Making sad sense of child abuse Dec. 23, 2013 - When a man in Israel was accused of sexually abusing his young daughter, it was hard for many people to believe -- a neighbor reported seeing the girl sitting and drinking hot chocolate with her father every morning, laughing, smiling, and looking relaxed. Such cases are not exceptional, however. Children react to sexual and physical abuse in unpredictable ways, making it hard to discern the clues. Now Dr. Carmit Katz of Tel Aviv University's Bob Shapell School of Social Work has found that when parents are physically abusive, children tend to accommodate it. But when the abuse is sexual, they tend to fight or flee it unless it is severe. The findings, published in Child Abuse & Neglect, help explain children's behavior in response to abuse and could aid in intervention and treatment. "All the cases of alleged physical abuse in the study involved parents, while we had very few cases of alleged parental sexual abuse," said Dr. Katz. More than the type of abuse, it may be that children feel they have no choice but to endure abuse by their parents, who they depend on for love and support. Disturbing data About 3.5 million cases of child abuse are reported in the United States every year. Similarly alarming situations exist in many other countries. Abused children often suffer from emotional and behavioral problems, which can later develop into sexual dysfunction, anxiety, promiscuity, vulnerability to repeated victimization, depression, and substance abuse. Israel is not immune. In 2011, trained Israeli authorities interviewed more than 15,000 children following complaints of abuse. Previous research showed that half of children do not disclose anything in interviews, even when there is evidence of abuse. Dr. Katz analyzed a random sample of 224 of the interviews in which children provided allegations. Roughly half the cases in the study involved allegations of multiple incidents of physical abuse by parents, while the other half involved allegations of sexual abuse. Dr. Katz found that the children responded to the abuse in two general ways. In physical abuse cases, the children tended to be accommodating -- they accepted and tried to minimize the severity of the abuse. On the other hand, children reporting sexual abuse tended to fight back. But when the alleged sexual abuse was severe, the children tended to act like physical abuse victims, accommodating the abuser. Older children, they found, were more likely to fight than younger ones. But surprisingly, the frequency of the abuse, familiarity with the abuser, and the child's gender did not significantly affect how the children responded. Accepting the unacceptable Dr. Katz says the study teaches an important lesson when it comes to parental physical abuse. Just because children do not fight or flee their parents does not mean they are not being abused. Children need their parents to survive, and in some cases, parents love, care for, and support their children when they are not abusing them. Under these impossible circumstances, children often feel their best option is accommodation. In one interview in the study, a child said, "Daddy was yelling on me because I didn't do my homework, so I told him I am sorry you are right and brought him his belt." There were many similar examples. The study may underreport children who accommodate sexual abuse by their parents, Dr. Katz says. Out of the 107 interviews in which children provided allegations of sexual abuse, only six involved a parent. Most of the cases of sexual abuse in the study were severe, and children tended to respond by accommodating their abusers. Previous research showed that children who accommodate their abusers are more likely to harbor feelings of guilt or shame, which may deter them from providing allegations. Accommodation, then, may actually be the dominant response to both types of parental abuse. The findings help make sense of the testimonies of children in abuse cases. This could help prosecute abusers and provide better intervention and treatment to abused children. Dr. Katz would like to see future studies dealing with children's encounters with clinicians following abuse and how cultural factors affect children's responses to abuse.