Inevitably, in a wide ranging review, there will be some important omissions. The main difficulties in assessing the available information have been the lack, in so many studies, of analysis along gender lines, the lack of control groups, and, in many instances, too small sample size. Despite these limitations there has, over the past decade, been an upsurge of interest in and awareness of the significance of the sexual abuse of boys. It permits us to identify a number of important trends and to draw certain conclusions. Firstly, the scale of the sexual abuse of boys is much greater than was believed 10 years ago. There is no reason to think this is simply an artifact of definition, or information gathering, or indeed of an increased willingness to recognize abusive behaviour between children, even though these will all have an effect. Whilst the trend is clear, the actual prevalence rate is difficult to determine, with a reported range of between 3% and 31%. A current 'best guess' suggests contact abuse in the range of 2-5% in the male population. As each study controls for its own definition of abuse, the narrowing in the ratio of boys to girls abused can be accepted as quite reliable, and additional evidence of a delayed recognition effect. Retrospective community evidence shows 1 boy is abused for every 2-4 girls abused. In contrast, the highest clinical ratios are for 1 boy to every 4 girls. Those who work with runaways, male child prostitutes, or child and adolescent psychiatric inpatient units appear particularly likely to encounter abused boys. Secondly, a variety of explanations have been advanced to explain the apparent under-reporting or under-detection of the sexual abuse of boys. Prominent among them have been the boy's fears of disbelief and of being labelled homosexual. Police patterns of reporting extra-familial abuse may mask its extent from protection or health agencies, which is important because extra-familial abuse does appear to be more common in boys, especially older boys, than girls. Although there has been some diminution of the cultural denial that girls can be abused, a parallel decrease of denial regarding boys has lagged behind. This is particularly true of father-son and of the much less common mother-son abuse. It is plausible that certain 'alertors' are more relevant for boys. The recent development of aggressive behaviour, homophobic anxiety, co-abuse of a sibling and abusing behaviour in particular deserve consideration.(ABSTRACT TRUNCATED AT 400 WORDS)

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It is important that these observations are put into context: the clinical case histories, all based on real patients, were selected to prompt value judgments to estimate the value placed by the correspondents on factors such as "antisocial behaviour"-criminal behaviour and drug or alcohol misuse. The general public, unlike the clinicians, have probably not considered in depth the implications of donor shortage; furthermore, the case histories had to be brief and oversimplified. It was, in part, for this reason that we arranged for two focus groups. There are methodological concerns too. We used quota rather than random sampling; random sampling is purer but requires more respondents and more resources. The quota sampling used has been found to be robust and consistent over time.We are grateful to all those who helped by taking part in this survey. We thank Miss Jayne Folwarski, Queen Elizabeth Hospital, Birmingham, for facilitating the study and Mr Brian Gosschalk, managing director, MORI, for his help and support.Contributors: JN initiated the project and developed the ideas with DA and PMacM; the questionnaires were developed with AM and MS, who conducted the focus groups and analysed the findings.Funding

Summary The experience of a workshop set up within a Department of Child Psychiatry to foster family therapy and to develop a brief focal technique is described. Details are provided of the first 29 cases. Twenty‐two families engaged in therapy and the referred child improved in 19 (87%) of these cases. Family change was measured using a methodology developed by Malan to assess psychodynamic change in individuals and problems in adapting it are discussed. Eleven (50%) of the engaged famines improved. The pattern of child and family improvement supported the theory that a symptomatic child can be a manifestation of family pathology. A contraindication to the brief focal approach is past or present formal mental illness in a parent. Marital disturbance was frequently covert: this affected the therapeutic plan but was not related to outcome.

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The characteristics of a series of 274 families who were referred to a sexual abuse treatment programme were analysed. Information was obtained on 411 abused children and 362 non-abused children. Different forms ofsexual abuse were noted, with 77% of girls and 23% of boys affected. Boys tended to be abused at a younger age, more severely, and for longer periods than girls. There was a predominance of lower social class groups among the parents, and a wide variety of family structures, with reasonable stability over time. Ninety six per cent ofperpetrators were men, and biological and step-parents predominated. Contributing factors in both the family history and the current perpetrators and their wives included sexual abuse, violence, chaotic families, marital problems, sexual difficulties, alcoholism, and subnormality.Follow up of 120 families, 180 victims, and 226 siblings showed that prosecution occurred in 60% ofcases, with a high percentage of perpetrators being imprisoned. Treatment was offered to 87% of families, but because the treatment programme was in the early stages of development a variable number of children and parents were offered family treatment or treatment in groups for parents and children separately. There was an improvement in the victim's circumstances in 61% of cases, and a noticeable

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