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IdentifyingSexually Abused Children ThroughTheirARTChild Abuse Education Foundation of WI, Inc.Scott R. Neubauer, BS MPA Educational [email protected] Phone (262) 729-03111200 West Royal Lee DrivePalmyra, WI 53156

ABOUTSCOTT NEUBAUERThe Child Abuse Education Foundation of WI, Inc. exists to preventchild abuse by educating child care professionals, teachers, social workersand law enforcement about the early identification, reporting andinvestigation of physical and sexual abuse of children.Scott Neubauer has been a lecturer at the University of WisconsinWhitewater since the fall semester of 2006. He currently teaches CriminalInvestigation and Criminal Investigation of Child Abuse. In addition tohis teaching, Scott works for the Child Abuse Education of WisconsinFoundation, giving presentations on child abuse throughout Wisconsin,Michigan and Illinois. Scott has 35 years experience in Law Enforcement, thelast 22 years serving as Chief of Police in Palmyra, WI. He holds a bachelor’sof science in Criminal Justice from the University of Wisconsin-Milwaukee and a master’s degree in Public Administration from the University ofWisconsin-Oshkosh. He is a life member of the Wisconsin Chiefs of PoliceAssociation and the 2004 Victim’s Advocacy Award winner for his child abuseinvestigations and presentations.For the last ten years Scott has been traveling the state of Wisconsin andbeyond giving talks on identifying child abuse. It is common when givingtalks to elementary and early childhood teachers for them to bring up specificconcerns about past and present students. One of the most frequently askedquestions is: Do we have enough information to report child abuse? Unlikephysical abuse, where the black eyes and bruises are an obvious giveaway, thesigns of sexual abuse are more difficult to identify. Scott has always usedthe following list of “red flags,” or indicators, to identify sexually abusedchildren: CONTACT USChild Abuse Education Foundation of WI, Inc. Scott R. Neubauer, BS MPA Educational Liaison [email protected] Phone (262) 729-0311 1200 West Royal Lee DrivePalmyra, WI 53156 Frequent masturbationToilet training regressionChildren touching other children’s private partsNon-age appropriate sexual knowledgeDramatic mood changesUncharacteristic rageSelf-mutilation

red flags to identify abuseFrequent MasturbationOn the surface one might assume that frequent masturbation in a youngchild is easily identified. After giving talks to hundreds of day care workers,however, we have learned that it is not uncommon for children with diaperrash to reach down their pants to scratch it. We have also been told that it iscommon for some children to sleep with their hand tucked into the waistbandof their pants. Such rational behavior and explanations make this indicatormore difficult to identify.Toilet Training RegressionWhen a toilet-trained child suddenly has accidents, and there is nomedical cause, it is a strong indicator of abuse. I have investigated caseswhere children as old as 15 started to wear diapers again for seeminglymysterious reasons, only to learn they were sexually abused. Unfortunately,Health Insurance Portability and Accountability Act (HIPAA) compliancemeans that medical information may be withheld, making this indicatordifficult to identify as well.Children Touching Other Children’sPrivate PartsExperts now agree that children under the age of five who are the victims ofchild abuse have substantially more difficulty dealing with their victimization.We believe that sexual contact is a learned behavior and when children areinappropriately touching playmates we have an indicator that the child mighthave been abused.Non-Age Appropriate Sexual KnowledgeChildren under the age of five do not understand that they are being sexuallyabused. They will, however, report it to someone when it hurts or becausethey don’t like something, such as oral sex. Children using slang terms for sexacts is a valid identifier of sexual abuse, since they have no reason for knowingsuch terms otherwise.Dramatic Mood Changes/Uncharacteristic RageIn Scott’s research involving 30 sexually abused boys he found a 1,000 percentincrease in violent crimes committed by the victims of sexual abuse over acontrol group (of non-abused boys). Scott did similar research on girls and againfound a 1,000 percent increase in violent crime over a similar control group.Unfortunately, anger and acting out is a byproduct of abuse. Most victimsdemonstrate unexplained anger or rage, but some also become sullen andwithdrawn due to feelings of shame, fear and confusion. The key toidentification is the suddenness of the personality change.Self-MutilationOur final red flag for child sexual abuse is self-mutilation. While it may seem selfexplanatory, self-mutilation can be the sign of a number of problems not related tosexual abuse. As such, it should not be used as a sole indicator.Parental Red FlagsHow many red flags justify making a report of sexual abuse? More importantly,how many signs will a police officer or social worker need to start an investigation?To supplement any red flags collected from observing the children, we have alsocompiled a list of red flags for when parents are suspected of sexually abusing theirchildren: Parentsmove frequently non-job relatedblame sexual knowledge on siblings Parents have previous arrests for child abuse Parents have prior arrests for drug or alcohol abuse ParentsProfessionals that work with children are not good at substantiating child abusethe first time an allegation is made. When there are repeat allegations, we do muchbetter with believing the child or children. In order to avoid repeat allegationsand investigations, parents who abuse their children will often make excuses, blame someone else, or move. Backgrounds on parents living in Wisconsincan easily be checked using the automated circuit court records system web site:wcca.wicourts.gov.

In 2006 Scott investigated a complaint from a local elementary school abouta third grade girl who repeatedly exposed her genitalia to fellow classmates during class and at recess. During the investigation, a counselor at the schoolsuggested Scott look at a drawing done by the girl’s five-year-old brother.When Scott saw the drawing (below), he knew the child was being sexuallyabused. His abuser turned out to be his older sister, who was in turn abusedby her father. With the cooperation of the school district Scott had the 3rdand 4th grade children, including the little girl, complete drawings of housesand persons. Scott’s objective was to see if the abused girl’s drawings wouldbe revealing of her abuse, as her brother’s drawing was. He wanted to know,given a set of known indicators, if we can differentiate a sexually abused child’sdrawings from her classmates’. And can we use these drawings to supplementthe other red flag indicators of abuse discussed earlier, since many of thoseindicators are difficult to easily identify?5 year old brother’s drawingThis drawing includes genitalia,use of hearts and wedges, all redflag indicators of child abuse.For the past two years, students at the University of Wisconsin-Whitewater and Scott have beenstudying art therapy as it relates to sexually abused children. From our research we have compiled and simplified a list of sexual abuse indicators found in art and compared that list to ourcollection of drawings done by the 3rd and 4th graders in our control group (minus drawingsdone by known victims of sexual abuse).HousesSmoke from chimneysNo doorsRainDark cloudsPeopleInclusion of genitalia (sexualized)Lack of handsExcessive use of heartsExcessive use of wedgesAggressive face (growling)Sad and crying faceSelf loathing130 HOUSESControl %31%2%1%0%0%5%5% (1 EACH)0%1%0%0%131 PEOPLEThe percentages above demonstrate how often children who are not abused (the control group)draw the listed indicators. For example, only 2% of the control group’s pictures featured houseswithout doors. This means that children who are not abused typically do not draw houseswithout doors. Children who are abused, however, are more likely to include this indicator in adrawing.Judging from the percentages above, we can see that not all indicators of sexual abuse found inchildren’s art should be given equal weight. As such, the indicators were broken down into twocategories: Red flags or stand alone indicators - observed in 2% or less of the control groupdrawings Yellow flags or indicators that require more than one observed element - observed in 5% ormore of the control drawingsFor example, we found that some 3rd and 4th grade children simply cannot draw hands sothey don’t include them in their drawings. This makes “lack of hands” a yellow flag indicator,requiring some other indicator to be present for it to be significant. None of our control groupchildren, however, drew sad or crying faces, making these red flag indicators.When the indicators above are compared to drawings done by sexually abused children, onefrequently finds more than one indicator in the drawings.Research FindingsChild Abuse & Art Therapy

No DoorsThe lack of doors on this house is a red flag. Thisdrawing also has smoke coming from the chimney, ayellow flag. Drawn by a 3rd grade sexual abuse victim.RainDraw by a 4th grade girl who was sexually abused by herfather. It contains rain, an element that children in thisage bracket do not typically draw. It also has wedges – theborders on each side of the house. Wedges are triangularobjects that can take the form of arrows, weapons, orunwelcoming borders, as is the case here.

Sad or Crying FacesExcessive Use of Hearts7Drawn by a 3rd grade girl who was a victim of sexualabuse. This drawing has not only a crying face but alsodepicts genitalia, both red flag indicators.*Malchiodi (1997), p. 154Hearts can be in the form of traditional Valentine’s Dayhearts (above), or the shape of an actual heart as depictedin the first drawing by the five-year-old brother. A singleheart is a yellow flag; more than one heart, as depicted inthis drawing, is a red flag.

Self-LoathingSexualized Drawings3Drawn by a 3rd grade girl sexually abused by her father.In addition to the target over her that depicts the selfloathing, this drawing also includes the use of wedges(the arrow) and genitalia (directly above the shaft of thearrow).*Malchiodi (1997), p. 156In addition to the sexualized female, this drawing also hasthe excessive use of hearts. Drawn by female victim ofsexual abuse.

We compiled a total of 40 drawings in four categories: 3rd grade houses, 4th grade houses,3rd grade persons, and 4th grade persons. Of those 40 drawings, nine were done by sexuallyabused children.We then tested college students at the University of Wisconsin-Whitewater in both entrylevel and advanced classes. The students were broken into two groups: control (untrained)and trained. The control group was simply shown the drawings on PowerPoint slides for tenseconds and asked to indicate whether or not they thought a sexually abused child did eachdrawing. The second group received training for approximately 50 minutes - training similarto the information found in this publication.An independent –samples t test comparing the mean scores of the trained and control groupsfound a significant difference between the mean number of pictures correctly identifiedbetween the two groups ( t(410) -12.755, p .01). The mean of the trained group was significantly higher (m 84.28, sd 9.66) than the mean of the control group (m 71.28, sd 10.37). This means the trained group (correct 84.28% of the time) was significantly better atidentifying whether or not a child was abused through his/her artwork than the control group(correct 71.28% of the time).We decided to further break down the research into four specific categories to determine thetraining’s effectiveness. In the category of third grade houses the control group correctlyidentified the pictures 72.70% of the time (on average) while the trained group averaged90.34% (t(410) -13.519, p .01). In the third grade people drawings we saw a similar result:the control group correctly identified 80.88% of the pictures and the trained group correctly identified 90.23% of the pictures (t(410) -7.441, p .01). Similarly, the trained group(79.92% correct) was better at identifying whether or not a house drawn by a fourth graderwas done by an abused child more often than the control group (66.49% correct) (t(410) -8.964, p .01). For pictures of people drawn by fourth grade students, the trained groupidentified the drawings correctly 76.63% of the time while the control group identified drawings correctly only 65.07% of the time (t(410) -7.224, p .01).Drawn by a sexually abused 4th grade girl. It depicts theaggressive or growling face on both figures, and is also anexample of storm clouds, a second red flag i ndicator.While the training significantly improved a person’s ability to correctly identify whether or nota picture was drawn by an abused child, it was more successful when the artwork demonstrating abuse was drawn by a third grade student. We believe this result may have occurredbecause our main test subject (the girl who was sexually abused by her father) began receivingcounseling at the end of her third grade year. The counseling she received may be why theindicators present in her drawings became more discrete, and thus more difficult to identify.We also gave our test to 49 daycare workers. The day care workers were able to correctlyidentify whether or not the artist of a given picture was abused 86.17% of the time. Webelieve their scores may be higher than those of the tested college students because they havea more vested professional interest in children.Our Statistics for Recognition of AbuseAggressive orGrowling Faces

Statistics for Recognition of AbuseDuring our testing we found that there is a wide range of artistic talent displayed in the drawingsof 3rd and 4th graders. Some of the more unusual drawings were consistently misidentified asbeing drawn by abused children, even if they had none of the indicators for sexual abusediscussed above. Those false positives were consistently less in our trained group.In some of these more unusual drawings, where there were no indicators, knowledge of thechildren and their home environment can provide explanations. In the first drawing immediatelyabove, the child wrote, “Stay out please!” This is not one of the discussed indicators, and can beexplained by the fact that the child’s family just had a baby who was sleeping in the bedroom. Inthe second drawing above, the child is attempting to represent himself as a cowboy - he lives in arural area where people commonly ride horses.Since there was a substantial range of artistic talent among our 3rd and 4the grade control groupin both the person and house drawings, we asked a graduate of the Milwaukee Institute of Artand Design to review our 261 drawings. She is an experienced judge of elementary art contests,and chose the following as a representation of the range in artistic talent at these ages.2

Children’s art shouldnot be used as astand-alone methodto identify sexuallyabused children.It is designed as a tool to be used when other previously listed indicators exist and confirmationof abuse is being sought: Frequent masturbation Toilet training regression Children touching other children’s private parts Non-age appropriate sexual knowledge Dramatic mood changes Uncharacteristic rage Self-mutilationAccording to the book “Recognition of Child Abuse for the Mandated Reporter” (Giardino, A. &Giardino, E.; 2002) children under the age of five who are sexually abused have substantially moredifficulty dealing with their victimization than older children. They initially don’t understand thatthey have been abused. My experience has been that over 50% of these sexual abuse victims unlike teen victims - go on to become abusers themselves. We need to get these children help. Myresearch in “The Relationship Between Child Sexual Abuse and Criminal Activity” demonstratesthat when children who are sexually abused do not get the help they need, there are devastating effects that last a lifetime. The good news is that we can turn abused children around by gettingthem help. The first step is identifying the abuse. Please take advantage of our research. Lookat the art of a child whom you suspect might have been abused. If you see the signs of abuse, immediately start the healing process for that child and report it to the police and social services.ReferencesCohen-Liebman, M.S., (1995). Drawings as judiciary aids in child sexual abuse litigation: acomposite list of indicators. The Arts in Psychotherapy 22(5), 475-483.Kenny, M. (2004). Teachers’ attitudes toward and knowledge of child maltreatment. ChildAbuse & Neglect, 28, 1311-1319.MacWilliams, B. Creative Arts Therapist. New York.Malchiodi, C.A. (1997). Breaking the Silence: Art Therapy with Children from Violent Homes.2nd ed. New York: Brunner-Routledge.Malchiodi, C.A. (1998). Understanding Children’s Drawings. New York: Guilford Publications.Neubauer, S. (1999). The relationship between sexual abuse and criminal activity (Master’sthesis, University of Wisconsin Oshkosh, 1999).Peterson, L.W. & Zamboni, S. (1998). Quantitative art techniques to evaluate child trauma: Acase review. Clinical Pediatrics, 45-51.ContributorsRebecca Mahan-StruppCo-InvestigatorUniversity of Wisconsin-WhitewaterIsabel DavisStatisticsUniversity of Wisconsin-WhitewaterB.A. PsychologyB.S. PsychologyErica NeubauerEditorUniversity of Wisconsin-WhitewaterRachel NeubauerArtMilwaukee Institute of Art and DesignB.A. EnglishB.A. Fine ArtsSpecial ThanksDr. Ruth Hammiller and Principal Steve Grenquest of Palmyra-Eagle School District for theirhelp and support.University of Wisconsin-Whitewater Student Researchers:Kyle AndersonKayla DunningSarah FelterSamantha HansonAmanda LindnerKate NormanDan Smith

Health Insurance Portability and Accountability Act (HIPAA) compliance means that medical information may be withheld, making this indicator difficult to identify as well. Children Touching Other Children's Private Parts Experts now agree that children under the age of five who are the victims of