A review of ten years’ research on child sexual abuse

A review of ten years’ research on child sexual abuse reveals that girls are about 2.5 to 3 times more likely to be sexually abused than boys. Thirty-six percent of victims are older than 12 years of age, but 28 percent are between four and seven of age and one quarter are between 8 and 11. Disabled children are at greater risk; dependency, institutional care and communication difficulties increase a child’s vulnerability to sexual abuse. Poverty, race and ethnicity do not appear to be risk factors for sexual abuse. The absence of one or both parents, however, is a significant risk factor, and the presence of a stepfather in the home doubles the risk for girls. Parental impairments such as illness, alcoholism and drug abuse, as well as serious marital conflicts, are associated with increased risk.

Depression, eating disorders and drug abuse are common in children with a history of sexual abuse. In addition, suicide and sexual promiscuity are linked to sexual abuse. Inappropriate sexualized behaviors in young children are common following abuse. A history of sexual abuse is associated with a significant increase in arrest rates for sex crimes and prostitution. Abuse also increases the risk for early pregnancy. Abused adolescents who become pregnant are more likely to have delivery complications and low-birth-weight infants.

Studies of sexually abused girls indicate possible neurological and biological effects. The hypothalamic, pituitary and adrenal glands, the sympathetic nervous system and possibly the immune system may be affected. MRI studies in adults who were sexually abused as children show neurological changes similar to those reported in combat veterans with Post-Traumatic Stress Disorder. Sexual abuse seems to function as an extreme form of stress in these children’s lives. Children vary greatly in their ability to cope with such traumatic events. Not all sexually abused children exhibit symptoms, and some children who initially seem OK deteriorate over time. Many individual and environmental variables influence the outcome for a child. If the child has additional risk factors such as family substance abuse, mental illness, domestic violence or other family dysfunction, researchers recommend that the child receive treatment even if he or she is not showing any symptoms of distress.

Unfortunately, disclosure of sexual abuse does not always end the abuse or the child’s distress. Children who voluntarily disclose abuse receive less treatment and support and have poorer outcomes than those whose abuse is discovered by an adult. When children receive treatment, most improve significantly over time. Cognitive-behavioral therapy is shown to be particularly effective when used with the child and a non-offending parent. Aggression and sexualized behavior appear to more more resistant to treatment than depression.

Prevention programs are controversial

Child-abuse prevention programs are controversial. Children can be effectively taught selfprotection skills, but there is some indication of negative effects such as increased anxiety in younger children and being uncomfortable with normal touching among older children. Visiting-nurse programs can be highly effective; intensive programs reduce the risk of child abuse and neglect by half, especially among poor, unmarried participants.

“Ten-Year Research Update Review: Child Sexual Abuse,” Journal of the American Academy of Child and Adolescent Psychiatry, Volume 42, Number 3, March 2003, pp. 269-278.

Published in ERN April/May 2003 Volume 16 Number 4

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