The children are silent because the perpetrators may have threatened to harm them or have accused them that they have caused the abuse or fear they will dissolve the family or even think they have no right to say 'no' and talk. For that reason adults should be alert to the direct evidence, such as:
-Physical problems, soreness, bruising, pain in the mouth or genital area, difficulty sitting, sexually transmitted diseases, pregnancy
-Nightmares, trouble sleeping and tremor, fatigue, tics, stuttering, sudden anorexia or bulimia. Gaining weight in order to "hide" his body.
-Regression to younger behaviors, such dummy finger, bedwetting at night.
-Sudden unexpected changes in mood such as depression, withdrawal, secrecy, solitude. Fear or phobia about specific individuals or locations, sudden shyness.
-Remove from parents and friends. Not talking, not opened as before. Afraid to leave the house or room.
Unexplained sexual-knowledge questions about his age, which occurs through improper sexual activity with toys, dolls or objects and having young adult words for body parts or sexual activities for younger children. Drawings that show sexual aggression, sexual acts.
-Ashamed of his body and does not want to undress or change clothes in front of others. Or begins to "caressed", touching other children and adults with persistent and inappropriate manner. I do not want to participate in trips, gymnastics, games, etc. group activities with other children.
-Indicates a new obsession for an older "friend" and has suddenly unduly gifts or money.
-Teenagers often have substance abuse, self-injury or attempted to leave the house.