title: Test balloons? Small signs of big events: a qualitative study on circumstances facilitating adults' awareness of children's first signs of sexual abuse.
abstract: This research examined caregivers' awareness of children's first signs of sexual abuse. The aim was to explore circumstances that facilitate adults' awareness of first signs in everyday natural settings. Data were obtained from a Norwegian university hospital's outpatient specialty mental health clinic. Included were all cases (N=20) referred during a two-year period for treatment after the disclosure of sexual abuse that was reported to the police and child protective service. Nonabusing caregivers' awareness of first signs were recollected in hindsight as part of therapy. Qualitative analysis was conducted to capture caregivers' experiences. As identified by caregivers, all children gave signs. Thereafter, children either stopped, delayed, or immediately disclosed sexual abuse. At first signs, each child had time and attention from trusted adults, connection to the abuser, and exhibited signs of reservation against that person or related activities. Then, if met with closed answers, first signs were rebuffed as once-occurring events. If met with open answers and follow-up questions, children continued to tell. Unambiguous messages were prompted only in settings with intimate bodily activity or sexual abuse related content. In sum, when trusted adults provided door-openings, children used them; when carefully prompted, children talked; when thoughtfully asked, children told. The study suggests that children's signs of sexual abuse can be understood as "test balloons" to explore understanding and whether anything is to be done. A disclosing continuation hinges on the trusted adult's dialogical attunement and supplementary door-openings. Divergent from an idea of behavioural markers, or purposeful versus accidental disclosures, this study calls for a broader attention: Moments of first signs are embedded in dialogue. A uniqueness at moments of first signs appears: Both to form such moments and to transform them into moments of meeting for joint exploration and telling, hinge upon how trusted caregivers scaffold opportunities for the child to disclose. Subsequently, support offers need to be addressed not only to strengthen children to tell, but also for caregivers and professionals to take into account the necessity of a dialogically oriented sensitivity towards children, both for telling to occur and for hearing to take place.
authors.affiliation: University Hospital of Northern Norway, Outpatient Specialty Mental Health Service for Children and Adolescents, Post Box 19, UNN, N-9038 Tromsø, Norway.
authors.forename: Anna Margrete
authors.initials: AM
authors.lastname: Flåm
authors.forename: Eli
authors.initials: E
authors.lastname: Haugstvedt
mesh_terms: D000293:Adolescent; D000328:Adult; D001364:Awareness; D017028:Caregivers / Q000193:education / Q000523:psychology*; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis* / Q000523:psychology*; D002675:Child, Preschool; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D033262:Narration; D010287:Parent-Child Relations; D036301:Qualitative Research; D012650:Self Disclosure; D014342:Truth Disclosure
keywords: Child sexual abuse; Dialogical research; First signs; Sexual abuse disclosure