THE LIFE-CHANGING BENEFITS OF EXERCISE

Exercise is not just about aerobic capacity and muscle size. Sure, exercise can improve your health and your physique, trim your waistline, improve your sex life, and even add years to your life. But that’s not what motivates most people to stay active. People who exercise regularly tend to do so because it gives them an enormous sense of well–being. They feel more energetic throughout the day, sleep better at night, have sharper memories, and feel more relaxed and positive about themselves and their lives. And it doesn’t take hours of pumping weights in a gym or running mile after mile to achieve those results.
By focusing on activities you enjoy and tailoring a regular mild to moderate exercise routine to your needs, you can experience the health benefits of exercise and improve your own life by:

• Easing stress and anxiety. A twenty-minute bike ride won’t sweep away all of life’s troubles, but exercising regularly helps you take charge of anxiety and reduce stress. Aerobic exercise releases hormones that relieve stress and promote a sense of well-being.
• Lifting your mood. Exercise can treat mild to moderate depression as effectively as antidepressant medication. Exercise also releases endorphins, powerful chemicals in your brain that energize your spirits and make you feel good.
• Sharpening brainpower. The same endorphins that make you feel better also help you concentrate and feel mentally sharp for tasks at hand. Exercise also stimulates the growth of new brain cells and helps prevent age-related decline.
• Improving self-esteem. Regular activity is an investment in your mind, body, and soul. When it becomes habit, it can foster your sense of self-worth and make you feel strong and powerful.
• Boosting energy. Increasing your heart rate several times a week will give you more get-up-and-go. Start off with just a few minutes of exercise a day, and increase your workout as you feel more energized. 

Obstacles to exercise: What’s holding you back?

Despite all the life-changing benefits, many of us still think of exercise as a chore, either something that we don’t have time for, or something that’s only suitable for the young or the athletic.
There are many commonly-held myths about exercise that make it seem more arduous and painful than it has to be. Overcoming obstacles to exercise starts with separating fact from fiction.

 

Why we don’t exercise

“I don’t have enough time to exercise.”
Even short low-impact intervals of exercise can act as a powerful tool to supercharge your health. If you have time for a 15-minute walk with the dog, your body will thank you in many ways.
“Exercise is too difficult and painful.”
Consider “no pain, no gain” the old fashioned way of thinking about exercise. Exercise doesn’t have to hurt to be incredibly effective. You don’t have to push yourself to the limit to get results. You can build your strength and fitness by walking, swimming, even playing golf or cleaning the house.
“I’m too tired to exercise.”
Regular exercise is a powerful pick-me-up that can significantly reduce fatigue and make you feel much more energetic. If you’re feeling tired, try taking a brisk walk or dancing to your favorite music and see how much better you feel afterwards.
“I’m too old to start exercising,” “I'm too fat,” or “My health isn’t good enough.”
It’s never too late to start building your strength and physical fitness, even if you’re a senior or a self-confessed couch potato who has never exercised before. And exercise is a proven treatment for many diseases—from diabetes to arthritis. Very few health or weight problems make exercise out of the question, so talk to your doctor about a safe routine for you.
“I’m not athletic.”
Do you hide your head when the tennis ball approaches? Are you stumped at the difference between a foul ball and a free throw? Join the ranks. Don’t worry if you’re not sporty or ultra-coordinated. Instead, find an activity like walking, jogging, or yoga that makes you feel good to be in your body.
“Exercise is boring.”
Sure, pounding on a treadmill for an hour may not be everyone’s idea of a good time. But not all exercise has to be boring; just about everyone can find a physical activity they enjoy. Try playing ping-pong (table tennis) or activity-based video games with your kids. So-called “exergames” that are played standing up and moving around—simulating dancing, skateboarding, soccer, or tennis, for example—can burn at least as many calories as walking on a treadmill; some substantially more. Once you build up your confidence, try getting away from the TV screen and playing the real thing outside.
 

Reaping the benefits of exercise is easier than you think

To reap the benefits of exercise, you don’t need to devote hours out your busy day, train at the gym, sweat buckets, or run mile after monotonous mile. You can reap all the physical and mental health benefits of exercise with 30-minutes of moderate exercise five times a week. Two 15-minute exercise sessions can also work just as well.
If that still seems intimidating, don’t despair. Even just a few minutes of physical activity are better than none at all. If you don’t have time for 15 or 30 minutes of exercise, or if your body tells you to take a break after 5 or 10 minutes, for example, that’s okay, too. Start with 5- or 10-minute sessions and slowly increase your time. The more you exercise, the more energy you’ll have, so eventually you’ll feel ready for a little more. The key is to commit to do some moderate physical activity—however little—on most days. As exercising becomes habit, you can slowly add extra minutes or try different types of activities. If you keep at it, the benefits of exercise will begin to pay off.
 

Do I need different types of exercise?

While any kind of exercise offers tremendous health benefits, different types of exercise focus more on certain aspects of your health. You can concentrate on one type of exercise or mix them up to add variety to your workouts and broaden the health benefits.

• Aerobic activities like running, cycling, and swimming strengthen your heart and increase your endurance.
• Strength training like weight lifting or resistance training builds muscle and bone mass, improves balance and prevents falls. It’s one of the best counters to frailty in old age.
• Flexibility exercises like stretching and yoga help prevent injury, enhance range of motion, reduce stiffness, and limit aches and pains. 

Easy exercise tip 1: Move more in your daily life

If you're not ready to commit to a structured exercise program, think about physical activity as a lifestyle choice rather than a single task to check off your to-do list. Look at your daily routine and consider ways to sneak in activity here and there. Even very small activities can add up over the course of a day.

• In and around your home. Clean the house, wash the car, tend to the yard and garden, mow the lawn with a push mower, sweep the sidewalk or patio with a broom.
• At work and on the go. Look for ways to walk or cycle more. For example, bike or walk to an appointment rather than drive, banish all elevators and use the stairs, briskly walk to the bus stop then get off one stop early, park at the back of the lot and walk into the store or office, take a vigorous walk during your coffee break. Walk while you’re talking on your cell phone.
• With friends or family. Walk or jog around the soccer field during your kid’s practice, make a neighborhood bike ride part of weekend routine, play tag with your children in the yard or play exercise video games. Walk the dog together as a family, or if you don’t have your own dog, volunteer to walk a dog from a shelter. Organize an office bowling team, take a class in martial arts, dance, or yoga with a friend or spouse.

Easy exercise tip 2: Start slowly—a little is better than nothing

Exercise doesn’t need to be an all or nothing commitment. If you haven’t exercised before or you’ve tried an exercise program in the past and been unable to stick with it, it’s important not to set unrealistic goals. Committing to exercise for an hour a day in a gym may be too challenging at first, whereas committing to 10 minutes just three or four times a week is more manageable. Once these short windows of activity become a habit and you start experiencing the benefits, it’s easier to progress to the next level.

Tips for getting started in an exercise program

• Focus on activities you enjoy. If you hate jogging, you won’t be able to maintain a jogging program no matter how good it is for you. On the other hand, if you love to swim, dance, or play tennis you’ll find it easier to sick with an exercise program that’s built around those activities.
• Take it slow. Start with an activity you feel comfortable doing, go at your own pace, and keep your expectations realistic. For example, training for a marathon when you’ve never run before may be a bit daunting, but you could give yourself the goal of participating in an upcoming 5k walk for charity.
• Focus on short-term goals, such as improving your mood and energy levels and reducing stress, rather than goals such as weight loss or increased muscle size, as these can take longer to achieve.
• Make exercise a priority. If you have trouble fitting exercise into your schedule, consider it an important appointment with yourself and mark it on your daily agenda. Commit to an exercise schedule for at least 3 or 4 weeks so that it becomes habit, and force yourself to stick with it. Even the busiest amongst us can find a 10-minute slot to pace up and down an office staircase or take the dog for a walk.
• Go easy on yourself. Do you feel bad about your body? Instead of being your own worst critic, try a new way of thinking about your body. No matter what your weight, age, or fitness level, there are others like you with the same goal of exercising more. Try surrounding yourself with people in your shoes. Take a class with others of a similar fitness level. Accomplishing even the smallest fitness goals will help you gain body confidence.
• Expect ups and downs. Don’t be discouraged if you skip a few days or even a few weeks. It happens. Just get started again and slowly build up to your old momentum. 

Easy exercise tip 3: Make exercise fun

You are more likely to exercise if you find enjoyable, convenient activities. Give some thought to your likes and dislikes, and remember that preferences can change over time.

Pair an activity you enjoy with your exercise 

 There are numerous activities that qualify as exercise. The trick is to find something you enjoy that forces you to be active. Pairing exercise with another activity makes it easier and more fun. Simple examples include:

• Take a dance or yoga class.
• Blast some favorite music and dance with your kids.
• Make a deal with yourself to watch your favorite TV shows while on the treadmill or stationary bike.
• Workout with a buddy, and afterwards enjoy coffee or a movie.
• Enjoy outdoor activities such as golf, playing Frisbee, or even yard work or gardening. 

Make exercise a social activity

Exercise can be a fun time to socialize with friends and working out with others can help keep you motivated. For those who enjoy company but dislike competition, a running club, water aerobics, or dance class may be the perfect thing. Others may find that a little healthy competition keeps the workout fun and exciting. You might seek out tennis partners, join an adult soccer league, find a regular pickup basketball game, or join a volleyball team.
For many, a workout partner can be a great motivator. For example, if you won’t get out of bed to swim yourself, but you would never cancel on a friend, find a swim buddy.

Easy exercise tip 4: Stay motivated

No matter how much you enjoy an exercise routine, you may find that you eventually lose interest in it. That’s the time to shake things up and try something new, add other activities to your exercise program, or alter the way you pursue the exercises that have worked so far.

Set yourself goals and rewards

Rewarding yourself for reaching an exercise goal is one of the best ways to stay motivated. Set an achievable goal regarding your participation and effort, not necessarily how much weight you can lift, miles you can bike, or pounds you can lose lost. If you stumble in your efforts, regroup and begin again. Reward yourself when you reach your goals—a new pair of shoes, a dinner out, whatever works to motivate you.

Other ways to keep your exercise program going

• Be consistent. Make your workouts habitual by exercising at the same time every day, if possible. Eventually you will get to the point where you feel worse if you don’t exercise. That dull, sluggish feeling fitness buffs get when they don’t work out is a strong incentive to get up and go.
• Record your progress. Try keeping an exercise journal of your workouts. In a matter of months, it will be fun to look back at where you began. Keeping a log also holds you accountable to your routine.
• Keep it interesting. Think of your exercise session as time dedicated to you. Enjoy that time by listening to music, chatting with friends, and varying locations. Exercise around natural beauty, new neighborhoods, and special parks.
• Spread the word. Talking to others about your fitness routines will help keep motivation strong and hold you accountable to your exercise program. You’ll be delighted and inspired hearing ways your friends and colleagues stay active and on track.
• Get inspired. Read a health and fitness magazine or visit an exercise website and get inspired with photos of people being active. Sometimes reading about and looking at images of people who are healthy and fit can motivate you to move your body.

INDICATORS OF CHILD SEXUAL ABUSE

Sexual abuse may result in physical or behavioral manifestations. It is important that professionals and the public know what these are because they signal possible sexual abuse. However, very few manifestations (e.g., gonorrhea of the throat in a young child) are conclusive of sexual abuse. Most manifestations require careful investigation or assessment.
Unfortunately, early efforts at cataloging indicators of sexual abuse were problematic. They included extremely rare findings, such as blood in a child's underpants and signs that could be indicative of many problems or no problem at all, such as "comes early to school and leaves late." Recent efforts to designate signs of sexual abuse are more helpful.

• They differentiate between physical indicators and psychosocial indicators. Although physical indicators may be noted by many people, a definitive determination is generally made by a medical professional. Similarly, anyone may observe psychosocial indicators; however, often but not always, a mental health professional is responsible for forming an opinion that the symptoms are indicative of sexual abuse.
• A differentiation is made between higher and lower probability indicators. That is, some indicators are diagnostic of sexual abuse, whereas others may be consistent with or suggestive of sexual abuse but could indicate other circumstances or conditions as well.

In this chapter, higher probability findings and lower probability physical indicators are discussed first. A comparable discussion of psychosocial indicators will follow. It should not be surprising that the indicators specified in this chapter are similar to the effects described in the previous chapter since indicators are to a large extent the effects of sexual abuse before disclosure. Therefore, these indicators should become a focus of treatment and not simply used to support or rule out an allegation of sexual abuse.

   

Medical Indicators of Child Sexual Abuse

Significant progress has been made in the medical field in the determination of sexual abuse. Medical professionals are no longer limited to the presence or absence of a hymen as the indicator of possible sexual abuse. A variety of types of genital findings have been documented. In addition, notable progress has been made in identifying anal findings. Moreover, physicians are able to describe the effects of different kinds of sexual activity, and subtle findings can be documented using magnification (a colposcope or otoscope).
However, this progress is not without its controversies. Knowledgeable and conscientious physicians may differ regarding conclusions about certain physical findings. This difference of opinion is primarily due to the fact that data collection regarding the physical signs of sexual abuse has preceded careful documentation of characteristics of genitalia and anal anatomy of children who have not been sexually abused and of variations among normal children. These legitimate differences of opinion have been augmented by challenges to the medical documentation from defense attorneys, their expert witnesses, and alleged offenders.
It is also important to appreciate that for the majority of sexually abused children there are no physical findings. These findings, particularly vaginal ones, are most useful with prepubertal victims. As children become older, the possibility of consensual sexual activity needs to be considered. Further, changes that occur with puberty render insignificant some symptoms that have great significance in young children.

Two High-Probability Physical Indicators

Despite the progress noted above, the highest probability indicators are ones identified over 10 years ago. They are:

• pregnancy in a child and
• venereal disease in a child.

The reason these findings are high probability is because there is little dispute over the fact that they require sexual activity.
Some professionals assume that pregnancy in a child less than age 12 signals abuse although others designate the age of 13 or 14. Of course, not all situations in which children of these ages become pregnant are abusive, and pregnancy in older adolescents can be a consequence of sexual abuse.
Venereal disease may be located in the mucosa of the vagina, penis, anus, or mouth. The upper age limits for venereal disease raising concern about sexual abuse are similar to those for pregnancy. In addition, there is a lower age limit, usually of 1 or 2 months, because infants may be born with venereal disease acquired congenitally if the mother has the disease.
Interestingly, variations are found within the medical community regarding the certainty that sexual activity causes particular venereal diseases in children. Specifically, there is consensus that syphilis and gonorrhea cannot be contracted from toilet seats or bed sheets, but some differences of opinion exist about other venereal diseases (genital herpes, condyloma acuminata or venereal warts, trichomonas vaginalitis, and urogenital chlamydia), despite the conclusion that such infections are caused by sexual contact in adults.⁴⁵ In a recent review of the research, Smith, Benton, Moore, and Runyan conclude that there is "strong evidence" that all of these venereal diseases are sexually transmitted, except for herpes, for which there is "probable evidence." They also review the evidence on human immunodeficiency virus (HIV) and conclude that there is strong evidence it is sexually transmitted as well, unless contracted pre- or perinatally.⁴⁶

Genital Findings

High-probability findings specific to the genitalia include the following:

• semen in the vagina of a child,
• torn or missing hymen,
• other vaginal injury or scarring,
• vaginal opening greater than 5 mm, and
• injury to the penis or scrotum.

Semen in the vagina is the highest probability finding, but it is uncommon.
Although there is a fair amount of variability among girl children in the extent, shape, and other characteristics of hymens,⁴⁷ the complete absence of or a tear in the hymen of a young girl is indicative of sexual abuse. In older girls, it is important to determine whether other sexual activities may account for the absence or the tear. Conditions such as bumps, friability, and clefts in the hymen may be a result of sexual abuse, but they are also found in girls without a reported history of sexual abuse.⁴⁸
Health care professionals document and describe injuries to or bleeding from the vaginal opening by likening it to a clock face, 12 o'clock being the anterior midline and 6 o'clock the posterior. Abrasions, tears, and bruises to the vagina between 3 and 9 o'clock, or to the posterior, are more likely to be the result of penile penetration, whereas injuries between 9 and 3 o'clock, or anteriorly, are more likely the consequence of digital manipulation or penetration.⁴⁹
There is some controversy regarding what transverse diameter to use as a guideline for differentiating between girls with genital evidence consistent with penetration and those with no genital evidence, with measures ranging from 4 to 6 mm being advocated as indicative of sexual abuse.⁵⁰ One factor that may affect findings is the age of the child, with the expectation that older girls will have larger vaginal openings. Heger, an expert in physical findings related to sexual abuse, discounts the importance of hymenal transverse diameter, noting that it varies in size depending on the position in which the child is examined.⁵¹ It is also important to note that not all girls who have a reported history of penetration evidence enlarged vaginal openings, tears, abrasions, or bruising.
Absent another explanation for an injury to the penis, which is consistent with the child's account of the abusive incident, the injury should be considered indicative of sexual abuse. Bite marks, abrasions, redness, "hickeys," scratches, or bruises may be found.
Lower probability genital findings are as follows:

• vaginal erythema,
• increased vascularity,
• synechiae,
• labial adhesions,
• vulvovaginitis, and
• chronic urinary tract infections.

Erythema or redness and swelling might be caused by genital manipulation or intrusion perpetrated by a significantly older person. However, it might also be the result of poor hygiene, diaper rash, or perhaps the child's masturbation.⁵² Increased vascularity, synechiae, and labial adhesions may be a consequence of sexual abuse, but they are common findings in children with other genital complaints.⁵³
Vulvovaginitis and chronic urinary tract infections can be sequelae of sexual abuse but also can be caused by other circumstances, such as poor hygiene, a bubble bath, or, in the case of urinary tract infections, taking antibiotics.

Anal Findings

The following are high-probability findings:

• destruction of the anal sphincter,
• perianal bruising or abrasion,
• shortening or eversion of the anal canal,
• fissures to the anal opening,
• wasting of gluteal fat, and
• funneling.

Very occasionally there will be a finding of total absence of anal sphincter control, indicative of chronic anal penetration. If there has been forceful anal penetration, it may result in bruising and scrapes. A shortening or eversion of the anal canal has been found in very young children who have been chronically anally penetrated.⁵⁴ Perianal fissures and scars from fissures are thought to be indicative of sexual abuse except when they occur at 12 o'clock and 6 o'clock,⁵⁵ in which case they may be the result of a large stool. If the fissure is wider externally and narrows internally, this is consistent with object penetration of the anus. The converse finding is consistent with the passage of a large, firm stool.⁵⁶ Funneling and wasting of the gluteal fat around the anal opening can occur from chronic anal penetration. This is a rare finding in children but may be found in male adolescent prostitutes. The following anal findings are lower probability:

• perianal erythema,
• increased perianal pigmentation,
• perianal venous engorgement, and
• reflex anal dilatation.

Perianal erythema, increased pigmentation, and venous engorgement are all physical findings noted in children who have a history of anal penetration. However, these conditions also have been reported in substantial numbers of children with no reported history of sexual abuse, suggesting that they can be caused by other conditions.⁵⁷ In the case of the first two findings, these conditions could be a consequence of poor hygiene.
A finding that is in some dispute is reflex anal dilatation, that is, gaping of the anus or the twitching of the anal sphincter at the time of physical exam. Some physicians believe that it is a consequence of anal penetration,⁵⁸ but others have noted this finding in children whose lower bowel is full of stool. However, gaping of 20 mm or more is thought to be indicative of anal penetration.⁵⁹

Oral Findings

Generally oral sex leaves little physical evidence. The only physical findings that have been noted are the following:

• injury to the palate or
• pharyngeal gonorrhea.

Sometimes the child will sustain an injury to the soft or hard palate from being subjected to fellatio. This may cause bruising, especially pinpoint bruises called petechiae, or abrasions.⁶⁰ Children may also contract pharyngeal gonorrhea as a consequence of oral sex, as described above.

 

 Psychosocial Indicators of Child Sexual Abuse

Comparable efforts to identify the psychosocial indicators of child sexual abuse have been made by mental health professionals. In 1985, 100 national experts in sexual abuse met to develop criteria for the "Sexually Abused Child Disorder," in the hope that it would be included in the Diagnostic and Statistical Manual Three-Revised (DSMIII-R). It was not, but the effort remains important. The criteria of the "Sexually Abused Child Disorder" differentiate three levels of certainty (high, medium, and low) and vary by developmental stage. These criteria include both sexual and nonsexual indicators.⁶¹
The work of Friedrich focuses on sexualized behavior, indicators unlikely to be found in other traumatized or normal populations. His Child Sexual Behavior Inventory has been field-tested on 260 children between 2 to 12 years of age, who were alleged to have been sexually abused and 880 children not alleged to have been sexually abused. It was found to reliably differentiate the two types of children. However, a substantial proportion of children in Friedrich's research, determined sexually abused, are not reported to engage in sexualized behavior. Moreover, children who learn about sex from nonabusive experiences may engage in sexualized behavior.
In this manual, a two-category typology of behavioral indicators is proposed:

• sexual indicators, generally being higher probability indicators; and
• nonsexual behavioral indicators, usually considered lower probability.

Sexual Indicators

Sexual indicators vary somewhat depending on the child's age. The discussion of these indicators will be divided into those likely to be found in younger sexually abused children (aged 10 or younger) and those likely to be found in older sexually abused children (older than age 10). However, this distinction is somewhat arbitrary, and within these two groups there are children at very different developmental stages. Finally, indicators that are important for children of all ages are noted.

Sexual Indicators Found in Younger Children

These behaviors are high-probability indicators because they represent sexual knowledge not ordinarily possessed by young children.

• Statements indicating precocious sexual knowledge, often made inadvertently.
  • A child observes a couple kissing on television and says that "the man is going to put his finger in her wee wee."
  • A child comments, "You know snot comes out of Uncle Joe's ding dong."
• Sexually explicit drawings (not open to interpretation).
  • A child draws a picture of fellatio.
• Sexual interaction with other people.
  • Sexual aggression toward younger or more naive children (represents an identification with the abuser).
  • Sexual activity with peers (indicates the child probably experienced a degree of pleasure from the abusive activity).
  • Sexual invitations or gestures to older persons (suggests the child expects and accepts sexual activity as a way of relating to adults).
• Sexual interactions involving animals or toys.
  • A child may be observed sucking a dog's penis.
  • A child makes "Barbie™* dolls" engage in oral sex.

The reason sexual knowledge is more compelling when demonstrated by younger children than older ones is that the latter may acquire sexual knowledge from other sources, for example, from classes on sex education or from discussions with peers or older children. Even younger children may obtain knowledge from sources other than abuse. However, children are not likely to learn the intimate details of sexual activity nor for example, what semen tastes like and penetration feels like without direct experience.
Another indicator often cited is excessive masturbation. A limitation of this as an index of sexual abuse is that most children (and adults) masturbate at some time. Thus, it is developmentally normal behavior, which is only considered indicative of sexual abuse when "excessive." However, a determination that the masturbation is excessive may be highly subjective. The following guidelines may be helpful.

• Masturbation is indicative of possible sexual abuse if:
  • Child masturbates to the point of injury.
  • Child masturbates numerous times a day.
  • Child cannot stop masturbating.
  • Child inserts objects into vagina or anus.
  • Child makes groaning or moaning sounds while masturbating.
  • Child engages in thrusting motions while masturbating.

Sexual Indicators Found in Older Children

As children mature, they become aware of societal responses to their sexual activity, and therefore overt sexual interactions of the type cited above are less common. Moreover, some level of sexual activity is considered normal for adolescents. However, there are three sexual indicators that may signal sexual abuse.

• sexual promiscuity among girls,
• being sexually victimized by peers or nonfamily members among girls, and
• adolescent prostitution.

Of these three indicators, the last is most compelling. One study found that 90 percent of female adolescent prostitutes were sexually abused.⁶² Although there has not been comparable research on male adolescent prostitutes, there are clinical observations that they become involved in prostitution because of sexual abuse.⁶³

A High-Probability Sexual Indicator for All Children

Finally, when children report to anyone they are being or have been sexually abused, there is a high probability they are telling the truth. Only in rare circumstances do children have any interest in making false accusations. False allegations by children represent between 1 and 5 percent of reports.⁶⁴ Therefore, unless there is substantial evidence that the statement is false, it should be interpreted as a good indication that the child has, in fact, been sexually abused.

Nonsexual Behavioral Indicators of Possible Sexual Abuse

The reason that nonsexual behavioral symptoms are lower probability indicators of sexual abuse is because they can also be indicators of other types of trauma. For example, these symptoms can be a consequence of physical maltreatment, marital discord, emotional maltreatment, or familial substance abuse. Nonsexual behavioral indicators can arise because of the birth of a sibling, the death of a loved one, or parental loss of employment. Moreover, natural disasters such as floods or earthquakes can result in such symptomatic behavior.
As with sexual behaviors, it is useful to divide symptoms into those more characteristic of younger children and those found primarily in older children. However, there are also some symptoms found in both age groups.

Nonsexual Behavioral Indicators in Young Children

The following symptoms may be found in younger children:

• sleep disturbances;
• enuresis;
• encopresis;
• other regressive behavior (e.g., needing to take transitional object to school);
• self-destructive or risk-taking behavior;
• impulsivity, distractibility, difficulty concentrating (without a history of nonabusive etiology);
• refusal to be left alone;
• fear of the alleged offender;
• fear of people of a specific type or gender;
• firesetting (more characteristic of boy victims);
• cruelty to animals (more characteristic of boy victims); and
• role reversal in the family or pseudomaturity.

Nonsexual Behavioral Indicators in Older Children

• eating disturbances (bulimia and anorexia);
• running away;
• substance abuse;
• self-destructive behavior, e.g.,
  • suicidal gestures, attempts, and successes and
  • self-mutilation;
• incorrigibility;
• criminal activity; and
• depression and social withdrawal.

Nonsexual Behavioral Indicators in All Children

Three types of problems may be found in children of all ages:

• problems relating to peers,
• school difficulties, and
• sudden noticeable changes in behavior.

Summary

Sexually abused children may manifest a range of symptoms, which reflect the specifics of their abuse and how they are coping with it.
Suspicion is heightened when the child presents with several indicators, particularly when there is a combination of sexual and nonsexual indicators. For example, a common configuration in female adolescent victims is promiscuity, substance abuse, and suicidal behavior. Similarly, the presence of both behavioral and physical symptoms increases concern. However, the absence of a history of such indicators does not signal the absence of sexual abuse.

SOME CHILDREN`S VOICES YOU NEVER HEAR

DOWNLOAD THIS IMPORTANT INFORMATION, (PDF FORMAT) CLICK HERE:http://www.woman.ch/uploads/19nov/guide/WWSFpreventionGuide-2011-en.pdf

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MEDICINES AND VACCINES ARE SAFE? MEDICINAS SEGURAS? MIKE ADAMS, ENGLISH, ESPAÑOL

VIDEO ABOUT MEDICINE INDUSTRY, VACCINES, DRUGS. HEALTH. 

VIDEO ACERCA DE LA INDUSTRIA DE LA MEDICINA Y COMO FUNCIONA REALMENTE. 

( ESPAÑOL, ENGLISH ) .

THE TRUTH OF COSMETICS

THE STORY OF COSMETICS, EXAMINES THE PERVASIVE USE OF TOXIC CHEMICALS IN OUR EVERYDAY PERSONAL CARE PRODUCTS, FROM LIPSTICK TO BABY SHAMPOO. PRODUCED WITH FREE RANGE STUDIOS AND HOSTED BY ANNIE LEONARD, THE SEVEN-MINUTE FILM BY THE STORY OF STUFF PROYECT REVEALS THE IMPLICATIONS FOR CONSUMER AND WORKER HEALTH AND THE ENVIRONMENT AND OUTLINES WAYS WE CAN MOVE THE INDUSTRY AWAY FROM HAZARDOUS CHEMICALS AND TOWARDS SAFER ALTERNATIVES. THE FILM CONCLUDES WITH A CALL FOR VIEWERS TO SUPPORT LEGISLATION AIMED AT ENSURING THE SAFETY OF COSMETICS AND PERSONAL CARE PRODUCTS. VISIT THE WEBSITE: http://www.storyofstuff.org/

LEAVING YOUR CHILD HOME ALONE

Every parent eventually faces the decision to leave their child home alone for the first time. Whether they are just running to the store for a few minutes or working during after-school hours, parents need to be sure their children have the skills and maturity to handle the situation safely. Being trusted to stay home alone can be a positive experience for a child who is mature and well prepared. It can boost the child's confidence and promote independence and responsibility. However, children face real risks when left unsupervised. Those risks, as well as a child's ability to deal with challenges, must be considered. This factsheet provides some tips to help parents and caregivers when making this important decision.

Depending on the laws and child protective policies in your area, leaving a young child unsupervised may be considered neglect, especially if doing so places the child in danger. If you are concerned about a child who appears to be neglected or inadequately supervised, contact your local child protective services (CPS) agency. If you need help contacting your local CPS agency, call the Childhelp® National Child Abuse Hotline at 800.4.A.CHILD (800.422.4453). Find more information on their website: www.childhelp.org

What to Consider Before Leaving Your Child Home Alone

When deciding whether to leave a child home alone, you will want to consider your child's physical, mental, and emotional well-being, as well as laws and policies in your State regarding this issue. There are many resources you can refer to for guidance. (See the end of this factsheet for some of them.) These resources typically address the considerations below.
Legal Guidelines

Some parents look to the law for help in deciding when it is appropriate to leave a child home alone. According to the National Child Care Information Center, only Illinois and Maryland currently have laws regarding a minimum age for leaving a child home alone.1 Even in those States other factors, such as concern for a child's well-being and the amount of time the child is left alone, are considered. States that do not have laws may still offer guidelines for parents. For information on laws and guidelines in your State, contact your local CPS agency. If you need help contacting your local CPS agency, call Childhelp® at 800.422.4453.
Age and Maturity

There is no agreed-upon age when all children are able to stay home alone safely. Because children mature at different rates, you should not base your decision on age alone.

You may want to evaluate your child's maturity and how he or she has demonstrated responsible behavior in the past. The following questions may help:

    Is your child physically and mentally able to care for him- or herself?
    Does your child obey rules and make good decisions?
    Does your child feel comfortable or fearful about being home alone?


Circumstances

When and how a child is left home alone can make a difference to his or her safety and success. You may want to consider the following questions:

    How long will your child be left home alone at one time? Will it be during the day, evening, or night? Will the child need to fix a meal?
    How often will the child be expected to care for him- or herself?
    How many children are being left home alone? Children who seem ready to stay home alone may not necessarily be ready to care for younger siblings.
    Is your home safe and free of hazards?
    How safe is your neighborhood?


Safety Skills

In addition to age and maturity, your child will need to master some specific skills before being able to stay home alone safely. In particular, your child needs to know what to do and whom to contact in an emergency situation. Knowledge of basic first aid is also useful. You may want to consider enrolling your child in a safety course such as one offered by the Red Cross.2 The following questions may also help:

    Does your family have a safety plan for emergencies? Can your child follow this plan?
    Does your child know his or her full name, address, and phone number?
    Does your child know where you are and how to contact you at all times?
    Does your child know the full names and contact information of other trusted adults, in case of emergency?

Tips for Parents

Once you have determined that your child is ready to stay home alone, the following suggestions may help you to prepare your child and to feel more comfortable about leaving him or her home alone:

    Have a trial period. Leave the child home alone for a short time while staying close to home. This is a good way to see how he or she will manage.
    Role play. Act out possible situations to help your child learn what to do.
    Establish rules. Make sure your child knows what is (and is not) allowed when you are not home. Some experts suggest making a list of chores or other tasks to keep children busy while you are gone.
    Check in. Call your child while you are away to see how it's going, or have a trusted neighbor or friend check in.
    Talk about it. Encourage your child to share his or her feelings with you about staying home alone.
    Don't overdo it. Even a mature, responsible child shouldn't be home alone too much. Consider other options, such as programs offered by schools, community centers, youth organizations, or churches, to help keep your child busy and involved.

LONG-TERM CONSEQUENCES OF CHILD ABUSE AND NEGLECT

An estimated 905,000 children were victims of child abuse or neglect in 2006 (U.S. Department of Health and Human Services, 2008). While physical injuries may or may not be immediately visible, abuse and neglect can have consequences for children, families, and society that last lifetimes, if not generations.

The impact of child abuse and neglect is often discussed in terms of physical, psychological, behavioral, and societal consequences. In reality, however, it is impossible to separate them completely. Physical consequences, such as damage to a child's growing brain, can have psychological implications such as cognitive delays or emotional difficulties. Psychological problems often manifest as high-risk behaviors. Depression and anxiety, for example, may make a person more likely to smoke, abuse alcohol or illicit drugs, or overeat. High-risk behaviors, in turn, can lead to long-term physical health problems such as sexually transmitted diseases, cancer, and obesity.

This factsheet provides an overview of some of the most common physical, psychological, behavioral, and societal consequences of child abuse and neglect, while acknowledging that much crossover among categories exists.

Factors Affecting the Consequences of Child Abuse and Neglect

Not all abused and neglected children will experience long-term consequences. Outcomes of individual cases vary widely and are affected by a combination of factors, including:
The child's age and developmental status when the abuse or neglect occurred
The type of abuse (physical abuse, neglect, sexual abuse, etc.)
The frequency, duration, and severity of abuse
The relationship between the victim and his or her abuser (English et al., 2005; Chalk, Gibbons, & Scarupa, 2002)

Researchers also have begun to explore why, given similar conditions, some children experience long-term consequences of abuse and neglect while others emerge relatively unscathed. The ability to cope, and even thrive, following a negative experience is sometimes referred to as "resilience." A number of protective and promotive factors may contribute to an abused or neglected child's resilience. These include individual characteristics, such as optimism, self-esteem, intelligence, creativity, humor, and independence, as well as the acceptance of peers and positive individual influences such as teachers, mentors, and role models. Other factors can include the child's social environment and the family's access to social supports. Community well-being, including neighborhood stability and access to safe schools and adequate health care, are other protective and promotive factors.

 Physical Health Consequences

The immediate physical effects of abuse or neglect can be relatively minor (bruises or cuts) or severe (broken bones, hemorrhage, or even death). In some cases the physical effects are temporary; however, the pain and suffering they cause a child should not be discounted. Meanwhile, the long-term impact of child abuse and neglect on physical health is just beginning to be explored. According to the National Survey of Child and Adolescent Well-Being (NSCAW), more than one-quarter of children who had been in foster care for longer than 12 months had some lasting or recurring health problem (Administration for Children and Families, Office of Planning, Research, and Evaluation [ACF/OPRE], 2004a). Below are some outcomes researchers have identified:

Shaken baby syndrome. Shaking a baby is a common form of child abuse. The injuries caused by shaking a baby may not be immediately noticeable and may include bleeding in the eye or brain, damage to the spinal cord and neck, and rib or bone fractures (National Institute of Neurological Disorders and Stroke, 2007).

Impaired brain development. Child abuse and neglect have been shown, in some cases, to cause important regions of the brain to fail to form or grow properly, resulting in impaired development (De Bellis & Thomas, 2003). These alterations in brain maturation have long-term consequences for cognitive, language, and academic abilities (Watts-English, Fortson, Gibler, Hooper, & De Bellis, 2006). NSCAW found more than three-quarters of foster children between 1 and 2 years of age to be at medium to high risk for problems with brain development, as opposed to less than half of children in a control sample (ACF/OPRE, 2004a).

Poor physical health. Several studies have shown a relationship between various forms of household dysfunction (including childhood abuse) and poor health (Flaherty et al., 2006; Felitti, 2002). Adults who experienced abuse or neglect during childhood are more likely to suffer from physical ailments such as allergies, arthritis, asthma, bronchitis, high blood pressure, and ulcers (Springer, Sheridan, Kuo, & Carnes, 2007).

Psychological Consequences

The immediate emotional effects of abuse and neglect—isolation, fear, and an inability to trust—can translate into lifelong consequences, including low self-esteem, depression, and relationship difficulties. Researchers have identified links between child abuse and neglect and the following:

Difficulties during infancy. Depression and withdrawal symptoms were common among children as young as 3 who experienced emotional, physical, or environmental neglect. (Dubowitz, Papas, Black, & Starr, 2002).

Poor mental and emotional health. In one long-term study, as many as 80 percent of young adults who had been abused met the diagnostic criteria for at least one psychiatric disorder at age 21. These young adults exhibited many problems, including depression, anxiety, eating disorders, and suicide attempts (Silverman, Reinherz, & Giaconia, 1996). Other psychological and emotional conditions associated with abuse and neglect include panic disorder, dissociative disorders, attention-deficit/hyperactivity disorder, depression, anger, posttraumatic stress disorder, and reactive attachment disorder (Teicher, 2000; De Bellis & Thomas, 2003; Springer, Sheridan, Kuo, & Carnes, 2007).

Cognitive difficulties. NSCAW found that children placed in out-of-home care due to abuse or neglect tended to score lower than the general population on measures of cognitive capacity, language development, and academic achievement (U.S. Department of Health and Human Services, 2003). A 1999 LONGSCAN study also found a relationship between substantiated child maltreatment and poor academic performance and classroom functioning for school-age children (Zolotor, Kotch, Dufort, Winsor, & Catellier, 1999).

Social difficulties. Children who experience rejection or neglect are more likely to develop antisocial traits as they grow up. Parental neglect is also associated with borderline personality disorders and violent behavior (Schore, 2003).

Behavioral Consequences

Not all victims of child abuse and neglect will experience behavioral consequences. However, behavioral problems appear to be more likely among this group, even at a young age. An NSCAW survey of children ages 3 to 5 in foster care found these children displayed clinical or borderline levels of behavioral problems at a rate of more than twice that of the general population (ACF, 2004b). Later in life, child abuse and neglect appear to make the following more likely:

Difficulties during adolescence. Studies have found abused and neglected children to be at least 25 percent more likely to experience problems such as delinquency, teen pregnancy, low academic achievement, drug use, and mental health problems (Kelley, Thornberry, & Smith, 1997). Other studies suggest that abused or neglected children are more likely to engage in sexual risk-taking as they reach adolescence, thereby increasing their chances of contracting a sexually transmitted disease (Johnson, Rew, & Sternglanz, 2006).

Juvenile delinquency and adult criminality. According to a National Institute of Justice study, abused and neglected children were 11 times more likely to be arrested for criminal behavior as a juvenile, 2.7 times more likely to be arrested for violent and criminal behavior as an adult, and 3.1 times more likely to be arrested for one of many forms of violent crime (juvenile or adult) (English, Widom, & Brandford, 2004).

Alcohol and other drug abuse. Research consistently reflects an increased likelihood that abused and neglected children will smoke cigarettes, abuse alcohol, or take illicit drugs during their lifetime (Dube et al., 2001). According to a report from the National Institute on Drug Abuse, as many as two-thirds of people in drug treatment programs reported being abused as children (Swan, 1998).

Abusive behavior. Abusive parents often have experienced abuse during their own childhoods. It is estimated approximately one-third of abused and neglected children will eventually victimize their own children (Prevent Child Abuse New York, 2003).

Social Consequences

While child abuse and neglect almost always occur within the family, the impact does not end there. Society as a whole pays a price for child abuse and neglect, in terms of both direct and indirect costs.

Direct costs. Direct costs include those associated with maintaining a child welfare system to investigate and respond to allegations of child abuse and neglect, as well as expenditures by the judicial, law enforcement, health, and mental health systems. A 2001 report by Prevent Child Abuse America estimates these costs at $24 billion per year.

Indirect costs. Indirect costs represent the long-term economic consequences of child abuse and neglect. These include costs associated with juvenile and adult criminal activity, mental illness, substance abuse, and domestic violence. They can also include loss of productivity due to unemployment and underemployment, the cost of special education services, and increased use of the health care system. Prevent Child Abuse America estimated these costs at more than $69 billion per year (2001).

Summary

Much research has been done about the possible consequences of child abuse and neglect. The effects vary depending on the circumstances of the abuse or neglect, personal characteristics of the child, and the child's environment. Consequences may be mild or severe; disappear after a short period or last a lifetime; and affect the child physically, psychologically, behaviorally, or in some combination of all three ways. Ultimately, due to related costs to public entities such as the health care, human services, and educational systems, abuse and neglect impact not just the child and family, but society as a whole.