Seminar on Child Sexual Abuse
Ralph C. Underwager
VIII. Behavioral indicators
A. Various behaviors and behavior changes are often cited as signs of sexual abuse in
children and adolescents. 1. For example, The Journal of the American Medical Association
(JAMA, 1985, p. 798) includes the following as behavioral signs of sexual abuse:
a. Become withdrawn and daydream excessively b. Evidence poor peer relationships c.
Experience poor self-esteem d. Seem frightened or phobic, especially of adults e.
Experience deterioration of body image f. Express general feelings of shame or guilt g.
Exhibit a sudden deterioration in academic performance h. Show pseudomature personality
development i. Attempt suicide j. Exhibit a positive relationship toward the offender k.
Display regressive behavior l. Display enuresis and/or encopresis m. Engage in excessive
masturbation n. Engage in highly sexualized play o. Become sexually promiscuous
2. Such lists have been widely disseminated through the media, pamphlets, popular
articles, seminars and workshop aimed at training or consciousness raising.
3. To spread these claims without appropriate cautions about the limitations of such
information can generate mistakes, confusion, over-reaction, and over-interpretation. 4.
In the late nineteenth and early twentieth centuries there was a great deal of public
attention given to the pernicious and destructive habit of masturbation by children. J.
Kellogg, M. D., originator of corn flakes, produced several books for parents to help them
stamp out this evil. The behavioral indicators parents used then to know if their children
were masturbating are the same behavioral indicators now said to prove a child has been
abused (Legrand, Wakefield, & Underwager, 1989). These beliefs resulted in serious
damage to children including clitoridectomies for young females and physical restraints
5. It is an error in diagnosis to use non-discriminating signs to make a diagnosis. If a
sign can be caused by 100 different variables, it cannot to be used to select a single
B. Age-inappropriate sexual behavior in children is often claimed to be a better
1. What children normally and naturally do sexually is much more frequent and involved
than most people assume (Best, 1983; Gundersen, Melas & Skar, 1981; Martinson, 1981).
Without knowing what a normal level is, it cannot be determined what is precocious,
greater interest than normal, and what may indicate abuse.
2. Rosenfeld and his colleagues (Rosenfeld, Bailey, Siegel & Bailey, 1986; Rosenfeld,
Siegel & Bailey, 1987) emphasize getting normative information on nakedness, genital
touching and bathing practices before deciding whether these behaviors support a suspicion
of sexual abuse. They found that genital touching of parents on an incidental basis is not
uncommon even among 10-year-olds.
3. Friedrich, Grambsch, Broughton, Kuiper, and Beilke, R. N. (1991) report that their
normal, nonabused sample of children showed a wide variety of sexual behaviors at
relatively high frequencies.
4. However, Friedrich et al. also found that behaviors more imitative of adult sexual
behavior were unusual. Therefore, if a child is found engaging in explicitly sexual
behavior, such as oral-genital contact, this should be carefully checked out.
5. But even this does not prove that the child was sexually abused by an adult. Peer
sexual play, inadvertently seeing adults having intercourse, or access to x-rated video
might account for it. D. Behavioral indicators result from stress in general and are not
specific to the stress of sexual abuse.
1. These alleged behavioral indicators of sexual abuse are found in many different
situations, including divorce, conflict between parents, economic stress, wartime
separations, absent father, and almost any stressful situation children experience.
2. The stress resulting from parents divorcing, particularly if the divorce is bitter and
custody is contested, can result in many of the behavioral indicators in children.
3. Possible consequences arising from an allegation of sexual abuse-a frightening and
perhaps painful physical examination by a stranger, separation from one or both parents,
possible removal to a foster home, multiple interrogations by a number of
inter-viewers-are themselves the source of significant stress.
4. The base rates of the presence of many such behaviors in normal children, in troubled
children, in non-abused children, and as part of the developmental process for all
children is so high that any attempt to use them as indicating abuse will result in a high
rate of error.
E. In addition, not all sexually abused children are symptomatic subsequent to sexual
abuse (Gomes-Schwartz, Horowitz, & Cardarelli, 1990), so the absence of behavioral
symptoms cannot be used to rule out sexual abuse.
E. Child Sexual Abuse Accommodation Syndrome (CSAAS) (The following criticisms apply also
to the Sexually Abused Child Syndrome.)
1. The CSAAS was developed and described by a psychiatrist, Roland Summit (1983). It is
used by interviewers to justify their questioning and interpretation of the responses of
children while undergoing an interview.
2. Summit proposes five categories of behavior that constitute the syndrome. The five are
1) secrecy, 2) helplessness, 3) entrapment and accommodation, 4) delayed, conflicted, and
unconvincing disclosure, and 5) retraction.
3. The concepts of this putative syndrome are being used to decide whether or not a
child's statements about being sexually abused are valid or false.
4. There are no scientific research studies that support the validity and reliability of
the CSAAS or the sexually abused child syndrome (Corwin, 1988).
5. In spite of the complete lack of validation the syndrome has been adopted by many
professionals involved with allegations of sexual abuse. For example, the concept of
secrecy, that a child who has been abused will keep it a secret, is used to support the
tactic of continuing to pursue questioning when a child denies abuse.
6. The application of the CSAAS to children's statements means that nothing they say can
count against the belief that abuse happened. Once an allegation hits a professional who
believes in the validity of the CSAAS concept, nothing can falsify it.
7. Summit (1992) acknowledges that the the CSAAS is a clinical opinion, not a scientific
instrument and admits that its original basis was his experience consulting with
practitioners about incestuous abuse. (Summit did not see the child victims himself.)
8. Although Summit 1992) denies that the CSAAS is specific to father-daughter incest, the
syndrome has been criticized by others as inapplicable to different circumstances, such as
an accused neighbor, or a baby sitter, or in a divorce and custody battle.
9. Myers (1993) notes that the CSAAS is a nondiagnostic syndrome because it does not point
with any certainty to sexual abuse and he states that it should not be used as evidence
that the alleged abuse occurred.
10. Courts have generally ruled that CSAAS is inadmissible to prove that abuse occurred
but it has been admitted to rehabilitate children when there is delayed reporting and
recantation (Myers, 1993).
F. It is the consensus of scientific opinion that no specific behavioral syndromes
characterize victims of sexual abuse; therefore the presence of symptoms cannot be used to
demonstrate that abuse or occurred and the absence of symptoms does not rule it out (e.g.,