Methodological issues in child sexual abuse research

The amount of research concerning the prevalence and consequences of child sexual abuse has increased dramatically during the past decade. Too little attention has been paid to possible methodological influences on this research. This investigation reports on the influences of response rate, ordering of questions, and definition of child sexual abuse on the results of a survey of college students' childhood and adolescent sexual experiences. Response rates affected prevalence rate estimates, and the use of varying definitions of child sexual abuse affected estimates of both prevalence and consequences. The importance of the awareness of these methodological issue in future research efforts is discussed.     

Dimensions of child sexual abuse before age 15 in three Central American countries: Honduras, El Salvador, and Guatemala

OBJECTIVE: The prevalence of sexual abuse during childhood or adolescence varies depending on the definitions and age categories used. This study examines the first national, population-based data available on child sexual abuse that occurs before age 15 in three countries: El Salvador, Guatemala, and Honduras. This study uses comparable indicators and measures of sexual abuse for the three countries to document the prevalence of abuse, types of perpetrators, and the association of child sexual abuse with recent intimate partner violence. METHODS: Child sexual abuse was defined as sexual abuse that first occurs before age 15. Nationally representative data from El Salvador, Guatemala, and Honduras were used. In El Salvador, separate questions on forced intercourse and non-penetrative sexual abuse were asked. Bivariate and multivariate analyses were performed using STATA Version 8SE. RESULTS: The prevalence of child sexual abuse varied from 7.8% in Honduras to 6.4% in El Salvador and 4.7% in Guatemala. In all three countries, the overwhelming majority of women who reported child sexual abuse first experienced the abuse before age 11. Perpetrators tended to be a family member, a neighbor, or an acquaintance. Bivariate and multivariate analyses indicated that women who experienced child sexual abuse in Guatemala and Honduras were about two times more likely to be in violent relationships as women who did not experience abuse. This relationship was not significant in multivariate analyses for El Salvador where the prevalence of intimate partner violence was the lowest. CONCLUSIONS: Child sexual abuse in Central America is clearly a problem with the prevalence between 5% and 8%. Child sexual abuse can have long-term negative health impacts including exposure to intimate partner violence in adulthood. Programs to prevent abuse and treat victims of child sexual abuse are needed in Central America.     

Childhood experience of sexual abuse among Hong Kong Chinese college students

OBJECTIVES: This study aimed to explore the prevalence rate and profiles of abusers and victims of child sexual abuse in a Chinese society. METHOD: A convenience sample of 2,147 Hong Kong Chinese college students completed questionnaires which included items on definitions of child sexual abuse, recall of sexual abuse experience before age 17, information about the sexual abuse incidents, and personal demographics. RESULTS: The overall prevalence rate for various forms of child sexual abuse was 6%, with the rates being higher for females than for males. The average age of the victims at the time of the sexual abuse was 11 years old, with a majority of them experiencing sexual abuse during their teenage years. The average age of the abusers as estimated by the victims was 24 years old, and only 28% of the abusers were strangers to the victims. Males were about three times more likely than females to be sexually abused by their friends, whereas females were about twice more likely than males to be sexually abused by strangers. Only 39% of the victims reported their sexual victimization to others, and 56% of the reported incidents were not followed up. CONCLUSIONS: As compared to Western studies, the present study showed lower rates for more intimate or severe forms of child sexual abuse. The Chinese victims were more reluctant to disclose their sexual victimization than their Western counterparts. Limitations and practical implications of the study are also discussed.     

Sexual abuse in the national incidence study of child abuse and neglect: An appraisal

The National Incidence Study of Child Abuse and Neglect was a major, government sponsored effort to collect data on reported and unreported child abuse. It used a systematic representative sample methodology and very precisely developed definitions of child abuse. This paper reviews some of the main limitations of the study in regard to findings on sexual abuse. First, there is probably less “new” data in the study on sexual abuse than on other forms of abuse, since so many of the study cases of sexual abuse were “officially reported” cases. In addition, the study limited its definition of sexual abuse only to cases where a caretaker was the perpetrator, a definition that is much more restrictive than what is used in many treatment programs. Finally, the data on perpetrators has a number of problems that stem from the study's definitions of sexual abuse. The paper makes suggestions for future incidence type studies of sexual abuse.     

Explaining lower rates of sexual abuse in China

Accumulating research suggests that rates of child sexual abuse are comparatively low in China. This commentary is an effort to evaluate whether it reflects a true lower prevalence or alternatively the effect of inhibited disclosure by victims. We conclude that while some estimates have almost certainly been affected by inhibited disclosure, the overall magnitude of the contrast between Chinese and international rates, particularly for girls, and its consistency with other indicators do suggest a true lower prevalence, although the evidence is equivocal. We discuss some factors that could account for such lower rates including Confucian family values, definitions of masculinity and a collectivist culture that may be protective.     

Sexual interest in children,child sexual abuse,and psychological sequelae for children

This article reviews the literature on sexual victimization of minors and the role of school psychologists in assessing and intervening with sexually abused minors. Although estimates of child sexual abuse prevalence differ widely owing to disclosure biases and the definitions that researchers have used in studying it, it is clear that child sexual abuse is a serious public problem. Also troubling is the extent to which “normal” adults, especially males, exhibit sexual interest in children, suggesting that a substantial number may be at risk for victimizing minors; fortunately, a variety of inhibitory mechanisms prevent most adults from committing this crime. Although victims typically suffer from sexual abuse, surprisingly, some evidence suggests that victims of sexual abuse can exhibit neutral or even positive outcomes, a controversial finding that has numerous possible explanations. Tragically, childhood sexual abuse may lead the victim to become an abuser later in life, sometimes while still a minor. We suggest directions for future research. © 2001 John Wiley & Sons, Inc.     

Child sexual and physical abuse among college students in Singapore and the United States

OBJECTIVES: The purpose of this study was to explore differences in rates and characteristics of child sexual and physical abuse experiences among women in Singapore and the US. METHOD: Participants (N=153) completed an anonymous questionnaire which assessed experiences of childhood sexual and physical abuse, abuse characteristics (e.g., victimization age, severity), and behavioral and subjective reactions to such experiences (e.g., labeling of experiences as abuse, psychological symptomatology). Exposure to other forms of traumatic life events was also assessed. RESULTS: In comparison to Singaporean women, US women were more likely to report a history of child sexual abuse, and to report experiencing more severe forms of sexual abuse. Women in Singapore were more likely than women in the US to report a history of child physical abuse, to report experiencing injury as a result of the abuse, and to disclose the abuse. Singaporean women with a history of child sexual abuse reported elevated psychological symptom levels relative to their nonabused peers and to US women with a history of child sexual abuse, even after controlling for exposure to other types of traumatic events. No significant differences in symptomatology with regard to child physical abuse were observed. CONCLUSIONS: Although preliminary in nature, the present findings are among the first to demonstrate differences in psychological adjustment between sexually abused and nonabused Asian women living in Asia. This study also provides some of the first support for cross-national differences in the psychological adjustment of child sexual abuse survivors.     

Childhood sexual abuse among university students in Tanzania

OBJECTIVES: There are no prevalence data for childhood sexual abuse among Tanzanian university students. This investigation addressed this paucity. The nature of sexual abuse was also investigated. METHOD: Participants (N=487) from a university in Tanzania completed a questionnaire which assessed abusive childhood sexual experiences, gathering information about age of victim, duration of abuse, perpetrators, amount of force or persuasion involved, and potential causes of child sexual abuse. A number of individuals were also interviewed about their experiences. RESULTS: The overall prevalence rate for child sexual abuse was 27.7%, with rates being higher for females than for males. The average age of the victim when abuse occurred was 13.8 years. Perpetrators were generally unidentified by respondents; nonetheless, a surprisingly high proportion of female perpetrators was noted. There was a considerable amount of force or persuasion involved in the abusive behavior: betrayal of trust, bribes and physical force were cited frequently. Poverty and superstition were the primary explanations given for child sexual abuse. CONCLUSION: The study provides evidence for the existence of child sexual abuse in Tanzania. Poverty feeds the "sugar daddy/mammy" phenomenon and combined with various forms of superstition is an important factor in child sexual abuse in Tanzania.     

Childhood sexual experiences among substance-using non-gay identified Black men who have sex with men and women

This study explored potential variations in childhood sexual abuse (CSA) by examining qualitative accounts of first sexual experiences among non-disclosing, non-gay identified Black men who have sex with men and women (MSMW). We analyzed data from semi-structured qualitative interviews with 33 MSMW who described first sexual experiences with male and female partners. Thematic analysis revealed four patterns of first sexual experiences including: unwanted sexual experiences with a male or female consistent with definitions of childhood sexual abuse; consensual sex with an older male or female; bodily exploration with another male or female child; and consensual sex with a peer-age female. Most of the experiences described by participants as consensual with an older male or female, however, met criteria for childhood sexual abuse found in the extant literature. Several men discussed childhood sexual experiences (CSE) relative to their experiences with alcohol, drugs, and same-sex behavior as adults. Findings suggest that the relationship between CSE and risk-taking behavior may be shaped by whether men perceive their experiences as abusive or consensual, and have implications for researchers, treatment providers and counselors.     

Reporting rates of child sexual abuse in Indigenous communities in two Australian jurisdictions

Child sexual abuse is a significant problem in many Indigenous communities; there is also evidence of chronic under-reporting of this crime. This study aimed to compare reporting rates between Indigenous and non-Indigenous cases of child sexual abuse across two Australian jurisdictions. Datasets comprising child sexual abuse reports from the Police Information Management Systems of the two jurisdictions were used to calculate reporting rates, and to compare case characteristics and case progression. Results indicated that the reporting rate for child sexual abuse of Indigenous children was between two and four times that of non-Indigenous children. In the Indigenous cases, the second jurisdiction had lower reporting rates than the first jurisdiction. Further analysis of the Indigenous cases only found that cases in the second jurisdiction were more severe, more likely to have a forensic interview, and more likely for the suspect to be charged, than in the first jurisdiction. However, there were no significant differences in conviction rates between the two jurisdictions. Differences observed in severity and case progression suggest that the lower reporting rates observed in the second jurisdiction may be due to comparatively high levels of under-reporting, rather than lower actual levels of child sexual abuse. In conclusion, reporting rates of child sexual abuse can be better understood when further information, such as case characteristics and case progression rates, is available.     

Two approaches to the handling of child abuse: A comparison of the English and Dutch systems

The legal and administrative systems for handling child abuse cases in England and The Netherlands are briefly described and it is argued that the two systems illustrate respectively the “legal” and “medical” models. The implications for this in practice are contrasted. In England the stress is on careful adherence to criteria for abuse, on procedures for placing children's names on child abuse registers, and removing them if they are no longer at risk, while in The Netherlands the stress is on family need with the abusive incident being regarded as no more than a signal that help is needed. This allows a much wider definition of abuse. In England sexual and emotional abuse are still relatively rarely used as grounds for intervention whereas in the Netherlands concepts such as “cognitive abuse” and “sexual neglect” are gaining currency. Other implications of the models such as differences in attitudes to confidentiality and public attitudes to authority and to seeking help are considered, as are the consequences for incidence figures. The handling of two cases with very similar circumstances are compared. Finally, it is argued that while each system might present the other with new ideas, the systems have to be seen in the social context of the two countries and neither system is likely to appear superior to professionals in the other country.     

The prevalence and circumstances of child sexual abuse: changes across a decade

OBJECTIVE: This study reports the prevalence of child sexual abuse of African American and European American women and compares the circumstances of these incidents to data collected a decade ago. METHOD: Stratified probability sampling was used to recruit comparable samples of African American and European American women in Los Angeles County for a larger study of women's sexual decision making. Incidents of contact abuse were obtained from women 18 to 36 years old in 1994 and compared to women with those demographic characteristics from a comparable 1984 dataset. The prevalence of abuse, characteristics of the victim, assault, alleged perpetrator, disclosure, and long-term effects by ethnic group affiliation were assessed. RESULTS: Of the total sample, 34% reported at least one incident prior to age 18. Ethnic differences were found with respect to prevalence, location of abuse, and number of incidents of rape. While comparisons made with the 1984 dataset revealed no significant difference in prevalence rates over the 10 year period, changes in circumstances were noted. CONCLUSIONS: Although the prevalence of child sexual abuse in Los Angeles County remained fairly stable, several circumstances of abuse underwent change. These characteristics are discussed in relation to how sexual abuse among ethnically diverse samples in Los Angeles County has changed over a decade and how these differences can help better tailor prevention messages to different communities.     

The international epidemiology of child sexual abuse: A continuation of Finkelhor (1994)

ObjectiveThe purpose of this paper was to compare the prevalence rates of child sexual abuse reported by [Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18 (5), 409–417] with those found in recent publications in order to confirm the widespread prevalence of child sexual abuse.MethodsRelevant articles about prevalence of child sexual abuse were identified through searches of computerized databases and a handsearch of Child Abuse & Neglect and the Journal of Child Sexual Abuse.ResultsThirty-eight independent articles were identified, corresponding to 39 prevalence studies; these articles report the prevalence of childhood sexual abuse in 21 different countries, ranging from 0 to 53% for women and 0 to 60% for men.ConclusionsComparison of the present study with that of [Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18 (5), 409–417] shows a similarity between prevalence distributions; there appears to be a general pattern that remains more or less constant over the years, especially in women.Practice implicationsTwelve years after the first revision study about the international prevalence of child sexual abuse, there is still a need for new data about this topic. The present study shows child sexual abuse is still a widespread problem in the society. In this research, carried out on 38 independent studies, there is new data for 21 countries over the world, being especially relevant the results obtained from other countries different from those pertaining to North America or Europe. It is important to point out the high prevalence found in most of the countries, so this information could be a new warning to make society and governments aware of this problem and undertake actions to prevent sexual abuse in childhood.     

Child emotional aggression and abuse: definitions and prevalence

Objective

Research on and intervention for child emotional abuse and emotional aggression toward children have been severely hampered because there have been no agreed-upon, clinically usable definitions.

Methods

We have (a) proposed and field-tested a set of criteria to operationally define child emotional abuse for clinical settings and (b) used these criteria to design a parent-report measure of parental emotional aggression and child emotional abuse that could be used in research. In this paper, we review the development and field trials of these criteria for making substantiation decisions.

Results

Agreement between master reviewers and field decisions was extremely high in a 5-site development trial (96% agreement, κ = .89) and a 41-site dissemination trial (90% agreement, κ = .73). We compare these criteria to other research criteria in the literature. We then present data collected using a self-report measure designed to parallel these criteria from an anonymous online survey of US Air Force personnel and their spouses. The final sample (N = 52,780) was weighted to be representative of the United States civilian population. The prevalence of parents’ emotionally aggressive acts was much higher than the prevalence of emotional abuse (acts plus impact), but rates of parents’ acts of emotional aggression were lower than those typically reported in the literature. Additional analyses tested for differential effects due to gender of perpetrator (i.e., mothers or fathers), age of victim, and clustering within families. These factors did not drive rates of aggression or abuse.

Conclusions

In sum, the criteria developed and proposed appear to support reliable clinical decision making regarding child emotional abuse and can be translated to research survey tools that better capture the continuum of parents’ emotional aggression and child emotional abuse than the measures that are currently available, advancing the state of the science with respect to child emotional abuse.     

The incidence and prevalence of intrafamilial and extrafamilial sexual abuse of female children

Data obtained from a random sample of 930 adult women in San Francisco provide the soundest basis heretofore available for estimating the prevalence of intrafamilial and extrafamilial sexual abuse of female children. This article describes the methodology of this survey, as well as some of the key findings. For example: 16% of these women reported at least one experience of intrafamilial sexual abuse before the age of 18 years; 12% reported at least one such experience before the age of 14 years; 31% reported at least one experience of extrafamilial sexual abuse before the age of 18 years; and 20% reported at least one such experience before the age of 14 years. When both categories of sexual abuse are combined, 38% reported at least one experience before the age of 18 years; and 28% reported at least one such experience before the age of 14 years. Only 2% of the cases of intrafamilial and 6% of the cases of extrafamilial child sexual abuse were ever reported to the police. A plea is made for the urgent need to recognize the magnitude of the problem of child sexual abuse, and to act to prevent it.     

Methodological considerations in research on the prevalence of child sexual abuse

Recent studies with nonclinical populations have yielded widely varying estimates of the prevalence of child sexual abuse. This paper focuses on four representative studies, describing how differences in methodology and sample characteristics may contribute to the variation in prevalence rates. Two aspects of data collection appear to be the most significant factors accounting for discrepant findings. First, the use of face-to-face interviews is associated with much higher prevalence rates than the use of self-administered questionnaires. Second, higher prevalence rates are reported in studies that use multiple questions to ask about specific types of abusive sexual behavior. Variation in the age range of subjects is an additional factor that may also have an effect on prevalence rates. The evidence reviewed points to several aspects of methodology and sample characteristics that do not seem to influence prevalence findings. These are the use of random sampling techniques, the area of the country in which the study is conducted, the educational level of subjects, and the ethnic composition of the sample.     

“His body is human,but he has a tiracchāna heart”: An ethnographic study of the epigenesis of child abuse in Cambodia

In Cambodia, more than half of all children experience physical, emotional, or sexual abuse. This article examines how Cambodians view the causes and effects of child abuse and analyses its underlying cultural forces. Adopting a conceptual framework originally developed for the cultural context of violence against women, 110 cases of child abuse were ethnographically studied, comprising 61 cases of sexual abuse (50 girls and 11 boys), 26 cases of physical abuse (13 girls and 13 boys), and 23 cases of emotional abuse or neglect (13 girls and 10 boys). The perpetrators included fathers and other close relatives, lay Buddhist officiants and monks, and neighbors. Most informants viewed the sexual or physical abuse of children as stemming from “cultural attractors,” including blighted endowment caused by deeds in a previous life, a bad character starting early in life, astrological vulnerability to abuse, preordained entanglement between the child and the abuser (they are “fated” to meet), sexual craving, “entering the road to ruin,” and a moral blindness that portrays the abuser as blameless. Although these traits are similar to those identified in the explanations of violence against women, there were notable differences such as the role of the tiracchāna in explaining sexual abuse, including incest. Using these findings, this article identifies a cultural epigenesis of child sexual abuse, and provides a blueprint for developing a culturally responsive plan to prevent child abuse.     

Conceptualization, reporting and underreporting of child abuse in Hong Kong

OBJECTIVE: To understand the conceptualization of child abuse and attitudes on reporting behaviors of Hong Kong adults. METHODS: Cross-sectional telephone survey of 1,001 randomly selected subjects. MAIN RESULTS: There is a discrepancy between perceived prevalence and the ability to name different child abuse types without prompting: 79.9% named physical abuse, while 41.2% felt it was common: 21.0% named child neglect, while 76.9% felt it was common; 13.4% named psychological abuse, while 47.4% felt it was common; 6.8% named sexual abuse, while 23.5% felt it was common. Most respondents classified severe physical abuse situations as abusive (e.g., "severely injuring a child"). Other scenarios such as "mildly injuring a child" and neglect and psychological abuse scenarios (e.g., "leaving a young child alone at home" and "shouting at a child often") were often not classified as abusive. As regards case-reporting behavior, only about 40% would report abuse cases to authorities. Those who would not report abuse were less likely to classify abuse situations as abusive and more likely to think that seeking help is difficult, troublesome and unhelpful. CONCLUSIONS: The official reported prevalence figures for child abuse in Hong Kong should be interpreted with care, because underreporting is likely to be serious. Hong Kong people's conceptualization and awareness of what comprises child abuse is found to differ from official definitions. They are reluctant to report abuse cases, due to their perceived low efficacy of case reporting. Both the difference in conceptualization and the reluctance to report might partly be attributable to Chinese culture.     

Patterns of child abuse and neglect associated with chronological age of children living in a midwestern county.

OBJECTIVE: The main objective of the study was to investigate the relationship between age of the very young victim and the type of abuse perpetrated against that victim. A secondary objective was to examine gender and racial differences in child abuse and neglect in children between the ages of birth and 7 years. METHOD: Archived data for all cases of substantiated abuse of children for the years of 1990-1996 inclusive were retrieved from a data bank at a county children services department (N = 876). Chi-square analyses were used to determine age, gender, and racial differences in child abuse and neglect in children 0 to 7 years of age. RESULTS: Neglect was the most common form of primary substantiated abuse recorded for this population of children under the age of 7 years, although the incidence of neglect decreased as chronological age of the child increased. Sexual abuse increased in occurrence as the children got older. Girls were more likely to be victims of sexual abuse than boys. No significant age differences were observed for physical abuse or for emotional abuse, and no racial differences were detected for any of the four types of abuse examined. CONCLUSIONS: Although the findings of this study are in agreement with those of previously published reports, there is some question as to whether archived data are an accurate reflection of actual patterns of maltreatment occurring in very young children or whether they represent the types of abuse that are subjectively identified and reported by authorities.