How Much Child Sexual Abuse is “Below the Surface,” and Can We Help Adults Identify it Early?

Abstract

Child sexual abuse (CSA) occurs frequently in society to children aged between 2 and 17. It is significantly more common in girls than boys, with the peak age for CSA occurring when girls are aged 13–17. Many children experience multiple episodes of CSA, as well as having high rates of other victimizations (such as physical assaults). One of the problems for current research in CSA is different definitions of what this means, and no recent review has clearly differentiated more severe forms of CSA, and how commonly this is disclosed. In general we suggest there are four types of behavior that should be included as CSA, namely (1) non-contact, (2) genital touching, (3) attempted vaginal and anal penetrative acts, and (4) vaginal and anal penetrative acts. Evidence suggests that CSA involving types (2), (3), and (4) is more likely to have significant long-term outcomes, and thus can be considered has having higher-impact. From the research to date approximately 15% of girls aged 2–17 experience higher-impact CSA (with most studies suggesting that between 12 and 18% of girls experience higher-impact CSA). Approximately 6% of boys experience higher-impact CSA (with most studies suggesting that between 5 and 8% experience higher-impact CSA). The data also suggests that in over 95% of cases the CSA is never disclosed to authorities. Thus, CSA is frequent but often not identified, and occurs “below the surface” in the vast majority of higher-impact cases. Helping adults to understand “below the surface” CSA might help them to recognize it early, but there are very few indicators specific to CSA, making this a challenging goal to achieve. Nonetheless, given that CSA frequently occurs with other types of abuse, a training program that focuses on both CSA and other abuse may offer a method to allow both early recognition and prevention by adults in the general population.

An epidemiological overview of child sexual abuse

“…In the age-group of 2–17 years, nearly 15% of girls and 6% of boys face severe consequences of CSA. [6]…”

“…[346912] The overall prevalence is seen to be high among both gendersthough studies suggest girls are more prone than boys[346910111219203132], few studies report that there is no difference[16], while some others report males to be more prone. [18] In most (95%) of the cases, the perpetrator is known to the child (relatives, neighbors, step parents, highly trusted people).…”

“…The estimates vary widely depending on the country under study, the definitions used, the type of CSA studied, the extent of coverage, and the quality of data. [1456] However, sexual violence is seen to occur in all ages, in all socioeconomic classes, and nearly in all countries with differences in the magnitude. [4] Hence, this study intended to provide a brief overviewof CSA to enhance the awareness of primary care physicians, policy makers, counsellors, police personnel, teachers, and the community.…”

Height deficit in early adulthood following substantiated childhood maltreatment: A birth cohort study

“…The use of legally defined cases are likelyto underestimate the true prevalence of childhood maltreatment (Theodore et al, 2005) and may account for the observed weak associations, particularly for sexual abuse (Martin and Silverstone, 2013). Maltreated children may have substantially higher rates of early alcohol and tobacco use (Mills et al, 2014), possibly gateways to subsequent cannabis use (Fergusson et al, 2006).…”

“…In contrast to prior studies (Hayatbakhsh et al, 2009), however, sexual abuse was not significantly associated with cannabis use disorders. For instance, it is possible that sexual abuse is underreported (Martin and Silverstone, 2013) because of inconsistent definitions (Martin and Silverstone, 2013), secrecy (Polonko, 2006) and stigma . Conversely, the nature and severity of sexual abuse (Hahm et al, 2010;Kendall-Tackett and Becker-Blease, 2004), may mean that it is more likely to be reported and attract an agency response before there is progression to long-term disorders (Kendall-Tackett and Becker-Blease, 2004) involving cannabis use.…”