Ten-Year Research Update Review: Child Sexual Abuse

doi:10.1097/00004583-200303000-00006

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 42, Issue 3, March 2003, Pages 269-278

https://doi.org/10.1097/00004583-200303000-00006 Get rights and content

ABSTRACT

Objective

To provide clinicians with current information on prevalence, risk factors, outcomes, treatment, and prevention of child sexual abuse (CSA). To examine the best-documented examples of psychopathology attributable to CSA.

Method

Computer literature searches of Medline and PSYCInfo for key words. All English-language articles published after 1989 containing empirical data pertaining to CSA were reviewed.

Results

CSA constitutes approximately 10% of officially substantiated child maltreatment cases, numbering approximately 88,000 in 2000. Adjusted prevalence rates are 16.8% and 7.9% for adult women and men, respectively. Risk factors include gender, age, disabilities, and parental dysfunction. A range of symptoms and disorders has been associated with CSA, but depression in adults and sexualized behaviors in children are the best-documented outcomes. To date, cognitive-behavioral therapy (CBT) of the child and a nonoffending parent is the most effective treatment. Prevention efforts have focused on child education to increase awareness and home visitation to decrease risk factors.

Conclusions

CSA is a significant risk factor for psychopathology, especially depression and substance abuse. Preliminary research indicates that CBT is effective for some symptoms, but longitudinal follow-up and large-scale “effectiveness” studies are needed. Prevention programs have promise, but evaluations to date are limited.

Section snippets

EPIDEMIOLOGY OF CSA

Before the late 1970s, CSA was regarded as rare. In the following decades, the incidence—based on official statistics—increased dramatically (Finkelhor, 1984;U.S. Department of Health and Human Services, 1998). Although much of this apparent increase probably reflected a growing awareness among the public and professionals, some studies suggest that the overall incidence of child abuse and neglect increased. Using as official observers a variety of professionals who routinely came in contact

RISK FACTORS FOR CSA

CSA occurs across all socioeconomic and ethnic groups (Finkelhor, 1993). A number of factors, however, have been identified that increase risk for CSA.

INTERGENERATIONAL TRANSMISSION OF CSA

The observation that child abusive behavior occurs across generations more often than would be expected by chance has led to a number of theories ranging from the postulation of large sociopolitical and cultural cycles (Buchanan, 1996) to maladaptive family processes (Ney, 1992) to psychodynamic models based on identification with the aggressor, low self-esteem, and related constructs (Steele, 1997). The actual rates of intergenerational occurrence of child abuse are lower than is often

OUTCOMES ASSOCIATED WITH CHILDHOOD SEXUAL ABUSE

A variety of adult psychiatric conditions have been clinically associated with CSA. These include the DSM disorders of major depression, borderline personality disorder, somatization disorder, substance abuse disorders, posttraumatic stress disorder (PTSD), dissociative identity disorder, and bulimia nervosa. Initially the evidence for these associations was based primarily on findings of high rates of retrospectively reported CSA in clinical samples with these diagnoses. Increasingly these

PRINCIPLES OF PSYCHOPATHOLOGY IN CSA

The array of disorders and dysfunctional behaviors associated with CSA has been difficult to account for with a simple cause-and-effect model. This apparent diversity can be explained in part by the heterogeneity of CSA experiences, the complexity of the confounds among abuse severity variables, and a host of moderating and mediating constitutional and environmental variables together with important individual differences in coping strategies that may come into play at different points in

EFFECTS OF DISCLOSURE AND STABILITY OF SELF-REPORTS OF CSA OVER TIME

Unfortunately, disclosure by the child of abuse does not always result in the termination of the abuse or end the child's distress (Palmer et al., 1999). A follow-up comparison of children who had accidental disclosures of CSA (i.e., their abuse was discovered by an adult) versus children who deliberately disclosed, revealed that the former were doing significantly better at 1 year (Nagel et al., 1996). Children who voluntarily disclosed their abuse received less treatment and support, which

Asymptomatic Children

Not all sexually abused children have serious psychiatric sequelae. When evaluated with standard instruments, up to 40% of sexually abused children may present with few or no symptoms (Finkelhor and Berliner, 1995). A number of reasons have been offered including the possibility that asymptomatic children had minor abuse, that they are more resilient, or that they have a coping style that masks their distress. The limited longitudinal data available, however, suggest that 10% to 20% of

Child Education Programs

There is considerable debate within the field as to the best approach to CSA prevention. School-based education programs directed at teaching children to identify potential abuse situations, to respond in a self-protective fashion, and to tell a trusted adult are popular. A meta-analysis of 16 evaluation studies of school-based child education programs found that such programs are generally successful at teaching children CSA concepts and self-protection skills (Rispens et al., 1997). In most

FUTURE DIRECTIONS

Research on CSA shares most of the methodological limitations and thorny dilemmas associated with child abuse and neglect research in general. These include determining what constitutes representative samples, uniformity of definitions, classification of multiple forms of maltreatment, understanding self-selection biases for research participation, detecting false negatives, and determination of appropriate comparison groups (Briere, 1992;Ferguson, 1997). The existence of sleeper effects,

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Cited by (1053)

Factors differentiating risk of sexual abuse victimization by adults and peers among adolescents
2024, Child Abuse and Neglect
Research suggests that around half of all cases of sexual abuse among children and adolescents are perpetrated by peers. Yet, there is limited understanding of the distinct risk factors associated with adult versus peer offenders.
To identify factors that increase the risk of sexual abuse victimization and explores variations in these factors depending on whether the perpetrator was an adult or a peer.
9240 secondary school students aged between 12 and 16 years (M = 14, SD = 0.88) in Norway participated.
An electronic questionnaire was administered in schools to investigate experiences of sexual abuse and potential risk factors. The data were analyzed using multiple logistic regression analyses.
Two factors were related to a greater risk of being a victim of sexual abuse committed by an adult than a peer: background from a non-European country (OR = 1.93, p = 0.038) and other experiences of violence (OR = 1.63–2.91, p < 0.005). The use of alcohol was found to be related to a greater risk of victimization by peers than by adults (OR = 0.53, p = 0.031).
Adolescents vulnerable to sexual abuse exhibit common traits, regardless of whether the perpetrator is an adult or peer. Yet, specific factors heighten the risk with peers over adults, and vice versa. Recognizing distinct risk factors for abuse by adults and peers enables decision-makers and community workers to create targeted prevention strategies for children and adolescents.
Effectiveness of child sexual abuse prevention programs on knowledge acquisition: A meta-analytical study
2023, Child Abuse and Neglect
Child sexual abuse (CSA) is a type of maltreatment considered a global health problem. CSA is a traumatic experience with important consequences for the victim's health. It is essential to report the effectiveness of CSA prevention programs to offer society useful tools to combat this abuse.
We aimed to study the effectiveness of CSA prevention programs on the knowledge acquisition based on comparing pre- and post-treatment changes, and also if their effectiveness is related to program-related and methodological variables.
Standardised mean change (with studies that report pre-post program measures) of the effectiveness of CSA prevention programs published between 2014 and 2021 was carried out.
The general effectiveness of these programs and whether the results were influenced by program-related variables (the duration, the target population, participants' age, or the type of intervention) or by methodology-related factors (the agent who taught them, the geographical area where they were carried out or the way the programs were evaluated) were analysed. A total of 43 samples analysing knowledge about CSA as a dependent variable were included.
The results reported a combined effect size considered large (d_MR = −0.96, 95 % CI [−1.10, −0.82], p < .001). High inter-study heterogeneity was observed in the meta-analysis, although only the geographic area where the studies were conducted appears as a significant moderator.
In conclusion, the prevention programs included in this analysis significantly improved the participants' knowledge acquisition.
Cumulative childhood trauma, sex motives and sexual satisfaction among emerging adults
2023, Child Abuse and Neglect
To better understand sexual satisfaction in emerging adults, previous research has emphasized the importance of considering the role of developmental experiences, such as cumulative childhood trauma (CCT; the number of different forms of abuse and neglect sustained during childhood). However, the mechanisms by which CCT and sexual satisfaction are related remain unknown. Sex motives are suggested as an explanatory mechanism given the previously found associations between sex motives and both sexual satisfaction and CCT.
This study examined the direct associations between CCT and sexual satisfaction, as well as indirect associations through sex motives, in emerging adults.
A sample of 437 French Canadian emerging adults (76 % women, mean age of 2.3) were recruited.
Participants completed online self-reported validated questionnaires assessing CCT, sex motives and sexual satisfaction.
Results from a path analysis revealed that CCT was associated with a higher endorsement of the self-affirmation sex motive ( $β$  = 0.25, p < .001) which was linked to lower sexual satisfaction ( $β$  = −0.13, p < .001). CCT was also associated with a higher endorsement of the coping $(β$  = 0.25, p < .001) and partner approval ( $β$  = 0.09, p < .05) sex motives. A higher endorsement of the intimacy ( $β$  = 0.28, p < .001) and pleasure ( $β$  = 0.24, p < .001) sex motives, and a lower endorsement of the partner approval sex motive ( $β$  =  −0.13, p < .001) were linked to greater sexual satisfaction.
Results suggest education and intervention targets to improve emerging adults' sexuality.
A Longitudinal Study of Risk Factors for Sexual Victimization in Puerto Rican Youth
2023, Academic Pediatrics
To determine whether youth, family, and neighborhood factors and minoritized status are associated with youth-reported sexual victimization from childhood through young adulthood.
We analyzed longitudinal data from 2 population-based samples of Puerto Rican youth living in the South Bronx (as a minoritized group) and Puerto Rico (as a nonminoritized group). Waves 1 to 3 were collected annually beginning in 2000 (youth age 5–13). Wave 4 was collected 2013 to 2017 (youth age 15–29). We estimated multivariable associations between youth, family, and neighborhood factors and minoritized status at Wave 1 (independent variables); and youth-reported sexual victimization at Waves 1 to 4 (dependent variables).
None of the factors was associated with youth-reported sexual victimization at Wave 1 (N = 1911). Among youth reporting no previous history of sexual victimization at Wave 1 (n = 1823), youth in the South Bronx vs Puerto Rico were more likely to report sexual victimization at Waves 2 or 3 (odds ratio (OR) [95% confidence interval (CI)] = 3.62 [1.46–8.97]). Older youth were less likely to report sexual victimization (OR [95% CI] = 0.77 [0.65–0.91]) (all P < .01). Among youth reporting no history of sexual victimization at Waves 1 to 3 (n = 1782), youth in the South Bronx (OR [95% CI] = 2.53 [1.52–4.22]), female youth (OR [95% CI] = 2.81 [1.83–4.30]), and youth whose parents had more than a high school degree (OR [95% CI] = 2.25 [1.38–3.67]) were more likely to report sexual victimization at Wave 4 than their counterparts (all P ≤ .001).
Future research should investigate how living as a minoritized youth may contribute to an increased risk of sexual victimization.
Child Sexual Abuse and Employment Earnings in Adulthood: A Prospective Canadian Cohort Study
2023, American Journal of Preventive Medicine
Child sexual abuse remains a worldwide concern with devastating consequences on an individual's life. This longitudinal study investigates the associations between child sexual abuse (official reports versus retrospective self-reports) and subgroups by perpetrator identity (intrafamilial and extrafamilial), severity (penetration/attempted penetration, fondling/touching, noncontact), and chronicity (single, multiple episodes) and employment earnings in adulthood in a cohort followed for over 30 years.
The Quebec Longitudinal Study of Kindergarten Children database was linked to child protection services (official reports of sexual abuse) and to Canadian government tax returns (earned income). The sample included 3,020 individuals in Quebec French-language school kindergartens in 1986/1988, followed until 2017, and assessed with retrospective self-reports at age 22 years. Tobit regressions were used for associations with earnings (ages 33–37 years), adjusting for sex and family socioeconomic characteristics in 2021–2022.
Individuals who experienced child sexual abuse had lower annual earnings. Those with retrospective self-reported sexual abuse (n=340) earned $4,031 (95% CI= –7,134, –931) less annually at ages 33–37 years than nonabused individuals (n=1,320), with pronounced differences for those with official reports (n=20), earning $16,042 (95% CI= –27,465, –4,618) less. Individuals self-reporting intrafamilial sexual abuse earned $4,696 (95% CI= –9,316, –75) less than those who experienced extrafamilial sexual abuse, whereas those self-reporting penetration/attempted penetration earned $6,188 (95% CI= –12,248, –129) less than those who experienced noncontact sexual abuse.
Earnings gaps were highest for severest child sexual abuse (official reports, intrafamilial, penetrative). Future studies should investigate the underlying mechanisms. Improving support for victims of child sexual abuse could yield socioeconomic returns.
The lifetime prevalence of child sexual abuse assessed in young adults in Lithuania
2023, Child Abuse and Neglect
We examined the prevalence of different types of childhood sexual abuse (CSA) in Lithuania focusing on how these experiences were related to victim's age and relationship to the perpetrator.
The participants came from a representative household survey of youth aged 18–29 and the sample consisted of 2000 participants (47.7 % women) with a mean age of 23.9 years (SD = 3.6). The ISPCAN Child Abuse Screening Tool Retrospective version (ICAST-R, Dunne et al., 2009) for young adults was used to investigate childhood exposure to CSA. Both current sociodemographic information and information on circumstances during childhood (e.g., number of siblings, family members with whom the participant lived between 7 and 12 year of age) were collected.
The prevalence of any CSA experience before the age of 18 was 15.9 %, with higher rates for women (13.5 % and 18.5 % for men and women, respectively). Being spoken to in a sexual way or sexual things being written about the person was the most prevalent form of CSA. In contrast, number of victims that reported sexual intercourse was much lower. The most common type of perpetrator was another young person. Intrafamilial CSA was rare with higher risk in step-relationships.
Our study provides representative prevalence estimates of the CSA in a region for which such estimates were not previously available. These Lithuanian estimates correspond well with previous literature. Importantly, the findings point to peers being an important perpetrator group in CSA cases. This and other findings can inform the planning of relevant policy measures and actions to both prevent CSA and investigate cases effectively.

View all citing articles on Scopus

: From Children's Hospital Medical Center, Cincinnati.

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RESEARCH UPDATE REVIEWTen-Year Research Update Review: Child Sexual Abuse

ABSTRACT

Objective

Method

Results

Conclusions

Section snippets

EPIDEMIOLOGY OF CSA

RISK FACTORS FOR CSA

INTERGENERATIONAL TRANSMISSION OF CSA

OUTCOMES ASSOCIATED WITH CHILDHOOD SEXUAL ABUSE

PRINCIPLES OF PSYCHOPATHOLOGY IN CSA

EFFECTS OF DISCLOSURE AND STABILITY OF SELF-REPORTS OF CSA OVER TIME

Asymptomatic Children

Child Education Programs

FUTURE DIRECTIONS

Child Abuse Negl

Child Abuse Negl

Child Abuse Negl

J Am Acad Child Adolesc Psychiatry

Biol Psychiatry

Child Abuse Negl

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Child Abuse Negl

Biol Psychiatry

Biol Psychiatry

J Am Acad Child Adolesc Psychiatry

Lancet

Child Abuse Negl

Public Health

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Child Abuse Negl

Child Abuse Negl

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Child Abuse Negl

Child Abuse Negl

Child Abuse Negl

J Adolesc

Clin Psychol Rev

Child Abuse Negl

Child Abuse Negl

J Am Acad Child Adolesc Psychiatry

Child Abuse Negl

Child Abuse Negl

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Child Abuse Negl

Child Abuse Negl

Appl Prev Psychol

Child Abuse Negl

Child Abuse Negl

Child Abuse Negl

Child Abuse Negl

Child Abuse Negl

Child Abuse Negl

The medical evaluation of the sexually abused child: lessons from a decade of research

Pediatrics

Integration of teen pregnancy and child abuse research: identifying mediator variables for pregnancy outcome

J Prim Prev

Early sexual abuse and clinical depression in adult life

Br J Psychiatry

Methodological issues in the study of sexual abuse effects

J Consult Clin Psychol

Impact of sexual abuse on the HIV-risk-related behavior of adolescents in intensive psychiatric treatment

Am J Psychiatry

Cycles of Child Maltreatment: Facts, Fallacies and Interventions

Treatment of traumagenic beliefs among sexually abused girls and their mothers: an evaluation study

J Abnorm Child Psychol

Interventions for sexually abused children: initial treatment outcome findings

Child Maltreat

RESEARCH UPDATE REVIEW
Ten-Year Research Update Review: Child Sexual Abuse