Child sexual abuse

Child sexual abuse occurs when an adult or older child forces or coerces a child into sexual activity. In some definitions of the sexual abuse of children, the abuse hinges on the motivations of the abuser rather than on the specifics of the activity with a child; in this view the sexual abuse of a child occurs in any activity "before the age of legal consent, that is for the sexual gratification of an adult or a significantly older child". (reference for quote: Charles F. Johnson:Chapter 35 – Abuse and Neglect of Children in Behrman: Nelson Textbook of Pediatrics, 17th ed. ISBN 1416024506) There are also legal definitions of child sexual abuse, which, worldwide, is ordinarily considered a crime and therefore is variously described by different statutes and laws. It is important to note that, along with overtly sexually explicit activities, child sexual abuse can also include indecent exposure, voyeurism, and exposing a child to pornography. Physical contact is not required for the sexual abuse of a child to have occured.

Demographics: incidence and prevalence

Estimates of the number of children who endure sexual abuse vary worldwide. Some of these statistics are based on reporting by health care professionals in countries where central reporting of any suspected child abuse is mandatory by law. Because of the stigma associated with sex, and the extreme stigma associated with sexual activity in a child, not only are many cases not reported despite such laws, but there is a definite trend for adults to fail to recognize the fact that such abuse has occurred. As a result, child sexual abuse tends to go unreported. Additionally, the criteria for acts that are considered sexual abuse change a bit regionally and culturally.

USA and Canada

According to a 2004 report by the U.S. Department of Health and Human Services, 2.2% of under 4 year olds, 9.1% of 4-7 year olds, 11.4% of 8-11 year olds, and 16.5% of 12-15 year olds reported being sexually abused. It has been suggested by many health care professionals that girls are abused far more often than boys. However due to sexism, and the social connotation that abuse of boys by women is enjoyable, the sexual abuse of boys may be underreported. As a result, boys may be victims of sexual abuse just as frequently as girls.

Underreporting and statistical inaccuracies

Due to social taboo and the negative stigma associated with child sexual abuse, many children do not disclose the abuse. There are many reasons why children do this, such as fear of getting the abuser in trouble, not wanting to disrupt the family structure, or out of fear of not being believed. Additionally, threats (physical or otherwise) may be used by the abuser to keep the child from breaking the silence. Because of this, a significant number of child sexual abuse cases never get reported to the proper authorities. In turn, this makes it very difficult to gather accurate statistics, as the percentages of abused children may be much higher than what is recorded. Furthermore, if certain children are more likely to report the abuse than other children, many studies on child sexual abuse may be guilty of sampling bias; that is, certain children are either systematically or accidentally not included in the study. This is also true of many studies on child sex offenders, as many do not account for predators that have not yet been reported or have yet to go through the legal system. Lastly, studies that use questionnaires or surveys as a means of alleviating sampling bias may also be guilty of response bias. In studies such as these, the subjects may fail to answer the questions accurately due to the stigma attached to the subject; or in some cases, may fail to answer the survey at all. All of these problems combined make it very difficult to gather accurate, neutral statistics on child sexual abuse using a representative sample.

Children at high risk

Any child can be a victim of child sexual abuse. However most recent studies show that caucasian children account for the highest percentage of child sexual abuse, second being Hispanics, and third being African Americans (in the U.S.). The average age group for child sexual abuse is 8-11; with an average age of 9.9 for boys, and 9.6 for girls. Additionally, children who are on the brink of puberty are at a high risk for abuse, as many child sex offenders will take advantage of their developing sexual curiosity. Furthermore, children who lack confidence or do not have strong social support (i.e. friends, family, etc) are at a much higher risk for sexual abuse, as many fixated offenders (see below) tend to seek out such children. Lastly, children with special needs (i.e. lacking a father figure, living in poverty) are also at a higher risk for abuse because many offenders will shower such children with attention and gifts only to abuse their relationship at a more opportune time. Despite this however, it should be noted that sexual abuse occurs in both lower and upper class families, and is not limited to any specific ethnic group or any other social group.

Child sex offenders

Child sexual abuse can be perpetrated by anyone regardless of age, race, lifestyle, or any other individual factors. However, men account for the majority (96%) of child sexual abuse cases; though females can abuse as well. Furthermore, it is very common (and most probable) that the offender is either related to the child or knows the child by other means. This means adults who have a trusting relationship with the child are most likely to be an abuser; which includes aunts, uncles, cousins, teachers, coaches, etc. Additionally, child sex offenders can usually be categorized as regressed or fixated, based on the motive for their crime.

Regressed offenders

Regressed offenders are primarily attracted to adults their own age, but may be passively aroused by minors. Typically, with regressed offenders, any sexual activity in their adolescent years has been exclusively with peers their own age (not younger children). Additionally, regressed offenders tend only to offend when under times of stress, or under the influence of drugs or alcohol. Most importantly, regressed offenders are primarily attracted to adults, and would prefer an adult partner over that of a child. However when they encounter problems within their adult relationship, they may seek out a child to temporarily fulfill their sexual desires. Due to this, it would be inaccurate to refer to a regressed offender as a pedophile, as he or she is not primarily attracted to children.

Fixated offenders

Fixated offenders are much different in that their primary sexual interest is with children, not adults. Most fixated offenders meet the APA's diagnostic criteria for pedophilia, and are either primarily or exclusively aroused by prepubescent children. Fixated offenders are either not interested in or incapable of holding adult relationships, hence why they pursue relationships with children. Most sexual acts perpetrated by fixated offenders are not related to drugs or alcohol. Lastly, it should be noted that fixated offenders are not only attached to children physically, but also emotionally.

Older children and teens

Older children and teenagers are also capable of sexually abusing younger children. As long as the abuser is older, has a mental advantage, and has greater sexual knowledge than the child engaging in the act, the act can also be considered child sexual abuse. Many studies have shown that most fixated offenders recognized their attraction to children well before adulthood. Teens or older children who take younger children to secret places, excessively hug or kiss younger children who don't want such attention, or make frequent comments about the physical development of others may be exhibiting warning signs that indicate possible abuse of the younger child. It should also be noted that many children begin abusing younger children before the age of 18, and such instances are not uncommon. In many cases, children who sexually abuse younger children may have learned the behavior from being sexually abused themselves.

Homosexuals

Contrary to many popular myths, there is no conclusive evidence to prove homosexuals are at a higher risk for sexually abusing children. In the U.S., many religious and conservative organizations claim that 1/3 of sexual abuse cases involve men abusing boys, thus proving that homosexuals abuse disproportionately compared to heterosexuals. Unfortunately, many of these claims fail to address the fact that not every man who abuses a boy is a homosexual, as that is very rarely the case. Homosexual men are sexually attracted to adult men and their masculine characteristics. However of the studies done on fixated offenders, those who abuse boys are actually attracted to their lack of maturity, prepubescence, and feminine characteristics (i.e. underdeveloped muscles, lack of pubic hair, etc). Therefore, men who are primarily attracted to children (regardless of gender) are by definition, a pedophile; not a homosexual.

Intrafamilial child sexual abuse (incest)

Intrafamilial child sexual abuse refers to the sexual abuse of a minor where the offender is related by blood or marriage. It has been suggested that incestuous abuse is more often perpetrated by regressed offenders due to the motive of their crime. For example, a father may turn to his younger daughter while experiencing difficulties with his sex life; not because he's attracted to her, but because he wants to release sexual urges. In cases like this, it is much easier for an offender to abuse a child he/she is related to, than to seek out someone else's children. This differs from fixated or pedophilic offenders who typically abuse children whom they are not related to, or have very little family-related victims. Furthermore, it has been suggested that children who are abused by a close family member or relative may be less inclined to disclose the abuse. This notion is backed by the idea that incest carries a much deeper social stigma/taboo than sexual abuse alone; hence why some children may delay longer in disclosing the abuse, or may not disclose it at all.

Child grooming

In most cases, before any sexual abuse actually occurs, the abuser will usually groom the child before initiating any sexual activity. Child grooming refers to any deliberate actions taken by an adult to form a trusting relationship with a child, for the purpose of later having sexual contact. The act of grooming a child sexually may include (and usually does include) activities that are legal in and of themselves. Typically, this is done to gain the child's trust as well as the trust of other adults in the child's life. Furthermore, research has shown children are less likely to report the crime if it involves someone that the he or she knows, trusts, and cares about. Additionally, a trusting relationship with the family means the child's parents will be less likely to believe any potential accusations, or suspect the abuse. Some examples of child grooming may include:

• Taking an undue interest in someone's child.
• Giving gifts or money for no apparent reason.
• Hugging, kissing, tickling, or other physical contact even when the child does not want this attention.
• Showing pornography to the child.
• Taking the child on special outings, away from other adults.

It is important to note that many abusers will go out of their to be charming, nice, and helpful to divert attention away from their deeper motive. By assimilating themselves into a child's family life, the child's parents will feel more comfortable leaving their child unattended with the potential abuser. The period between assimilating one's self into the family, to actual sexual contact is when the grooming process takes place.

Effects of child sexual abuse

Child sexual abuse can cause permanent physical and mental damage depending on the age of the child and the force used by the abuser. Physical damage can result from penetration, which can cause lacerations or infections in the vagina or anus. Typically, any attempted penetration with a child under 11 or who is still underdeveloped will usually result in pain and bleeding. In extreme cases, child sexual abuse involving penetration may even cause damage to the child's internal organs. In addition to physical damage, child sexual abuse can also have significant mental effects on the child, that may carry into adulthood. Child sexual abuse has been linked as a possible cause for psychopathology. Additionally, other emotional damage can also result from the abuse such as depression, post-traumatic stress disorder, anxiety, poor self-esteem, Somatoform disorders, and other behavior problems or self destructive behavior. One study conducted by Widom, which controlled for possible confounding variables, found that 37.5% of the study's sexually abused subjects met the criteria for post traumatic stress disorder. However it was also noted that other family/lifestyle variables can contribute to the symptoms.

Abuse of boys by women

It has been suggested that young boys may experience double the trauma when sexually abused by an adult female, due to the widespread belief that boys either cannot be abused by women, or that they enjoyed the experience. However one study found differing results, showing that most men who had sexual relations with a woman as a boy regarded their experience as positive. Incest: Origins of the Taboo (2005) suggests that the most serious damage results from mother-son incest, compared to other incestuous relationships. Crawford claims that current societal views underestimate the reality and damage done by female sexual abusers.

Positive/negative reflections of child sexual abuse

Several studies have shown that some children may regard their experience as positive. However in many cases, those who are sexually abused as a child will view it as positive at the time, but reflect on it negatively as they enter adulthood. One such study by Urquiza (1987) found that 38% of 53 adult males regarded their sexual abuse as positive at the time, while only 15% retained this attitude. According to Coffey et al. (1996), this may be due in part to the stigma attached to child sexual abuse. In addition, Russell (1986) speculated that the perception of a sexually abusive event as 'positive' could stem from a mechanism for coping with traumatic experiences. Conversely, some researchers such as John Money, David Finkelhor, and Gabriel Holguin, have suggested that the presumption of trauma or damage can itself cause iatrogenic harm to child victims. Or in otherwords, automatically assuming that the abuse caused harm may actually create harm that otherwise, would never have existed. Browne and Finkelhor (1986) warn "advocates not [to] exaggerate or overstate the intensity or inevitability of [child sexual abuse] consequences."

Warning signs

Typically, warning signs can be detected in both the child and the abuser when sexual abuse is about to occur or has already taken place.

Emotional/behavioral warning signs in children

• Depression
• Low self-esteem
• Problems sleeping/bed-wetting
• Irrational fears of a certain place or person.

Physical warning signs in children

• Torn, stained, or bloody underwear.
• Difficulty walking or sitting.
• Redness, pain, bleeding, or bruising in the genital, vaginal, or anal area.

Behaviorial warning signs in child sexual abusers

Most child sexual abusers tend to share some common characteristics. While there are plenty of offenders who abuse children with no behavioral warning signs at all, a significant percentage of child sex offenders share these common attributes:

• Relates better to children than adults; feels more comfortable around children.
• Has few close adult friends.
• Prefers children in a specific age group.
• Usually prefers one gender over the other.
• May seek employment or volunteer opportunities with programs involving children in the preferred age group.
• Talks to children in ways that equalize their relationship.
• May offer to babysit or take children on trips where the situation can be manipulated to sleep with, bathe, or dress children.

See also

• Child abuse
• Incest
• Pedophilia
• Rape