Sexual Abuse or Tourette Syndrome?

Article excerpt

Sexual abuse of children is a common and serious problem in our society (Haugaard & Peppucci, 1989). A wide range of behavioral abnormalities have been linked to sexual and physical abuse, including bed-wetting, soiling, aggressive behaviors, hyperactivity, rituals, conduct disorder, running away from home, suicidal thoughts, phobias, separation anxiety, sleep disorders, compulsive masturbation, inappropriate sexual talk and play, poor concentration, and poor academic performance (Haugaard & Peppucci, 1989). However, DeYoung (1986) cautioned about the dangers of the indiscriminant use of such indicator lists because they describe symptoms seen in children with other stressors and other disorders. All of the above-mentioned symptoms may occur in association with attention deficit hyperactivity disorder (ADHD) and Tourette syndrome (TS) (Comings, 1987, 1990; Comings & Comings, 1987a, 1987b; Eldridge, Sweet, Lake, Ziegler, & Shapiro, 1977; Erenberg, Cruse, & Rothner, 1986; Nee, Caine, Polinsky, Eldridge, & Ebert, 1980; Stefl, 1984). When individuals who interact with children are asked to be alert to such symptoms but are not taught that alternative explanations exist for such behaviors, injustices can occur. Over the past 10 years, Comings (1990) observed more than a dozen cases where inappropriate actions were taken because the social agencies had no knowledge or understanding of TS. The following case convinced the authors that wider awareness of this problem was needed.

Case Report

After hearing a talk about sexual abuse, Dan, a seven-year-old boy, told his teacher that his father often goes after his penis on a "weenie hunt." Because Dan was well known by the teacher to have a short temper, to constantly pull at his crotch, to grab the crotch of other children and adults, to touch the breasts of teachers, and to do other inappropriate things such as display hyperactivity and hide under desks in school, the teacher suspected he was a victim of sexual abuse by his father and contacted the Department of Protective Social Services (DPSS). In reviewing the record it was found that the family had been reported previously. One report was two months earlier when Dan had been reported for grabbing the crotch of the playground monitor. During the investigation of the last incident, Dan, his twin brother, and two older sisters were interviewed. Dan told the workers that his father had a special room in the house where he kept movies that were rented to neighbors and friends. He and his siblings appeared in a film along with other children he did not know. In late February, the DPSS removed the two boys from the home and four days later came back and removed the rest of the children. The parents were not allowed to see or talk to their children. The parents were on welfare and were receiving Aid to Families with Dependent Children and welfare for themselves. The father was accused of sexually molesting his children, of taking pornographic movies of the children for viewing by adults, and of being a major drug trafficker. All support by public agencies was discontinued, the neighbors were informed of the presence of a sexual abuser in their neighborhood, and his wife was encouraged to leave him.

Is this a straightforward case of sexual abuse with appropriate protective action? The family contacted the authors five days before they were to appear in court. They were seen the next day in the clinic with the following history.

Dan was a "very active" child. He would often take his diapers off, play with himself, and run around inside and outside the house with no clothes on. Between two and three years of age he became obsessed with telephones and stole toy phones from other children. One day his mother opened his toy box and found 15 phones in it. He developed throat-clearing noises that were present every day for more than a year. At age three his parents placed him in a preschool, but he was asked to leave because of his aggressive and disruptive behaviors, refusal to listen, extremely short attention span, constant grabbing at his crotch and the crotch of others, and grabbing at the teachers' breasts. …