Quiz #1

Chapter 5: Child Sexual Abuse

Lecture Outline

I. Scope of the Problem of Child Sexual Abuse

a. Definitions of Child Sexual Abuse (CSA)

i. Child Sexual Abuse—the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or stimulation of such conduct for the purpose of producing a visual depiction of such conduct; or the rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children

ii. Criminal Justice System definitions of CSA—deals with crimes committed on Federal property, interstate transport of minors for sexual purposes, and the shipment or possession of child pornography

iii. Legal/Illegal sexual activity definitions of CSA

1. In most states, the age of consent falls somewhere between 14 and 18 years.

2. Sexual contact between an adult and a minor who has not reached the age of consent is illegal (statutory rape).

3. Incest is illegal regardless of the victim’s age or consent.

4. CSA consists of acts such as sexual abuse/sexual assault, sexual exploitation, and internet exploitation.

5. Sexual assault encompasses anal or vaginal penetration by the penis or another object, oral-genital and oral-anal contact, touching of the genitals or other intimate body parts whether clothed or unclothed, and genital masturbation of the perpetrator in the presence of a child.

6. The younger the child, the greater the force/coercion, the closer the victim/perpetrator relationship, and an actual act of sexual penetration, the worse the crime is considered to be

iv. Clinical definition of CSA—contacts or interactions between a child and an adult when the child is being used for sexual stimulation of the perpetrator or another person when the perpetrator or another person is in a position of power or control over the victim

v. Medical definition of CSA— engaging of a child in sexual activities that the child cannot comprehend, for which the child is developmentally unprepared and cannot consent, and that violates the social taboos of society

1. Brief—any sexual activity with a child below the age of consent

2. Incest – sexually prohibited activities between blood-related individuals; illegal at any age

vi. only relatively recently has CSA been recognized as a social problem

vii. normal touching ideas/definitions:

1. parents rarely bathed with their children at any age, particularly with children of the opposite sex, after the children were 3 to 4 years old

2. children’s touching of mothers’ and fathers’ private areas was relatively common among preschoolers but declined as the children became older

3. some types of sexual behavior are common in nonabused children (e.g., children touching their own sexual parts)

b. Prevalence of Child Sexual Abuse

i. Challenges to the Accuracy of Statistics (more alignment help needed)

1. research findings have called into question the accuracy of Child Protective System reports because the reports includes CSA perpetrated by parents and caregivers

2. research findings have called into question the accuracy of children’s memories: 44% of substantiated abuse before age 2 was not identified by 45 adolescents

3. the majority of victims do not disclose their abuse immediately, and a significant number do not disclose it for years… dependent upon

a. victim’s relationship to the perpetrator

b. severity of sexual abuse

c. developmental/cognitive variables

d. fear of negative consequences

e. if parents provide accurate sex education to the child, disclosure improves

f. gender differences: females are far more likely to disclose CSA

i. male underreporting due to

1. expectation that boys should be dominant and self-reliant

2. notion that early sexual experiences are a normal part of boys’ lives

3. fears associated with homosexuality, because most boys who are abused are abused by men

4. pressure on males not to express helplessness or vulnerability

ii. Reporting CSA

1. Disclosure to medical personnel

a. most CSA sufferers do not disclose their victimization right away; there is less urgency for doctors to conduct an examination immediately

b. prompt exam is necessary when a child is in pain, needs medication, or must be tested for a disease

c. perform an examination if forensic materials might still be collectable

d. nurse or doctor can reiterate a child’s disclosures in court be accepted, an exception to the hearsay rule of evidence

2. Disclosure related to memory of CSA inaccuracies

a. children’s memory and reporting can be altered and manipulated with leading questions

b. the greater the severity of PTSD symptomotology, the greater the accuracy of the memories

c. children rarely lie about sexual abuse

d. memory repression of CSA events

i. unconscious forgetting (repression) as a protection against anxiety; cannot bring to mind under ordinary circumstances because it is so painful and/or frightening

ii. results from either repression of negative feelings associated with the abuse or amnesia associated with dissociative defenses (i.e., multiple personality disorder) of a traumatic event

iii. critics claim that what some individuals perceive to be memories may be fantasies or illusions of contextual cues or implantation by therapists or other perceived authority figures

iv. research findings clearly show that repressed memories do exist

v. CSA that was not experienced as traumatic were not inclined to report repressed memory syndrome; they appeared not to think of the CSA for years, or to simply forget it and later, environmental cues triggered their recall

c. Estimates of CSA

i. Official records are underestimates of the actual incidence of sexual crimes, so the true victimization rates are significantly higher

ii. Official Reports

1. nationally, CSA represents 9.1% of all child maltreatment cases

2. criminal justice data generally report more sexual abuse than do Child Protective Agency data

3. 50% of children 12-years-old or below reporting in an ER for child rape were age 4 or younger

4. 96% of the cases of suspected/assessed CSA will result in a normal genital/anal exam

5. 69.9% of all child fatalities were caused by parents; of these 22.9% were attributed to sexual abuse

iii. Self-Reports

1. likely underestimate actual rates because some adults may not remember their experiences or may be reluctant to report them

2. Gallop organization (Finkelhor et al., 1997) reported that 23% of children sampled had been touched in a sexual way before age18

3. The Kaiser-Permanente sample of adults reported sexual abuse by almost 25% of women and 16% of men

4. National Health and Life Survey (Leung et al., 2010) reported that 125 Of children had experienced sexual touching before age 12

5. National Violence Against Women Survey (Tjaden & Thoennes,1998a) reported completed rape before age 18: 9% of females; 2% of males

6. Adult military samples showed a prevalence rate between 27% and 49%, suggesting an overall rate of at least 33%

iv. Trends

1. increase in reporting rates for child sexual abuse during the 1980s and early 1990s (NIS-2)

a. added teenagers to the category of perpetrators

2. mid-to-late 1990s indicate a marked decline in reporting rates of CSA (NIS-4)

II. Characteristics of Victims of Child Sexual Abuse

a. Age

i. maltreatment as a whole may decline with a child’s increasing age, but not CSA

ii. peak of CSA is around age 12

iii. most sexual touching is pre-pubertal, occurring at about age 12

b. Gender

i. majority of CSA victims are female

ii. boys may be abused more often but are less likely to report

c. Socioeconomic Status (SES)

i. children living in families with low SES status suffer significantly more

ii. children living in families characterized by single parenthood, lower education, parental stress, parental depression, and marital conflict/marital violence are more at risk for CSA

iii. children whose fathers are unemployed, or both parents who are out of the house working and children left unmonitored are at increased vulnerability for CSA victimizations

iv. living in a rural area compared with living in urban areas was a risk factor

d. Blame for CSA

i. blame placed on perpetrators remained high over time; use of force and/or more frequent abuse was linked with more perpetrator blame

ii. actual penetration was linked with higher levels of self-blame

iii. self-blame decreased over time, but initial level of victims’ self-blame predicted later level of depression

iv. youth frequently reported confusion as to why the CSA occurred

v. there were no significant gender differences in self-blame

vi. self-blame and perpetrator blame are both unhealthy because of attributions (i.e. beliefs about causality)

1. victims of CS contrasted with other victims (e.g., violent crimes) adopted significantly higher levels of global attributions (i.e., other negative events are likely to happen to me)

2. the attributions of stability (i.e., negative events will always happen to me) increased in survivors of sexual assault survivors

III. Characteristics of Perpetrators of Child Sexual Abuse

a. Family Structure of Perpetrators

i. single parents are overrepresented among sexual abusers

ii. highest rates (10 times greater) occurred among single parents who had a cohabitating partner

b. Age of Perpetrators

i. majority of sex offenders are adults between 21 and 40 years of age

ii. juveniles accounted for 17% of arrests for all types of sexual crimes in 2007

c. Gender of Perpetrators

i. males are disproportionately the perpetrators of sexual crimes against children

ii. 1-2% of males in the general population will be convicted of a sexual offense in their lifetime

iii. some CSA committed by females goes unrecognized or is unacknowledged

iv. liberal estimate suggested that female perpetrators represent no more than 10% (perhaps only 2%) of CSA abusers

v. large percentages of female offenders are abuse victims themselves, and depression was the primary trigger for their perpetration of CSA

vi. there are many unresolved issues surrounding female CSA offenders: do they abuse younger children than males? Do female CSA offenders frequently act in concert with male offenders Do they show significant psychopathology?

vii. Female and male offenders have several similarities

1. fondling/touching of genitals is the most frequent type of CSA

2. they manifest inadequate social skills and display cognitive distortions

3. they have grown up in highly dysfunctional families and suffered sexual abuse, sometimes severe abuse during childhood

d. Relationship of Perpetrator of CSA to Victim

i. most typical type of perpetrator is an acquaintance of the family or the child

IV. Dynamics and Effects of Child Sexual Abuse

a. Dynamics of Child Sexual Abuse

i. Initiation of CSA

1. perpetrators do not molest every child, they generally select children who are vulnerable; they select certain children

2. perpetrators do not use uniform strategies to perpetrate abuse initially; some use force, threats, fear, or use subterfuge by telling the child the activities are for educational purposes

3. perpetrators undertake grooming—premeditated behavior intended to manipulate the potential victim into complying with the sexual abuse through conditioning the child through rewards and punishments until sexual activity becomes routine

4. Perpetrators use various online techniques to groom children (e.g., obtain a compromising picture of the child (adolescent) and then blackmail the child with it to obtain sexual favors

ii. Child pornography

1. a visual depiction of any kind, including a drawing, cartoon, sculpture, painting, photograph, film, video, or computer/ computer-generated image or picture, whether made or produced by electronic, mechanical, or other means, of sexually explicit conduct involving a minor

2. 1978: U.S. Congress passed the Protection of Children Against Sexual Exploitation Act in an attempt to halt the production and dissemination of pornographic materials involving children

3. 1986: Child Sexual Abuse and Pornography Act provides for federal prosecution of individuals engaged in child pornography

4. child pornography may stimulate perpetration of CSA offenders, serves to educate and stimulate victims, can be used as a blackmail tool

iii. Prostitution

1. significant numbers of adult women began to work as prostitutes when they were children

2. characteristics of adolescent prostitutes often include a history of childhood maltreatment, personal and parental alcohol or drug abuse, poor family functioning,

3. many share a runaway or thrown away youth status

b. Effects of Child Sexual Abuse

i. Mimicking sexual behavior-sexualized behavior is most predictive of the occurrence of sexual abuse

1. overt sexual acting out toward adults or other children

2. , compulsive masturbation, excessive sexual curiosity, sexual promiscuity, and precocious sexual play and knowledge

ii. PTSD is the second most predictive behavior

1. occurs when a person lives through/witnesses an event that appears to be life-threatening and experiences intense fear or helplessness

2. symptoms of PTSD include

a. diminished responsiveness

b. chronic physiological arousal leading to symptoms such as sleeplessness

c. flashbacks

3. components of PTSD

a. avoidance of stimuli (person, place) that are related to PTSD

b. reexperiencing the CSA event(s)

c. dysphoria (depressed mood state)

d. hyperarousal (startle, overly responsive to certain stimulus events

4. more than one third of sexually abused children meet criteria for PTSD

5. Children may also suffer the effects of cumulative traumas

iii. Psychopathology

1. CSA is associated with substantial increased risk of psychopathology

2. CSA typically contributes to Borderline Personality Disorder

3. 17% of the preschool group (4 to 6 years of age), 40% of the school-age group (7 to 13 years of age), and 8% of the adolescent group (14 to 18 years of age) evidenced pathological symptoms

iv. Long-term effects

1. Anger generated by CSA

a. not being able to disclose CSA to a parent who is emotionally fragile

b. people’s reactions to their disclosure

c. no one protected them

d. they felt singled out for victimization

e. they were assigned to out-of-home placement because their family broke up

f. they may have to testify in open court

2. Polyvictimization – Other victimizations also occur

a. revictimization of CSA rates are high

b. increase the risk for mental health problems, especially depression and anxiety

c. mother-daughter CSA has unusually profound effects because of factors such as the betrayal of trust and the inability to cope effectively

v. Reactions to disclosure: negative responses tend to aggravate victims’ experience of trauma

V. Explaining Child Sexual Abuse

a. Victim of CSA

i. children are developmentally (and legally) incapable of consenting to take part in sexual activities with adults

b. Perpetrator of CSA often have

i. deviant patterns of sexual arousal

ii. a childhood history of sex abuse

iii. a neurobiological basis of psychopathology

iv. personality disorders (e.g., antisocial personality disorder)

v. d ineffective means of coping with stress

vi. deviant sexual arousal–pedophilia—sexually attracted to children

vii. detection of deviant sexual arousal can be made by plethysmography—procedure most often used to determine whether a CSA perpetrator is sexually aroused by children

viii. cognitive distortions—disinhibitors of CSA where perpetrators rationalize and defend their behavior through distorted ideas or thoughts

ix. early developmental environment that includes several stressful events, such as poor attachment between parent and child, low self-esteem, limited coping abilities, low-quality relationships with others, and a history of sexual abuse that leads the child to rely on sexualized coping methods, including masturbation and sexual acts with others, as a way to avoid current stressors

c. Differences among CSA Offenders

i. Child molesters are different from rapists: molesters more likely experienced (Box 5.11)

1. CSA events

2. Early exposure to pornography

3. Early onset of masturbation

4. Sexual activities with animals

5. Displayed anxious parental

ii. Adolescent CSA offenders are different from adolescent nonsex offenders; adolescent CSA offenders (Box 5.12)

1. Experienced CSA abuse history

2. Had fewer antisocial peers

3. Were exposed to sexual violence

4. Fewer substance abuse problems

5. Had a less extensive criminal history

6. Experienced early exposure to pornography

7. Tended to be socially isolated

8. Had atypical sexual interests

9. Experienced other abuse or neglect (polyvictimization)

10. Had low self-esteem

11. Suffered from anxiety

iii. Adolescent CSA offenders are similar to adolescent nonsex offenders; adolescent CSA offenders (Box 5.12)

1. Had low intellectual ability

2. Exposure to nonsexual violence

3. Suffered from social incompetence

4. Had conventional sexual experiences

5. Had family communication problems

6. Held similar beliefs or attitudes toward women/sexual offending

d. Family of CSA Victims

i. Some experts have (do) view the mother’s role as contributing to a child’s vulnerability by withdrawing from their children or being unavailable to them

ii. Have significant levels of dysfunction in families of CSA victims, including marital conflict, poor relationships between children and parents, divorce, spouse abuse, frequently disorganized and lack cohesion

e. Social Influences Contributing to CSA

i. patriarchal social system

ii. mass-media portrayals of sexuality and children

VI. Practice, Policy, & Prevention of Child Sexual Abuse

a. Practice Issues Related to CSA

i. Needs of CSA victims

1. tailor the services to meet the particular needs of each individual client

ii. Needs of CSA therapists

1. be alert to counter transference—a therapist’s own personal reactions toward victims, perpetrators, and victims’ families

a. a victim’s sexualized behavior

b. recollecting one’s own victimization

2. be alert to vicarious traumatization (i.e. secondary trauma) as a result of being exposed to victims and their traumatic histories

iii. Therapy for CSA Victims

1. Goals

a. alleviate any significant symptoms presented by the individual child or adult

b. help patient disavow self-blame: help victims overcome negative attributions and cognitive distortions such as guilt, shame, and stigmatization

c. help victim with cognitive restructuring—victims change their perceptions of “being different” or “to blame” for the abuse and relocate the responsibility for the abuse onto the offender

d. help victim reduce anxiety and fear

i. give victims the opportunity to defuse these feelings by talking about their abuse experiences in the safety of a supportive therapeutic relationship

ii. explore therapeutic avenues, such as reenacting the abuse through play

iii. teach child victims the strategies to manage fear and anxiety, such as relaxation techniques, problem-solving skills, and how to use positive coping statements and positive imagery

e. help victim cope with anger/depression/low self-esteem

i. express anger in appropriate ways

ii. cognitive and interpersonal exercises and role-play to emphasize the clients’ survival skills and personal strengths

iii. gain a sense of empowerment through sex education and training in self-protection skills that may also prevent any further victimization

iv. Treatment for Perpetrators

1. Goals

a. reduce the likelihood of recidivism (i.e. repeated offenses)

b. tailor approach to the offender’s needs

c. predict recidivism more accurately, thus better protecting the public

d. understand the offender’s childhood history to understand the determinants of CSA

e. treatments were fairly effective

2. Models

a. Perpetrator offense categorization

i. Victim Empathy Distortion

ii. Cognitive Distortion

iii. Emotional Identification

b. Social needs categorization

i. Self-Esteem

ii. UCLA Loneliness

iii. Underassertiveness

iv. Personal Distress

3. Types of treatments for CSA perpetrators

a. Medical interventions

i. castration—surgical removal of the testicles

ii. chemical castration

iii. brain surgery

iv. drug therapy

v. medroxyprogesterone acetate (i.e. Depo-Provera)— reduces testosterone levels

b. Insight therapy: individual counseling to help CSA offenders understand the role sexual abuse plays in their life (mixed effectiveness, but as effective as other treatments)

c. Family systems approach (shows some effectiveness)

i. Tries to reunify families in which incest has occurred

ii. Addressed a parents’ failure to protect the victim from abuse

iii. Addresses feelings of guilt and depression

iv. Discuss the inappropriateness of secrecy

v. Address the victim’s anger toward the parents

vi. Declare the perpetrator’s responsibility for the abuse, not the child’s or the mother’s

vii. Define acceptable forms of touching

viii. Point out confusion about blurred role boundaries

ix. Try to improve poor communication patterns

x. Emphasize the negative effect the CSA abuse on the child

d. Cognitive-behavioral therapy

i. Is the most widely implemented and actively researched forms of therapy for CSA offenders

ii. Is concerned with altering the deviant sexual arousal patterns of CSA perpetrators

iii. Teaches offenders how to recognize and change their distorted beliefs

iv. Focuses on perpetrators’ nonsexual difficulties, such as anxiety

b. Policy Issues Surrounding CSA

i. Legal approaches

1. Legal considerations

a. sex offender registries

b. governing sex offenders in the community, such as their place of residence and areas within the city where they cannot go

c. forcing offenders to wear electronic positioning devices

2. 2006: Adam Walsh Child Protection and Safety Act calls for

a. integration of state sex offender registries into a national registry available to every state

b. imposition of mandatory sentences for crimes against children and civil provisions to detain dangerous sex offenders after incarceration

c. increased prosecution of individuals who perpetrate Internet Crimes Against Children

d. establishment of a new registry that would allow designated individuals to conduct background checks of prospective adoptive and foster parents

ii. Case management considerations

a. whether the child must be separated from his or her home

b. whether the offenders must leave home

c. whether the case merits involvement of the juvenile court and or the criminal court

d. what type of treatment plan should be inaugurated that might necessarily include visitation and eventually family reunification

iii. Interviewing considerations

1. Identification of “what and how” questions were associated with more disclosure

2. Child Advocacy Centers considerations

a. Establish an appropriate setting

b. Use multidisciplinary investigation team and coordinated forensic interviews

c. Use team case reviews

d. Use medical evaluation, therapeutic intervention, and victim advocacy

e. Stay involved in ongoing CSA treatment, not just first-response interventions

f. Identify the best treatment option: caregivers and children evaluated their experiences as satisfactory, but it did not achieve its goal of satisfying the children to the extent desired

3. Police interviews findings

i. children disclosed more nonsexual information than sexual information

ii. children avoided the topic as much as possible

iii. children sometimes denied the CSA despite its documentation

iv. second and third interviews yielded twice as many sexual details as the first interview

v. child denied and avoided more during the first interview than during subsequent interviews

iv. Prosecuting

1. :Prosecutors file charges in only about 66% of child abuse cases and only 49% of these reach a verdict

2. A common practice is to plea bargain a CSA offense down to a lesser offense

v. Mandatory reporting laws – Do they help or hurt? A disagreement is ongoing

c. Prevention of CSA

i. Children’s Programs

1. School-based Empowerment Programs

a. focused primarily on equipping children with the skills they need to respond to or protect themselves

b. help children avoid and report victimization

c. teach children knowledge and skills that experts believe will help them to protect themselves from a variety of dangers

d. primary prevention (i.e. keeping the abuse from occurring) and detection (i.e. encouraging children to report past and current abuse)

e. inexpensive way to reach many school-age children

ii. Adults’ Programs

1. geared toward adults who are often in a position to empower children to protect themselves

2. target adults who can help children avoid sexually abusive experiences

3. audiovisual materials, books, and educational workshops are available

4. give specific instruction in how to talk to their children about sexual abuse

5. help them to identify behaviors in children that are associated with CSA

6. learn how to respond when a child victim discloses abuse