BY DEBBIE PAGE

At the statewide 2024 Symposium on Domestic and Sexual Violence held in Statesville, Executive Director Beth McKeithan and Dove House Nurse Practitioner Heather Waleski described serving children who have experienced or witnessed sexual or other abuse in Dove House’s child-friendly facility.

To avoid re-traumatization, the Dove House forensic interviewer conducts a single interview for all law enforcement and other agencies’ needs in a home-like setting, provides comprehensive victim advocate services, offers onsite pediatric sexual assault medical exams, and contributes to the 88 percent successful prosecution rate of abuse cases.

McKeithan said that the staff stays in touch as long as survivors need them. They hold monthly meetings to discuss cases to make sure no one is falling through the cracks.

The professionals working with children in domestic violence cases learn as much as possible about the incident, including the medical status of victims and perpetrators, and the arrest status of perpetrators.

The interviewer is supportive of the child and family, arranging for any needed medical care and connecting the child and family with support services or therapy. 

The interviewer also reassures parents that the Dove House services are intended to help them put their lives back together, not to remove their children. The interviewer also provides pamphlets with information about services and phone numbers for help.

To combat sexual abuse, McKeithan said the Dove House staff offer the “Body First” program to first- and fifth-graders to teach body safety, provide abuse definitions, and introduce safety planning and how to identify safe adults. The program teaches children how to avoid internet predators.

SEX ABUSE STATS

Waleski presented startling child sex abuse statistics, stating that 1 in 4 girls and 1 in 6 boys experience sexual abuse. One in every 10 kids are sexually abused before age 18.

Dove House sees 180 to 250 cases a year from Iredell and Alexander counties

Kids often do not report sexual abuse because they have been threatened or are afraid of getting themselves or their parents in trouble. They sometimes think they did something wrong or that no one will believe them. The abuser also may offer them presents to buy their silence.

“Only an estimated 35 percent of victims ever report being abused, so we are only getting a portion of what is happening,” said Waleski.

Waleski also reported on North Carolina domestic violence homicides statistics, which have risen from 53 in 2018 to 73 in 2023. The state, which added this reporting last year, also had 23 domestic violence-related suicides in 2023.

DOMESTIC VIOLENCE SEVERELY IMPACTS CHILDREN

McKeithan said that between 3 million and 10 million children and adolescents in the U.S. witness violence between their parents or caregivers each year.

Parents or caregivers involved in a violent relationship may think that the fighting does not affect their children, but even children who do not actually see domestic violence are affected by the chronic family conflict. They may develop serious emotional and behavioral problems unrecognized by their parents or caregivers, so these children do not always get needed help.

A child’s sense of self depends on the behavior patterns they observe in their family, friends, and school. Consistent routines so critical for children are absent in physically and emotionally abusive homes, which starve a child’s development at all ages.

Dove House works with various justice programs, partners, medical providers, and mental health practitioners to help children heal after signs of emotional maltreatment, physical assault, or sexual abuse.

Children living in these violent homes feel powerless because they cannot stop violence. They feel confused because the abuse does not make sense, angry because it should not be happening, and guilty because they somehow feel responsibility.

They are sad because of the loss of innocence and safety, and they are afraid they may lose someone they love or that others may find out about their violent home life. Children in these situations also feel alone because they think this abusive environment is only happening to them.

IMPACT OF ADVERSE CHILDHOOD EXPERIENCES (ACEs)

Waleski said negative childhood experiences cause trauma, toxic stress, and adverse childhood experiences (ACEs).

When children experience acute (temporary) trauma, stress hormones are activated that cause a cascade of biological responses. Intense emotional responses, dysregulation (inability to control or regulate one’s emotional responses), and behavioral changes then occur.

These acute traumas can be overcome with a change of environment and a healthy, supportive caregiver.

Chronic trauma is a different story. This ongoing trauma causes the activation of stress hormones with a continuous immune system cascade. The child’s constant stress response results in physiological hyper-arousal (high emotional state) and hyper-vigilance for danger or threat.

The impact is pronounced. Children become unable to adapt, adjust, or participate in the normal aspects of life. They have profound changes in brain structure and function, their body’s organ systems, and even in their genetic makeup

The stress hormones profoundly affect their brain development. Waleski said their “lizard brain” takes over to survive in the traumatic situation so they can no longer generate rational thoughts. Their adverse life experiences warp their coping skills..

McKeithan added that not all kids have the same responses to witnessing or experiencing abuse. Five kids can see the same thing and have five different responses and versions of what they saw.

REDUCING STRESSORS

Children must learn to manage stress in a safe, nurturing caregiver relationship in a safe environment to develop a healthy stress response.

McKeithan suggested that teachers try to reduce children’s stress by starting each class or day with mindfulness or calming activities to lower the emotional states of children who may be in chronic stress.

Waleski noted that kids are resilient but must be removed from the stressor situation to begin to heal. The frontal decision-making section of children’s brains do not function well if in chronic stress.

Instead, their flight or flight area in the back of the brain is much more developed, explaining their extreme responses to what are minor situations to most.

Teachers are expecting healthy brains in their classrooms, but if they lack healthy brains, children will not learn and absorb information at same rate.

Waleski believes most ADHD diagnoses are probably really trauma symptoms. In these cases, the medication does not work because the children do not really have ADHD.

McKeithan said these children, after having counseling and therapy, often come off meds.

RESPONSES TO TRAUMA VARY

Waleski said several factors impact a child’s response to trauma, including the nature, severity, and timing (age of child) of the trauma. Specific child risk and protective factors and prior trauma exposure also affect his or her response, as does the caregiver’s and family’s role, reaction, and risk and protective factors.

In a adverse child experiences (ACEs) study by Kaiser Permanente and the CDC of 17,000 adult subjects, researchers generated an ACE score for each and then compared the score to their current risk behaviors (drug or alcohol use, sexual promiscuity, smoking, dangerous activities, etc.) and health status.

The three types of ACEs studied were abuse (physical, emotional, sexual), neglect (physical and emotional), and household dysfunction (mental illness, mother abused, divorce, incarcerated relative, substance abuse).

The calculation of ACE score includes exposure to recurrent and severe physical or emotional abuse, contact with sexual abuse, and growing up in a household with an alcoholic or drug abuser or with an incarcerated, chronically depressed, or mentally ill person.

Having an institutionalized individual family member, experiencing physical violence against mother, or the absence of both parents were also included in the score.

The study found having ACEs are common and that a dose-response relationship between ACEs and lifelong risk behaviors and poor health exists. In other words, the more a child has exposure to ACEs, the more risk behaviors and health issues will occur as adults.

The study found that ACEs trigger later high-risk behaviors that affect the person’s health, including smoking, severe obesity, physical inactivity, depression, alcoholism, illicit/injected drug abuse, and sexual promiscuity.

Common disease conditions associated with ACEs include ischemic heart disease, diabetes, stroke, cancer, suicide, skeletal fractures, chronic bronchitis/emphysema, STDs, and hepatitis.

Waleski said that coping skills and mood regulation are affected by chronic exposure to abuse and domestic violence.

McKeithan said that their extreme reactions to minor incidents are because they experience much higher stress levels and fly off the handle.

“We can teach coping skills, but we cannot change their brain structure,” added Waleski, “becauses ACEs hinder the development of the front of brain that controls decision-making.”

McKeithan also pointed out that research shows that “having only one person in their lives to support children can cause enough resilience to break the cycle.”

DOMESTIC VIOLENCE AND PHYSICAL ABUSE

Many children exposed to violence in the home are also victims of physical abuse.

Waleski said that children who witness domestic violence or are victims of abuse themselves are at serious risk for long-term physical and mental health problems.

Children who witness violence between parents may also be at greater risk of being violent in their future relationships.

Waleski listed symptoms related to children growing up with domestic violence at different stages.

From birth to age five, young children who experience domestic violence have sleep and/or eating disruptions, exhibit withdrawal or lack of responsiveness, and have intense or pronounced separation anxiety. Inconsolable crying can lead to abuse of the baby or child as well.

They also show developmental regression, loss of acquired skills, intense anxiety, worries, new fears, and increased aggression and impulsive behavior.

From ages 6 to 11, children exposed to domestic violence may have nightmares or sleep disruptions, demonstrate aggression and difficulty with peer relationships, and lack concentration and task completion in school.

They also withdraw or are emotionally numb. Others avoid school or are truant.

At middle and high school ages, youths in homes where there is domestic violence demonstrate anti-social, impulsive or reckless behavior, experience school failure, or may engage in substance abuse. They may also run away from home.

They may also have involvement in violent or abusive dating relationships. They may also suffer symptoms of depression, anxiety, and withdrawal.

She also noted that problematic sexual behaviors can develop in these children by acting out sexual behaviors they have witnessed toward other children. This behavior is significantly related to living in homes with poor health, criminal activity, or violence.

“If we can get them into cognitive behavior therapy, they can heal and have extremely low recidivism.”

McKeithan added that “with teens, adults often give up on them changing. We have to dig down on behaviors and get services to both the aggressor and victim because both still children.”

Waleski said that the success of therapy is linked to age. With older children, ages 16-17, therapy has less success.

The greater the number of life stresses, including parental battering, death, incarceration, illness or injury requiring hospitalization, family deaths, child illness requiring hospitalization, the greater the number and frequency of sexual behaviors observed in children.

As many as 68 percent of children with sexual behavior problems have witnessed intimate partner violence among their caregivers.