Child Sexual Abuse: What Can We Do?

During April, we recognize National Child Abuse Prevention Month and the importance of communities working together to support and strengthen families and prevent child maltreatment. Throughout the year, communities are encouraged to increase awareness about child and family well-being and work together to implement effective strategies that support families and prevent child abuse and neglect. 

An important topic that many people do not speak about is the sexual abuse of children. It is an uncomfortable conversation to have, however, closing off the narrative leads to a lack of disclosure, processing, and healing. The lack of awareness, education, and open dialogue leads to a much harder path to recovery for victims. By making our own lives more comfortable, the lives of the victims become significantly more challenging. 

 Child sexual abuse (CSA) is a prevalent problem, with just over 10% of the population suffering from this kind of abuse (Peréz-Fuentes et al., 2013). Among U.S. children, one in five girls and one in 20 boys experience CSA before the age of 18 (Finkelhor et al., 2014). Adverse outcomes for victims of CSA include mental health issues such as depression, suicidality, low self-esteem, and PTSD (McCutcheon et al., 2010). Many behavioral issues like risky sexual behavior and substance use have also been linked to victims of CSA (Konkolÿ Thege et al., 2017). 

A large concern surrounding CSA is a lack of education and awareness. Children must be better educated about grooming techniques, warning signs among their peers, and basic definitions of sex and anatomy. Adults must be educated to see warning signs, properly intervene, and reduce stigma. It is important for adults to listen when children talk about potential CSA.  

Therapists can utilize brief screening tools (e.g., SPAQ) in early sessions to identify individuals who may have experienced CSA. Once confirming the existence, the Child Sexual Abuse Assessment Tool can be utilized to determine appropriate developmental sexual behavior. Therapists can then educate clients on the prevalence of CSA, normalize their experience, and encourage open communication between partners, children, or parents. With cultural competency in mind, therapists can psychoeducate parents on the benefits of speaking candidly about the trauma that has occurred. Concerns about re-traumatization can be addressed, and realistic goals for treatment can be established. For therapists working in school settings, it is of the utmost importance to implement psychoeducation seminars for students and adults who are in and around the campus. Topics of discussion can include appropriate touch and terminology, warning signs, and how to approach a suspected victim.  

Those who have experienced sexual trauma are almost four times more likely to develop a substance use disorder (SUD) due to PTSD than their counterparts (Levin et al., 2021). Research indicates that individuals with PTSD are more likely to have chronic medical conditions, physical health problems, and cognitive impairments (O’Doherty et al., 2015).  

Therapists play a crucial role in alleviating the harmful consequences surrounding victims and their families. The most common intervention for CSA is Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), which aims to reduce traumatic symptoms such as anxiety, hypervigilance, depression, experiential avoidance, and intrusive thoughts (Liotta et al., 2015). Including the caregiver in sessions helps build support, increases communication about the trauma, and teaches coping skills. With consent from parents, therapists can also educate children on appropriate sexual behavior, terminology, and feelings towards themselves or others depending on their developmental status. Illuminating the need for therapy throughout these different developmental stages will ensure victims receive adequate care as they mature. Through a systemic approach and early interventions, victims have a better chance of healing before maladaptive behaviors develop. 

Many victims do not disclose, or they minimize their experiences of CSA (McLean et al., 2014). In one study, 19% of participants disclosed their abuse after a year had passed, and 26% had not disclosed it (Kogan, 2004). Unsurprisingly, there are a variety of factors contributing to low disclosure rates. Both age and gender are significant predictors in that younger children are less likely to disclose than older children and boys appear to be more reluctant to disclose than girls (McElvaney, 2015). In 91% of cases, the perpetrator is someone known and trusted by the victim or family (CDC, 2022). Children who are abused by a family member are less likely to disclose and more likely to delay disclosure than those abused by someone outside the family (McElvaney, 2015).  

It is essential to bring more awareness about CSA to the general population. Focused training should be provided to anyone working with children, clarifying how to approach suspected victims. Opening the dialogue is essential; while it is uncomfortable, it can be helpful for the growth and healing of victims.  

 References  

 Centers for Disease Control and Prevention (CDC). (2022). About child sexual abuse. https://www.cdc.gov/child-abuse-neglect/about/about-child-sexual-abuse.html?CDC_AAref_Val=https://www.cdc.gov/violenceprevention/childsexualabuse/fastfact.html 

 Finkelhor, D., Shattuck, A., Turner, H. A., & Hamby, S. L. (2014). The lifetime prevalence of child sexual abuse and sexual assault assessed in late adolescence. Journal of Adolescent Health, 55(3), 329–333. https://doi.org/10.1016/j.jadohealth.2013.12.026 

Kogan, S. M. (2004). Disclosing unwanted sexual experiences: Results from a national sample of adolescent women. Child Abuse & Neglect, 28(2), 147-165. https://doi.org/10.1016/j.chiabu.2003.09.014 

 Konkolÿ Thege, B., Horwood, L., Slater, L. et al. (2017) Relationship between interpersonal trauma exposure and addictive behaviors: a systematic review. BMC Psychiatry, 17, 164. https://doi.org/10.1186/s12888-017-1323-1 

 Levin, Y., Lev Bar-Or, R., Forer, R., Vaserman, M., Kor, A., & Lev-Ran, S. (2021). The association between type of trauma, level of exposure and addiction. Addictive Behaviors, 118, 106889. https://doi.org/10.1016/j.addbeh.2021.106889 

 Liotta, L., Springer, C., Misurell, J. R., Block-Lerner, J., & Brandwein, D. (2015). Group treatment for child sexual abuse: Treatment referral and therapeutic outcomes. Journal of Child Sexual Abuse: Research, Treatment, & Program Innovations for Victims, Survivors, & Offenders, 24(3), 217-237. https://doi-org.chapman.idm.oclc.org/10.1080/10538712.2015.1006747 

 McCutcheon, V. V., Sartor, C. E., Pommer, N. E., Bucholz, K. K., Nelson, E. C., Madden, P. A. F., & Heath, A. C. (2010). Age at trauma exposure and PTSD risk in young adult women. Journal of Traumatic Stress, 23(6), 811-814. https://doi.org/10.1002/jts.20577 

 McElvaney, R. (2015). Disclosure of child sexual abuse: Delays, non‐disclosure and partial disclosure: What the research tells us and implications for practice. Child Abuse Review, 24(3), 159-169. https://doi-org.chapman.idm.oclc.org/10.1002/car.2280 

 McLean, C. P., Morris, S. H., Conklin, P. et al. (2014) Trauma characteristics and posttraumatic stress disorder among adolescent survivors of childhood sexual abuse. J Fam Viol 29, 559-566. https://doi-org.chapman.idm.oclc.org/10.1007/s10896-014-9613-6 

 O’Doherty, D. C., Chitty, K. M., Saddiqui, S., Bennett, M. R., Lagopoulos, J. (2015). A systematic review and meta-analysis of magnetic resonance imaging measurement of structural volumes in posttraumatic stress disorder. Psychiatry Research: Neuroimaging, 232(1), 1-33. Recent systematic review and meta-analysis of structural brain changes in PTSD. 

 Pérez-Fuentes, G., Olfson, M., Villegas, L., Morcillo, C., Wang, S., & Blanco, C. (2013). Prevalence and correlates of child sexual abuse: A national study. Comprehensive Psychiatry, 54(1), 16–27. https://doi.org/10.1016/j.comppsych.2012.05.010