Child sexual abuse
Child sexual abuse (CSA), also called child molestation, is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation.[1][2] Forms of child sexual abuse include engaging in sexual activities with a child (whether by asking or pressuring, or by other means), indecent exposure, child grooming, and child sexual exploitation,[3][4][5] such as using a child to produce child pornography.[1][6]
"Child sex offender" redirects here. For sex crimes committed by minors, see Juvenile sex crimes.
CSA is not confined to specific settings; it permeates various institutions and communities. CSA affects children in all socioeconomic levels, across all racial, ethnic, and cultural groups, and in both rural and urban areas. Schools, homes, and online spaces are just a few contexts where minors are vulnerable to abuse and exploitation.(in places where child labor is common). Child marriage is one of the main forms of child sexual abuse; UNICEF has stated that child marriage "represents perhaps the most prevalent form of sexual abuse and exploitation of girls".[7] The effects of child sexual abuse can include depression,[8] post-traumatic stress disorder,[9] anxiety,[10] complex post-traumatic stress disorder,[11] and physical injury to the child, among other problems.[12] Sexual abuse by a family member is a form of incest and can result in more serious and long-term psychological trauma, especially in the case of parental incest.[13]
Before the age of 18, 1 in 5 children are sexually abused, this equates to more than 1 million children will be sexually abused this year.[14][15] Reports by the Centers for Disease Control and Prevention, reveal that about 1 in 4 girls and 1 in 20 boys in the United States experience child sexual abuse.[14] One study found an estimated 19.7% of females and 7.9% of males experienced some form of child sexual abuse prior to the age of 18.[16] Most sexual abuse offenders are acquainted with their victims; approximately 30% are relatives of the child, most often brothers, fathers, uncles, or cousins;[17] around 60% are other acquaintances, such as "friends" of the family, babysitters, or neighbors; strangers are the offenders in approximately 10% of child sexual abuse cases.[18] Most child sexual abuse is committed by men; studies on female child molesters show that women commit 14% to 40% of offenses reported against boys and 6% of offenses reported against girls.[18][19][20]
The word pedophile is commonly applied indiscriminately to anyone who sexually abuses a child,[21] but child sexual offenders are not pedophiles unless they have a strong sexual interest in prepubescent children.[22][23] Under the law, child sexual abuse is often used as an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a minor or exploits a minor for the purpose of sexual gratification.[6][24] The American Psychological Association states that "children cannot consent to sexual activity with adults", and condemns any such action by an adult: "An adult who engages in sexual activity with a child is performing a criminal and immoral act which never can be considered normal or socially acceptable behavior."[25]
Effects
Psychological
Child sexual abuse can result in both short-term and long-term harm, including psychopathology in later life.[12][26] Indicators and effects include depression,[8][27][28] anxiety,[10] eating disorders,[29] poor self-esteem,[29] somatization,[28] sleep disturbances,[30][31] and dissociative and anxiety disorders including post-traumatic stress disorder.[9][32] While children may exhibit regressive behaviours such as thumb sucking or bedwetting, the strongest indicator of sexual abuse is sexual acting out and inappropriate sexual knowledge and interest.[33][34] Victims may withdraw from school and social activities[33] and exhibit various learning and behavioural problems including cruelty to animals,[35][36][37][38] attention deficit/hyperactivity disorder (ADHD), conduct disorder, and oppositional defiant disorder (ODD).[29] Teenage pregnancy and risky sexual behaviors may appear in adolescence.[39] Child sexual abuse victims report almost four times as many incidences of self-inflicted harm.[40] Sexual assault among teenagers has been shown to lead to an increase in mental health problems, social exclusion and worse school performance.[41][42]
Disclosure
Children who received supportive responses following disclosure had less traumatic symptoms and were abused for a shorter period of time than children who did not receive support.[117][118] In general, studies have found that children need support and stress-reducing resources after disclosure of sexual abuse.[119][120] Negative social reactions to disclosure have been found to be harmful to the survivor's well-being.[121] One study reported that children who received a bad reaction from the first person they told, especially if the person was a close family member, had worse scores as adults on general trauma symptoms, post traumatic stress disorder symptoms, and dissociation.[122] Another study found that in most cases when children did disclose abuse, the person they talked to did not respond effectively, blamed or rejected the child, and took little or no action to stop the abuse.[120] Non-validating and otherwise non-supportive responses to disclosure by the child's primary attachment figure may indicate a relational disturbance predating the sexual abuse that may have been a risk factor for the abuse, and which can remain a risk factor for its psychological consequences.[123]
The American Academy of Child and Adolescent Psychiatry provides guidelines for what to say to the victim and what to do following the disclosure.[124] Asa Don Brown has indicated: "A minimization of the trauma and its effects is commonly injected into the picture by parental caregivers to shelter and calm the child. It has been commonly assumed that focusing on children's issues too long will negatively impact their recovery. Therefore, the parental caregiver teaches the child to mask his or her issues."[125]
In many jurisdictions, abuse that is suspected, not necessarily proven, requires reporting to child protection agencies, such as the Child Protection Services in the United States. Recommendations for healthcare workers, such as primary care providers and nurses, who are often suited to encounter suspected abuse are advised to firstly determine the child's immediate need for safety. A private environment away from suspected abusers is desired for interviewing and examining. Leading statements that can distort the story are avoided. As disclosing abuse can be distressing and sometimes even shameful, reassuring the child that he or she has done the right thing by telling and that they are not bad and that the abuse was not their fault helps in disclosing more information. Anatomically correct dolls are sometimes used to help explain what happened, although some researchers consider the dolls too explicit and overstimulating, which might contribute to non-abused children behaving with the dolls in one or more ways that suggest they were sexually abused.[126] For the suspected abusers, it is also recommended to use a nonjudgmental, nonthreatening attitude towards them and to withhold expressing shock, in order to help disclose information.[127]
Offenders
Demographics
Offenders are more likely to be relatives or acquaintances of their victim than strangers.[151] A 2006–07 Idaho study of 430 cases found that 82% of juvenile sex offenders were known to the victims (acquaintances 46% or relatives 36%).[152][153]
More offenders are male than female, though the percentage varies between studies. The percentage of incidents of sexual abuse by female perpetrators that come to the attention of the legal system is usually reported to be between 1% and 4%.[154] Studies of sexual misconduct in US schools with female offenders have shown mixed results with rates between 4% and 43% of female offenders.[155] Maletzky (1993) found that, of his sample of 4,402 convicted child sex offenders, 0.4% were female.[156]
According to research conducted in Australia by Kelly Richards on child sexual abuse, 35.1% of female victims were abused by another male relative and 16.4% of male victims were abused by another male relative. Male relatives were found to be the most relevant predators in the case of both gender.[157]
In U.S. schools, educators who offend range in age from "21 to 75 years old, with an average age of 28".[158]
According to C.E. Dettmeijer-Vermeulen, Dutch national spokeswoman on human traffic and sexual violence against children, in the Netherlands, 3% of the convicted perpetrators are women,[159] 14.58% of the victims are boys[159] and "most victims were abused by a family member, friend or acquaintance."[159] One in six perpetrators is underage.[160]
Typology
Early research in the 1970s and 1980s began to classify offenders based on their motivations and traits. Groth and Birnbaum (1978) categorized child sexual offenders into two groups, "fixated" and "regressed".[161] Fixated were described as having a primary attraction to children, whereas regressed had largely maintained relationships with other adults, and were even married. This study also showed that adult sexual orientation was not related to the sex of the victim targeted, e.g. men who molested boys often had adult relationships with women.[161]
Later work (Holmes and Holmes, 2002) expanded on the types of offenders and their psychological profiles. They are divided as follows:[162]
Prevalence
Global
Based on self-disclosure data, a 2011 meta-analysis of 217 studies estimated a global prevalence of 12.7%–18% for girls and 7.6% for boys. The rates of self-disclosed abuse for specific continents were as follows:[204]
