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“Who did you tell?”

“What did they do after you told them?”

These are questions I ask almost every child that I interview. The answers are important; they tell me not just who the child trusts, but also about that child’s history, including what their life as a survivor of childhood sex abuse has been like. I am a child abuse pediatrician, specializing in the care of children with concerns for neglect, physical abuse, and sexual abuse. The majority of my work is in sexual abuse, and I am often called to court to explain not only physical exam findings, but the process of disclosure. Most commonly, I explain why children wait to tell.

Recent events, ranging from the women-focused “#metoo” movement to outcries of repeated sexual abuse by powerful men in government and Hollywood, have made sexual abuse, child sexual abuse, and disclosure part of the national conversation. Statistically, children wait an average of two years before beginning the disclosure process, if they ever report it at all. No one who regularly works with victims of abuse is surprised to see victims come forward years after their abuse has ended.

Disclosure is a process, not a singular event. The reasons for delaying disclosure vary, but I see many common themes repeated over and over. We see these same themes repeated in the media by victims who have come forward against high-profile perpetrators.

“I mean, no one was going to believe me.”--Boy, 10 years old at first disclosure, 7 when abuse started

Most sexual abuse/assault in children and adults is committed by someone trusted by and known to the victim. Children are frequently warned to stay away from strangers with candy. They are rarely encouraged to stand up to their uncle, priest, teacher, grandparent, or the community leader who is aiding their family. When a trusted adult turns into a perpetrator, the victim feels isolated. Telling other people about what happened to them can be devastating not only for the victim, but also for their family if the abuser is offering (or perceived to be offering) protection or help to the family in some way. Assuming, of course, the family is willing to believe the victim at all.

“When I told my teacher, she said ‘It’s not a big deal.’”--15 years old, age 6 when abuse started

Children frequently do a “trial run” of disclosure, telling a trusted adult or friend a piece of what has happened to them to see how that person reacts. The disclosure process can take years to start, and a person may never completely reveal everything. If they are believed and feel safe, they will often disclose more. If that person discredits them, questions them, or fails to act on the information, the child will often recant their initial disclosure. Interventions, such as removing the alleged perpetrator from the home with the aim of protecting the victim, often result in family disruption and conflict. Victims may even take it all back in an effort to undo the changes they see occurring in their families.

“I wasn’t supposed to be there.” --16 years old at first disclosure, 14 when abuse started

Shame is another reason victims wait to disclose. They place much of the blame for what happened on themselves. They weren’t supposed to stay out late. They weren’t supposed to be at that party. They knew what kind of reputation the perpetrator had. They shouldn’t have worn that outfit if they didn’t want to be noticed. People are afraid of the repercussions of coming forward. They don’t want to have their entire dating or sexual history publicized. They don’t want to be publicly demeaned for what they wore or drank. They don’t want to be blamed for aiding their own assault.

And finally, young people often lack the basic vocabulary to describe what was done to them. I remember a girl who referred to her grandfather as “eating her cookie” being dismissed, when the actual interaction was anything but harmless. Lacking basic sex education and knowledge of appropriate names for body parts, she was unable to communicate her abuse to others.

Many of the children I see cannot tell me when their abuse first started, but they have all been able to say when they first disclosed and what that person did with the information. As a community, there are many ways we can encourage disclosure and ensure the safety of victims. Giving them the space and time to do so is essential. We must be willing to take the time to listen and be patient, even when their stories make us uncomfortable. We must start by believing.

Northrop is a pediatrician in Raleigh, N.C., and an assistant professor of pediatrics at Wake Forest Baptist Health.

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