, M. (2016). Journal of affective disorders 189, 336-343.
Domhardt, M., Munzer, A., Fegert, J.M., & Goldbeck, L. (2015). Resilience in survivors of child sexual abuse: A systematic review of the literature. Trauma, Violence, and Abuse 16(4), 476-493.
Holloway, J.L., & Pulido, M.L. (2018). Sexual abuse prevention concept knowledge: Low income children are learning but still lagging. Journal of Child Sexual Abuse 27(6), 642-662.
Irish, L., Kobayashi, I., & Delahanty, D.L. (2009). Long-term physical health consequences of childhood sexual abuse: A meta-analytic review. Journal of Pediatric Psychology 35(5), 450-461.
Kenny, M.C., & Wurtele, S.K. (2010). Children’s abilities to recognize a “good” person as a potential perpetrator of childhood sexual abuse. Child Abuse & Neglect 34, 490-495.
LaPook, J. (2018, September 9). Aly Raisman speaks out about sexual abuse. 60 Minutes. Retrieved from https://www.cbsnews.com/news/aly-raisman-60-minutes-us-olympic-gold-medal-gymnast-i-am-a-victim-of-sexual-abuse/
Lewy, J., Cyr, M., & Dion, J. (2015). Impact of interviewers’ supportive comments and children’s reluctance to cooperate during sexual abuse disclosure. Child Abuse & Neglect 43, 112-122.
Noll, J.G., Haralson, K.J., Butler, E.M., & Shenk, C.E. (2011). Child maltreatment, physiological dysregulation, and risky sexual behaviors in female adolescents. Journal of Pediatric Psychology 36(7), 743-752.
Noll, J.G., Trickett, P.K., Long, J.D., Negriff, S. Susamn, E.J. Shalev, I., Li, J.C., & Putnam, F.W. (2017). Childhood sexual abuse and early timing of puberty. Journal of Adolescent Health 60, 65-71.
Noll, J.G., Zeller, M.H., Trickett, P.K., & Putnam, F.W. (2007). Obesity risk for female victims of childhood sexual abuse: A prospective study. Pediatrics 120(1), e61-e67.
Noll, J.G., & Grych, J.H. (2011). Read-React-Respond: An integrative model for understanding sexual revictimization. Psychology of Violence 1(3), 202-215.
Noll, J.G., Shenk, C.E., Yeh, M.T., Ji, J., Putnam, F.W., & Trickett, P.K. (2010). Receptive language and educational attainment for sexually abused females. Pediatrics 126(3), e6150-e622.
Noll, J.G. (2008). Sexual abuse of children – unique in its effects on development? Child Abuse & Neglect 32, 603-605.
Noll, J.G., & Shenk, C.E. (2013). Teen birth rates in sexually abused and neglected females. Pediatrics 131(4), e1181-e1187.
Noll, J.G., Trickett, P.K., Harris, W.W., & Putnam, F.W. (2009). The cumulative burden borne by offspring whose mothers were sexually abused as children: Descriptive results from a multigenerational study. Journal of Interpersonal Violence 24(3), 424-449.
Rheingold, A.A., Zajac, J.E., Patton, M., de Arellano, M., Saunders, B., & Kilpatrick, D. (2015). Child sexual abuse prevention training for childcare professionals: An independent multi-site randomized controlled trial of Stewards of Children. Prevention Science 16(3), 374-385.
Wurtele, S.K., & Kenny, M.C. (2011). Normative sexuality development in childhood: Implications for developmental guidance and prevention of childhood sexual abuse. Counseling and Human Development 43(9), 1-24.
Wurtele, S.K. (2012). Preventing the sexual exploitation of minors in youth-serving organizations. Children and Youth Services Review 34, 2442-2453.