Child Sexual Abuse

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Key points

  • Child sexual abuse (CSA) is truly a global problem, often defying myths and stereotypes, and does not appear to be decreasing over time.

  • There are many different definitions of CSA, adding to the challenges of measurement, assessment, and treatment.

  • Globalization and modern technology may increase the risk of abuse and exploitation, but may also offer opportunities to strengthen our responses, particularly in areas with lower resources.

  • Several therapies have been shown to be efficacious in

Phenomenology and definitions

CSA encompasses many types of sexually abusive acts toward children, including sexual assault, rape, incest, and the commercial sexual exploitation of children. Although there are some differences among these, the unifying term of “child sexual abuse” is used throughout this article to describe commonalities across these experiences. There are many definitions of CSA in use, each of which may have subtle differences in coverage or terminology that influence surveillance and reporting efforts,

Epidemiology

Accurate measurement of the prevalence of childhood CSA is made difficult by several methodological issues. Definitions of CSA typically vary across studies, such as in terms of the age used to define childhood, whether an age difference is specified, or if peer abuse is included, as well as the types of acts considered as sexual abuse (eg, both contact and noncontact). Decisions of sample selection (eg, convenience or probability sampling), survey methods (face-to-face interviews or

Risk factors

Childhood sexual abuse often occurs alongside other forms of abuse or neglect, and in family environments in which there may be low family support and/or high stress, such as high poverty, low parental education, absent or single parenting, parental substance abuse, domestic violence, or low caregiver warmth.15, 19 Children who are impulsive, emotionally needy, and who have learning or physical disabilities, mental health problems, or substance use may be at increased risk.19, 20 The risk of

Factors influencing disclosure

Experiences of childhood CSA often go undisclosed and unrecognized. A review of the literature10 reveals the many factors that inhibit disclosure. In addition to being developmentally vulnerable, children are often manipulated to feel guilty or responsible for the abuse. These children may fear the disclosure will not be believed, or that it will negatively affect their own well-being and that of their families. Moreover, they may be concerned about consequences for the perpetrator, as often

Course and outcomes

The heterogeneity of definitions of child sexual abuse is also reflected in the widely varied reactions, ranging from severe psychological impact to no evidence of negative psychological sequelae.34 For those who are affected, the mental health effects of childhood sexual abuse are varied.35 Child survivors of sexual abuse are at increased risk for anxiety, inappropriate sexual behavior and preoccupations, anger, guilt, shame, depression, posttraumatic stress disorder (PTSD), and other

Systems involvement

There are numerous systems involved after a child experiences sexual abuse, which may include Child Protective Services (CPS), police, legal teams, medical teams, other child protection agencies, foster care and child welfare agencies, and/or residential treatment facilities. CPS is generally responsible for the investigation of and intervention in cases of suspected sexual abuse whereby the offender is in a caretaking role for the child. Law enforcement agencies are usually responsible for the

Therapeutic strategies

Treatment of a child and familial system after sexual abuse is multifaceted and generally requires a biopsychosocial approach. Depending on the presence and extent of physical injury, medical professionals may be involved in ongoing treatment. Children and their caretakers (family or foster caretakers) are usually assigned a case manager. The role of a case manager is to link the child and family to necessary services, and continue to assess need. Case managers often help the family connect

Dissemination and Implementation

Research shows that despite high rates of CSA and known negative sequelae, many children who have experienced sexual abuse either do not receive treatment or receive treatment that has not proved to be effective.86, 87 The wide-scale dissemination and implementation (D&I) of evidence-based treatments (EBT) is an area of high interest, and is also wrought with many challenges.88 For example, effective D&I usually requires ongoing, multilevel strategies across numerous partnerships (eg, trainers,

Summary

CSA is truly a global problem, often defying myths and stereotypes, and it does not appear to be decreasing over time. There are many different definitions of CSA, adding to the challenges of measurement, assessment, and treatment. Globalization and modern technology may increase the risk of abuse and exploitation, but may also offer opportunities to strengthen our responses, particularly in areas of lower resources. It is clear that CSA is associated with the risk of negative psychosocial and

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