“Overnight, she went from an extroverted and confident personality, who played an integral role in class discussions, to a socially withdrawn child with a new hostility towards adults,” recalls a teacher in a UAE school, who spoke upon condition of anonymity. “In retrospect, it was very challenging to notice the physical indicators of child abuse as this particular student was veiled. Yet the breaking point was when we had a class discussion about the impact of abuse on brain development. Unfortunately and fortunately, this topic triggered a severe panic attack for my student and eventually helped her disclose that she is being abused by a family friend, and that she has been self-harming to cope with her pain. The school followed immediate safeguarding protocol and contacted the authorities.
“The most heart-breaking aspect of this story is that the student was old enough to be aware that she is being abused, yet her guilt and shame silenced her for years. That is why it is our responsibility as teachers and parents to uncover the subtle cues and make a child feel safe enough to disclose their trauma before it is too late,” she adds.
300 million
children regularly face abuse.
This pupil is one of the millions of young victims globally, silenced by their perpetrator, silenced by their own guilt, and silenced by the stigmatisation of society. According to the World Health Organisation (WHO) abuse affects three in four children between the ages of 2 to 4 years old regularly – that is about 300 million kids. Likewise, one in five females and one in 13 males have reported that they were sexually abused as a child.
No matter which of the following prefixes you place before the term ‘abuse’- be it emotional, physical, neglect or sexual - the end result is a child whose developmental, physical and mental wellbeing will be detrimentally impeded by trauma.
What is child abuse?
Child abuse constitutes children under the age of 18 years old who are subjected to significant harm as a result of intentional inflicting of hurt or as a result of failing to prevent harm. Child abuse may take place within the child’s family, community or institutional setting.
The UAE has always been extremely intolerant of child abuse and neglect, and has driven a global campaign and policy makers, who drafted the Child Protection Law, coined Wadeema’s Law. This Federal Law No. 3 of 2016 concerning child rights stresses that all children must be provided with appropriate living standards, access to health services, education, equal opportunities in essential services and facilities without any kind of discrimination. The law protects children against all forms of negligence, exploitation, physical and psychological abuses.
How does child abuse begin?
The majority of child abuse cases tend to occur at the hands of perpetrators that the victim knows, rather than strangers. Dr Nayla Daou, clinical psychologist and founder of the Clear Minds Center of Emotional Health, says, “Perpetrators go through a ‘grooming’ process with their victims in order to gain their trust and to build an emotional connection with the child before the abuse even occurs. There are many manipulative tactics that an abuser uses to maintain this ‘special’ relationship. The child then begins to feel special to this abuser, to feel a sense of loyalty. They can love the abuser and not see that the abuse is not normal.”
The red flags of unreported child abuse
A child enduring abuse tends to experience an immense level of shame, guilt and confusion. If the perpetrator is the child’s parent, relative or family friend, this exasperates any chances of reporting the abuse. Dr Sneha John, clinical psychologist specialised in children and adolescents who works in Camali Clinic, maintains that, “…children are less likely to report abuse because they may not be able to comprehend what has happened as they are still developing cognitively. If it is from a family member or a loved one, it becomes even more challenging for them to recognise that this is harm. Even if they know this is a threat, children may not have the words to describe what is happening to them or may not process the trauma as deeply as adults. The second aspect is the fear of what happens next because children don’t know what will happen to them; whether they will get in trouble or whether they will get further abuse from the perpetrator or others. Hence, they keep the abuse under wraps to stay safe. In other cases, children suppress and deny the abuse by lying about the event in order to normalise their trauma. This is just their way of bouncing back from the situation.” That is why it is crucial to identify the red flags of a child being potentially abused:
- Changes in behaviour in terms of defiance, anger, hostility or hyperactivity.
- Changes in school performance in terms of absences and academic regression.
- Reluctance to leave school activities in order to avoid going home.
- Withdrawal from friends and usual activities.
- Emergence of psychological concerns such as anxiety, unusual fears, depression, and sudden loss of self-esteem.
- Attempts at escaping.
- Suicide ideation, self-harm or suicide attempts.
What are the different types of child abuse?
Physical abuse is the deliberate hurting of a child in the form of pinching, hitting, biting, shaking, throwing, poisoning, scalding or burning, and drowning or suffocating a child.
Physical indicators that a child is being physically abused include untreated injuries, burns, bite marks, scratches, or bruises in difficult-to-spot places such as behind the ear or groin. Behavioural indicators meanwhile include fearful watchfulness, fear of returning home, undue fear of adults, aggressive or withdrawn behaviour, chronic running away from home or self-mutilation tendencies.
Children are less likely to report abuse because they may not be able to comprehend what has happened as they are still developing cognitively. If it is from a family member or a loved one, it becomes even more challenging for them to recognise that this is harm.
Sexual abuse is the sexual exploitation of a child for another person’s gratification or gain. It involves physical contact, in the form of assault by penetration (rape or oral sex) or non-penetrative acts such as kissing, rubbing, touching outside clothing, and masturbation. Sexual abuse can also involve non-contact activities such as forcing a child to look at sexual images or sexual activities, involving a child in the production of sexual images, encouraging a child to behave in a sexually inappropriate manner or grooming a child (via e-technology) in preparation for abuse. Sexual abuse may be inflicted by adult males, adult females and other children.
Physical indicators that a child may be subjected to sexual abuse include bloody underwear, pain during urination, itching in genital areas, soreness and bleeding in the genital or anal areas, bruises on the buttocks or inner thighs, difficulty in walking or sitting, or anorexia and bulimia.
Behavioural cues one should be aware of include inappropriate sexual knowledge or language for the child’s age, inappropriate sexual contact with other children, low self-esteem, fear of the dark, guardedness of being approached by anyone, chronic depression, acquisition of phones or money without a valid explanation, substance misuse, receiving phone calls or messages from adults beyond the child’s normal range of contact, and association with older adults (specifically men) beyond the child’s normal range of contacts.
Emotional abuse is the persistent emotional maltreatment or psychological abuse of a child, whereby a child is deliberately hurt by being told that he/she is unloved, inadequate, or worthless. Emotional abuse also encompasses preventing the child from expressing their opinions, intentionally silencing them, or making fun of how and what they communicate about. Emotional abuse can take place in the form of bullying, be it in person or online (via social networks).
Physical indicators that a child is being emotionally abused involve wetting and soiling, frequent vomiting, sudden speech disorders and signs of mutilation. Behavioural indicators include thumb sucking, rocking, chronic incidents of running away from home, attention-seeking behaviour, social withdrawal, fear of change, and avoidance of certain situations such as riding the bus or going to school.
Neglect pertains to the failure to provide for a child’s basic needs in terms of adequate food, hygiene, clothing, shelter or supervision. Such failure causes significant developmental impairment and makes a child vulnerable to other types of abuse.
Physical indicators that a child is being neglected include poor growth, poor hygiene, constant hunger, inadequate clothing, untreated illnesses, and exposure to danger due to lack of supervision. Behavioural indicators include compulsive stealing or begging, poor record of school attendance, hiding food for later, low self-esteem, listlessness and poor peer relationships.
Psychological impact of child abuse
The trauma of child abuse does not remain within the parameters of the actual event, rather, the trauma lingers into late adulthood as there are significant long-term psychological effects. Dr John argues, “A child abuse victim progressing though adulthood may be involved in a series of mental health problems such as depression, anxiety and complex trauma. This occurs because child abuse trauma tends to resurface when the individual experiences a certain situation, conversation or person. Such resurfacing causes significant distress even though the individual themselves may not know why this is happening to them. For trauma functions at a subliminal level and thus such triggers prevent the individual from coping.” Dr John maintains that long-term psychological effects of child abuse include:
- Sleep disruptions such as insomnia or sleep paralysis.
- Problems with appetite and eating disorders emerge because the individual develops negative associations with food, physical appearance and their body image.
- Suicidal behaviours are also triggered by childhood abuse because the individual tends to self-blame, internalise the guilt and victimise themselves. Thus, suicide ideation or a suicide attempt is one route to get rid of their childhood trauma.
- Entering abusive relationships in the context of friendship, work or romance. That is, a childhood abuse survivor tends to enter relationships that place them in the familiar role of a victim.
The difficulty of sustaining healthy relationships for child abuse survivors also stems from their psychological feelings of guilt and shame. Dr Daou says, “Survivors of sexual abuse may blame themselves for what happened and may internalise many negative beliefs about themselves, such as ‘I am worthless’, ‘I am dirty’, ‘I can't trust anyone’. They can have significant difficulties in relationships because they have a hard time trusting others and trusting their internal voice and feelings. They can have a fear of intimacy and feel disgusted with themselves. They may feel they have no control over their lives. They can also become promiscuous in order to regain control over their own bodies.”
Survivors of sexual abuse may blame themselves for what happened and may internalise many negative beliefs about themselves, such as ‘I am worthless’, ‘I am dirty’, ‘I can't trust anyone’. They can have significant difficulties in relationships because they have a hard time trusting others and trusting their internal voice and feelings.
Psychological treatments of childhood abuse:
An array of psychological and psychiatric treatments can be provided to support childhood abuse survivors in their journey of processing their trauma. In less severe cases of child abuse, psychological therapy is always the first choice of treatment followed by the introduction of medication, if needed. Yet in more severe cases, medication tends to be the first line of treatment. Dr John recommends that, “…a risk assessment with the child abuse survivor and a clinical interview with the family should be immediately conducted. If the suicidal risk is high, I would refer the patient to the outpatient psychiatrist or refer him/her to a hospital if it is not safe for the patient to remain at home. Medication may be also used if it is very difficult for the child to regulate their emotions, as medication can stabilise their emotions and help them sustain a conversation about their trauma.”
Albeit the form and duration of treatment is highly individualised according to the specific case of abuse, there is evidence-based research that shows that the following psychological treatments effectively treat childhood abuse according to the following age ranges of the survivor.
3- to 9-year-old children: Abstract free play base therapy
Play-based cognitive behaviour therapy can be used to help young child abuse survivors develop appropriate coping skills. Dr John notes, “…such coping skills can help the child bounce back with resilience and move forward from their trauma. As psychologists, we don’t go into so much detail about the abuse they endured, rather we equip them with the necessary stress management skills and resilience so they can develop healthier views of the world, the people around them and themselves.”
9- to 18-year-old children: Trauma-focused cognitive behavioural therapy (CBT) and psychoeducation
Cognitive behavioural therapy is used with child abuse survivors of this age range to help the child identify the core negative beliefs they have absorbed from the traumatic event, and to correct the lingering rules they have developed from their beliefs. Dr Daou argues, “All trauma informed CBT therapies aim to help an individual reconnect with their bodies, trust their bodies and their emotions, regulate their nervous system and process the traumas they have endured.”
Dr John adds, “Psychoeducation is also included for family members so that they can learn how to help and support the journey of the child abuse survivor. For many families, it could be the first time they are speaking about the trauma, and so it is important for the parents to be involved depending on the case.”
18-year-old children and above: Trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR)
Additional components of CBT can be used to help the child abuse survivor become strong enough to overcome the traumatic event. Dr John says, “CBT components such as exposure and cognitive reprocessing should be used because the patient is more aware and can delve into what the traumatic event generated. EMDR is also used in therapy to help the individual process trauma using bilateral stimulation, whereby eye movements are monitored to help the patient focus on narrating and processing every single traumatic and distressing residue of what they remember. Over time, such therapy helps them cultivate more positive beliefs and helps them overcome their trauma through conscious awareness.”
Who to contact when reporting child abuse
If you are being subjected to child abuse, have witnessed a case of child abuse, or even suspect a case of child abuse, you can report your concern to the Ministry of Interior (MoI) through the hotline number 116111 or through the MoI’s Child Protection Centre's website, and the 'Hemayati' (Arabic for protect me) app.
Other channels for reporting child abuse include:
- Community Development Authority- CDA on hotline: 800988
- EWAA Shelter for Women and Children on hotline: 8007283
- Dubai Foundation for Women and Children: 800111
- Child protection centre in Sharjah on toll-free helpline number: 800 700
- Hemaya Foundation for Children and Women - Ajman on hotline: 800himaya (800446292)
- Aman Centre for Women and Children through RAK Police: 07-2356666
-The writer is a psychology lecturer in the UAE.
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