A major challenge in traumatology is our capacity to identify and treat trauma of early childhood. Sexual abuse prevalence rates, for example, are around 25% in women and 15% in men. The numbers of individuals who have sexualized trauma from early childhood is likely very high. This poses a variety of clinical challenges.

     Sexually abused preverbal children are particularly difficult to work with because they are usually unable to recognize and/or express the origin of their fears, even once they obtain verbal skills. They may present as constantly fearful, and their fear quickly turns into panic in situations that contain cues related to their sexual abuse. Further, because sexual abuse is extremely intimate in nature (and often occurs in the home, especially with females), young children who are sexually abused often use dissociation as a primary mode of adaptation and may have attachment disruptions to caregivers, thus resulting in a cascade of relational issues that disrupt normal development and the capacity to engage in therapeutic experiences.

     Sexually abused children show a plethora of divergent behavioral and emotional symptoms. They can have cognitive delays (such as language), decreased social interaction, increased dependence on the caregiver, hyperactivity, inexplicable irritability/crying, difficulty sleeping, enuresis or encopresis, and masturbation or increased sexual knowledge. Possible symptoms are so broad that sexual abuse may not usually be the first thing suspected, as these children are certainly unable to verbalize their abuse. Even if abuse is expected, medical exams have not proven to help substantiate abuse in the majority of cases-a normal medical exam in a sexually abused child is, in fact, normal. Further, many people, including experts, have assumed for years that infants are incapable of remembering their abuse and therefore are resilient to its effects. This is not true.

     Recent research provides strong evidence that infants can encode, retrieve, and be affected by early traumatic memories. Early memories are even more salient than later memories because they are some of the first associations infants make concerning social interactions as they are organizing their conceptualization of the world. (see Perry, 2009) Therefore, while sexually abused children are placing novel stimuli into categories of “fearful” vs. “pleasurable” (as these are the two most primal, guiding emotions infants have) they label sexual feelings and human beings as fearful, and thus create a maladaptive schema of their environment.

     Some children can later pair words with sexual scenes they encoded nonverbally and replicated during play. Other children can never label the origin of their fears. In children who can later pinpoint details of their abuse, helping them work through these details in a safe environment can help reduce their fearfulness. In children who cannot, building a safe environment with multiple trustworthy caregivers may be one of the only ways to slowly allay their fears and restore their ability to trust.

 Perry, B.D. (2009) How we remember. CYC-Online, 122, April, 2009 (www.cyc-net.org/cyconline/cyconline-apr2009-perry.html)