A review of the epidemiological research on child sexual abuse. Clinical samples

This article reviews the major empirical studies which have been carried out in an attempt to estimate the prevalence of child sexual abuse among females in clinical inpatient and outpatient samples. Along with the earlier review (Pilkington and Kremer, 1995) dealing with community and student samples, this paper likewise highlights a number of unresolved methodological issues which may contribute to the variance in reported prevalence rates. These include a myriad of definitions of child sexual abuse and different methods of eliciting information on possible histories of abuse. These issues are here discussed in the context of the findings of both review articles.     

Experiences of Mothers Who Are Child Sexual Abuse Survivors: A Qualitative Exploration

Child sexual abuse has been associated with a number of problems affecting women over their lifespan, including difficulties with parenting. However, there is a modest number of qualitative studies examining the impact of child sexual abuse on survivors who are mothers. There is a particular need for qualitative investigations that ask survivors who are mothers general questions about the impact of child sexual abuse on their lives rather than those that specifically ask about the impact of child sexual abuse on parenting. The former approach would allow survivors to describe effects that may impact parenting but that survivors do not consciously link to affecting their parenting. Such information may inform interventions to assist this population of survivors. This secondary data analysis examined themes revealed in interviews with 44 survivors of child sexual abuse who were mothers. Participants were seeking treatment for their child sexual abuse and completed an in-person interview in which they were asked open-ended questions about the sexual abuse they experienced as a child and how their abuse affects them now as adults. The interviews were recorded, transcribed, and coded using thematic analysis. The following six themes emerged from the narratives: (a) being a parent, (b) family of origin dysfunction, (c) the impact of abuse, (d) the abuse history and response to abuse, (e) coping, and (f) hopes and desires for the future. This study highlights several ways in which child sexual abuse impacts survivors who are mothers, areas for further study, and the need for interventions to assist this population in meeting the challenges they face as mothers.     

Child sexual abuse myths: attitudes, beliefs, and individual differences

Child sexual abuse myths comprise incorrect beliefs regarding sexual abuse, victims, and perpetrators. Relations among myth acceptance, responses to disclosure, legal decisions, and victims' subsequent psychological and health outcomes underscore the importance of understanding child sexual abuse myths. Despite accurate knowledge regarding child sexual abuse among many professional and other individuals, child sexual abuse myths persist. A Google search produced 119 child sexual abuse myths, some with overlapping themes. Coders grouped myths into four categories: (a) minimizations or exaggerations of the extent of harm child sexual abuse poses, (b) denials of the extent of child sexual abuse, (c) diffusions of perpetrator blame, and (d) perpetrator stereotypes. This review provides available data regarding the prevalence for these myths, empirical research that refutes or confirms myth categories, and considerations of cultural contexts and implications.     

Child Sexual Abuse and Adult Mental Health,Sexual Risk Behaviors,and Drinking Patterns Among Latino Men Who Have Sex With Men

One in five Latino men who have sex with men has experienced child sexual abuse. Although concerning in itself, child sexual abuse may increase an individuals’ likelihood of depression and risk-taking in adult life, including engagement in HIV risk behaviors and alcohol and substance use. It is therefore urgent that researchers and practitioners better understand the long-term effects of child sexual abuse. We utilized logistic and linear regression to assess associations between child sexual abuse (operationalized as forced or coerced sexual activity before age 17) and depression, sexual behaviors, and drinking patterns in a sample of 176 adult Latino men who have sex with men from New York City. Over one-fifth (22%) of participants reported child sexual abuse. In multivariable models, participants with histories of child sexual abuse were significantly more likely than participants without such histories to screen for clinically significant depressive symptoms and heavy drinking and reported more anal sex acts, male sexual partners, and incidents of condomless anal intercourse in the previous three months. These findings confirm a high prevalence of child sexual abuse among Latino men who have sex with men and associations between child sexual abuse and adulthood depressive symptoms, high-risk alcohol consumption, and sexual risk behaviors. We recommend that providers who serve Latino men who have sex with men incorporate child sexual abuse screenings into mental health, HIV prevention, and substance use treatment programs, utilizing approaches that are inclusive of resilience.     

Child Sexual Abuse News: A Systematic Review of Content Analysis Studies

Public knowledge and attitudes toward child sexual abuse are shaped through media depictions and coverage. Since the media are the main source of information about child sexual abuse, studies of child sexual abuse news can help us understand how news is created, how child sexual abuse is presented to the public, and what is the possible impact of such presentation and coverage on the audience. A systematic review of content analysis research is conducted using predefined criteria in order to identify quality studies, main findings, research gaps and to develop recommendations for future studies. International databases were systematically searched using keywords in September 2017. A total of 24 original quantitative content analysis studies published in the English language were included in the review and evaluated according to research methodology. The framework of child sexual abuse news media studies is developed and main findings are highlighted: (1) presentation and coverage of child sexual abuse (n = 7); (2) prevalence of coverage of CSA cases reported to the authorities (n = 2); (3) presentation and coverage of child abuse and sexual crimes where child sexual abuse is only a subtopic (n = 9); (4) presentation and coverage of specific child sexual abuse cases or issues (n = 6). Although studies represent valuable contribution, most did not meet content analysis design and reporting standards or both (e.g., calculating intercoder reliability), which seriously compromises validity and replicability requirements. Recommendation for future studies and most common errors in conducting content analysis are emphasized.     

Self Psychology and Male Child Sexual Abuse: Healing Relational Betrayal

The prevalence of male child sexual abuse (MCSA) is higher than initially thought with up to 26 % of men in community samples reporting sexual abuse in childhood, and up to 36 % of men in clinical samples reporting childhood sexual abuse. Disclosure of MCSA is complex because of men’s difficulties in viewing themselves as victims, especially of sexual violence. This difficulty is exacerbated by societal attitudes that sexual abuse rarely occurs with boys, and is further complicated with the taboo of victimization by same sex perpetrators. Too often, the response to disclosure is disbelief and minimization. For these reasons disclosure is often delayed or withheld thus prolonging the abuse. The negative effects of child sexual abuse are well documented and far reaching with depression, anxiety, post-traumatic stress disorder, addictions, sexual dysfunction and impaired interpersonal relations as common presenting issues in therapy. Treatment is indicated for significant numbers of male survivors. This paper identifies aspects of interpersonal relational difficulties commonly experienced by male sexual abuse survivors, and describes self psychology as guiding a clinical approach to address these interpersonal difficulties. The application of self psychology with male sexual abuse survivors is traced and discussed through the use of a clinical case study with Adam.     

Prevalence of Sexual Trauma History Using Behaviorally Specific Methods of Assessment in First Year College Students

There are several challenges associated with evaluating the prevalence of sexual trauma, including child sexual abuse and adult sexual assault. The aim of this study was to assess sexual trauma prevalence rates among first year college students (N = 954) using behaviorally specific questions and a more representative recruitment sample that did not rely on self-selection. Participants completed a list of sexual trauma questions, including general questions containing labels such as “rape” or “abuse” as well as behaviorally specific questions that describe specific behaviors that qualify as sexual trauma without labels. Results indicated that 6.7% of the sample reported at least one incident of child sexual abuse, with similar rates for men and women. Women were more likely to report a history of adult sexual assault, which was reported by 12.4% of the total sample. Participants were also more likely to endorse a history of sexual trauma when answering behaviorally specific rather than general “label” questions. Women survivors in particular were more likely than men to identify their experiences as abuse/assault (66.7% versus 21.1% for child sexual abuse), which may help explain prevalence differences between men and women in prior research. Men may be less likely than women to label their experiences as abuse and may be underidentified in sexual trauma research without the use of behaviorally specific questions. Overall, the results of this study suggest that the prevalence of sexual trauma is better assessed using behaviorally specific questions and that this is an important topic of study among both men and women.     

Prevalence of Childhood Sexual Abuse in China: A Meta-Analysis

The objective of the current study was to explore the estimated prevalence of childhood sexual abuse in China. We conducted a meta-analysis that used the data from 36 articles. A total of 125 independent samples and 131,734 participants were included. The results revealed no significant difference in the prevalence of childhood sexual abuse between Chinese men (9.1%) and women (8.9%). The prevalence of childhood sexual abuse in studies from mainland areas was significantly higher than that from Hong Kong/Taiwan. The estimated prevalence of childhood sexual abuse in China also differed according to the definition of child sexual abuse, data collection method, year of data collection, and the mean age of participants at the time of assessment.     

UK Paramedics Confidence in Identifying Child Sexual Abuse: A Mixed-Methods Investigation

United Kingdom (UK) paramedics are in a prime position to identify children and young people who are victims or at risk of sexual abuse. Paramedics have access, by phone, or in person, to unprepared homes and communities which other health professionals such as social workers may not. Little research exists however, investigating UK paramedic confidence in identifying child sexual abuse. This mixed-method explanatory sequential investigation used the self-reported confidence levels of 276 UK paramedics to inform the design of seven semi-structured focus groups with 25 UK paramedics from a large ambulance service with operating models similar to all UK services. Multiple factors contribute to a lack of confidence in identifying child sexual abuse, child sexual exploitation, and female genital mutilation, including a perceived lack of exposure to sexual abuse, the perceived hidden nature of sexual abuse, and the lack of physical symptoms and examination. An overarching lack of knowledge is the most significant contributor to a lack of confidence which in turn perpetuates misinformation surrounding prevalence, location, and the signs and symptoms of sexual abuse. These findings suggest a lack of sufficient training and a need for further research evaluating the content of current training and its method of delivery.     

Differentiating Children with and without a History of Repeated Problematic Sexual Behavior

Although the issue of dissociative amnesia in adult survivors of child sexual abuse has been contentious, many research studies have shown that there is a subset of child sexual abuse survivors who have forgotten their abuse and later remembered it. Child sexual abuse survivors with dissociative amnesia histories have different formative and therapeutic issues than survivors of child sexual abuse who have had continuous memory of their abuse. This article first discusses those differences in terms of the moderating risk factors for developing dissociative amnesia (e.g., age, ethnicity, gender, etc.) and then mediating risk factors (e.g., social support, trait dissociativity, etc.). The differences between the two types of survivors are then explored in terms of treatment issues.     

Prevention of Child Sexual Abuse: Analysis and Discussion of the Field

Prevention of child sexual abuse is complicated, challenging, and highly necessary as sexual abuse of children and youth represents an extensive problem across the world. This article reviews the existing preventive interventions targeting children, parents, and professionals. An alternative way of organizing the child sexual abuse prevention research literature is offered and applied with emphasis on three areas: (a) child sexual abuse prevention interventions, (b) meta-analyses of child sexual abuse prevention interventions, and (c) general theoretical models about prevention and the child. Based on an analysis of these areas, it was found that there was a lack of connection between theoretical models and concrete preventive interventions. An overview of current challenges and future possibilities in this area is provided.     

The prevalence and nature of child sexual abuse: evidence from a female university sample in the UK

It is well established that child sexual abuse is a considerable international problem, yet evidence regarding its prevalence in the United Kingdom is extremely sparse, with the most comprehensive study conducted over a decade ago. The aim of this study is to establish a current estimate of the prevalence and nature of child sexual abuse in the United Kingdom, using a sample of female university students. Of the 213 female undergraduate students who completed questionnaires, 28 were sexually abused, giving a prevalence rate of 13.14%. Information was also obtained regarding the nature of the abuse. These results show that a substantial proportion of female students in the United Kingdom, who appear to be coping with tertiary education, have been sexually abused in childhood. The implications regarding the benefits of prevalence rates to health practitioners are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

Prevalence of Child Sexual Abuse in the Nordic Countries: A Literature Review

This review examined child sexual abuse in the Nordic countries focusing on prevalence rates and victims’ age and relationship to the perpetrator. The results show a prevalence of child sexual abuse (broadly defined) between 3–23% for boys and 11–36% for girls. The prevalence rates for contact abuse were 1–12% for boys and 6–30% for girls, while 0.3–6.8% of the boys and 1.1–13.5% of the girls reported penetrating abuse. The findings suggest an increased risk of abuse from early adolescence. In adolescence, peers may constitute the largest group of perpetrators. The results highlight the need for preventive efforts also targeting peer abuse. Future research should include cross-national and repeated studies using comparable methodology.     

Exploring the Relationship Between Adverse Childhood Experiences and Hope

ABSTRACT

To explore the relationship between adverse childhood experiences and hope, a convenience sample of caregivers bringing in children for medical investigation of child abuse at a regional child advocacy center were surveyed for adverse childhood experiences and dispositional hope. Hope in this sample had a significant negative correlation to the adverse childhood experiences subscale “abuse” (r = –.19; p < .05). The relationship between hope and the other adverse childhood experiences subscales “neglect” (r = –.14) and “dysfunctional family” (r = –.16) was not statistically significant. An analysis of variance was performed to determine if caregivers who have experienced both sexual and physical abuse (M = 29.67; SD = 15.96) have lower hope scores compared to those caregivers who have experienced neither physical nor sexual abuse (M = 42.64; SD = 18.44). This analysis (F (1, 84) = 5.28; p < 0.05) showed that caregivers who experienced both physical and sexual abuse scored significantly lower on hope compared to their counterparts who experienced no adverse events, with an estimated effect size of moderate strength (d = 0.70). Higher adverse childhood experiences scores are associated with lower hope. This result was especially true for those adult caregivers who reported experiencing both physical and sexual abuse when compared to adults who did not experience either form of child trauma. While the empirical literature continues to demonstrate the negative consequences of adverse childhood experiences across the life span, hope offers a compelling new line of inquiry in child maltreatment research especially for studies targeting prevention or intervention.     

Problems of Research in Male Child Sexual Abuse

The focus of the present paper is the main problems found in the study of male child sexual abuse. Aspects of child sexual abuse of males reviewed here include (a) definitions, (b) prevalence rates and under-reporting, (c) effects, (d) possible mechanisms of how sexual abuse affects male victims, (e) gender related risks, (f) types of abuse, (g) perpetrators of abuse, and (h) the victim/perpetrator cycle. We conclude that while much research is urgently required in this area, some tentative conclusions are warranted and some important trends are beginning to emerge for future research directions.     

Training Knowledge of Professionals on Specific Topics in Child Sexual Abuse

This exploratory study examined the training background and self-reported level of knowledge of a group of professionals on specific topics in child sexual abuse. The results show that while the vast majority of those working with adult victims, female victims, and incest victims have received training, many professionals working in the area of child sexual abuse treatment have not had training on topics directly related to their work. It was found that fewer than 40% of those working with female offenders, victims and offenders who are gay or lesbian, victims and offenders who have developmental disabilities, or in cases where cultural issues are relevant, have had training in working with these types of cases. Those professionals who had received training reported feeling more knowledgeable on these topics than did those without training. It is recommended that graduate degree programs and continuing education programs examine their offerings in the area of child sexual abuse.     

Training Mental Health Professionals in Child Sexual Abuse: Curricular Guidelines

This study explored whether counseling practices with women survivors of child sexual abuse reflect the belief that women do not sexually abuse children. Canadian therapists (n?=?164) who work with women survivors of child sexual abuse were surveyed about their beliefs about what constitutes child sexual abuse, who commits child sexual abuse, and their practices regarding inquiries about abusive behavior. A majority self-reported that they ask women and think it is important to ask but most believe that clients will not spontaneously self-disclose inappropriate sexual thoughts or behaviors. How broadly or narrowly therapists defined child sexual abuse was not related to self-reported therapeutic discussion. Therapists demonstrated differential gender beliefs about child sexual abuse perpetration, but this did not relate to self-reported counseling practices. Implications for therapist education are discussed.