By Dr. Yameika Head
What is childhood sexual abuse and who are the victims?
Unfortunately, Hannah’s story is a common occurrence. Child sexual abuse is any sexual act between an adult and a minor or between 2 minors where one exerts power over the other. Forcing and coercing a child into a sexual act or any non-contact acts such as exhibitionism, exposure to pornography, voyeurism, and communicating in a sexual manner via phone or internet all encompass the definition of child sexual abuse. Child sexual abuse is more prevalent than what the public realizes. About 1 in 10 children will be sexually abused before their 18th birthday, that’s 1 in 7 girls and 1 in 25 boys before they turn 18. It has been documented that there is a decline in the incidents of child sexual abuse but we are unsure of the exact cause for this. The primary reason may be that only 38% of child victims disclose and we know from multiple studies that many never disclose. There are many privacy issues as well when it comes to reporting sexual abuse cases. News sources and public police reports do not disclose victims names and thus many not be included in the statistics.
Who are the Perpetrators?
One of the many misconceptions about perpetrators of abuse are that individuals feel that they know what a “child molester” looks like, but they are often wrong. Perpetrators of abuse can be neighbors, friends, family members, coaches, priests, etc. Abusers can be, and often are, other children. About 90% of children who are victims of sexual abuse know their abuser and only 10% are abused by a stranger. About 60% of children who are sexually abused are abused by the family they trust. Also, many believe that all abusers are pedophiles, but not all are. Those that are not pedophiles are often offenders who offend during times of stress and later in life. Pedophilic offenders tend to offend at an early age and have multiple victims (frequently not family members).
How does sexual abuse occur?
Eighty one percent of child sexual abuse incidents for all ages occur in one-perpetrator/one-child circumstances and most occurs in the home, specifically the home of the victim or the perpetrator. Most abusers form close relationships with the child AND the family and often “groom” children prior to beginning the abuse. Grooming is the process where the offender gradually draws the victim into a sexual relationship and maintains the relationship in secrecy. Grooming behaviors can include providing special attention to the child, special gifts, isolating the child from others, gradually crossing physical boundaries (touching, caressing) and using secrecy, blame or threats to maintain that relationship. No child is immune to sexual abuse.
Do all sexual abuse victims disclose their abuse?
Child sexual abuse victims are unique from adult sexual assault victims in that they often delay disclosing their sexual abuse. Multiple studies have found that disclosure rates for children range from 24% to 96%. This includes immediate disclosure and delayed disclosure. Disclosure rates among adults who experienced sexual abuse during their childhood are more consistent and range from 31% to 42%. In a relevant retrospective adult study by Smith and colleagues (2000), they determined that 27% disclosed immediately, 58% waited more than a year, and 28% did not divulge until asked during the survey. There is overwhelming evidence that children who do disclose will disclose to a friend or peer. In one study by Priebe and Svedin (2008), 80% said that a “friend of my own age” was the only person that they told. Many children disclose to a parent only when the abuser is not a family member. The next individuals noted in the study to which children disclosed were educators, but as mentioned above many children do not disclose at all. So why don’t children tell? In some studies, it was noted that many children did try to tell someone but they were not heard, not believed, or no action was taken by those they disclosed to. Those that choose not to disclose do so for a variety of reasons such as being threatened, fear of the perpetrator, lack of opportunity, a lack of understanding of child sexual abuse, or a close relationship with the perpetrator. Other impediments would include, shame, fear of separation from the family, or fear of their parent’s reaction. Males are even less reluctant to report out of fear of being labeled homosexual or as a victim. Mental health difficulties also inhibit disclosure such as dissociative symptoms or PTSD.
What are the effects of childhood sexual abuse?
The immediate effects of child sexual abuse are emotional and mental health problems. These children will have major depressive episodes, symptoms of posttraumatic stress disorder, suicide ideation and attempts, self-blame, and guilt. This can lead to disruptions in normal development and can have a lasting impact leading to dysfunction and distress well into adulthood. Age-inappropriate behavior can be a very important and telling sign where abuse is concerned. Children who have been sexually abused have 3 times as many sexual behavior problems as children who have not been sexually abused. Academic problems are common. Sexually abused children perform lower on psychometric testing when compared to non-abused cohorts. 39% of 7-12 year-old girls that have been sexually abused had some academic difficulties. Abused children have higher rates of high school absentee rates, more grade retention, increased need for special education services, and school adaptation. Substance abuse problems often occur in these children. Adolescents were 2-3 times more likely to have an alcohol use/dependence problem than non-victims. Stemming from substance abuse, they also often become more delinquent and exhibit more criminal behaviors. In addition, teen pregnancy is much higher in sexually abused girls, 2.2 times more likely than in their non-abused peers. The long term effects of sexual abuse are tremendous and it is daunting public health problem. Survivors of child sexual abuse are twice as likely to smoke, be physically inactive, and become severely obese. They are 30% more likely to develop serious conditions such as cancer, diabetes, high blood pressure, stroke and heart problems. Adult survivors of child sexual abuse have higher rates of healthcare utilization and report more health complaints than their non-abused peers.
How are sexual abuse cases investigated?
Only about a third of child sexual abuse cases are identified and even fewer are reported. Most disclosures are to friends and many do not result in reports. Child protection agencies investigate 55% of child sexual abuse incidents. Some are “screened out” due to not enough information or other reasons. False reports of child sexual abuse are rare. It is estimated that only 4-8% of child sexual abuse reports are fabricated and of those that are, they are fabricated by adults involved in custody disputes or adolescents. When disclosure does occur, the person should report to the police or child protective services or both. In every state, there are people that are willing to help victims and families. You can always contact your local Children’s Advocacy Center and they will gladly give you directions on what to do.
In closing, children and adults have lasting effects from the abuse they have suffered and we know that they often do not tell and suffer in silence. Hannah should be applauded for her bravery in telling her story. Her resilience after suffering so tremendously lets us know that bad things can happen in our lives, but with support we can overcome anything.
Thank you Hannah!
Dr. Yameika Head is the Medical Director of the Crescent House, a service of The Children’s Hospital at The Medical Center Navicent Health. She is double boarded in General Pediatrics and Child Abuse Pediatrics and is the Program Director of the Pediatric Residency Program through MCNH/Mercer University School of Medicine.
Childhelp National Abuse Hotline: 1-800-4-A-CHILD (4454)- 24/7 (Trained volunteer to help you report a crime)
National Sexual Assault Hotline: 800-656-HOPE (4673)
Safe Horizon:1-800-621-HOPE (4673)