The assessment of sexual abuse in children is a complex and difficult undertaking, particularly due to the legal implications of the findings. Often misconceptions about how sexually abused children present lead evaluators to miss important signs. Do you know, for example, which sexual acting out behaviors in children are just part of normal development and which are indicators of abuse? How does the language used in an interview with an abused child affect the child’s responses? What does it mean if children present bizarre and unbelievable reports of abusive events? Children may self-stimulate as a part of normal development but when it is intense, repeated, in public, and injurious it is a more worrisome sign. When interviewing children about abuse, it is important not to  ask “yes”or “no questions,” as  this may box a child into an answer that does not reflect their experience, but is simply a way to please the evaluator. Using open-ended questions like “Tell me about….” will yield more reliable results. Studies show that children sometimes present wished for rescue fantasies while they are describing events that really happened. So for example a child might say, “My dog came into the room and chased him away,” when this was more a wish than reality. But, nonetheless they are describing something real prior to the rescue fantasy. It is very difficult to “program” or influence a young child to give a consistent description of events for which they have little prior experience. In fact, when abuse cannot be proven, evaluators sometimes resort to this explanation when it would be more accurate to conclude sometimes, “we just don’t know."

The clinician dealing with sexually abused children will face many ethical dilemmas as they engage in assessment or treatment with this population. When treating abused children it is important to know whether there are court proceedings that are upcoming. If so, one should not use imagination techniques, like mastering the trauma through fantasy, and cognitive behavioral approaches have to wait until court proceedings have already transpired. Instead the therapist can use supportive techniques and help the child cope with their post-disclosure adjustment to any new family constellation..

While assessment of sexual abuse is difficult, current research provides guides and practical tools for mastering the task of distinguishing between sexually abused and non-abused children.