Children who have been sexually abused may display a range of emotional and behavioral reactions, many of which are characteristic of children who have experienced other types of trauma.

These reactions include:

• An increase in nightmares and/or other sleeping difficulties
• Withdrawn behavior
• Angry outbursts
• Anxiety
• Depression
• Not wanting to be left alone with a particular individual(s)
• Sexual knowledge, language, and/or behaviors that are inappropriate for the child’s age

Although many children who have experienced sexual abuse show behavioral and emotional changes, many others do not. It is therefore critical to focus not only on detection, but on prevention and communication—by teaching children about body safety and healthy body boundaries, and by encouraging open communication about sexual matters.

Age-Specific Effects

Very young children might engage in traumatic play in which the child re-enacts some aspect of the experience. For example, a child may act out running away from a “bad man” over and over again. The play may or may not be specific to the sexual abuse. You might see other signs of stress, an increase in oppositional or withdrawn behavior, tantrums, or nightmares. The child might engage in age-inappropriate sexual behavior such as trying to engage another child in oral-genital contact or simulated intercourse. The child might talk about her body as being “hurt” or “dirty.”

As children grow into adolescence and develop more autonomy, the difficulties they can get into may be more serious. Teenagers might be more likely to abuse substances or engage in high-risk behaviors, including indiscriminant sexual behavior. A teenager avoiding traumatic reminders may withdraw socially. Self-cutting and suicidal behaviors are also more common among adolescents.

Long-term Consequences

Research has repeatedly shown that child sexual abuse can have a very serious impact on physical and mental health, as well as later sexual adjustment. Depending on the severity of and number of traumas experienced, child sexual abuse can have wide-reaching and long-lasting effects. Those who have suffered multiple traumas and received little parental support may develop post-traumatic stress disorder, depression, and anxiety. Their ability to trust adults to take care of them may also be jeopardized. Sadly, when children do not disclose sexual abuse and/or do not receive effective counseling, they can suffer difficulties long into the future. As one child expressed it, “Abuse is like a boomerang. If you don’t deal with it, it can come back to hurt you.” On the other hand, children who have the support of an understanding caregiver and effective treatment can recover without long-term effects.