Statistics, Signs, Adverse Effects, and Prevention Strategies
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Child sexual abuse affects tens of thousands of children and young teens every year. Though sexual abuse is all too common, many adults are unprepared or unwilling to deal with the problem when faced with it, leading to underreporting of the crime and stigmatizing of the victim. Child sexual abuse can take many forms, but is always a violation of a young person’s rights, and increases the risk of many adverse physical and mental health conditions. An atmosphere of silence and poor communication around sexuality contributes to child sexual abuse. Programs can help empower young people to report unwanted contact and can prepare parents, clergy, and youth-serving professionals to recognize the signs of child abuse and take appropriate action.
Child Sexual Abuse Rates Have Declined But Many Remain At Risk
Child sexual abuse is defined in various ways, making it challenging to generalize about its prevalence in society and its effect on children, teens, and families.1,2
Many professionals define child sexual abuse broadly to include both direct genital contact and indirect interactions such as ‘exposure’ or internet-based activity (for example, the sending of electronic sexual images to minors) up through age.17.3,4,5
Others have defined child sexual abuse much more narrowly, such as "unwanted sex" with a perpetrator who is older, before the age of 14 years.6
Despite the obstacles to data collection, it is estimated that child sexual abuse has declined by more than 50 percent in the U.S. since the early 1990s, based on reports to child protection agencies and law enforcement officials.2,3,7
Recent estimates suggest that between 1-3 percent of U.S. youth experience child sexual abuse in any given year.2,3
Substantiated cases of child sexual abuse — i.e. cases in which accusations have been confirmed with evidence — are estimated to be a small proportion of actual incidents of child sexual abuse. Only a small proportion of victims disclose their experiences, and among those many wait to disclose until months or years after they experienced the abuse.7
Mandated reporters of child sexual abuse — for example, teachers, medical providers, or others who serve youth — are required in the U.S. to report suspected child sexual abuse to child protection or law enforcement authorities.8,9
Some Children and Young People Are More At Risk for Sexual Abuse
Females are more likely than males to experience child sexual abuse. Estimates of prevalence range widely, with studies suggesting that 12-40 percent of females and 4-16.5 percent of males in the U.S. have experienced at least one instance of sexual abuse in childhood or adolescence.3,10,11
Research indicates a connection between bullying and child sexual abuse, with bully/victims (those youth who bully their peers and have also been bullied) especially at risk for child sexual abuse.12
Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are more likely to have experienced sexual abuse than heterosexual youth. However, sexual abuse does not "cause" heterosexual youth to become LGBTQ.13,14,15
Youth with physical, emotional, or cognitive disabilities are over three times more at risk for child sexual abuse than their non-disabled peers, and may not be able to disclose to a trusted adult because of a disability which impairs communication (e.g. a hearing-impaired youth who has not been taught sign language for this concept).9
Youth are at higher risk for child sexual abuse if they live in households characterized by instability, interpersonal conflict, and other forms of abuse.16
Children who live with only one parent are at elevated risk of child sexual abuse, particularly by males who are sexually involved with the mothers but not fully part of the household.3
Youth who have experienced child sexual abuse are also more likely to have witnessed violence at home or experienced other forms of physical or emotional abuse at home.17
Patterns Among Perpetrators of Child Sexual Abuse
Most perpetrators of child sexual abuse are relatives or close acquaintances of the youth they target. "Stranger Danger" — the notion that youth are at highest risk of sexual abuse from strangers — is a widely-accepted myth that continues to drive public policy around this issue.18
Among those known to have committed child sexual abuse, the vast majority are male. Among juvenile offenders, over 90 percent of known perpetrators are male.3,19
Juvenile offenders account for over 1 in 3 known perpetrators of child sexual abuse. The majority of under-age youth who commit sexual offenses against other youth are male, and are more likely to act in groups against more vulnerable males (especially against pre-pubescent male children).19
Although perpetrators are more likely than others to have experienced sexual abuse during their own childhood, most victims of sexual abuse do not go on to commit sexual abuse later in life.7
Recidivism rates for child sexual abuse are far lower than widely believed by the general public, and are lower than recidivism rates for many other criminal behaviors. Recidivism rates for juvenile offenders are especially low.3,19
Signs and Symptoms of Child Sex Abuse
In most substantiated cases of child sexual abuse, there are no physical symptoms of harm to alert adults.8
Child sexual abuse most often comes to the attention of adults when children disclose, although only a small percentage of sexually abused youth disclose due to a variety of factors:
- Youth may have been threatened with harm by the perpetrator if they tell someone.7,20
- Some youth may fear that other adults will not believe them if they disclose.20
- Often, youth blame themselves for the abuse.20
- In some cases, youth do not understand the activity to be harmful and maintain secrecy because sexual matters are normally not discussed in their household.20
Youth affected by sexual abuse may come to the attention of an adult through indirect signals that something is wrong: age-inappropriate sexual language or behavior, avoidance of certain close family members or acquaintances, or avoidance of certain locations may all be indicators that the youth has experienced sexually abusive conduct by an adult or peer.9
The Effects of Child Sex Abuse are Severe and Far Reaching
Child sexual abuse contributes to health disparities. People who have experienced sexual abuse as children are at higher risk for numerous adverse health conditions. The impact of sexual abuse may not become evident for some individuals until later in adulthood.
- Mental health conditions such as depression, anxiety, post-traumatic stress disorder (PTSD), insomnia, and lack of trust in others are reported more often by people who have experienced child sexual abuse.1,5,10,13
- Physical health conditions such as HIV or other STDs, unintended pregnancy, alcohol or other drug abuse, hypertension, and obesity are all reported with greater frequency among people who have experienced child sexual abuse.1,6,8,13,17
Many survivors of sexual abuse overcome adverse health conditions, and can prove especially resilient when provided with therapy and other supports that empower them to take control over their lives and relationships.3,11,16,20
Child sexual abuse is found in all racial and ethnic communities in the U.S., and at all income levels. However, in some communities sexual abuse is less likely to be disclosed for several complex reasons.
Cultural taboos against talking about sexual issues may hinder the willingness of youth to disclose, or of adults to believe youth when they tell what happened.21
Highly regimented ideas about females and virginity, especially beliefs that place the burden of responsibility for a family’s honor on females, may inhibit girls from disclosing sexual abuse out of fear that they will be blamed and punished.20,21
Highly regimented ideas about males and authority, especially beliefs that adult males must be respected and deferred to, may inhibit youth of any gender from resisting or reporting adult male perpetrators.20,21
In recent-immigrant communities where some residents may not be legal citizens, disclosing sexual abuse to child protection or law enforcement authorities can be especially risky for youth as well as adults who suspect child sexual abuse, since removal of a perpetrator may jeopardize other family relations though citizenship status checks and the threat of deportation.7,21
In low-income families dependent on a sole breadwinner, such as a single mother, youth victims as well as adult witnesses may be reluctant to disclose sexual abuse for fear that the sole earner of income will be removed from the household.7,21
In communities of color in the U.S., long histories of distrust toward social welfare and law enforcement agencies may hinder the willingness of youth or adults to disclose child sexual abuse, or report suspected sexual abuse, to authorities. Racial and ethnic communities with historical experiences of discrimination stigma may be concerned that "airing dirty laundry" around the prevalence of child sexual abuse in their community could result in outsiders’ invoking such information to justify further discriminatory treatment.7,21
Preventing Child Sexual Abuse
An atmosphere of trust, confidentiality, and openness to discussing sexual issues all contribute to prevention of child sexual abuse. These social determinants also contribute to the healing and resilience of people who have experienced sexual abuse.21
School-based prevention programs that teach avoidance skills to youth show evidence that youth empowerment and safety can be increased, and also help reduce stigma and self-blame for sexually abused youth.3,22
Training of medical providers, school staff, clergy, child protection caseworkers, forensic interviewers, and law enforcement officials can increase the willingness of youth to disclose child sexual abuse as well as the willingness of adults to report suspected abuse.2,14,23
Training parents to refute common myths around "stranger danger" can help to increase their awareness of far more common (and preventable) sexual abuse risk factors in the household.18,22
Training parents to teach proper names for genitals and other reproductive organs to their youngest children can help to increase youths’ empowerment to resist sexual abuse or disclose it to trusted adults. It can also reduce shame, stigma, and self-blame for youth who have experienced child sexual abuse.22,24
Evidence is lacking that laws and policies prevent child sexual abuse when they focus on monitoring and restricting known perpetrators. There is stronger evidence that sexual abuse is prevented — rather than simply avenged &mdsah; through laws, policies, and fully-funded funded programs that focus on early identification of people at risk for committing child sexual abuse. Effective strategies help those at-risk of committing sexual abuse by confronting attitudes and behaviors that contribute to exploitation of children. Effective strategies also hold open the possibility for offenders — especially juvenile offenders whose recidivism rates are low — to re-integrate into society and establish productive and trusting relationships with family and community members.2,3,7,22
By Kurt Conklin, MPH, MCHES
Advocates for Youth © February 2012
- Arreola SG, Neilands TB, Díaz R. Childhood sexual abuse and the sociocultural context of sexual risk among adult Latino gay and bisexual men. Am J Public Health. 2009;99:s432-s438.
- Wurtele SK. Preventing sexual abuse of children in the twenty-first century: preparing for challenges and opportunities. J Child Sexual Abuse. 2009;18:1-18.
- Finkelhor D. The prevention of child sexual abuse. Future of Children. 2009;19:169-194.
- McCarthy JA. Internet sexual activity: a comparison between contact and non-contact child pornography offenders. J Sexual Aggression. 2010;16:181-195.
- Rose Wilson D. Health consequences of childhood sexual abuse. Persp in Psychiatric Care. 2010;46:56-64.
- Gwandure C. Sexual assault in childhood: risk HIV and AIDS behaviours in adulthood. AIDS Care. 2007;19:1313-1315.
- Tabachnick J, Klein A. A reasoned approach: reshaping sex offender policy to prevent child sexual abuse. Association for the Treatment of Sexual Abusers. Available at: http://www.atsa.com/sites/default/files/ppReasonedApproach.pdf. Accessed November 28, 2011.
- Newton AW, Vandeven AM. The role of the medical provider in the evaluation of sexually abused children and adolescents. J Child Sexual Abuse. 2010;19:669-686.
- Skarbek D, Hahn K, Parrish P. Stop sexual abuse in special education: an ecological model of prevention and intervention strategies for sexual abuse in special education. Sex Disabil. 2009;27:155-164.
- Barrett B. The impact of childhood sexual abuse and other forms of childhood adversity on adulthood parenting. J Child Sexual Abuse. 2009;18:489-512.
- Kress VE, Adamson NA, Yensel J. The use of therapeutic stories in counseling child and adolescent sexual abuse survivors. J of Creativity in Mental Health. 2010;5:243-259.
- Holt M, Finkelhor D, Kaufman Kantor G, et al. Hidden forms of victimization in elementary students involved in bullying. School Psychology Rev. 2007;36:345-360.
- Arreola S, Neilands T, Pollack L, et al. Childhood sexual experiences and adult health sequelae among gay and bisexual men: defining childhood sexual abuse. J Sex Research. 2008;45:246-252.
- Brady S. The impact of sexual abuse on sexual identity formation in gay men. J Child Sexual Abuse. 2008;17:359-376.
- Friedman MS, Marshal MP, Guadamuz TE, et al. A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. Am J Public Health. 2011;101:1481-1494.
- Walker EC, Holman TB, Busby DM. Childhood sexual abuse, other childhood factors, and pathways to survivors’ adult relationship quality. J Fam Viol. 2009;24:397-406.
- Jones DJ, Runyan DK, Lewis T, et al. Trajectories of childhood sexual abuse and early adolescent HIV/AIDS risk behaviors: the role of other maltreatment, witnessed violence, and child gender. J Clinical Child & Adol Psychology. 2010;39:667-680.
- Babatsikos G. Parents’ knowledge, attitudes and practices about preventing child sexual abuse: a literature review. Child Abuse Rev. 2010;19:107-129.
- Finkelhor D, Ormrod R, Chaffin M. Juveniles who commit sex offenses against minors. OJJDPBulletin. 2009;December.
- Ligiéro DP, Fassinger R, McCauley M. Childhood sexual abuse, culture, and coping: a qualitative study of Latinas. Psychology Women Qtly. 2009;33:67-80.
- Aronson Fontes L, Plummer C. Cultural issues in disclosures of child sexual abuse. J Child Sexual Abuse. 2010;19:491-518.
- Wurtele SK, Kenny MC. Partnering with parents to prevent childhood sexual abuse. Child Abuse Rev. 2010;19:130-152.
- DeMarni Cromer L, Goldsmith RE. Child sexual abuse myths: attitudes, beliefs, and individual differences. J Child Sexual Abuse. 2010;19:618-647.
- Kenny MC. Child sexual abuse prevention: psychoeducational groups for preschoolers and their parents. J for Specialists in Group Work. 2009;34:24-42.