COMPASSION FOR THE ABUSED
CHILD SEXUAL ABUSE ~~WHAT PARENTS SHOULD KNOW
What is child sexual abuse?
Child (1) sexual abuse is any interaction between a child and an adult (or another child) in which the child is used for the sexual stimulation of the perpetrator or an observer. A central characteristic of any abuse is domination of the child by the perpetrator through deception, force, or coercion into sexual activity. Children, due to their age, cannot give meaningful consent to sexual activity. Child sexual abuse includes touching and nontouching behaviors:
sexual kissing inappropriate touching or fondling of the child’s genitals, breasts, or buttocks masturbation oral-genital contact sexual or digital (with fingers) penetration pornography (forcing the child to view or use of the child in) child prostitution exposure or “flashing” of body parts to the child voyeurism (ogling of the child’s body) verbal pressure for sex
Who are the victims of child sexual abuse?
Children of all ages, races, ethnicities, cultures, and economic backgrounds are vulnerable to sexual abuse. Child sexual abuse occurs in rural, urban, and suburban areas. It affects both girls and boys in all kinds of neighborhoods and communities, and in countries around the world.
Who are the perpetrators of child sexual abuse?
Most children are abused by someone they know and trust. An estimated 60% of perpetrators of sexual abuse are known to the child but are not family members, e.g., family friends, babysitters, childcare providers, neighbors. About 30% of perpetrators are family members, e.g., fathers, brothers, uncles, cousins. Just 10% of perpetrators are strangers to the child. In most cases, the perpetrator is male regardless of whether the victim is a boy or girl. Heterosexual and gay men are equally likely to sexually abuse children. A perception that most perpetrators are gay men is a myth and harmful stereotype. Some perpetrators are female -- It is estimated that women are the abusers in about 14% of cases reported among boys and 6% of cases reported among girls. Child pornographers and other abusers who are strangers may make contact with children via the Internet. Not all perpetrators are adults - an estimated 23% of reported cases of child sexual abuse are perpetrated by individuals under the age of 18.
Other common characteristics of perpetrators include:
a history of abuse (either physical or sexual) alcohol or drug abuse little satisfaction with sexual relationships with adults lack of control over their emotions mental illness in some cases
How prevalent is child sexual abuse?
Some CDC research has estimated that approximately 1 in 6 boys and 1 in 4 girls are sexually abused before the age of 18. Other governmental research has estimated that approximately 300,000 children are abused every year in the United States. However, accurate statistics on the prevalence of sexual abuse of children and adolescents are difficult to collect because it is vastly under-reported and there are differing definitions of what constitutes sexual abuse. Boys (and later, men) tend not to report their victimization, which may affect statistics. Some men even feel societal pressure to be proud of early sexual activity regardless of whether it was unwanted. Boys are more likely than girls to be abused outside of the family. Most mental health and child protection professionals agree that child sexual abuse is not uncommon and is a serious problem in the United States.
What are the risk and protective factors?
Research is still evolving around what risk factors presage child sexual abuse due to the difficulty involved in getting data. However, some general characteristics have been identified: Age: Older children tend to be at greater risk for sexual abuse 0-3 y/o: 10% of victims 4-7 y/o: 28.4% of victims 8-11 y/o: 25% of victims 12 and older: 35.9% of victims Gender: Girls tend to be at greater risk of sexual victimization than boys. However, boys are more likely to be victimized by a perpetrator outside the family than girls. Disability: Children with disabilities are at elevated risk of abuse, particularly, if the disability impairs their perceived credibility, e.g., blindness, deafness,
and mental retardation. Prior history of victimization Those with a prior history of sexual victimization are extremely likely to be revictimized. Some research estimates an increased risk of over 1000%. Family characteristics
Absence of one or both parents is a risk factor. Some research found that children living with only one biological parent at twice the risk of sexual victimization. Children living without both biological parents were at three times the risk of sexual victimization. Older children from father-only families were also at increased risk of sexual victimization compared to other children. Presence of a stepfather in the home doubled the risk of sexual victimization for girls. Parental characteristics associated with increased risk. Researchers have found that parents with a history of childhood sexual victimization are at an estimated risk 10 times greater for having a sexually abused child.
Multiple caretakers for the child Caretaker or parent who has multiple sexual partners Drug and/or alcohol abuse Stress associated with poverty Social isolation and family secrecy Child with poor self-esteem or other vulnerable state History of abuse among other family members (e.g., siblings, cousins) Unsatisfactory marriage or intimate partner violence for the mother Parents leaving child at home alone without adequate supervision
What are the effects of sexual abuse?
Not all sexually abused children exhibit symptoms (some estimate up to 40% of children are asymptomatic) however others experience serious and long-standing consequences. Child sexual abuse can result in both short-term and long-term harm, including mental health problems that extend into adulthood. Sexual abuse can affect psychological, emotional, physical, and social domains of the child’s life, including increased risk for:
Depression Guilt Fear Post-traumatic stress disorder (PTSD) Dissociative and anxiety disorders Eating disorders Poor self-esteem Somatization, i.e., the expression of distress in physical symptoms Chronic pain
Behavioral problems can include: Sexualized behavior – which brings elevated risk for pregnancy and sexually transmitted infections School/learning problems Substance abuse Destructive behavior Sexual dysfunction in adulthood Criminality in adulthood Suicide
(1) For our purposes, the term “child” includes adolescents below the age of consent.
RECOGNIZING THE PROBLEM ~~
What are the warning signs of sexual abuse?
Consider the possibility of sexual abuse when the child exhibits:
An increase in nightmares and/or other sleeping difficulties Angry outbursts
Anxiety Depression Difficulty walking or sitting Withdrawn behavior Pregnancy or contraction of a venereal disease, particularly if under age 14 Propensity to run away Refusal to change for gym or to participate in physical activities Regressive behaviors depending on their age (e.g., return to thumb-sucking or bed-wetting) Reluctance to be left alone with a particular person or people Sexual knowledge, language, and/or behaviors that are unusual and inappropriate for their age
Take it very seriously when a child reports sexual abuse by a parent or another adult caregiver. Consider the possibility of sexual abuse when the parent or other adult caregiver:
Is unduly protective of the child or severely limits the child's contact with other children, especially those of the opposite sex Is secretive and isolated Describes marital difficulties involving sexual relations or family power struggles.
What steps can parents/caregivers take to prevent and minimize risk for sexual abuse?
Teach your children: Basic sexual education - a health professional can provide basic sexual education to your children if you feel uncomfortable doing so.
That sexual advances from adults are wrong.
To communicate openly - they should feel free to ask questions and talk about their experiences. Make it clear that they should feel free to report abuse to you or any other trusted adult. If you’re concerned about possible sexual abuse, ask questions.
*The difference between good secrets (those that are not kept secret for long) and bad secrets (those that must stay secret forever). The difference between “okay” and “not okay” touches. *(My note is that it may not be a good idea to not use the word 'secret' but to use the word 'surprise' & to teach the children to tell you about anyone who uses the word 'secret', whether the word was intended or good or bad.)
Accurate names for their private parts and how to take care of them (i.e., bathing, wiping after bathroom use) so they don’t have to rely on adults or older children for help. That adults and older children never need help with their own private parts. That they can make decisions about their own bodies and say “no” when they do not want to be touched or do not want to touch others (even refusing to give hugs). Make sure that you know your child’s friends and their families. If you feel uneasy about leaving your child with someone, don’t do it.
What should parents/caregivers do if they suspect abuse?
Give the child a safe environment in which to talk to you or another trusted adult.
Encourage the child to talk about the abuse, but be careful to not suggest events that may not have occurred.
Guard against displaying emotions that would influence the child's telling of the information. Listen, stay calm, and
remain supportive of the child with words and gestures.
Reassure the child that he or she did nothing wrong.
Seek assistance for the child from a psychologist or other licensed mental health provider .
Arrange for a medical examination for the child. Select a medical provider who has experience in examining children and identifying
sexual and physical trauma. It may be necessary to explain to the child the difference between a medical examination and the abuse incident. Many states require that individuals who know or suspect that a child has been sexually abused must report the abuse to local law enforcement
or child protection officials. In all 50 states, medical personnel, mental health professionals, teachers, and law enforcement personnel are
required by law to report suspected abuse.
Ask for help - There are a number of organizations focused on providing assistance to families dealing with child abuse: American Professional Society on the Abuse of Children (312) 554-0166 National Center for Missing and Exploited Children 24 hour hotline 1-800-THE-LOST Child Help USA (1-800) 4-A-CHILD Prevent Child Abuse America (1-800) CHILDREN Child Welfare Information Gateway (formerly National Clearinghouse on Child Abuse and Neglect Information) (1-800) 394-3366
What treatments are available for children and adolescents who have been sexually abused?
There are a number of empirically validated treatments for children who have been sexually abused Individual therapy Family therapy Group therapy Trauma-focused cognitive behavioral therapy Child-centered therapy
There is no “one size fits all” treatment for sexual abuse. Therapists may take a range of approaches to treatment depending on the individual characteristics of the child and the length of treatment. Recovery is possible - children can be very resilient and with a combination of effective treatment and support from parents/caregivers, they do recover from abuse. For more information on treatment of child sexual abuse, please visit the National Child Traumatic Stress Network.
APA resources: Protecting Our Children from Abuse and Neglect Resolution Opposing Child Sexual Abuse Topics page on Sexual Abuse Understanding Child Sexual Abuse Understanding and Preventing Child Abuse and Neglect External resources: Advocates for Youth American Professional Society on the Abuse of Children Child Help USA Child Welfare Information Gateway National Center for Missing and Exploited Children National Center for PTSD Site on Child Sexual Abuse National Child Traumatic Stress Network Site on Child Sexual Abuse National Institutes of Health (NIH) Clearinghouse on Child Sexual Abuse Prevent Child Abuse America Sources: Advocates for Youth (1995). Child sexual abuse: An overview. Washington, DC: Author. Retrieved April 8, 2010. American Medical Association (1992). Diagnostic and treatment guidelines on child sexual abuse. Chicago, IL: Author. American Psychological Association (2010). Understanding child sexual abuse: Education, prevention, and recovery. Washington, DC: Author. Black, D. A., Heyman, R. E., & Slep, A. M. Smith. (2001). Risk factors for child sexual abuse. Aggression and Violent Behavior,6(2-3), 203-229. Centers for Disease Control and Prevention. (2005). Adverse childhood experiences study: Data and statistics. Atlanta, GA: Centers for Disease Control
and Prevention, National Center for Injury Prevention and Control. Retrieved April 1, 2010. National Center for Missing and Exploited Children (2010). What to do if a child discloses sexual molestation. Alexandria, VA: Author. Retrieved April 7, 2010. National Child Traumatic Stress Network (2007). Questions and answers about child sexual abuse treatment (PDF, 65KB). Washington, DC: Author.
Retrieved April 2, 2010. National Child Traumatic Stress Network (2009). Child sexual abuse fact sheet (PDF, 65KB). Washington, DC: Author. Retrieved April 2, 2010. Putnam, F. W. (2003). Ten year research update review: Child sexual abuse. Journal of the American Academy of Child Adolescent Psychiatry, 42(3), 269-278. Sedlak, A. J., & Broadhurst, D. D. (1996). The third national incidence survey of child abuse and neglect. Washington, DC: U.S. Department of Health and
Human Services. Snyder, H. N. (2000). Sexual assault of young children as reported to law enforcement: Victim, incident, and offender characteristics. Washington, DC:
U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Retrieved April 5, 2010.