Simon McCarthy-Jones

Simon is an Associate Professor in Clinical Psychology and Neuropsychology in the Department of Psychiatry at Trinity College Dublin

As with most people, researchers around the world have been confined inside by Covid-19 restrictions. Unable to go out and collect new information, many have turned to look more closely at what existing research can tell us. As a result, the last year and a half has seen a wide variety of review articles published on child sexual abuse. Such articles systematically review all the available evidence on a specific question to see what overall picture emerges. 

Here I’ll briefly summarise what has been found. Of course, as the authors of these reviews themselves note, such findings come with caveats. For example, there is often an over-reliance on data from students in Western countries. To allow you to delve into the details and nuances of what these reviews found, I’ve included links to each article.

How common is child sexual abuse in women?

Chinese researchers reviewed 48 studies from 16 countries (mostly the U.S. and European countries), involving over 20,000 people. These studies had all asked people about whether they had experienced childhood trauma using the same questionnaire (the short form of the Childhood Trauma Questionnaire). The researchers focussed specifically on women’s answers.

The review found that the overall rate of child sexual abuse reported by women was 24% (i.e., one in four). They noted that the highest rate of child sexual abuse was found in sex workers (41%), followed by people with mental health difficulties (32%), prisoners (18%) and then the general population (17%).

Link to study: https://doi.org/10.1177/1524838020912867

What helps children tell?

This Dublin-based study by Emma Brennan and Rosaleen McElvaney reviewed what is known about what helps children disclose the sexual abuse they have suffered. They conclude that the combination of needing to tell and having the opportunity to tell is what helps children disclose. 

Needing to tell arose from children realising that the abuse was not normal, from the distress at having to keep it secret, and wanting something to be done about the abuse. The opportunity to tell was enabled by having someone they could trust, expecting to be believed, and being asked.

The review concluded by noting that all children need to:

• have access to a trusted adult they can approach if they are upset or confused about something in their lives;
• be educated about what behaviours are and are not okay;
• know about the importance of asking for help, 
• have adults who are interested, attentive, respectful and pro-active in protecting them from harm.

Link to study: https://doi.org/10.1002/car.2617

What risk factors are associated with sexual exploitation in children?

Child sexual exploitation (CSE), the authors of this review tell us, is “considered a subtype of human trafficking”. Although definitions vary, CSE is commonly viewed as involving “the actual or attempted abuse of a position of vulnerability, differential power, or trust over adolescents and children for sexual activity (online and/or offline) in exchange for something of value (e.g., gifts, money, substances, or developmental needs, including shelter, food, and protection)”. Although research has examined factors associated with child sexual exploitation, the authors were concerned to find out which ones should be prioritised. 

The authors concluded that the key factors associated with sexual exploitation in children were sexual risk behaviours, trauma, and exposure to sexual violence. They found that the biggest risk factors associated with CSE centred around early, risky, and abusive sexual behaviours including “sexual risk-taking behaviours (e.g., condomless sex, sexual intercourse in public, or meeting face-to-face with strangers from an online environment for sex), having more than five sex partners, and being exposed to child pornography.”

The authors recommend that “youth that present to health services with sexual risk behaviours, sexually transmitted infection and HIV testing, a history of sexual violence online or offline, and a profile of trauma symptoms (e.g., PTSD, externalizing problems, anxiety, or emotional dysregulation) warrant thorough assessment” for potential child sexual exploitation risk.

Link to study: https://doi.org/10.1001/jamanetworkopen.2020.17682

What is the relation between child sexual abuse and depression?

The authors of this review were interested in two questions. The first was how child sexual abuse is related to the age at which depression started. Here they drew on 13 studies with 8,652 people diagnosed with depression. They found that depressed people who were sexually abused as children had their depression start six years earlier than depressed people who had not been sexually abused as children.

The researchers then turned to 23 studies with 3,340 survivors of child sexual abuse to examine how the age of someone when their child sexual abuse started related to the development of depression. They found that suffering sexual abuse at a younger age was related to higher levels of depression.

The authors conclude by recommended that “screening for child maltreatment experiences should be done routinely for the treatment of depression.”

Link to study: https://doi.org/10.1002/car.2592

How does child sexual abuse impact women’s later experiences of mothering?

This review set out to answer two questions; how do mothers who have experienced child sexual abuse currently parent their children and how do they believe the abuse experiences have affected their parenting? 

In looking at the available research, the most common theme the authors identified was “mothers’ desire to protect their children from abusive experiences, such as the ones that they experienced when they were younger, and actions they took to protect their child from abuse”.

Yet the researchers noted that, despite mothers’ attempts to protect their children from abuse, “many mothers in studies included in this review disclosed that their child had also been the victim of abuse”. Most commonly mothers had children who experienced child sexual abuse at the hands of others.

The researchers also found that some mothers reported child-rearing practices were affected by their experiences of child sexual abuse. These included “discipline, intimate parenting behaviors, parenting knowledge and skills, and the ability to parent.” They also noted that multiple studies also described the effects of experiencing child sexual abuse on some mothers’ “breastfeeding and the mother–child relationship, including availability and bonding, communication, role-reversal, ability to give the child room to grow, and the relationship generally.”

The researchers tried to understand why suffering child sexual abuse could impact someone’s later parenting behaviors. They noted that in many studies, “mothers described mental health, physical health, substance use problems, and financial difficulties as additional influences on parenting behaviors”.

Link to study: https://doi.org/10.1177/1049732319882914

What factors make it more likely child sexual abuse survivors will be re-victimised later in life?

This review found that specific risk factors for a child sexual abuse survivor being re-victimised later in life included also having suffered other forms of maltreatment in the home, risky sexual behavior (particularly in adolescence), post-traumatic stress disorder, struggling to manage one’s emotions, and using problematic coping strategies such as using drink or drugs. They only found one factor that appeared to protect people from later re-victimisation: perceived parental care.

The researchers recommended that risky sexual behaviors and negative childhood environmental factors should be targets of both public health and clinical interventions. They also noted that promoting parental care before and after childhood victimization experiences may reduce the risk of revictimization. 

Link to study: https://doi.org/10.1177/1524838018823274

How can child sexual abuse survivors be supported?

In 2017, the World Health Organization (WHO) published clinical guidelines on responding to children and adolescents who have been sexually abused. The authors of this review article present a summary of the work they did that informed the development of these WHO guidelines. The authors concluded that:

“After considering the evidence and other important factors (e.g., cost-effectiveness, acceptability, feasibility), the World Health Organization Guideline Development Group made a conditional recommendation to offer CBT [cognitive-behavioural therapy] with a trauma focus to sexually abused children or adolescents experiencing PTSD symptoms”.

They also noted that:

“promising interventions (e.g., prolonged exposure, individual psychotherapy, Risk Reduction through Family Therapy), require further investigation to increase certainty that effect sizes are not due to chance.”

The authors end their review by reflecting that:

“advocacy and political will are necessary to ensure that the health sector and other sectors are working in a coordinated manner to provide comprehensive care and support; also needed is an appropriate judicial system response for children and adolescents who have been sexually abused”

Link to study: https://doi.org/10.1016/j.chiabu.2019.104203

What interventions are effective in preventing child sexual abuse?

This review looked at research on child sexual abuse interventions in developing countries and their effectiveness. 

The authors found that most interventions were done in an educational setting with preschool and primary school-aged children. The intervention typically focussed on “improving children’s understanding of their bodies, appropriate and inappropriate touch, and who they could reach out to if they have concerns about someone’s behavior.” The review concluded that these interventions were successful in improving “young people’s knowledge and/or skills regarding keeping themselves safe can be successful in that goal”.

Some problems were noted though. First, it was observed that researchers had not tested if this improved knowledge in children led to a decrease in sexual abuse victimization as a result. The researchers also observed that there was a lack of focus on interventions targeted at the general population.

They conclude that “If the focus on school-based strategies to prevent child sexual abuse continues in developing countries, a significant gap in knowledge of the efficacy of population-level interventions outside of school contexts, and consistency across the application of interventions will remain. Evaluations are needed that address the efficacy of broader government-led or whole-of-community prevention interventions to reduce actual prevalence of child sexual abuse, or that can link increased knowledge and skill with reduced victimization.”

Link to study: https://doi.org/10.1016/j.chiabu.2020.104395