Child Sexual Abuse Research Paper

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Child sexual abuse is an important mental health issue, and one characterized by significant advances in the last 20 years, with continuing developments and refinements. However, it is also a very controversial issue. In part, the controversy can be understood in light of the emotional dilemma sexual abuse creates. On the one hand, we assume that to sexually abuse a child is to engage in monstrous behavior with devastating consequences. On the other hand, we find it virtually impossible to believe that an adult would behave so reprehensibly toward a child. Thus, allegations of sexual abuse evoke the competing reactions of rage and denial. In some respects, these reactions are manifested in the quandary of whether to believe the child or believe the offender. Often this dilemma is heightened because the child is reticent in disclosure, and the offender is insistent and persuasive in denial.

The goal of this research paper is to enlighten this controversy and put the problem of sexual abuse in perspective, relying upon existing knowledge about sexual abuse. In fact, child sexual abuse is common, may have many manifestations—from horrendous acts to those that differ in degree from acceptable behavior, and results in a spectrum of sequelae—from pervasive to negligible.

In this research paper, sexual abuse will be defined, its prevalence and incidence addressed, its impact described, and professional interventions discussed. These interventions include child protection investigation, mental health assessment, treatment, and prevention.

Outline

I. Definition of Child Sexual Abuse

A. Child Victim

B. Offender

C. Abusive Acts

II. The Extent of Sexual Abuse

A. Prevalence of Child Sexual Abuse

B. Incidence of Reported Sexual Abuse

C. False Allegations of Sexual Abuse

III. Effects of Child Sexual Abuse

A. Sexual Sequelae

B. Nonsexual Symptoms of Sexual Abuse

IV. Intervention in Child Sexual Abuse

A. The Child Protection System (CPS)

B. Mental Health Assessment

C. Treatment

V. Prevention of Sexual Abuse

A. Community and Professional Education

B. Prevention Programs Targeted at Specific Populations

C. Prevention Programs Targeting Particular Institutions

VI. Conclusion

I. Definition of Child Sexual Abuse

For an event to meet the definition of child sexual abuse, there should be a victim, an offender, and a sexual act. Characteristics and subcategories of each component of the definition will be discussed in this section. In addition, the variability in definitions employed in both research and clinical practice will be noted. Finally, situations that are regarded as ‘‘gray areas’’ will receive attention.

A. Child Victim

Child victim status is defined primarily by age. However, there is some variability in what is considered the upper age limit. Research definitions, legal definitions, and treatment definitions of child victims may differ in their determination of when adult status or informed consent begins. Legal definitions of the upper age limit may differ by state and by statute (e.g. statutory rape, incest, criminal sexual conduct statutes). Also, some researchers have used a lower maximum age for boys than for girls. The maximum age used in research for girls is generally 16 or 18, but some researchers have used a maximum age of 12 for boys. Interesting assumptions about gender underlie this differential. This lower age seems to be based upon assumptions that boys are more capable of protecting themselves than girls and more desirous of sexual activity than girls. Hence boys’ sexual experiences during adolescence that otherwise meet the definition of sexual victimization may not be considered abusive by researchers and others.

Research findings indicate that victims are fairly evenly distributed across the age span of childhood, that is preschoolers, latency-aged children, and adolescents. Diagnosis is more difficult for preschoolers because of their less well-developed communication skills and concerns about their suggestibility. Nevertheless, because of increased awareness of sexual abuse, allegations involving younger and younger children are coming to professional attention. Thus, there are cases involving the sexual abuse of infants.

For the relationship to be considered abusive, there usually is an age differential between the victim and the offender, the victim generally being at least 5 years younger than the offender, and 10 years younger when the victim is an adolescent. However, based upon her research of 930 women, Diana Russell pointed out that acts can be abusive without the age differential; for example, a brother may be only 3 years older than his sister, but still can impose his will for sexual activity upon her. A gray area is how to handle a situation of what appears to be consensual sexual activity between a teenager and a significantly older person, for example a 14-year-old girl and a 30-year-old man, or a 13-year-old boy and a 25-year-old woman.

More girls are reported than boys as victims, boys constituting one-fifth to one-third of cases, depending upon the source of the statistics. Although girl victims remain the majority, the proportion of girl victims is higher in intrafamilial cases than in extrafamilial ones. Thus, girls may be more vulnerable to family members, such as fathers, stepfathers, uncles, and grandfathers, and boys at relatively greater risk from persons in the community, such as coaches, boy scout leaders, and adolescents whom they admire.

Professionals who work with boy victims believe there is a greater failure to disclose sexual victimization by boy victims than by girls. This differential reporting is thought to be related to more support for girls, in the process of their socialization, to talk about their problems than for boys, and the fact that boys must overcome not only the taboo of sexual activity with an adult, but usually the taboo associated with homosexual activity, when they disclose.

B. Offender

A sex offender may be a male or female, although the vast majority are males, between 85 and 99% depending upon the study. As awareness of sexual abuse grows, so does the proportion of female offenders identified. Generally, offenders are adults or adolescents. A gray area in definition is how to classify latency-aged or even younger children who are sexual predators. Although many of these children are ‘‘abuse reactive,’’ that is, maladaptively coping with their own sexual victimization by sexually accosting sexually naive or younger children, a substantial minority of child predators have not been sexually victimized. Some researchers and clinicians characterize them as ‘‘children with sexual behavior problems’’ to avoid stigmatizing them as sex offenders. Nevertheless, the acts they perpetrate may be quite serious.

There is some controversy about offender motivation, for example, some individuals asserting that the offender is motivated by a desire for dominance, not sexual gratification. Sexual abuse, like any sexual act, may fulfill a variety of needs, including the assertion of power, but what differentiates it for other exercises of power is its sexual content.

For some offenders (pedophiles), their preferred sexual object is a child, while other offenders experience and act upon sexual arousal to children because of a range of circumstantial factors. These factors include the availability of a child, the absence of an adult sexual partner, and an assault on the offender’s self-esteem, such as a divorce or employment loss. Nevertheless, an initial act because of circumstances appears to enhance risk for subsequent sexual abuse to children. The proportion of sexual offenders who prefer children to those who do not is not known, but it is generally assumed that pedophiles are the minority. However, on average they have a greater number of victims.

C. Abusive Acts

Sexual abuse involves the full spectrum of sexual activity. These acts are designated in Table I.

This list of sexual acts progresses from the least intrusive and therefore possibly least traumatic to the most intrusive and possibly most traumatic. However, the judgment regarding trauma is from a professional perspective, not from a child’s. Victims may have a different perception. Most clinicians and some researchers include noncontact behaviors—exposure, voyeurreism, and lewd and lascivious remarks, in the definition of abusive acts. Activities that do not involve the adult in the sex acts directly, such as prostituting a child or using the child in pornography, are also subsumed under the definition.

Table I. Sexually Abusive Activities (with examples)

1. Noncontact behavior.

A. Exposure.
Example: A coach wore his sweatpants low in front, with his penis hanging over the top, during girls’ gym practice.

B. Voyeurism.
Example: A stepfather drilled a hole in the bathroom wall so he could observe his daughter toileting and bathing.

C. Lewd and lascivious talk.
Example: A mother told her son she wanted to suck his penis.

2. Fondling/sexual contact
Example: A mother’s boyfriend rubbed a 7-year-old girl’s genital area on top of her panties while they watched Pocahontas.
Example: A 15-year-old brother grabbed his little sister’s hand and placed it on his penis, saying ‘‘rub it.’’

3. Oral–genital contact

A. Fellatio.
Example: A camp counselor cornered a 10-year-old boy in the shower and put his penis in the boy’s mouth.

B. Cunnilingus. Example: A grandfather bit his granddaughter’s vagina.

C. Analingus. Example: A 6-year-old boy described how it tickled when his friend’s father ‘‘licked his butt.’’

4. Digital penetration of the vagina or anus.
Example: A 6-year-old girl said her brother’s friend put a finger in her peepee and it hurt.

5. Penile penetration of the vagina or anus.
Example: A 4-year-old boy said, ‘‘Uncle Jimmy poked me in the butt and it stinged.’’

6. Sexual exploitation.

A. Child prostitution.

B. Child pornography
Example: Sisters, aged 4 and 5, were fondled while naked, by men who were strangers and their pictures were taken. Their mother received money from the men.

II. The Extent of Sexual Abuse

How widespread is the problem of child sexual abuse? We know about its extent from studies of prevalence and reported incidence. Both sources of information tell us sexual abuse is experienced by large numbers of children. How serious a problem is false allegations? Making this determination is more difficult, but there is some useful research. Prevalence, incidence, and the issue of false reports will be discussed in this section.

A. Prevalence of Child Sexual Abuse

The term, prevalence, is used to refer to the proportion of a designated population that has a particular problem or characteristic. In the case of sexual abuse, prevalence refers to the number of people who were sexually abused during childhood. Data about prevalence are gathered in retrospective studies of adults. This research may involve face to face interviews, self-administered questionnaires, or telephone surveys. Researchers may ask a single general question, such as ‘‘were you sexually abused as a child?’’ or multiple questions designed to approach the topic from several perspectives and gather information about a variety of relationships and experiences. Findings vary depending upon methodology, with studies using face-to-face interviews and multiple questions yielding higher rates of child sexual abuse. Taking into account the variability in findings, estimates are that, in the general population, between 1 in 3 or 4 women were sexually abused during childhood and between 1 in 6to 10men.

B. Incidence of Reported Sexual Abuse

Incidence refers to the number of reports of a particular phenomenon, usually occurring during a circumscribed time frame. In the United States, there are governmental and nongovernmental initiatives to gather incidence data on child sexual abuse.

Illustrative of governmental efforts is a provision in the Child Abuse Prevention and Treatment Act of 1974, which requires that the federal government collect annual statistics on reports of child maltreatment received by local Child Protection Agencies. These data include reports of child sexual abuse. Over the 20 years this information has been collected, there has been a steady increase in reports of child abuse and neglect, and a fairly steady increase in the proportion of sexual abuse cases among reports. According to the National Committee for the Prevention of Child Abuse (NCPCA), sexual abuse cases constitute about 11% of cases currently reported—in 1995 almost 350,000 cases. Currently, approximately one-third of reports are substantiated after investigation by Child Protective Services (CPS), or about 110,000 cases of child sexual abuse annually.

Although the number of cases from the CPS reports is considerable, a study of 1000 parents conducted by the Gallup Poll in 1995 yielded a projection 10 times larger, of one million children sexually abused during the previous year. Part of the reason that the Child Protective Services number is lower is that CPS only concerns itself with situations in which a caretaker is the abuser. Most extrafamilial sexual abuse cases are not handled by CPS, but by law enforcement. However, the higher number in the Gallup Poll projection likely also indicates a substantial number of cases do not come to professional attention. Moreover, even the Gallup Poll figure is probably a low estimate because parents would be unlikely to report themselves if they were sexually abusing their children, and they might even be reluctant to report relatives and friends.

C. False Allegations of Sexual Abuse

The modest substantiation rate noted in the discussion of NCPCA findings raises the question of false allegations. Why are so many more cases being reported than are being substantiated? Does this mean that two-thirds of the reports made are false? It does not. There are many reasons that a case may not be substantiated, other than that someone made a false claim of sexual abuse.

In studies conducted at the Kempe National Center on Child Abuse and Neglect, a very small proportion of unsubstantiated cases were determined to be false allegations, altogether about 5%. Another interesting finding is that adults are more likely to make false reports of sexual abuse to children than are children. The largest proportion of unsubstantiated cases involved ‘‘insufficient information.’’ Illustrative would be situations in which the child protection caseworker could not locate the family, or the child refused to talk to the caseworker. The next largest proportion were ‘‘legitimate cause for concern, but no sexual abuse.’’ In these cases, reporting was appropriate, but some more plausible alternative explanation for the source of concern about abuse was found. An example might be a case in which the source of the child’s advanced sexual knowledge was observing adults engaging in sexual activity. This is not to say that false allegations are nonexistent. They do exist, but research to date indicates that true reports are very much more common.

III. Effects of Child Sexual Abuse

The impact of sexual abuse depends upon many factors: the offender–victim relationship, the particular sexual act(s), the frequency and duration of the sexual abuse, the nature of inducements to participate and admonitions regarding disclosure, the response of nonabusive caretakers to disclosure, and the personality and personal history of the child. Research documents that the most important element in the child’s recovery is having a caring and concerned, nonoffending parent. Thus, being believed and supported makes a great deal of difference in the long-term well-being of the victim.

Clinicians and researchers generally divide the effects of sexual abuse into sexual and nonsexual effects. These sexual and nonsexual emotional and behavioral impacts of sexual abuse also serve as indicators of its likelihood, when professionals are making a determination about whether a child has been sexually abused.

A. Sexual Sequelae

William Friedrich, a clinician and researcher at the Mayo Clinic, has played a leadership role in cataloging the sexual effects and researching differences in the rates of sexualized behaviors in children with and without a history of sexual abuse. Table II is drawn from version 3 of Friedrich’s Child Sexual Behavior Inventory (CSBI).

Sexualized behavior is the most common impact of sexual abuse, but according to Friedrich’s research, it is present in only about 40% of children with a history of sexual abuse. Friedrich and his colleagues have assessed for the presence of sexualized behaviors separately for males and females and for children from ages 2 to 6 and 7 to 12 years. Preliminary data are available from research on version 3 of the CSBI. Children with a history of sexual abuse were compared to children from psychiatric and normal populations. Children with a history of sexual abuse rank higher than children in the other two groups on total score for sexualized behavior (sexually abused, 14.2; psychiatric population, 3.45; normal population, 3.5). In addition, 22 of the 40 items differentiate children with a history of sexual abuse from the other two groups, regardless of age and sex. These items are numbers 6, 8, 10–12, 17–19, 21, 23–28, 30, 32, 33, 35–37, and 39.

Table II. Items from the Child Sexual Behavior Inventory

1. Dresses like the opposite sex.
2. Stands too close to people.
3. Talks about wanting to be the opposite sex.
4. Touches sex (private) parts when in public places.
5. Masturbates with hand.
6. Draws sex parts when drawing pictures of people.
7. Touches or tries to touch mother’s or other women’s breasts.
8. Masturbates with toy or object (blanket, pillow, etc.).
9. Plays with a friend.
10. Touches another child’s sex (private) parts.
11. Tries to have sexual intercourse with another child or adult.
12. Puts mouth on another child’s/adult’s sex parts.
13. Touches sex (private) parts when at home.
14. Touches an adult’s sex (private) parts.
15. Touches animals’ sex parts.
16. Makes sexual sounds (sighs, moans, heavy breathing, etc.)
17. Asks others to engage in sexual acts with him or her.
18. Rubs body against people or furniture.
19. Puts objects in vagina or rectum.
20. Tries to look at people when they are nude or undressing.
21. Pretends that dolls or stuffed animals are having sex.
22. Shows sex (private) parts to adults.
23. Tries to look at pictures of nude or partially dressed people.
24. Talks about sexual acts.
25. Kisses adults that they do not know well.
26. Gets upset when adults are kissing or hugging.
27. Overly friendly with men he/she does not know well.
28. Kisses other children he/she does not know well.
29. Talks flirtatiously.
30. Tries to undress other children against their will (opening pants, shirts, etc.).
31. Eats breakfast.
32. Wants to watch television or movies that show nudity or sex.
33. When kissing, he/she tries to put his/her tongue in other person’s mouth.
34. Hugs adults that he/she does not know well.
35. Shows sex (private) parts to children.
36. Tries to undress adults against their will (opening pants, shirts, etc.).
37. Is very interested in the opposite sex.
38. Puts his/her mouth on mother’s or other women’s breasts.
39. Knows more about sex than other children their age.
40. Other sexual behaviors (please describe).

B. Nonsexual Symptoms of Sexual Abuse

Nonsexual symptoms are less definitively linked to sexual victimization because they are more likely than sexual symptoms to derive from other experiences and traumas. For example, while such behavioral and emotional symptoms can come from being sexually victimized, they can also be the result of physical abuse, neglect, divorce, auto accidents, or natural disasters. Nevertheless, Table III lists nonsexual symptoms and, where relevant, their possible relationship to subgroups of victims.

The array of possible impacts is considerable. However, not every child is seriously affected. In fact in a 1993 survey of 45 comparative studies of the impact of sexual abuse, Kendall-Tackett, Williams, and Finkelhor found that about a third of the victims of child sexual abuse were reported to be asymptomatic. In addition, about two-thirds of children showed recovery during the first year to year-and-a-half after the abuse. Although children with a history of child sexual abuse had more symptoms than both clinical and nonclinical comparison groups—fear, PTSD, behavior problems, sexualized behaviors, and low selfesteem being the most frequently noted, no single symptom characterized the majority of children.

Table III. Psychosocial Symptoms of Sexual Abuse: Nonsexual Behavioral and Emotional Indicators of Distress

I. Sleep disturbances

A. Night waking
B. Nightmares
C. Night terrors
D. Refusal to go to bed (in some cases, because it is the site of the sexual abuse)
E. Refusal to sleep alone
F. Inability to sleep

II. Toileting disturbances

A. Previously toilet trained (more common in young victims)

1. Enuresis
2. Encopresis

B. Refusal to go into the bathroom (in some cases, because it is the site of the sexual abuse)

C. Smearing feces (more common in very disturbed victims)

D. Hiding feces (more common in very disturbed victims)

III. Eating disturbances

A. Anorexia (characteristic of adolescent girl victims)

B. Bulimia (characteristic of adolescent girl victims)

IV. Avoidant reactions

A. Fear of the alleged offender

B. Fear of persons of the same sex as the alleged offender

C. Refusal to be left alone

D. Fear of particular places that may be associated with abuse

V. Somatic complaints

A. Headaches (associated with nondisclosure)

B. Stomach aches (associated with nondisclosure)

C. Pelvic pain (may be related to affect or injury)

VI. Behavioral problems

A. Fire-setting (more characteristic of boy victims)

B. Cruelty to animals (more characteristic of boy victims)

C. Aggression toward more vulnerable individuals (younger, smaller, more naive, retarded individuals)

D. Delinquent behaviors (characteristic of older victims)

1. Incorrigibility
2. Running away (may be an adaptive response to avoid the offender)
3. Criminal activity

E. Substance abuse

F. Self-destructive behaviors (characteristic of adolescent girl victims)

1. Suicidal gestures, attempts, and successes
2. Suicidal thoughts
3. Self-mutilation

VII. School problems

A. Inattention

B. Sudden decline in school performance

C. School truancy

VIII. General disturbances of affect

A. Low self esteem

B. Anxiety

C. Fear

D. Anger

E. Dissociation

F. Posttraumatic stress disorder

Caveat: A determination of sexual abuse cannot be made based upon the presence of these factors alone; however when noted in conjunction with sexual indicators and other positive findings, they increase the likelihood of sexual abuse.

IV. Intervention in Child Sexual Abuse

Awareness of the extent of sexual abuse and its effects on functioning have led to positive outcomes. First, the problem of child sexual abuse is being taken seriously. The time has passed when sexual abuse was regarded as a problem of insignificant proportions and an experience that was not very harmful. Second, the fact that there are mechanisms for reporting child maltreatment is illustrative of government and social policy commitment to address the problem of child sexual abuse, and child maltreatment more generally. Third, with reporting statutes has come greater professional and public awareness of child sexual abuse. Professionals are more likely to consider sexual abuse as a possible source of children’s symptoms, and children’s caretakers and others are more likely to notice symptoms. Moreover, media attention to sexual victimization has made the public more cognizant of the problem and may serve to decrease victims’ sense of isolation.

In addition, there have been refinements in how governmental and mental health systems address child sexual abuse. In part, because of controversies about the truth of children’s assertions about their sexual abuse, there have come advances in expertise in case investigation and assessment, the development of sexual abuse specific treatment programs, and efforts to prevent sexual abuse before it happens.

Crucial to long-term child well-being is sensitive and well-orchestrated intervention. If professionals can effectively investigate, evaluate, and ameliorate in situations of sexual abuse, children can survive their victimization and lead productive lives. The advances in assessment and treatment of child sexual abuse will be described in this section.

A. The Child Protection System (CPS)

Each state has a Child Protection System, whose responsibility includes investigation and intervention in all cases of child maltreatment involving children’s caretakers. These investigations take place at the local, usually county level, and are conducted by child protection caseworkers. This response is structured to be immediate, and the involvement of CPS short term. Child protection caseworkers act as case managers and are supposed to refer children and families to ongoing therapy and other services. Not all of these caseworkers have mental health or competent, on the job training; their case loads are usually high; and the availability of treatment and other services may be limited. Consequently the promise of the Child Protection System is greater than the delivery.

B. Mental Health Assessment

In addition to CPS investigations, mental health professionals in a variety of contexts have become involved in the assessment of sexual abuse allegations. The goals of these mental health assessments are several: determining the likelihood of sexual abuse, making recommendations about child safety, proposing treatment plans, predicting prognosis for response to treatment, and assisting in legal intervention. With regard to the final goal, because sexual abuse is not only a mental health problem, but also a crime, mental health professionals may assist in litigation to protect children, to criminally prosecute alleged offenders, and to exact civil damages in cases involving sexual abuse.

There are a number of models for mental health assessment of possible sexual abuse. For example, models can involve the child alone, the child and other family members, and the offender alone. The appropriate model depends on the goals of the assessment, the nature of the child–alleged offender relationship, and the age and functioning of the child. Sensitive and careful assessments assist the child and others affected by the allegation in seeing the assessment process as health promoting rather than traumatic.

A somewhat unique characteristic of sexual abuse assessments for mental health professionals is the importance of determining whether an event (sexual abuse) occurred. Mental health skills need to be adapted and expanded to address this requirement. Mental health professionals must usually engage in direct inquiry about sexual abuse with the child and others, using nonleading questions. A variety of child interview questioning protocols have been developed to guide evaluators.

Evaluators employing this protocol are urged to use open-ended questions (found at the top of the continuum) and only to resort to more close-ended questions when open-ended ones do not assist the child in communicating his/her experience. For example, if a child does not respond to a focused question, ‘‘Are there things you like about your grandpa?’’ the mental health evaluator might ask a multiple choice question, ‘‘Does he ever do special things with you, buy you things, or do any other nice things you can think of?’’ The more open-ended the question, the more confidence the mental health evaluator should have in the child’s response and vice versa. However, both analogue studies and clinical research indicate most children require direct or focused questions to disclose sensitive material. If information is elicited using a close-ended question, the interviewer should follow this disclosure with a more open-ended question. Leading questions and coercion are inappropriate for use in an evaluation of a child for sexual abuse.

Other special features of sexual abuse assessments include the following: Mental health professions should gather information on past and current history of the abuse allegation and of the people involved. Collaboration with other professionals, for example, examining physicians, child protection caseworkers, police officers, and lawyers, is integral to such assessments. The mental health professional must be able to clearly articulate criteria he/she uses in determining the likelihood of sexual abuse. In a review of such decision-making strategies in 1995, Faller found 12 sufficiently elaborated to be discussed. The criteria shown in Table IV are found in these decision-making strategies.

An interesting and somewhat surprising finding from Faller’s review was the number of mental health professionals who endorsed medical findings as an important factor. This is interesting because, of course, medical evidence is not gathered by mental health professionals. Furthermore, most cases of sexual abuse have no medical findings. The other items endorsed by the majority of mental health professionals were criteria derived from child interviews, specifically details about the sexual abuse and details about the context of the abuse.

Table IV. Criteria Included in Guidelines for Decision Making about Sexual Abuse

I. Child interview information

A. Sexual abuse description from the child

1. Detail about the sexual abuse
2. Child’s perspective evident in the description of abuse
3. Advanced sexual knowledge for the child’s developmental stage

B. Offender behavior description, as described by the child

1. Use of inducements to participate in the sexual activity
2. Admonitions not to tell about the sexual abuse
3. Progression of abuse from less to more intrusive sexual acts

C. Information about the context of the sexual abuse

1. Idiosyncratic event
2. Where the abuse occurred
3. When the abuse occurred

D. Emotional reaction to the abuse by the child

1. Affect consistent with the abuse description
2. Affect related to the offender
3. Recall of affect during abuse
4. Reluctance to disclosure

E. Child functioning

1. Competency

a. Cognitive test results
b. Recall of past events
c. Ability to differentiate the truth from a lie
d. Ability to differentiate fact from fantasy
e. Child is not suggestible

2. Child is motivated to tell the truth
3. Consistency of the child’s accounts
4. Feasibility of the events the child describes

F. Structural qualities of the child’s account

II. Information from other sources

A. Child’s behavior in other contexts

1. Statements to others about the abuse
2. Nonsexual behavioral and emotional symptoms
3. Sexualized behavior
4. Evidence of advanced sexual knowledge

B. Offender characteristics

1. Overall functioning
2. Results of polygraph
3. Results of plethysmograph
4. Psychological test results
5. Evidence of other victims
6. Confession /admission

C. Family

1. Information related to nonoffending parent
2. Marital functioning and family functioning
3. Family history of abuse

D. Other

1. Medical findings
2. Police evidence
3. Witnesses

C. Treatment

Mental health professionals assume that every sexually abused child deserves and needs treatment. And in fact, children who are victims of sexual abuse are more likely to receive treatment (from 44 to 73% of them receiving treatment, according to Finkelhor and Berliner) than are victims of other types of child maltreatment.

Treatment of child sexual abuse may only involve the child, the child and his/her family, or the offender and sometimes the offender’s family. The relationship of the victim to the offender will usually have an impact on the structure of treatment. However, in intrafamilial sexual abuse, the offender’s prognosis also affects whether his treatment will prepare him/her for some level of future contact with the child. Because of space limitations, the focus in this research paper will be on child victim treatment.

A variety of theoretical frameworks related to treatment and rehabilitation are being used in victim treatment, including psychodynamic, play therapy, cognitive behavioral, and eclectic, drawing upon psychodynamic, behavioral, and family systems frameworks. However, one thing they have in common is that they dictate a direct focus on the abuse in the course of treatment. For example, it is not recommended that the therapist merely focus on the child’s self-esteem or avoidance of men without addressing the underlying cause of these problems, the experience of sexual abuse.

A variety of treatment modalities are employed, the most common being individual, group, and family therapies. These may be employed concurrently or in progression, depending upon the structure of the treatment program, the functioning of the child, and the treatment issues being addressed.

Common treatment issues for victims are fears and phobias associated with the sexual abuse, the inability to trust adults, altered body image, guilt and responsibility associated with the abuse and its aftermath, anger because of the abuse, sexualized behavior, a need to understand aspects of the sexual abuse experience, and personal boundary and prevention issues.

A number of treatment manuals and descriptive writings have been developed that propose the structure of the treatment and even provide specific exercises to address treatment issues. These are geared to children at different developmental stages, and some have been especially developed for boys.

Illustrative of treatment manuals is one developed by Mandell and Damon for group treatment of 7- to 12-year-old sexually abused children. It includes guidelines for group membership selection and a rationale for group treatment. It also contains 10 modules and provides topics and exercises for each module. Issues covered in the curriculum are shown in Table V.

Outcome studies of treatment efficacy for victims of sexual abuse are just beginning to be conducted. In 1995, Berliner and Finkelhor provided a summary of 29 treatment outcome studies. All of these treatments lasted less than a year and most were treatment of a few weeks. These studies demonstrated that children who receive treatment for sexual abuse improve, but only 5 studies demonstrated that it was the therapy, itself, rather than, for example, the passage of time, that led to the children’s improvement.

In providing appropriate treatment, the mental health professional must consider the nature of the abuse, the child’s age and functioning, the offender– victim relationship, and the impact and symptomology. The treatment approach and modality should take into account the child within his/her context and should be of sufficient length to address the child’s treatment issues and symptoms. A systematic way of measuring the child’s functioning before and after treatment is advisable. The child may need to return to treatment as subsequent developmental stages raise new concerns about past abuse and when new crises and traumas reactivate issues related to the sexual abuse.

Table V. Treatment Issues Developed by Mandell and Damon

1. Learning to trust others, beginning with other members of the group.
2. Identifying feelings (e.g., proud, special, jealous, worried, embarrassed, ashamed).
3. Telling the secret (i.e., disclosing the sexual abuse).
4. Feelings related to sexual abuse (e.g., betrayal, shame, guilt, responsibility, secrecy, protectiveness, helplessness).
5. The effect of sexual abuse on the victim, caretakers, and the family unit.
6. Recovery from sexual abuse.
7. Rebuilding and enhancing self esteem.
8. Protecting oneself in the future from sexual abuse and other harms.
9. Preparation for puberty.

V. Prevention of Sexual Abuse

Prevention of sexual abuse can be conceptualized as encompassing the following endeavors: (1) community and professional education; (2) prevention programs targeted at specific populations; and (3) prevention programs targeted at particular institutions.

A. Community and Professional Education

The Federal Statute that defines Child Protective Services (The Child Abuse Prevention and Treatment Act) restricts its federal grants for child abuse and neglect prevention and treatment services to states that provide education about child maltreatment (among other provisions). This provision is aimed at identifying maltreating families so that abuse can be stopped and its causes and effects ameliorated. However, because such education must define child maltreatment, it puts the community and professionals on notice about inappropriate forms of behavior toward children and, by doing this, can prevent some instances of child maltreatment, including sexual abuse.

Awareness of the unacceptability of child sexual abuse that derives from education also may serve as a deterrent for potential offenders. Some potential offenders may actually be ignorant about what sexual abuse is. In addition, it is fairly common for actual offenders to engage in ‘‘cognitive distortions’’ or rationalizations of their behavior. Examples might be telling themselves that because the behavior does not involve penile penetration, it is not abuse, or because the child is too young to understand, the abuse will not be harmful. It is possible, therefore, that potential offenders could be deterred and actual offenders could be led to cease sexual abuse by information that, for example ‘‘just touching’’ is abuse.

In addition, some potential offenders might be deterred by knowledge of the consequences of getting caught, information that could come from education. This might be professional education, community education, or information reported in the media. Although the media have provided some misinformation in their coverage of sexual abuse, they also have been the source of news stories that could have a deterrent effect, could lead to reporting of cases by victims or others, and could help victims feel less stigmatized and alone.

Another way education can be preventative is by causing earlier reporting of cases. That this is happening is suggested by changes in the types of cases that are being reported. In the 1950s and 1960s the clinical literature suggested that the modal case was one of an adolescent, who disclosed in the course of family conflict or after marital dissolution. Statistics from the most recent National Incidence Study, which gathers data on cases of child maltreatment coming to the attention of professionals, indicate that the children ages 3 through adolescence are at relatively equivalent risk for being identified as victims of sexual abuse.

B. Prevention Programs Targeted at Specific Populations

The dominant approach to prevention of child sexual abuse has been to rely on victims to avoid potentially abusive situations, to resist attempts to victimize them, and to report attempted and successful sexual abuse. This approach has been summarized as ‘‘say no, yell, and tell.’’ Sexual abuse prevention programs have been developed for and delivered to children from preschool age through adolescence. Most are delivered in school settings. Some programs involve classroom teachers and parents. There were initial concerns by program designers about program content because of the sensitivity of the topic and anticipated parental resistance. Because of this, many programs focused on ‘‘stranger danger’’ and avoided addressing the possibility that the offender could be, and in fact was much more likely to be, someone known to the child. Presently, many programs are imbedded in broader ‘‘personal safety’’ programs that address a variety of risks children may encounter. These include safety when crossing the street and riding a bike, physical abuse, bullying, and kidnapping.

These prevention programs have been the targets of considerable criticism. First, and justifiably, they have been criticized for making the child responsible for prevention. This especially is an issue with preschoolers. There have been concerns that the victims will not be successful at saying no, resisting, and yelling help and then will blame themselves if they are unable to protect themselves. Critics have queried, ‘‘Why not target the offenders rather than the potential victims?’’ Better still, programs in high school aimed at potential parents and potential perpetrators might be more efficacious.

Prevention supporters counter these arguments as follows: If children receive this training as children, they will not victimize children when they become adolescents and adults. Further, supporters state that the fact children receive this kind of training may inhibit offenders from trying to abuse them. Offenders will fear children are on guard.

Second, prevention programs have been criticized because of their impact on the recipients. Specifically, there are worries that the programs may engender fear and cause trauma. Moreover, they may create a gulf between children and important adults in their lives because these programs put children on notice that adults, even those closest them, may not be trustworthy. In addition, prevention programs have been criticized as the source of some false allegations of sexual abuse. However, outcome studies indicate that only a very small minority of children experience an elevation in anxiety because of participation in prevention programs. No empirical support has been found for the assertions that prevention programs result in fears of caretakers or generate false allegations of sexual abuse.

Third, prevention programs have been challenged for their lack of effectiveness. For example, children may not understand all of the concepts they are being taught; may not be able to use the concepts to defend themselves; and may soon forget what they have learned. These criticisms have especially been leveled at preschool programs. Prevention program supporters reply that critics are expecting too much of the programs. These programs should be one of several approaches to preventing sexual abuse. Moreover, it is unrealistic to expect a program of an hour or even of several hours over time, to have a lasting or lifetime effect. Regular, periodic doses of prevention that occur at least on a yearly basis are what is needed.

Although prevention programs are far from a panacea, they can be beneficial. Finkelhor and colleagues recently conducted a national telephone survey of youth and their parents related to these programs. This study was funded by the Boy Scouts of America and intended to address some of the above noted criticisms. Using a representative sample of 2000 young people, ages 10 to 16, these researchers found that about 70% had participated in a prevention program, 36% in the past year. Younger children were more likely to have participated in the previous year. The vast majority of both the youth and their parents rated the programs positively and26%of youth reported using some of the skills they had learned. Girls, African American children, and children from lower socioeconomic status families rated programs more positively.

C. Prevention Programs Targeting Particular Institutions

With the growing awareness of the problem of child sexual abuse has come an appreciation that certain institutions are vulnerable. That is, they may attract adults with a sexual interest in children. These persons are drawn to these institutions, sometimes because they naively find children’s company preferable, without any awareness of their sexual attraction to children, but other times with the clear knowledge they are looking for prey. Both types of adults choose vocations and avocations that afford them ready access to children. These include jobs in day care centers, positions as boy scout and cub scout leaders, volunteer assignments as big brothers and big sisters, work as camp counselors, employment in recreational programs for youth, religious vocations such as the priesthood or the ministry, work in group homes for trouble youth and in residential treatment programs, and positions as foster parents.

Compared to prevention programs that target children, those in vulnerable institutions have been slow to develop. Generally they have been inspired by the surfacing of scandalous cases. As a rule, these prevention programs include five components: (1) screening for potential pedophiles; (2) prevention material that is delivered to children in these institutions; (3) educational material provided to adults in the institutions; (4) rules that reduce risk; and (5) procedures for investigating complaints.

Since these institutions either rely on volunteers or pay staff modestly, their reluctance to take on the issue of sexual abuse and develop prevention programs is understandable. Nevertheless, the importance of prevention in these contexts cannot be overstated. The majority of youth affected in these institutions are males, and boy victims are more likely than girls to respond to the trauma of sexual abuse by victimizing others. Therefore, preventive interventions in these institutions can have far-reaching impacts, because of the number of children they can save and the number of perpetrators they can stop.

VI. Conclusion

Although child sexual abuse is a common and serious mental health problem, it is not unmanageable nor unspeakable. Prevention programs and early identification can decrease the extent of sexual abuse and ameliorate its impact. Impressive progress has been achieved in the last 20 years. Despite present challenges to children describing sexual victimization, adults recalling abuse during childhood, and mental health professionals who attempt to assist child victims and adult survivors, the prospects for further progress in preventing and treating child sexual abuse are good.

Bibliography:

Executive summary of the third National Incidence Study (NIS-3). Washington, DC: USDHHS, National Center on Child Abuse and Neglect.
Faller, K. C. (1996). Evaluating children suspected of having been sexually abused: APSAC Study Guide. Newbury Park, CA: Sage Publications.
Finkelhor, D., & Berliner, L. (1994). Research on the treatment of sexually abused children. Journal of Child and Adolescent Psychiatry, 34(11), 1408–1422.
Finkelhor, D., & Dziuba-Leatherman, J. (1995). Victimization prevention programs: A national survey of children’s exposure and reactions. Child Abuse and Neglect: The International Journal, 19(2), 129–141.
Friedrich, W. (1993). Sexual victimization and sexual behavior in children. Child Abuse and Neglect: The International Journal, 17(1), 59–66.
Gil, E., & Johnson, T. C. (1993). Sexualized children. Rockville, MD: Launch Press.
Jones, D., & McGraw, M. (1987). Reliable and fictitious accounts of sexual abuse to children. Journal of Interpersonal Violence, 2, 27–45.
Kendall-Tackett, K., Williams, L. M., & Finkelhor, D. (1993). Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113(1), 164–180.
Mandell, J., & Damon, L. (1989). Group treatment for sexually abused children. New York: Guilford Press.
Saunders, B., & Williams, L. (Eds.). (1996). Special section: Treatment outcome research. Child Maltreatment 1(4), 293–352.
Wurtele, S., & Miller-Perrin, C. (1992). Preventing child sexual abuse: Sharing the responsibility. Lincoln, NE: University of Nebraska Press.