Understanding Child Sexual Abuse: Education, Prevention and Recovery

What is child sexual abuse?

There is no universal definition of child sexual abuse. However, a central characteristic of any abuse is the dominant position of an adult that allows him or her to force or coerce a child into sexual activity. Child sexual abuse may include fondling a child's genitals, masturbation, oral-genital contact, digital penetration, and vaginal and anal intercourse. Child sexual abuse is not solely restricted to physical contact; such abuse could include noncontact abuse, such as exposure, voyeurism, and child pornography. Abuse by peers also occurs.

Accurate statistics on the prevalence of child and adolescent sexual abuse are difficult to collect because of problems of underreporting and the lack of one definition of what constitutes such abuse. However, there is general agreement among mental health and child protection professionals that child sexual abuse is not uncommon and is a serious problem in the United States.

The impact of sexual abuse can range from no apparent effects to very severe ones. Typically, children who experience the most serious types of abuse—abuse involving family members and high degrees of physical force—exhibit behavior problems ranging from separation anxiety to posttraumatic stress disorder. However, children who are the victims of sexual abuse are also often exposed to a variety of other stressors and difficult circumstances in their lives, including parental substance abuse. The sexual abuse and its aftermath may be only part of the child's negative experiences and subsequent behaviors. Therefore, correctly diagnosing abuse is often complex. Conclusive physical evidence of sexual abuse is relatively rare in suspected cases. For all of these reasons, when abuse is suspected, an appropriately trained health professional should be consulted.

Who are the victims of child sexual abuse?

Children and adolescents, regardless of their race, culture, or economic status, appear to be at approximately equal risk for sexual victimization. Statistics show that girls are sexually abused more often than boys are. However, boys' and, later, men's, tendency not to report their victimization may affect these statistics. Some men even feel societal pressure to be proud of early sexual activity (no matter how unwanted it may have been at the time). It is telling, however, to note that men who have been abused are more commonly seen in the criminal justice system than in clinical mental health settings.

Who are the perpetrators of child sexual abuse?

Studies on who commits child sexual abuse vary in their findings, but the most common finding is that the majority of sexual offenders are family members or are otherwise known to the child. Sexual abuse by strangers is not nearly as common as sexual abuse by family members. Research further shows that men perpetrate most instances of sexual abuse, but there are cases in which women are the offenders. Despite a common myth, homosexual men are not more likely to sexually abuse children than heterosexual men are.

What are the effects of child sexual abuse?

Children and adolescents who have been sexually abused can suffer a range of psychological and behavioral problems, from mild to severe, in both the short and long term. These problems typically include depression, anxiety, guilt, fear, sexual dysfunction, withdrawal, and acting out. Depending on the severity of the incident, victims of sexual abuse may also develop fear and anxiety regarding the opposite sex or sexual issues and may display inappropriate sexual behavior. However, the strongest indication that a child has been sexually abused is inappropriate sexual knowledge, sexual interest, and sexual acting out by that child.

The initial or short-term effects of abuse usually occur within 2 years of the termination of the abuse. These effects vary depending upon the circumstances of the abuse and the child's developmental stage but may include regressive behaviors (such as a return to thumb-sucking or bed-wetting), sleep disturbances, eating problems, behavior and/or performance problems at school, and nonparticipation in school and social activities.

But the negative effects of child sexual abuse can affect the victim for many years and into adulthood. Adults who were sexually abused as children commonly experience depression. Additionally, high levels of anxiety in these adults can result in self-destructive behaviors, such as alcoholism or drug abuse, anxiety attacks, situation-specific anxiety disorders, and insomnia. Many victims also encounter problems in their adult relationships and in their adult sexual functioning.

Revictimization is also a common phenomenon among people abused as children. Research has shown that child sexual abuse victims are more likely to be the victims of rape or to be involved in physically abusive relationships as adults are.

In short, the ill effects of child sexual abuse are wide ranging. There is no one set of symptoms or outcomes that victims experience. Some children even report little or no psychological distress from the abuse, but these children may be either afraid to express their true emotions or may be denying their feelings as a coping mechanism. Other children may have what is called "sleeper effects." They may experience no harm in the short run, but suffer serious problems later in life.

Can children recover from sexual abuse?

In an attempt to better understand the ill effects of child abuse, psychologists and other researchers have studied what factors may lessen the impact of the abuse. More research needs to be done, but, to date, factors that seem to affect the amount of harm done to the victim include the age of the child; the duration, frequency, and intrusiveness of the abuse; the degree of force used; and the relationship of the abuser to the child.

Children's interpretation of the abuse, whether or not they disclose the experience, and how quickly they report it also affects the short- and long-term consequences. Children who are able to confide in a trusted adult and who are believed experience less trauma than children who do not disclose the abuse. Furthermore, children who disclose the abuse soon after its occurrence may be less traumatized than those children who live with the secret for years.

Some researchers have begun to look at the question of whether someone can recover from sexual abuse, and, if so, what factors help in that recovery. Children and adults who were sexually abused as children have indicated that family support, extra-familial support, high self-esteem, and spirituality were helpful in their recovery from the abuse.

It is important for victims of abuse to relinquish any guilt they may feel about the abuse. Victims also report that attending workshops and conferences on child sexual abuse, reading about child sexual abuse, and undergoing psychotherapy have helped them feel better and return to a more normal life. Research has also shown that often the passage of time is a key element in recovery.

Counseling and other support services are also important for the caregivers of abused children. One of the strongest predictors of the child's recovery from the abuse experience is a high level of maternal and family functioning. (This, of course, assumes that the abuser was not a member of the immediate family or, if so, is not still living within the family.)

Protecting children from sexual abuse

The typical advice "Don't Talk to Strangers" doesn't apply in this case. Most sexual perpetrators are known to their victims.
Do not instruct children to give relatives hugs and kisses. Let them express affection on their own terms.
Teach your children basic sexual education. Teach them that no one should touch the "private" parts of their body. A health professional can also help to communicate sex education to children if parents are uncomfortable doing so.
Develop strong communication skills with your children. Encourage them to ask questions and talk about their experiences. Explain the importance of reporting abuse to you or another trusted adult.
Teach your children that sexual advances from adults are wrong and against the law. Give them the confidence to assert themselves against any adult who attempts to abuse them.
Make an effort to know children's friends and their families.
Instruct your child to never get into a car with anyone without your permission.
Teach your children that their bodies are their own. That it is OK to say they do not want a hug or that certain kinds of contact make them uncomfortable.
It is important to remember that physical force is often not necessary to engage a child in sexual activity. Children are trusting and dependent and will often do what is asked of them to gain approval and love.

What to do if you think a child you know has been the victim of sexual abuse

Give the child a safe environment in which to talk to you or another trusted adult. Encourage the child to talk about what he or she has experienced, but be careful to not suggest events to him or her that may not have happened. Guard against displaying emotions that would influence the child's telling of the information.
Reassure the child that he or she did nothing wrong.
Seek mental health assistance for the child.
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.
Be aware that many states have laws requiring that persons who know or have a reason to suspect that a child has been sexually abused must report that abuse to either local law enforcement officials 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.

Where to go for help

Several organizations can provide information and advice about child sexual abuse, including:

American Professional Society on the Abuse of Children
407 South Dearborn
Suite 1300
Chicago, IL 60605
(312) 554-0166
http://www.apsac.org/

National Center for Missing and Exploited Children
Charles B. Wang International Children's Building
699 Prince Street Alexandria, VA 22314-3175
24 hotline: 1-800-THE-LOST
http://www.missingkids.com/

Child Help USA
15757 North 78th Street
Scottsdale, AZ 85260
(800) 4-A-CHILD
http://www.childhelpusa.org/

Prevent Child Abuse America
332 S. Michigan Ave
Suite 1600
Chicago, IL 60604-4357
(800) CHILDREN
http://www.preventchildabuse.org/index.shtml

Child Welfare Information Gateway (formerly National Clearinghouse on Child Abuse and Neglect Information)
Children's Bureau/ACYF
1250 Maryland Avenue, SW
Eighth Floor
Washington, DC 20024
(800) 394-3366
http://www.childwelfare.gov/

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