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The Long Term Neurological and Developmental Effects of Sexual Abuse on Infant
Children
Mike Earl-Taylor and LindsayThomas
In the South African context, the widespread sexual abuse of children has
reached epidemic proportions and the recent highly publicised rape of infant
girls, ranging in age from 0 to 2 years must surely start to provoke alarm bells
ringing in a society where sexualised violence against women and children is
reaching unprecedented levels. Rhodes University researchers Mike Earl-Taylor,
and Ms Lindsay Rae Thomas, review one American expert's opinion on the
devastating neurological and developmental impact of sexual abuse on pre-verbal
infants. The following is an extract of an unpublished paper entitled " The
Phenomenon of Infant Rape in South Africa." [Earl-Taylor: April, 2000].
The sexual abuse of children and infants is, sadly, as universal, and as old
as the human race itself. But, it is only in recent years that much more
attention has been paid to the pervasive incidence of the sexual abuse of young
children, the majority of which, occurs within the family setting. The very same
environment in which a child should expect to be protected, nutured, loved, and
most importantly, be able to feel safe.
The term, "child abuse", is defined as sexual, physical, emotional
abuse, and neglect, which only enters our lexicon in 1962 as the "battered
baby syndrome." A phrase coined by American paediatric radiologists, who
working closely with psychiatrists, collated and researched non-accidental
injuries in infants and young children.
Sexual abuse of an infant is classified as a paraphilia [sexually deviant
behaviour] known as nepiophilia. This is derived from the Greek word "nepon"
- which means infant. It is related to, but is distinct from, the psychosexual
disorder of paedophilia. The latter, typically involves sexual arousal and
gratification with prebubescent children of either gender from ages 5 - 12, or,
generally, no older than 13.
The long lasting , and often permanent damaging effects of sexual abuse on
the affective, cognitive, behavioural, and physiological development of older
children is well documented in research literature. However, much less is known
on the effects of sexual abuse on infants, especially those in the pre-verbal
stage of development, and their ability to recall such painful and traumatic
events.
American psychiatrist, Dr Bruce Perry, is one of the leading experts in the
field of sexual abuse of the infant child. Perry is the Thomas S. Trammell
Research Professor of Child Psychiatry at The Baylor College of Medicine
[Texas], and the Chief of Psychiatry at the Texas Children’s Hospital.
In a recent pre-draft article for "Trauma, Violence, and Abuse: A Review
Journal", [online source: date and publication unknown], Perry dispels many
widely held perceptions, that very young infants cannot recall traumatic and
painful incidents in later life, on the basis that a pre-verbal infant would not
be capable of remembering and recalling any event. According to Perry, nothing
could be further from the truth.
Perry defines the key word as "recall" and posits that
unfortunately, for most of us, the concept of memory is limited to the storage
and recall of cognitive, narrative memory. In this conceptualization, it would
seem unlikely that a pre-verbal infant would have the capacity to remember and
recall specific events. This is especially so in view of the developmental
amnesia that usually occurs at approximately age three. As Perry suggests, in
the normal developmental phase, there appears to be a reorganisation of
cognitive and memory functions, such as narrative memory, for events prior to
age three or four, which are difficult to access in later life.
It is these two points that Perry argues have "led to the pervasive,
inaccurate and destructive view that infants do not recall traumatic experience,
including sexual abuse". He stipulates that the human brain has multiple
ways to "recall" experience. Indeed, as Perry argues, the brain is
designed to store and recall all sorts of information - motor, vestibular,
emotional, social, and cognitive.
When you walk, play the piano, feel your heart race in an empty parking-lot
at night, feel calmed by the touch of a loved one or create a "first
impression" after meeting someone for the first time, you are using memory.
Perry notes that all incoming sensory information creates neuronal patterns of
activity that are compared against previously stored patterns.
He states that new patterns can create new memories. Yet the majority of
these stored memory templates are based upon experiences that took place in
early childhood - the time in life, when these patterns of neuronal activity,
were first experienced and stored. And, according to Perry, the majority of our
"memories" are non-cognitive and pre-verbal. "It is the
experiences of early childhood that create the foundational organisation of
neural systems that will be used for a lifetime."
This is why, and here Perry is instructive, that contrary to general public
perception, infants and young children are more vulnerable to traumatic stress -
including sexual abuse. If the original experiences of the infant, with primary
care-giving adults involve fear, unpredictability, pain, and abnormal genital
sensations; neural organisation; in many key areas will be significantly, and
detrimentally, altered. Perry cites as an example, that abnormal associations
may be created between genital touch and fear, thereby laying the future
foundation for problems in psychosexual development.
He points out, that depending on the specific nature of the abuse, the
duration, the frequency and the time during the child's development, a host of
dysfunctional symptons can result. "In many ways, the long-term effects of
sexual abuse in infancy are the result of memories - physiological state
memories, motor vestibular memories, and emotional memories, which in later
years can be triggered by a host of cues that are pervasive".
Incestuousness in infancy is the most destructive in this regard, with father
to daughter incest, being the most damaging of all, as well as the most common
incidence of incest. Sexual abuse of an infant will result in the association of
fear, pain, and unpredictability into the very core of future human functioning
- the primary relational templates. As Perry argues, if these "original
templates" for all future relationships are corrupted by sexual
exploitation and abuse, the child will have a lifetime of difficulty with
intimacy, trust, touch, and bonding - indeed, the core elements of healthy
functioning and development throughout the life cycle will be altered.
Furthermore, if the child is sexually abused during early childhood, they may
not have any "cognitive" memory and are completely unaware of the
source of their fears, difficulties with intimacy and relationships, that has,
as its roots, betrayal in infancy. This can, and invariably will, lead to
problems in self-esteem, and will make any therapeutic intervention efforts even
more difficult.
The sexual abuse of the infant child, can, and often does, arrest, or
significantly delay, cognitive, emotional, and behavioural development. Perry
states that the sexual abuse of an infant is often accompanied by extreme
disruptions of normal care-giving behaviours, and by extreme and prolonged
stress responses on the part of the infant. He reiterates that altered care
giving and prolonged stress response[s] will profoundly impact on the healthy
development process of the infant.
The primary care-givers are the major mediators of emotional, cognitive and
the social environment, and, therefore, learning during infancy. It can be
further understood that healthy development in all domains can be severely
disrupted if these primary relationships are compromised. It is therefore almost
inevitable that emotional, behavioural, and cognitive development will be
arrested by early traumatic experience.
Perry stipulates that the development of infant-attachment and healthy
socio-emotional functioning depends on the presence of consistent, responsive,
attuned, and nurturing care givers. He adds that one of the central, if not core
tasks of these relationships, is to keep the child safe. It goes without saying,
that if these care-givers are unable to protect, or worse still, if they
participate in the sexual abuse of the child, the basis of all future relational
interactions is corrupted.
Understandably, then, the distortions in attachment that result from sexual
abuse in infancy can be toxic in all future relationships, and especially so in
the areas of self-esteem, intimacy, trust and the ability to bond. As Perry
articulates, "the cascade of problems that result from impaired
socio-emotional functioning due to early life sexual abuse can impact on all
domains of functioning and, more importantly, it will be a source of ongoing
confusion and pain to anyone experiencing sexual abuse in infancy.
On the issue of physiological changes to the developing brain as a result of
sexual abuse, Perry reminds us that the brain is designed to change in response
to experience, and further, that all experiences change the brain. With
traumatic experiences, the major changes are in those parts of the brain
involved in stress and fear responses. Perry goes on to note that many studies
with adults, and now with children, have demonstrated a host of
neurophysiological changes that are related to traumatic stress.
"While many more well-controlled studies are needed, it is likely that
certain brainstem catecholamine systems, for example, the locus coeruleus nora
adrengeric, the limbic areas, the amygdala, and the neuroendocrine
hypothalamic-pituitary-adrenal axis, and cortical systems involved in regulating
stress and arousal, may be altered in traumatised children".
The sequelae that result from sexual abuse of infants will vary as the
function of several key factors These are, the nature of the abuse, the
duration, the frequency, intensity, the developmental, rather than
chronolological age the child, as well as the presence of attenuating factors,
such as attentive, loving, and supportive, caregivers in the child’s life.
Perry argues that, in general, with all traumatic experiences, the earlier in
life the abuse occurs, the less "specific" and more pervasive the
resulting problems appear to be. For example, when traumatised as an adult,
there is a specific increase in the sympathetic nervous system reactivity when
exposed to cues associated with the traumatic event.
However, with young children, following traumatic stress, Perry notes that
there appears to be a generalised increase in autonomic nervous system
reactivity, in addition to the cue-specific activity. This, he avers, is due to
the sequential and functionally interdependent nature of development, and the
traumatic disruption of the organisation and functioning neural system which can
result in a plethora of related development and dysfunction. Pertinent examples
are motor activity and language delays in traumatised children under the age of
six.
In the final analysis, Perry sees the "causes" of these delays, as
likely due to the primary, trauma-induced alterations in other domains, notably
the stress response systems which influence physiological activity,
hypervigilance and concentration. This, in turn, can impact on the young child’s
motivation and willingness to explore, as well as, on its capacity to process
new information, the ability to focus for long periods and the ability to learn
new information.
As is often the case with older children who have been the subject of sexual
abuse, there are, without critical and timeous therapeutic interventions,
counselling, and support mechanisms, serious long term consequences. The scars
of the physiological trauma are far easier to heal than the psychological damage
and subsequent developmental dysfunctions and their sequelae, as a direct result
of sexual abuse in early childhood.
Treatment of sexually abused infants and young children can include the
monitoring of the child's neural pattern over a duration of years, to detect
whether neurophysiological damage is present, and the extent. Play therapy and
flooding techniques can also be utilised, depending on the symptons presented.
In cases of intra-famillial sexual abuse, the dysfunctional aspects of the
family, would have to be addressed through interdisciplinary agencies via social
workers, police, mental health professionals, and child welfare workers.
With pre-verbal infants, the amelioration, and effective treatment of their
traumatic experiences presents caring professionals from both the medical and
mental health fields, with a significant challenge, not only in providing
holistic, and possibly long-term care and therapeutic programmes, but also to
place a firm emphasis on the importance of public awareness that the sexual
abuse of infants and children rightly deserves, in a concerted effort to
drastically reduce its occurrence, and especially so, here, in South Africa.
More Information
American citizen Mike Earl-Taylor has lived and worked in South Africa since
1990. A former social worker, and later journalist, he holds BSc and BA degrees
in Social Sciences from the University of Oregon, and an MA from Oregon State
University. Earl-Taylor is a Research and Development Officer with the
Department of Psychology-based MTN Centre for Crime Prevention. His interests
are the psychopathology of violent criminal behaviour in children, adolescents
and adults, as well as violent serial offending. He serves on the Committee of
Grahamstown's Child and Family Welfare and the Raphael HIV/Aids Counselling and
Support Centre.
Ms Lindsay Rae Thomas, a South African, has spent seven years travelling
extensively overseas, visiting North America, South America, Europe, Australia
and the Far East. She has a B.Psych. and a BA Hons in Psychology from the
University of Port Elizabeth. She is currently reading for her Master's degree
in Research Psychology at Rhodes University. Her research interests are in
Investigative Psychology, Forensic Psychology, Gender and Child Violence, Crime,
and she has also developed considerable expertise and research in HIV/Aids, and
related issues.
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