Identifying early signs of child abuse may lead to better outcomes.

Signs of child abuse are not always glaringly obvious. Some children may confide in a trusted adult or friend, but many will try to hide the evidence of abuse under long sleeves or behind fabricated stories. Jordan Harpley, LPCMHSP, social services representative at Parkridge Valley Hospital Child & Adolescent Campus, discussed how to recognize subtle behavioral signs in children that may indicate abuse.

“Don’t ignore signs of child abuse. If you feel that something is wrong, act on it. Make a report and get the child the help he or she needs. The earlier the intervention, the more successful the child may be.”

— Jordan Harpley, LPC-MHSP, social services representative at Parkridge Valley Hospital Child & Adolescent Campus

How can adults recognize signs of abuse in children?

Harpley: In younger children, the first clue is often their behavior. They may throw tantrums, isolate themselves or exhibit extreme physical aggression. Often, these behaviors are evident in their play. Children may not necessarily have the words for what happened to them, but their experience often comes out in their play

Physical abuse often appears as bruises showing up in areas on the body you wouldn’t expect, such as the stomach. Bruises may be symmetrical and resemble a handprint or belt buckle. Abusive parents may dress their children in unseasonal outfits to cover the marks.

Children who have been physically abused may reveal their experiences when playing typical games, such as house. They may have conversations that include, “mommy hit me because I got in trouble,” or “my daddy took the belt to me.” Children may also do to dolls what has been done to them — for example, using a stick to spank a doll.

Sexual abuse can be seen in a variety of behaviors. Kids who have been sexually abused may have problems going to the bathroom — so much so that they will sometimes urinate on themselves instead. Because they have been exposed to sex in a way that kids shouldn’t be, abused children may have an advanced, not age-appropriate knowledge of sex. This, too, can be seen in their play with toys or stuffed animals — the child may place objects near a doll’s or stuffed animal’s private areas. They may also know explicit terms related to genitalia or sex. Their interaction with other kids may show that they do not have a typical sense of boundaries, and they may try to touch people inappropriately.

Emotional abuse can cause children to have low self-esteem and make negative statements about themselves. Some children may act out — hitting, kicking, screaming or yelling — because that is the only way they can get attention from an adult at home. Although these behaviors do not result in positive interactions, acting out is the child’s way of getting an adult to notice him or her.

Signs of neglect may be similar to signs of emotional abuse, but neglected children may also have a number of health issues, lose unhealthy amounts of weight and appear dirty or unkempt. Some children will come right out and say something to the effect of “I have a pet rat,” and it turns out their house is infested. Others may show signs of neglect through their appearance and behavior.

Are there more subtle signs of abuse?

Harpley: Children who have trouble focusing on their schoolwork may be diagnosed with attention deficit/hyperactivity disorder (ADHD). But, abuse or trauma can affect cognitive function and reduce a child’s ability to process information or pay attention in class. This can cause children to be socially and academically behind students in their class and may produce other cognitive delays. It’s important to understand that abused children have much on their minds and, of course, won’t be able to concentrate on their schoolwork.

How should adults react if a child exhibits signs of abuse?

Harpley: If a child is in crisis and escalating out of control, the first action should be to call 911. If someone suspects signs of child abuse, the first thing he or she should do is to file a report with Child Protective Services (CPS) by calling (877) 237-0004 [that’s the number for Chattanooga-area CPS].

How do children who are abused get connected with care at Parkridge Valley?

Harpley: Parkridge Valley Child & Adolescent Campus has a residential program, which gets all referrals from the Tennessee Department of Children’s Services. We also have an acute program for crisis stabilization. Hospitals or families can call our RESPOND line at (423) 499-2300 and make a walk-in appointment for an assessment. Children who experience abuse but who are safe to transfer to our care are welcomed and treated at Parkridge Valley.

I am a counselor trained in trauma-focused cognitive behavioral therapy. When I work with a child, I help him or her explore thought processes — their feelings and behaviors — and how those are connected to the trauma they experienced. Education about trauma is a key element in therapy sessions, because many children I see don’t have the vocabulary to be able to say, “I’m angry, and this is why.” Much of the time, the kids just know that they don’t feel good. We equip them with the tools to be able to identify and explain different feelings, such as the difference between feeling sad and feeling mad.

I also work on identifying coping strategies. The child and I work together to help develop relaxation techniques that calm them down when they feel angry or anxious. We also work on identifying triggers — verbal or nonverbal events that lead to anger, sadness or anxiety — so that the child can handle such experiences without acting out in the future. All the work we do is to prepare children to be able to tell the story of what has happened to them. Children may feel most comfortable coloring or drawing their experience. We find the activity that empowers each child. We do this so the child encounters his or her feelings. If children internalize the fact that they were abused but do not deal with it, they will not be able to gain resolution. It will keep coming out in some way, shape or form. If they can be exposed to what happened to them and be free to share their feelings, they may better handle triggers in the future. Once children deal with the trauma, their behavior will begin to change. They may not be as sad, mad or aggressive toward other people, and instead they may use words to describe their feelings and using coping techniques to calm themselves when they get upset.

Learn more about RESPOND and how to find help for children suffering abuse.