Child sexual abuse
Child sexual abuse or child molestation is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation. Forms of child sexual abuse include asking or pressuring a child to engage in sexual activities (regardless of the outcome), indecent exposure (of the genitals, female nipples, etc.) to a child with intent to gratify their own sexual desires or to intimidate or groom the child, physical sexual contact with a child, or using a child to produce child pornography.
The effects of child sexual abuse can include depression, post-traumatic stress disorder, anxiety, complex post-traumatic stress disorder, propensity to further victimization in adulthood, and physical injury to the child, among other problems. 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.
The global prevalence of child sexual abuse has been estimated at 19.7% for females and 7.9% for males, according to a 2009 study published in Clinical Psychology Review that examined 65 studies from 22 countries. Using the available data, the highest prevalence rate of child sexual abuse geographically was found in Africa (34.4%), primarily because of high rates in South Africa; Europe showed the lowest prevalence rate (9.2%); America and Asia had prevalence rates between 10.1% and 23.9%. In the past, other research has concluded similarly that in North America, for example, approximately 15% to 25% of women and 5% to 15% of men were sexually abused when they were children. Most sexual abuse offenders are acquainted with their victims; approximately 30% are relatives of the child, most often brothers, fathers, uncles or cousins; 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. Most child sexual abuse is committed by men; studies show that women commit 14% to 40% of offenses reported against boys and 6% of offenses reported against girls. Some sources report that most offenders who sexually abuse prepubescent children are pedophiles, but some offenders do not meet the clinical diagnosis standards for pedophilia.
Under the law, "child sexual abuse" is 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. The American Psychiatric 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."
Child sexual abuse can result in both short-term and long-term harm, including psychopathology in later life. Indicators and effects include depression, anxiety, eating disorders, poor self-esteem, somatization, sleep disturbances, and dissociative and anxiety disorders including post-traumatic stress disorder. While children may exhibit regressive behaviours such as a return to thumb-sucking or bed-wetting, the strongest indicator of sexual abuse is sexual acting out and inappropriate sexual knowledge and interest. Victims may withdraw from school and social activities and exhibit various learning and behavioural problems including cruelty to animals, attention deficit/hyperactivity disorder (ADHD), conduct disorder, and oppositional defiant disorder (ODD). Teenage pregnancy and risky sexual behaviors may appear in adolescence. Child sexual abuse victims report almost four times as many incidences of self-inflicted harm.
A well documented long term negative effect is repeated or additional victimization in adolescence and adulthood. A causal relationship has been found between childhood sexual abuse and various adult psychopathologies, including crime and suicide, in addition to alcoholism and drug abuse. Males who were sexually abused as children more frequently appear in the criminal justice system than in a clinical mental health setting. A study comparing middle-aged women who were abused as children with non-abused counterparts found significantly higher health care costs for the former. Intergenerational effects have been noted, with the children of victims of child sexual abuse exhibiting more conduct problems, peer problems, and emotional problems than their peers.
Studies have found that 51% to 79% of sexually abused children exhibit psychological symptoms. The risk of harm is greater if the abuser is a relative, if the abuse involves intercourse or attempted intercourse, or if threats or force are used. The level of harm may also be affected by various factors such as penetration, duration and frequency of abuse, and use of force. The social stigma of child sexual abuse may compound the psychological harm to children, and adverse outcomes are less likely for abused children who have supportive family environments.
Dissociation and posttraumatic stress disorder (PTSD)
Child abuse, including sexual abuse, especially chronic abuse starting at early ages, has been found to be related to the development of high levels of dissociative symptoms, which includes amnesia for abuse memories. When severe sexual abuse (penetration, several perpetrators, lasting more than one year) had occurred, dissociative symptoms were even more prominent.
Besides dissociative identity disorder (DID) and posttraumatic stress disorder (PTSD), child sexual abuse survivors may present borderline personality disorder (BPD) and eating disorders such as bulimia nervosa.
Because child sexual abuse often occurs alongside other possibly confounding variables, such as poor family environment and physical abuse, some scholars argue it is important to control for those variables in studies which measure the effects of sexual abuse. In a 1998 review of related literature, Martin and Fleming state "The hypothesis advanced in this paper is that, in most cases, the fundamental damage inflicted by child sexual abuse is due to the child's developing capacities for trust, intimacy, agency and sexuality, and that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects." Other studies have found an independent association of child sexual abuse with adverse psychological outcomes.
Kendler et al. (2000) found that most of the relationship between severe forms of child sexual abuse and adult psychopathology in their sample could not be explained by family discord, because the effect size of this association decreased only slightly after they controlled for possible confounding variables. Their examination of a small sample of CSA-discordant twins also supported a causal link between child sexual abuse and adult psychopathology; the CSA-exposed subjects had a consistently higher risk for psychopathologic disorders than their CSA non-exposed twins.
A 1998 meta-analysis by Bruce Rind et al. generated controversy by suggesting that child sexual abuse does not always cause pervasive harm, that some college students reported such encounters as positive experiences and that the extent of psychological damage depends on whether or not the child described the encounter as "consensual." The study was criticized for flawed methodology and conclusions. The US Congress condemned the study for its conclusions and for providing material used by pedophile organizations to justify their activities.
Depending on the age and size of the child, and the degree of force used, child sexual abuse may cause internal lacerations and bleeding. In severe cases, damage to internal organs may occur, which, in some cases, may cause death. Herman-Giddens et al. found six certain and six probable cases of death due to child sexual abuse in North Carolina between 1985 and 1994. The victims ranged in age from 2 months to 10 years. Causes of death included trauma to the genitalia or rectum and sexual mutilation.
Child sexual abuse may cause infections and sexually transmitted diseases. Depending on the age of the child, due to a lack of sufficient vaginal fluid, chances of infections are higher. Vaginitis has also been reported.
Research has shown that traumatic stress, including stress caused by sexual abuse, causes notable changes in brain functioning and development. Various studies have suggested that severe child sexual abuse may have a deleterious effect on brain development. Ito et al. (1998) found "reversed hemispheric asymmetry and greater left hemisphere coherence in abused subjects;" Teicher et al. (1993) found that an increased likelihood of "ictal temporal lobe epilepsy-like symptoms" in abused subjects; Anderson et al. (2002) recorded abnormal transverse relaxation time in the cerebellar vermis of adults sexually abused in childhood; Teicher et al. (1993) found that child sexual abuse was associated with a reduced corpus callosum area; various studies have found an association of reduced volume of the left hippocampus with child sexual abuse; and Ito et al. (1993) found increased electrophysiological abnormalities in sexually abused children.
Some studies indicate that sexual or physical abuse in children can lead to the overexcitation of an undeveloped limbic system. Teicher et al. (1993) used the "Limbic System Checklist-33" to measure ictal temporal lobe epilepsy-like symptoms in 253 adults. Reports of child sexual abuse were associated with a 49% increase to LSCL-33 scores, 11% higher than the associated increase of self-reported physical abuse. Reports of both physical and sexual abuse were associated with a 113% increase. Male and female victims were similarly affected.
Navalta et al. (2006) found that the self-reported math Scholastic Aptitude Test scores of their sample of women with a history of repeated child sexual abuse were significantly lower than the self-reported math SAT scores of their non-abused sample. Because the abused subjects verbal SAT scores were high, they hypothesized that the low math SAT scores could "stem from a defect in hemispheric integration." They also found a strong association between short term memory impairments for all categories tested (verbal, visual, and global) and the duration of the abuse.
Incest between a child or adolescent and a related adult has been identified as the most widespread form of child sexual abuse with a huge capacity for damage to a child. One researcher stated that more than 70% of abusers are immediate family members or someone very close to the family. Another researcher stated that about 30% of all perpetrators of sexual abuse are related to their victim, 60% of the perpetrators are family acquaintances, like a neighbor, babysitter or friend and 10% of the perpetrators in child sexual abuse cases are strangers. A child sexual abuse offense where the perpetrator is related to the child, either by blood or marriage, is a form of incest described as intrafamilial child sexual abuse.
The most-often reported form of incest is father–daughter and stepfather–daughter incest, with most of the remaining reports consisting of mother/stepmother–daughter/son incest. Father–son incest is reported less often; however it is not known if the actual prevalence is less or it is under-reported by a greater margin. Similarly, some argue that sibling incest may be as common, or more common, than other types of incest: Goldman and Goldman reported that 57% of incest involved siblings; Finkelhor reported that over 90% of nuclear family incest involved siblings; while Cawson et al. show that sibling incest was reported twice as often as incest perpetrated by fathers/stepfathers.
Prevalence of parental child sexual abuse is difficult to assess due to secrecy and privacy; some estimates state that 20 million Americans have been victimized by parental incest as children.
Child sexual abuse includes a variety of sexual offenses, including:
- sexual assault – a term defining offenses in which an adult touches a minor for the purpose of sexual gratification; for example, rape (including sodomy), and sexual penetration with an object. Most U.S. states include, in their definitions of sexual assault, any penetrative contact of a minor’s body, however slight, if the contact is performed for the purpose of sexual gratification.
- sexual exploitation – a term defining offenses in which an adult victimizes a minor for advancement, sexual gratification, or profit; for example, prostituting a child, and creating or trafficking in child pornography.
- sexual grooming – defines the social conduct of a potential child sex offender who seeks to make a minor more accepting of their advances, for example in an online chat room.
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. In general, studies have found that children need support and stress-reducing resources after disclosure of sexual abuse. Negative social reactions to disclosure have been found to be harmful to the survivor’s well being. 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. 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. 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.
The American Academy of Child and Adolescent Psychiatry provides guidelines for what to say to the victim and what to do following the disclosure. 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."
The initial approach to treating a person who has been a victim of sexual abuse is dependant upon several important factors:
- Age at the time of presentation
- Circumstances of presentation for treatment
- Co-morbid conditions
The goal of treatment is not only to treat current mental health issues, but to prevent future ones.
Children and adolescents
Children often present for treatment in one of several circumstances, including criminal investigations, custody battles, problematic behaviors, and referrals from child welfare agencies.
The three major modalities for therapy with children and teenagers are family therapy, group therapy, and individual therapy. Which course is used depends on a variety of factors that must be assessed on a case by case basis. For instance, treatment of young children generally requires strong parental involvement, and can benefit from family therapy. Adolescents tend to be more independent, and can benefit from individual or group therapy. The modality also shifts during the course of treatment, for example group therapy is rarely used in the initial stages, as the subject matter is very personal and/or embarrassing.
Major factors that affect both the pathology and response to treatment include the type and severity of the sexual act, its frequency, the age at which it occurred, and the child’s family of origin. Roland C. Summit, a medical doctor had defined the different stages the victims of child sexual abuse go through, Child Sexual Abuse Accommodation Syndrome. He suggested that children who are victims of sexual abuse depict a range of symptoms that include secrecy, helplessness, entrapment, accommodation, delayed and conflicted disclosure and recantation.
Adults with a history of sexual abuse often present for treatment with a secondary mental health issue, which can include substance abuse, eating disorders, personality disorders, depression, and conflict in romantic or interpersonal relationships.
Generally the approach is to focus on the present problem, rather than the abuse itself. Treatment is highly varied and depends on the person’s specific issues. For instance, a person with a history of sexual abuse suffering from severe depression would be treated for depression. However, there is often an emphasis on cognitive restructuring due to the deep-seated nature of the trauma. Some newer techniques such as Eye Movement Desensitization and Reprocessing (EMDR) have been shown to be effective.
Sexual abuse is associated with many sub-clinical behavioral issues as well, including re-victimization in the teenage years, a bipolar-like switching between sexual compulsion and shut-down, and distorted thinking on the subject of sexual abuse (for instance, that it is common and happens to everyone). When first presenting for treatment, the patient can be fully aware of their abuse as an event, but their appraisal of it is often distorted, such as believing that the event was unremarkable (a form of isolation). Frequently, victims do not make the connection between their abuse and their present pathology.
Offenders are more likely to be relatives or acquaintances of their victim than strangers. A 2006–2007 Idaho study of 430 cases found that 82% of juvenile sex offenders were known to the victims (acquaintances 46% or relatives 36%).
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%. Studies of sexual misconduct in US schools with female offenders have shown mixed results with rates between 4% to 43% of female offenders. Maletzky (1993) found that, of his sample of 4,402 convicted pedophilic offenders, 0.4% were female. Another study of a non-clinical population found that, among those in the their sample that had been molested, as much as a third were molested by women.
In U.S. schools, educators who offend range in age from "21 to 75 years old, with an average age of 28" with teachers, coaches, substitute teachers, bus drivers and teacher's aides (in that order) totaling 69% of the offenders.
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." 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.
Later work (Holmes and Holmes, 2002) expanded on the types of offenders and their psychological profiles. They are divided thus:
- Situational – does not prefer children, but offend under certain conditions.
- Regressed – Typically has relationships with adults, but a stressor causes them to seek children as a substitute.
- Morally Indiscriminate – All-around sexual deviant, who may commit other sexual offenses unrelated to children.
- Naive/Inadequate – Often mentally disabled in some way, finds children less threatening.
- Preferential – has true sexual interest in children.
- Mysoped – Sadistic and violent, target strangers more often than acquaintances.
- Fixated – Little or no activity with own age, described as an "overgrown child."
Causal factors of child sex offenders are not known conclusively. The experience of sexual abuse as a child was previously thought to be a strong risk factor, but research does not show a causal relationship, as the vast majority of sexually abused children do not grow up to be adult offenders, nor do the majority of adult offenders report childhood sexual abuse. The US Government Accountability Office concluded, "the existence of a cycle of sexual abuse was not established." Prior to 1996, there was greater belief in the theory of a "cycle of violence," because most of the research done was retrospective—abusers were asked if they had experienced past abuse. Even the majority of studies found that most adult sex offenders said they had not been sexually abused during childhood, but studies varied in terms of their estimates of the percentage of such offenders who had been abused, from 0 to 79 percent. More recent prospective longitudinal research—studying children with documented cases of sexual abuse over time to determine what percentage become adult offenders—has demonstrated that the cycle of violence theory is not an adequate explanation for why people molest children.
The term "pedophilia" refers to persistent feelings of attraction in an adult or older adolescent toward prepubescent children, whether the attraction is acted upon or not. A person with this attraction is called a "pedophile".
In law enforcement, the term "pedophile" is generally used to describe those accused or convicted of child sexual abuse under sociolegal definitions of child (including both prepubescent children and adolescents younger than the local age of consent); however, not all child sexual offenders are pedophiles and not all pedophiles engage in sexual abuse of children. Law enforcement and legal professionals have begun to use the term predatory pedophile, a phrase coined by children's attorney Andrew Vachss, to refer specifically to pedophiles who engage in sexual activity with minors. The term emphasizes that child sexual abuse consists of conduct chosen by the perpetrator.
Recidivism rates for sex offenders are lower than for the general criminal population. Estimated rates among child sex offenders vary. One study found that 42% of offenders re-offended (either a sex crime, violent crime, or both) after they were released. Risk for re-offense was highest in the first 6 years after release, but continued to be significant even 10–31 years later, with 23% offending during this time. A study done in California in 1965 found an 18.2% recidivism rate for offenders targeting the opposite sex and a 34.5% recidivism rate for same-sex offenders after 5 years.
Child and young adolescent offenders
When a prepubescent child is sexually abused by one or more other children or adolescent youths, and no adult is directly involved, it is defined as child-on-child sexual abuse. The definition includes any sexual activity between children that occurs without consent, without equality, or due to coercion, whether the offender uses physical force, threats, trickery or emotional manipulation to compel cooperation. When sexual abuse is perpetrated by one sibling upon another, it is known as "intersibling abuse", a form of incest.
Unlike research on adult offenders, a strong causal relationship has been established between child and adolescent offenders and these offenders' own prior victimization, by either adults or other children.
A ten-country school-based study in southern Africa in 2007 found 19.6% of female students and 21.1% of male students aged 11-16 years reported they had experienced forced or coerced sex. Rates among 16-year-olds were 28.8% in females and 25.4% in males. Comparing the same schools in eight countries between 2003 and 2007, age-standardised on the 2007 Botswana male sample, there was no significant decrease between 2003 and 2007 among females in any country and inconsistent changes among males.
The prevalence of child sexual abuse in Africa is compounded by the virgin cleansing myth that sexual intercourse with a virgin will cure a man of HIV or AIDS. The myth is prevalent in South Africa, Zimbabwe, Zambia and Nigeria and is being blamed for the high rate of sexual abuse against young children.
South Africa has some of the highest incidences of child and baby rape in the world. A survey by CIET found around 11% of boys and 4% of girls admitted to forcing someone else to have sex with them. In a related survey conducted among 1,500 schoolchildren, a quarter of all the boys interviewed said that "jackrolling", a term for gang rape, was fun. More than 67,000 cases of rape and sexual assaults against children were reported in 2000 in South Africa, compared to 37,500 in 1998. Child welfare groups believe that the number of unreported incidents could be up to 10 times that number. The largest increase in attacks was against children under seven. The virgin cleansing myth is especially common in South Africa, which has the highest number of HIV-positive citizens in the world. Eastern Cape social worker Edith Kriel notes that "child abusers are often relatives of their victims – even their fathers and providers."
A number of high-profile baby rapes appeared since 2001 (including the fact that they required extensive reconstructive surgery to rebuild urinary, genital, abdominal, or tracheal systems). In 2001, a 9-month-old was raped and likely lost consciousness as the pain was too much to bear. In February 2002, an 8-month-old infant was reportedly gang raped by four men. One has been charged. The infant has required extensive reconstructive surgery. The 8-month-old infant's injuries were so extensive, increased attention on prosecution has occurred.
Democratic Republic of the Congo
Child rape is on the rise in the war ravaged eastern Democratic Republic of the Congo. Aid workers blame combatants on all sides for a culture of sexual violence, who operate with much impunity.
United States and Europe
In the UK, a 2010 study estimated prevalence at about 5% for boys and 18% for girls (not dissimilar to a 1985 study that estimated about 8% for boys and 12% for girls). More than 23,000 incidents were recorded by the UK police between 2009 and 2010. Girls were six times more likely to be assaulted than boys with 86% of attacks taking place against them. The estimates for the United States vary widely. A literature review of 23 studies found rates of 3% to 37% for males and 8% to 71% for females, which produced an average of 17% for boys and 28% for girls, while a statistical analysis based on 16 cross-sectional studies estimated the rate to be 7.2% for males and 14.5% for females. The US Department of Health and Human Services reported 83,600 substantiated reports of sexually abused children in 2005. Including incidents which were not reported would make the total number even larger. According to Emily M. Douglas and David Finkelhor, "Several national studies have found that black and white children experienced near-equal levels of sexual abuse. Other studies, however, have found that both blacks and Latinos have an increased risk for sexual victimization".
Surveys have shown that one fifth to one third of all women reported some sort of childhood sexual experience with a male adult. A 1992 survey studying father-daughter incest in Finland reported that of the 9,000 15-year old high school girls who filled out the questionnaires, of the girls living with their biological fathers, 0.2% reported father-daughter incest experiences; of the girls living with a stepfather, 3.7% reported sexual experiences with him. The reported counts included only father-daughter incest and did not include prevalence of other forms of child sexual abuse. The survey summary stated, "the feelings of the girls about their incestual experiences are overwhelmingly negative." Others argue that prevalence rates are much higher, and that many cases of child abuse are never reported. One study found that professionals failed to report approximately 40% of the child sexual abuse cases they encountered. A study by Lawson & Chaffin indicated that many children who were sexually abused were "identified solely by a physical complaint that was later diagnosed as a venereal disease...Only 43% of the children who were diagnosed with venereal disease made a verbal disclosure of sexual abuse during the initial interview." It has been found in the epidemiological literature on CSA that there is no identifiable demographic or family characteristic of a child that can be used to bar the prospect that a child has been sexually abused.
In US schools, according to the United States Department of Education, "nearly 9.6% of students are targets of educator sexual misconduct sometime during their school career." In studies of student sex abuse by male and female educators, male students were reported as targets in ranges from 23% to 44%. In U.S. school settings same-sex (female and male) sexual misconduct against students by educators "ranges from 18–28% of reported cases, depending on the study"
Significant underreporting of sexual abuse of boys by both women and men is believed to occur due to sex stereotyping, social denial, the minimization of male victimization, and the relative lack of research on sexual abuse of boys. Sexual victimization of boys by their mothers or other female relatives is especially rarely researched or reported. Sexual abuse of girls by their mothers, and other related and/or unrelated adult females is beginning to be researched and reported despite the highly taboo nature of female–female child sex abuse. In studies where students are asked about sex offenses, they report higher levels of female sex offenders than found in adult reports. This underreporting has been attributed to cultural denial of female-perpetrated child sex abuse, because "males have been socialized to believe they should be flattered or appreciative of sexual interest from a female." Journalist Cathy Young writes that under-reporting is contributed to by the difficulty of people, including jurors, in seeing a male as a "true victim".
||The examples and perspective in this article may not represent a worldwide view of the subject. (March 2010)|
In 2007 the Ministry of Women and Child Development published the "Study on Child Abuse: India 2007." It sampled 12447 children, 2324 young adults and 2449 stakeholders across 13 states. It looked at different forms of child abuse: physical abuse, sexual abuse and emotional abuse and girl child neglect in five evidence groups, namely, children in a family environment, children in school, children at work, children on the street and children in institutions.
The study's main findings included: 53.22% of children reported having faced sexual abuse. Among them 52.94% were boys and 47.06% girls. Andhra Pradesh, Assam, Bihar and Delhi reported the highest percentage of sexual abuse among both boys and girls, as well as the highest incidence of sexual assaults. 21.90% of child respondents faced severe forms of sexual abuse, 5.69% had been sexually assaulted and 50.76% reported other forms of sexual abuse. Children on the street, at work and in institutional care reported the highest incidence of sexual assault. The study also reported that 50% of abusers are known to the child or are in a position of trust and responsibility and most children had not reported the matter to anyone. Despite years of lack of any specific child sexual abuse laws in India, which treated them separately from adults in case of sexual offense, the 'Protection of Children Against Sexual Offences Bill, 2011' was passed the Indian parliament on May 22, 2012.
In one survey, 2.5% of Taiwanese adolescents report having experienced childhood sexual abuse.
Child sexual abuse is outlawed nearly everywhere in the world, generally with severe criminal penalties, including in some jurisdictions, life imprisonment or capital punishment. An adult's sexual intercourse with a child below the legal age of consent is defined as statutory rape, based on the principle that a child is not capable of consent and that any apparent consent by a child is not considered to be legal consent.
The United Nations Convention on the Rights of the Child (CRC) is an international treaty that legally obliges states to protect children's rights. Articles 34 and 35 of the CRC require states to protect children from all forms of sexual exploitation and sexual abuse. This includes outlawing the coercion of a child to perform sexual activity, the prostitution of children, and the exploitation of children in creating pornography. States are also required to prevent the abduction, sale, or trafficking of children. As of November 2008, 193 countries are bound by the CRC, including every member of the United Nations except the United States and Somalia.
Child sexual abuse has gained public attention in the past few decades and has become one of the most high-profile crimes. Since the 1970s the sexual abuse of children and child molestation has increasingly been recognized as deeply damaging to children and thus unacceptable for society as a whole. While sexual use of children by adults has been present throughout history, it has only become the object of significant public attention in recent times.
The first published work dedicated specifically to child sexual abuse appeared in France in 1857: Medical-Legal Studies of Sexual Assault (Etude Médico-Légale sur les Attentats aux Mœurs), by Auguste Ambroise Tardieu, the noted French pathologist and pioneer of forensic medicine.
The rise of public concern
Child sexual abuse became a public issue in the 1970s and 1980s. Prior to this point in time, sexual abuse remained rather secretive and socially unspeakable. Studies on child molestation were nonexistent until the 1920s and the first national estimate of the number of child sexual abuse cases was published in 1948. By 1968 44 out of 50 U.S. states had enacted mandatory laws that required physicians to report cases of suspicious child abuse. Legal action began to become more prevalent in the 1970s with the enactment of the Child Abuse Prevention and Treatment Act in 1974 in conjunction with the creation of the National Center for Child Abuse and Neglect. Since the creation of the Child Abuse and Treatment Act, reported child abuse cases have increased dramatically. Finally, the National Abuse Coalition was created in 1979 to create pressure in congress to create more sexual abuse laws.
Second wave feminism brought greater awareness of child sexual abuse and violence against women, and made them public, political issues. Judith Lewis Herman, Harvard professor of psychiatry, wrote the first book ever on father-daughter incest when she discovered during her medical residency that a large number of the women she was seeing had been victims of father-daughter incest. Herman notes that her approach to her clinical experience grew out of her involvement in the civil rights movement. Her second book Trauma and Recovery coined the term complex post-traumatic stress disorder and included child sexual abuse as a possible cause.
In 1986, Congress passed the Child Abuse Victims' Rights Act, giving children a civil claim in sexual abuse cases. The number of laws created in the 1980s and 1990s began to create greater prosecution and detection of child sexual abusers. During the 1970s a large transition began in the legislature related to child sexual abuse. Megan's Law which was enacted in 2004 gives the public access to knowledge of sex offenders nationwide.
Anne Hastings described these changes in attitudes towards child sexual abuse as "the beginning of one of history's largest social revolutions."
According to John Jay College of Criminal Justice professor B.J. Cling,
"By the early 21st century, the issue of child sexual abuse has become a legitimate focus of professional attention, while increasingly separated from second wave feminism...As child sexual abuse becomes absorbed into the larger field of interpersonal trauma studies, child sexual abuse studies and intervention strategies have become degendered and largely unaware of their political origins in modern feminism and other vibrant political movements of the 1970s. One may hope that unlike in the past, this rediscovery of child sexual abuse that began in the 70s will not again be followed by collective amnesia. The institutionalization of child maltreatment interventions in federally funded centers, national and international societies, and a host of research studies (in which the United States continues to lead the world) offers grounds for cautious optimism. Nevertheless, as Judith Herman argues cogently, 'The systematic study of psychological trauma...depends on the support of a political movement.'"
In the United States growing awareness of child sexual abuse has sparked an increasing number of civil lawsuits for monetary damages stemming from such incidents. Increased awareness of child sexual abuse has encouraged more victims to come forward, whereas in the past victims often kept their abuse secret. Some states have enacted specific laws lengthening the applicable statutes of limitations so as to allow victims of child sexual abuse to file suit sometimes years after they have reached the age of majority. Such lawsuits can be brought where a person or entity, such as a school, church or youth organization, was charged with supervising the child but failed to do so with child sexual abuse resulting. In the Catholic sex abuse cases the various Roman Catholic Diocese in the United States have paid out approximately $1 billion settling hundreds of such lawsuits since the early 1990s. There have also been lawsuits involving the American Religious Right. Crimes have allegedly gone unreported and victims were pressured into silence.  As lawsuits can involve demanding procedures there is a concern that children or adults who file suit will be re-victimized by defendants through the legal process, much as rape victims can be re-victimized by the accused in criminal rape trials. The child sexual abuse plaintiff's attorney Thomas A. Cifarelli has written that children involved in the legal system, particularly victims of sexual abuse and molestation, should be afforded certain procedural safeguards to protect them from harassment during the legal process.
In June 2008 in Zambia the issue of teacher-student sexual abuse and sexual assault was brought to the attention of the High Court of Zambia where a landmark case decision, with presiding Judge Philip Musonda, awarded $45million Zambian Kwacha ($13,000 USD) to the plaintiff, a 13-year-old girl for sexual abuse and rape by her school teacher. This claim was brought against her teacher as a "person of authority" who, as Judge Musonda stated, "had a moral superiority (responsibility) over his students" at the time.
A 2000 World Health Organization – Geneva report, “World Report on Violence and Health (Chap 6 – Sexual Violence)” states, “Action in schools is vital for reducing sexual and other forms of violence. In many countries a sexual relation between a teacher and a pupil is not a serious disciplinary offence and policies on sexual harassment in schools either do not exist or are not implemented. In recent years, though, some countries have introduced laws prohibiting sexual relations between teachers and pupils. Such measures are important in helping eradicate sexual harassment in schools. At the same time, a wider range of actions is also needed, including changes to teacher training and recruitment and reforms of curricula, so as to transform gender relations in schools.”
In March 2011 Europol, the European Police, in a mission called Operation Rescue, arrested 184 alleged members out of 670 identified, of an online paedophile ring and rescued 230 children which is considered as the biggest case of its kind.
||This "see also" section may contain an excessive number of suggestions. Please ensure that only the most relevant suggestions are given and that they are not red links, and consider integrating suggestions into the article itself. (May 2013)|
- Catholic sex abuse cases
- Child erotica
- Child Exploitation Tracking System (CETS)
- Child pornography
- Child sex tourism
- Child-on-child sexual abuse
- Child welfare
- Commercial sexual exploitation of children
- False allegation of child sexual abuse
- Institutional abuse
- Online predator
- Prostitution of children
- Sexual harassment and abuse of students by teachers
- "Child Sexual Abuse". Medline Plus. U.S. National Library of Medicine,. 2008-04-02.
- "Guidelines for psychological evaluations in child protection matters. Committee on Professional Practice and Standards, APA Board of Professional Affairs". The American Psychologist 54 (8): 586–93. August 1999. doi:10.1037/0003-066X.54.8.586. PMID 10453704. "Abuse, sexual (child): generally defined as contacts between a child and an adult or other person significantly older or in a position of power or control over the child, where the child is being used for sexual stimulation of the adult or other person."
- Martin J, Anderson J, Romans S, Mullen P, O'Shea M (1993). "Asking about child sexual abuse: methodological implications of a two stage survey". Child Abuse & Neglect 17 (3): 383–92. doi:10.1016/0145-2134(93)90061-9. PMID 8330225.
- Child sexual abuse definition from the NSPCC
- Roosa MW, Reinholtz C, Angelini PJ (February 1999). "The relation of child sexual abuse and depression in young women: comparisons across four ethnic groups". Journal of Abnormal Child Psychology 27 (1): 65–76. PMID 10197407.
- Widom CS (August 1999). "Posttraumatic stress disorder in abused and neglected children grown up". The American Journal of Psychiatry 156 (8): 1223–9. PMID 10450264.
- Levitan RD, Rector NA, Sheldon T, Goering P (2003). "Childhood adversities associated with major depression and/or anxiety disorders in a community sample of Ontario: issues of co-morbidity and specificity". Depression and Anxiety 17 (1): 34–42. doi:10.1002/da.10077. PMID 12577276.
- Roth, S.; Newman, E.; Pelcovitz, D.; Van Der Kolk, B.; Mandel, F. S. (1997). "Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV Field Trial for Posttraumatic Stress Disorder". Journal of traumatic stress 10 (4): 539–555. doi:10.1002/jts.2490100403. PMID 9391940
- Messman-Moore, T. L.; Long, P. J. (2000). "Child Sexual Abuse and Revictimization in the Form of Adult Sexual Abuse, Adult Physical Abuse, and Adult Psychological Maltreatment". Journal of Interpersonal Violence 15 (5): 489. doi:10.1177/088626000015005003.
- Dinwiddie S, Heath AC, Dunne MP, et al. (January 2000). "Early sexual abuse and lifetime psychopathology: a co-twin-control study". Psychological Medicine 30 (1): 41–52. doi:10.1017/S0033291799001373. PMID 10722174.
- Courtois, Christine A. (1988). Healing the incest wound: adult survivors in therapy. New York: Norton. p. 208. ISBN 0-393-31356-5.
- "Prevalence of Child Sexual Abuse in Community and Student Samples: A Meta-Analysis". Journalist's Resource.org.
- Julia Whealin, Ph.D. (2007-05-22). "Child Sexual Abuse". National Center for Post Traumatic Stress Disorder, US Department of Veterans Affairs.
- Finkelhor D (1994). "Current information on the scope and nature of child sexual abuse". The Future of Children 4 (2): 31–53. doi:10.2307/1602522. JSTOR 1602522. PMID 7804768.
- Gorey KM, Leslie DR (April 1997). "The prevalence of child sexual abuse: integrative review adjustment for potential response and measurement biases". Child Abuse & Neglect 21 (4): 391–8. doi:10.1016/S0145-2134(96)00180-9. PMID 9134267.
- Dube SR, Anda RF, Whitfield CL, et al. (June 2005). "Long-term consequences of childhood sexual abuse by gender of victim". American Journal of Preventive Medicine 28 (5): 430–8. doi:10.1016/j.amepre.2005.01.015. PMID 15894146.
- Ames, A.; Houston, D. A. (1990). "Legal, social, and biological definitions of pedophilia". Archives of Sexual Behavior 19 (4): 333–342. doi:10.1007/BF01541928. PMID 2205170.
- Laws, Dr. Richard; William T. O'Donohue (1997). "H. E.Barbaree, M. C.Seto". Sexual Deviance: Theory, Assessment, and Treatment. Guilford Press. pp. 175–193. ISBN 1-57230-241-0.
- Blaney, Paul H.; Millon, Theodore (2009). Oxford Textbook of Psychopathology (Oxford Series in Clinical Psychology) (2nd ed.). Oxford University Press, USA. p. 528. ISBN 0-19-537421-5. "Some cases of child molestation, especially those involving incest, are committed in the absence of any identifiable deviant erotic age preference."
- The Sexual Exploitation of Children, Chart 1: Definitions of Terms Associated With the Sexual Exploitation (SEC) and Commercial Sexual Exploitation of Children (CSEC) (p. 4), University of Pennsylvania Center for Youth Policy Studies, U.S. National Institute of Justice, August 2001.
- "APA Letter to the Honorable Rep. DeLay (R-Tx)" (Press release). American Psychological Association. June 9, 1999. Archived from the original on October 10, 1999. Retrieved 2009-03-08.
- Nelson EC, Heath AC, Madden PA, et al. (February 2002). "Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: results from a twin study". Archives of General Psychiatry 59 (2): 139–45. doi:10.1001/archpsyc.59.2.139. PMID 11825135.
- Widom CS, DuMont K, Czaja SJ (January 2007). "A prospective investigation of major depressive disorder and comorbidity in abused and neglected children grown up". Archives of General Psychiatry 64 (1): 49–56. doi:10.1001/archpsyc.64.1.49. PMID 17199054. Lay summary – ScienceDaily (January 3, 2007).
- Arnow BA (2004). "Relationships between childhood maltreatment, adult health and psychiatric outcomes, and medical utilization". The Journal of Clinical Psychiatry. 65 Suppl 12: 10–5. PMID 15315472.
- Walsh, K.; DiLillo, D. (2011). "Child sexual abuse and adolescent sexual assault and revictimization". In Paludi, Michael A. The psychology of teen violence and victimization 1. Santa Barbara, CA: Praeger. pp. 203–216. ISBN 0-313-39375-3.
- Noll, J. G., Trickett, P. K., Susman, E. J., & Putnam, F. W. (2006). "Sleep disturbances and childhood sexual abuse". Journal of Pediatric Psychology, 31 (5): 469–480. doi:10.1093/jpepsy/jsj040.
- Steine, I. M., Krystal et al (2012). "Insomnia, nightmare frequency, and nightmare distress in victims of sexual abuse: The role of perceived social support and abuse characteristics". Journal of Interpersonal Violence 27 (9): 51827–1843. doi:10.1177/0886260511430385.
- Arehart-Treichel, Joan (2005-08-05). "Dissociation Often Precedes PTSD In Sexually Abused Children". Psychiatric News (American Psychiatric Association) 40 (15): 34.
- Understanding child sexual abuse: education, prevention, and recovery. American Psychological Association Retrieved 30 October 2012
- Faller, Kathleen Coulborn (1993). Child Sexual Abuse: Intervention and Treatment Issues. Diane Publishing. p. 6. ISBN 0-7881-1669-X.
- Frank R. Ascione Cruelty to animals in normative, sexually abused, and outpatient psychiatric samples of 6- to 12-year-old children Anthrozoös 16.3 (2003): 194–212. See also:
...[in a study by William N. Friedrich of] 271 cases of substantiated sexual abuse in 2 to 12-year old children and 879 non-abused children... cruelty to animals was present for 34.8% of the sexually abused boys and 27.5% of the sexually abused girls, rates that [were] 7 and 8 times higher than the rates for non-abused children. Ascione, Children and animals: exploring the roots of kindness and cruelty Purdue University Press April 1, 2005, p. 118.
- J McClellan et al Clinical characteristics related to severity of sexual abuse: A study of seriously mentally ill youth Child Abuse & Neglect 19.10 (1995): 1245–1254
- WN Friedrich et al Behavior problems in sexually abused young children Journal of Pediatric Psychology, 11.1 (1986): 47–57
- Tyler, K.A. (2002). "Social and emotional outcomes of childhood sexual abuse: A review of recent research". Aggression and Violent Behavior 7 (6): 567–589. doi:10.1016/S1359-1789(01)00047-7.
- Noll, J. G et al (2003). "Revictimization and self-harm in females who experienced childhood sexual abuse: Results from a prospective study". Journal of Interpersonal Violence 18 (12): 1452–1471. doi:10.1177/0886260503258035.
- "Childhood Sex Abuse Increases Risk for Drug Dependence in Adult Women". NIDA Notes, National Institute of Drug Abuse, volume 17, no. 1. National Institutes of Health. April 2002.
- "Long-term correlates of child sexual abuse: Theory and review of the empirical literature". Applied and Preventive Psychology (Elsevier Ltd.) 4 (3, Summer 1995, Pages 143–166).
- Freyd JJ, Putnam FW, Lyon TD, et al. (April 2005). "Psychology. The science of child sexual abuse". Science 308 (5721): 501. doi:10.1126/science.1108066. PMID 15845837.
- Dozier, M., Stovall, K.C., & Albus, K. (1999). "Attachment and Psychopathology in Adulthood". In J. Cassidy & P. Shaver. Handbook of Attachment. NY: Guilford Press. pp. 497–519. ISBN 1-57230-826-5.
- Kendall-Tackett KA, Williams LM, Finkelhor D (January 1993). "Impact of sexual abuse on children: a review and synthesis of recent empirical studies". Psychological Bulletin 113 (1): 164–80. doi:10.1037/0033-2909.113.1.164. PMID 8426874. also published in Hertzig, Margaret E.; Ellen A. Farber (1994). Annual progress in child psychiatry and child development 1994. Psychology Press. pp. 321–356. ISBN 0-87630-744-6.
- Gauthier L, Stollak G, Messé L, Aronoff J (July 1996). "Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning". Child Abuse & Neglect 20 (7): 549–59. doi:10.1016/0145-2134(96)00043-9. PMID 8832112.
- Briere J (April 1992). "Methodological issues in the study of sexual abuse effects". Journal of Consulting and Clinical Psychology 60 (2): 196–203. doi:10.1037/0022-006X.60.2.196. PMID 1592948.
- Brown D (2000). "(Mis) representations of the long-term effects of childhood sexual abuse in the courts". Journal of Child Sexual Abuse 9 (3–4): 79–107. doi:10.1300/J070v09n03_05. PMID 17521992.
- Bonomi AE, Anderson ML, Rivara FP, et al. (March 2008). "Health care utilization and costs associated with childhood abuse". Journal of General Internal Medicine 23 (3): 294–9. doi:10.1007/s11606-008-0516-1. PMC 2359481. PMID 18204885.
- Roberts, R., O'Connor, T., Dunn, J., and Golding, J. (2004). "The effects of child sexual abuse in later family life; mental health, parenting and adjustment of offspring". hild Abuse & Neglect 28 (5): 525–545. doi:10.1016/j.chiabu.2003.07.006.
- Fergusson, D.M. & Mullen, P.E. (1999). Childhood sexual abuse: An evidence based perspective. Thousand Oaks, California: Sage Publications. ISBN 0-7619-1136-7.[page needed]
- Kendler KS, Bulik CM, Silberg J, Hettema JM, Myers J, Prescott CA (October 2000). "Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis". Archives of General Psychiatry 57 (10): 953–9. doi:10.1001/archpsyc.57.10.953. PMID 11015813.
- Briere J, Elliott DM (April 1993). "Sexual abuse, family environment, and psychological symptoms: on the validity of statistical control". Journal of Consulting and Clinical Psychology 61 (2): 284–8; discussion 289–90. doi:10.1037/0022-006X.61.2.284. PMID 8473582.
- Caffaro-Rouget, A.; Lang, R. A.; Van Santen, V. (1989). "The Impact of Child Sexual Abuse On Victims' Adjustment". Sexual Abuse: A Journal of Research and Treatment 2: 29. doi:10.1177/107906328900200102.
- Mannarino AP, Cohen JA (1986). "A clinical-demographic study of sexually abused children". Child Abuse & Neglect 10 (1): 17–23. doi:10.1016/0145-2134(86)90027-X. PMID 3955424.
- Tong L, Oates K, McDowell M (1987). "Personality development following sexual abuse". Child Abuse & Neglect 11 (3): 371–83. doi:10.1016/0145-2134(87)90011-1. PMID 3676894.
- Conte, J. R.; Schuerman, J. R. (1987). "The Effects of Sexual Abuse on Children: A Multidimensional View". Journal of Interpersonal Violence 2 (4): 380. doi:10.1177/088626058700200404.
- Bulik CM, Prescott CA, Kendler KS (November 2001). "Features of childhood sexual abuse and the development of psychiatric and substance use disorders". The British Journal of Psychiatry 179 (5): 444–9. doi:10.1192/bjp.179.5.444. PMID 11689403.
- Beitchman JH, Zucker KJ, Hood JE, daCosta GA, Akman D, Cassavia E (1992). "A review of the long-term effects of child sexual abuse". Child Abuse Negl 16 (1): 101–18. doi:10.1016/0145-2134(92)90011-F. PMID 1544021.
- Browne A, Finkelhor D (January 1986). "Impact of child sexual abuse: a review of the research". Psychological Bulletin 99 (1): 66–77. doi:10.1037/0033-2909.99.1.66. PMID 3704036.
- Holguin, G (2003). "The 'sexually abused child': Potential mechanisms of adverse influences of such a label". Aggression and Violent Behavior 8 (6): 645. doi:10.1016/S1359-1789(02)00101-5.
- Romans SE, Martin JL, Anderson JC, O'Shea ML, Mullen PE (January 1995). "Factors that mediate between child sexual abuse and adult psychological outcome". Psychological Medicine 25 (1): 127–42. doi:10.1017/S0033291700028154. PMID 7792348.
- Spaccarelli S, Kim S (September 1995). "Resilience criteria and factors associated with resilience in sexually abused girls". Child Abuse & Neglect 19 (9): 1171–82. doi:10.1016/0145-2134(95)00077-L. PMID 8528822.
- Chu JA, Frey LM, Ganzel BL, Matthews JA (May 1999). "Memories of childhood abuse: dissociation, amnesia, and corroboration". The American Journal of Psychiatry 156 (5): 749–55. PMID 10327909.
- Draijer N, Langeland W (March 1999). "Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients". The American Journal of Psychiatry 156 (3): 379–85. doi:10.1016/j.biopsych.2003.08.018. PMID 10080552.
- Hornor, G. (2010). "Child sexual abuse: Consequences and implications". Journal of Pediatric Health Care 24 (6): 358–364. doi:10.1016/j.pedhc.2009.07.003.
- Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP (January 1996). "The long-term impact of the physical, emotional, and sexual abuse of children: a community study". Child Abuse & Neglect 20 (1): 7–21. doi:10.1016/0145-2134(95)00112-3. PMID 8640429.
- Pope, Harrison G.; Hudson, James I. (Fall 1995). "Does childhood sexual abuse cause adult psychiatric disorders? Essentials of methodology". Journal of Psychiatry & Law 23 (3): 363–81.
- Levitt EE, Pinnell CM (April 1995). "Some additional light on the childhood sexual abuse-psychopathology axis". The International Journal of Clinical and Experimental Hypnosis 43 (2): 145–62. doi:10.1080/00207149508409958. PMID 7737760.
- Fleming J, Mullen PE, Sibthorpe B, Bammer G (February 1999). "The long-term impact of childhood sexual abuse in Australian women". Child Abuse & Neglect 23 (2): 145–59. doi:10.1016/S0145-2134(98)00118-5. PMID 10075184.
- Rind, Bruce; Tromovitch, Philip (1997). "A meta-analytic review of findings from national samples on psychological correlates of child sexual abuse". Journal of Sex Research 34 (3): 237. doi:10.1080/00224499709551891.
- Dallam SJ, Gleaves DH, Cepeda-Benito A, Silberg JL, Kraemer HC, Spiegel D (November 2001). "The effects of child sexual abuse: Comment on Rind, Tromovitch, and Bauserman (1998)". Psychological Bulletin 127 (6): 715–33. doi:10.1037/0033-2909.127.6.715. PMID 11726068.
- Oltmanns, Thomas F.; Emery, Robert E. (2001). Abnormal Psychology. Upper Saddle River, NJ: Prentice Hall. ISBN 0-13-187521-3.[page needed]
- US Congress (1999). "Whereas no segment of our society is more critical to the future of human survival than our children" (PDF). 106th Congress, Resolution 107.
- Anderson, James; Mangels, Nancie; Langsam, Adam (2004). "Child Sexual Abuse: A Public Health Issue". The Justice Professional 17: 107. doi:10.1080/08884310420001679386.
- Herman-Giddens ME, Brown G, Verbiest S, et al. (August 1999). "Underascertainment of child abuse mortality in the United States". JAMA 282 (5): 463–7. doi:10.1001/jama.282.5.463. PMID 10442662.
- De Jong AR (1985). "Vaginitis due to Gardnerella vaginalis and to Candida albicans in sexual abuse". Child Abuse & Neglect 9 (1): 27–9. doi:10.1016/0145-2134(85)90088-2. PMID 3872154.
- Developing Mind, Daniel Siegel, Guilford Press, 1999[page needed]
- Maia Szalavitz; Perry, Bruce (2006). The boy who was raised as a dog: and other stories from a child psychiatrist's notebook: what traumatized children can teach us about loss, love and healing. New York: Basic Books. ISBN 0-465-05652-0.[page needed]
- Ito Y, Teicher MH, Glod CA, Ackerman E (1998). "Preliminary evidence for aberrant cortical development in abused children: a quantitative EEG study". The Journal of Neuropsychiatry and Clinical Neurosciences 10 (3): 298–307. PMID 9706537.
- Teicher MH, Glod CA, Surrey J, Swett C (1993). "Early childhood abuse and limbic system ratings in adult psychiatric outpatients". The Journal of Neuropsychiatry and Clinical Neurosciences 5 (3): 301–6. PMID 8369640.
- Anderson CM, Teicher MH, Polcari A, Renshaw PF (2002). "Abnormal T2 relaxation time in the cerebellar vermis of adults sexually abused in childhood: potential role of the vermis in stress-enhanced risk for drug abuse". Psychoneuroendocrinology 27 (1–2): 231–44. doi:10.1016/S0306-4530(01)00047-6. PMID 11750781.
- Teicher MH (March 2002). "Scars that won't heal: the neurobiology of child abuse". Scientific American 286 (3): 68–75. doi:10.1038/scientificamerican0302-68. PMID 11857902.
- Ito Y, Teicher MH, Glod CA, Harper D, Magnus E, Gelbard HA (1993). "Increased prevalence of electrophysiological abnormalities in children with psychological, physical, and sexual abuse". The Journal of Neuropsychiatry and Clinical Neurosciences 5 (4): 401–8. PMID 8286938.
- Arehart-Treichel, Joan (March 2001). "Psychological Abuse May Cause Changes in Brain". Psychiatric News 36 (5): 36.
- Barabara E. Bogorad, Psy.D., A.B.P.P.,Founder and Former Director, Sexual Abuse Recovery Program Unit South Oaks Hospital, New York. "Sexual Abuse:Surviving the Pain". The American Academy of Experts in Traumatic Stress, Inc.
- Fridell, L. A. (1990). "Decision-Making Of The District Attorney: Diverting Or Prosecuting Intrafamilial Child Sexual Abuse Offenders". Criminal Justice Policy Review 4 (3): 249. doi:10.1177/088740349000400304.
- Turner, Jeffrey S. (1996). Encyclopedia of relationships across the lifespan. Westport, Conn: Greenwood Press. p. 92. ISBN 0-313-29576-X.
- Meyer, Isabel Denholm; Dorais, Michel (2002). Don't tell: the sexual abuse of boys. Montreal: McGill-Queen's University Press. p. 24. ISBN 0-7735-2261-1.
- Courtois, Christine A. (1988). Healing the incest wound: adult survivors in therapy. New York: Norton. ISBN 0-393-31356-5.[page needed]
- Goldman JD, Padayachi UK (May 1997). "The prevalence and nature of child sexual abuse in Queensland, Australia". Child Abuse & Neglect 21 (5): 489–98. doi:10.1016/S0145-2134(97)00008-2. PMID 9158908.
- Finkelhor, D. (1979). Sexually victimised children. New York: Free Press
- Cawson, Pat; Wattam, Corinne; Brooker, Sue (2000). Child Maltreatment in the United Kingdom: A Study of the Prevalence of Child Abuse and Neglect. London: National Society for the Prevention of Cruelty to Children. ISBN 978-1-84228-006-5.[page needed]
- Finkelhor, David; Ormrod, Richard (May 2001). "Child Abuse Reported to the Police". Juvenile Justice Bulletin (U.S. Office of Juvenile Justice and Delinquency Prevention).
- Definitions of Child Abuse and Neglect, Summary of State Laws, National Clearinghouse on Child Abuse and Neglect Information, U.S. Department of Health and Human Services.
- Finkelhor, David; Ormrod, Richard (June 2004). "Prostitution of Juveniles: Patterns From NIBRS". Juvenile Justice Bulletin (U.S. Office of Juvenile Justice and Delinquency Prevention).
- Child Sexual Exploitation: Improving Investigations and Protecting Victims, Massachusetts Child Exploitation Network, U.S. Office of Juvenile Justice and Delinquency Prevention, January, 1995.
- Grooming chatroom Content at ZDNet UK[unreliable source?]
- Gries, L.; Goh, D.; Andrews, M.; Gilbert, J.; Praver, F.; Stelzer, D. (2000). "Positive reaction to disclosure and recovery from child sexual abuse". Journal of Child Sexual Abuse 9 (1): 29–51. doi:10.1300/J070v09n01_03.
- Kogan, S. (2005). "The Role of Disclosing Child Sexual Abuse on Adolescent Adjustment and Revictimization". Journal of Child Sexual Abuse 14 (2): 25–47. doi:10.1300/J070v14n02_02. PMID 15914409.
- Arata, C. (1998). To tell or not to tell: Current functioning of child sexual abuse survivors who disclosed their victimization. Child Maltreatment, 3(1), 63.71.
- Palmer, S.; Brown, R.; Rae-Grant, N.; Loughlin, J. M. (1999). "Responding to children's disclosure of familial abuse: what survivors tell us". Child Welfare 2 (78): 259–282.
- Ullman, S.E. (2003). "Social reactions to child abuse disclosure: A critical review". Journal of Child Sexual Abuse 12 (1): 89–121. doi:10.1300/J070v12n01_05. PMID 16221661.
- Roesler, T.A. (1994). "Reactions to disclosure of childhood sexual abuse: the effect on adult symptoms". Journal of Nervous and Mental Disease 182 (11): 618–624. doi:10.1097/00005053-199411000-00004. PMID 7964669.
- Schechter DS, Brunelli SA, Cunningham N, Brown J, Baca P (2002). Mother-daughter relationships and child sexual abuse: A pilot study of 35 mothers and daughters (ages 1-9 years). Bulletin of the Menninger Clinic, 66(1), 39-60. 
- "Responding To Child Sexual Abuse." American Academy of Child & Adolescent Psychiatry.
- Brown, Asa Don, "The effects of childhood trauma on adult perception and worldview". (Dissertation) Capella University, 2008, 152 pages. AAT 3297512. ISBN 978-0-549-47057-1; Publication #3297512.
- Cynthia Winn; Anthony J. Urquiza (2004). Treatment For Abused And Neglected Children: Infancy To Age 18 – User Manual Series. Diane Pub Co. ISBN 0-7881-1661-4.
- Summit, Roland C. (January 1983). "The child sexual abuse accommodation syndrome". Child Abuse & Neglect 7 (22). PMID 6605796.
- Swaby, AN.; Morgan, KA. (2009). "The relationship between childhood sexual abuse and sexual dysfunction in Jamaican adults". J Child Sex Abus 18 (3): 247–66. doi:10.1080/10538710902902679. PMID 19856732.
- Edmond, T.; Rubin, A. (2004). "Assessing the long-term effects of EMDR: results from an 18-month follow-up study with adult female survivors of CSA". J Child Sex Abus 13 (1): 69–86. doi:10.1300/J070v13n01_04. PMID 15353377.
- Fergusson, DM.; Lynskey, MT.; Horwood, LJ. (Oct 1996). "Childhood sexual abuse and psychiatric disorder in young adulthood: I. Prevalence of sexual abuse and factors associated with sexual abuse". J Am Acad Child Adolesc Psychiatry 35 (10): 1355–64. doi:10.1097/00004583-199610000-00023. PMID 8885590.
- Joint Submission by The Office of the Governor C.L. Butch Otter, Governor and The Office of the Attorney General Lawrence Wasden, Attorney General January, 2008. "The Prosecution of Child Sexual Abuse in Idaho July 1, 2006 – June 30, 2007" (pdf). Retrieved 2008-01-28.
- Idaho Releases Yearly Report on Sexual Abuse, KPVI.com, Suzanne Hobbs
- M. S., Denov (01-AUG-2003). "The myth of innocence: sexual scripts and the recognition of child sexual abuse by female perpetrators". The Journal of Sex Research 40 (3): 303–314. doi:10.1080/00224490309552195.
- Educator Sexual Misconduct: A Synthesis of the Literature", U.S. Department of Education, 2004, p25, Shakeshaft, C.
- Maletzky, B.M. (1993). "Factors associated with success and failure in the behavioral and cognitive treatment of sexual offenders". Annals of Sex Research 6 (4): 241–258. doi:10.1007/BF00856862.
- Tomeo, M; Templer, D; Anderson, S; Kotler, D (2001). "Comparative Data of Childhood and Adolescence Molestation in Heterosexual and Homosexual Persons". Archives of Sexual Behavior 30: 5.
- Shakeshaft, C, "Educator Sexual Misconduct: A Synthesis of the Literature", U.S. Department of Education, 2004, p.24-25.
- Groth, A. Nicholas & Birnbaum, H. Jean (1978). "Adult sexual orientation and attraction to underage persons," Archives of Sexual Behavior Vo. 7, No. 3, 175–181
- Holmes, Ronald M.; Holmes, Stephen T. (2002-03-12). Profiling Violent Crimes: An Investigative Tool. Thousand Oaks, CA: Sage Publications, Inc. ISBN 978-0-7619-2593-4.
- "Pedophilia". Psychology Today. Sussex Publishers, LLC. 7 September 2006.
- E L Rezmovic ; D Sloane ; D Alexander ; B Seltser ; T Jessor (1996). "Cycle of Sexual Abuse: Research Inconclusive About Whether Child Victims Become Adult Abusers" (PDF). US Government Accountability Office General Government Division United States.
- Ward, T.; Hudson, S. M.; Marshall, W. L. (1995). "Cognitive distortions and affective deficits in sex offenders: A cognitive deconstructionist interpretation". Sexual Abuse: A Journal of Research and Treatment 7: 67–83.
- World Health Organization, International Statistical Classification of Diseases and Related Health Problems 10. § F65.4
- American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (fourth edition text revision), § 302.2
- ""pedophilia" (n.d.)". The American Heritage Stedman's Medical Dictionary. 2008-05-06. "The act or fantasy on the part of an adult of engaging in sexual activity with a child or children."
- ""pedophile" (n.d.)". The American Heritage Dictionary of the English Language, Fourth Edition. 2008-05-06.
- "American Psychiatric Association Statement Diagnostic Criteria for Pedophilia" (PDF). American Psychiatric Association. 2003-06-17. Archived from the original on 2007-06-29.
- Self-Report of Crimes Committed by Sex Offenders, M. Weinrott and M. Saylor, Journal of Interpersonal Violence, vol.6 (1991). A study finding that child sexual offenders self-reported high degree of "crossover" sexual offenses, defined as rapes of adult women, as well as of both related and non-related children).
- See, for example, State v. Frazier, 2005-Ohio-3356.
- See, for example, Prosecuting Child Sex Tourists at Home, Margaret A. Healy, Fordham International Law Journal, vol.18, 1995.
- How We Can Fight Child Abuse, Andrew Vachss, Parade Magazine, August 20, 1989.
- Myths and Facts About Sex Offenders
- Hanson RK, Steffy RA, Gauthier R (August 1993). "Long-term recidivism of child molesters". Journal of Consulting and Clinical Psychology 61 (4): 646–52. doi:10.1037/0022-006X.61.4.646. PMID 8370860.
- Frisbie, L.V. (1965). Treated sex offenders who reverted to sexually deviant behavior. Federal Probation
- Shaw JA, Lewis JE, Loeb A, Rosado J, Rodriguez RA (December 2000). "Child on child sexual abuse: psychological perspectives". Child Abuse & Neglect 24 (12): 1591–600. doi:10.1016/S0145-2134(00)00212-X. PMID 11197037.
- Caffaro, J; Conncaffaro, A (2005). "Treating sibling abuse families". Aggression and Violent Behavior 10 (5): 604. doi:10.1016/j.avb.2004.12.001.
- Gray A, Pithers WD, Busconi A, Houchens P (June 1999). "Developmental and etiological characteristics of children with sexual behavior problems: treatment implications". Child Abuse & Neglect 23 (6): 601–21. doi:10.1016/S0145-2134(99)00027-7. PMID 10391518.
- Gray, Alison; Busconi, Aida; Houchens, Paul; Pithers, William D. (1997). "Children with sexual behavior problems and their caregivers: Demographics, functioning, and clinical patterns". Sexual Abuse: A Journal of Research and Treatment 9 (4): 267. doi:10.1007/BF02674853.
- Bromberg, Daniel S.; Johnson, Blair T. (2001). "Sexual interest in children, child sexual abuse, and psychological sequelae for children". Psychology in the Schools 38 (4): 343. doi:10.1002/pits.1023.
- Wieckowski, Edward; Hartsoe, Peggy; Mayer, Arthur; Shortz, Joianne (1998). Sexual Abuse: A Journal of Research and Treatment 10 (4): 293. doi:10.1023/A:1022194021593.
- Andersson N, Paredes-Solís S, Milne D, et al. Prevalence and risk factors for forced or coerced sex among school-going youth: national cross-sectional studies in 10 southern African countries in 2003 and 2007. BMJ Open 2012;2:e000754. doi:10.1136/bmjopen-2011-000754
- "Child rape survivors saves 'virgin myth' victims". cnn.com. 2009-06-04. Retrieved 2012-04-05.
- Child Rape: A Taboo within the AIDS Taboo: More and more girls are being raped by men who believe this will 'cleanse' them of the disease, but people don't want to confront the issue, by Prega Govender, Sunday Times (South Africa), April 4, 1999.
- Oprah scandal rocks South Africa
- South Africa’s rape shock
- South African Men Rape Babies as "Cure" for AIDS, Jane Flanagan, Daily Telegraph (UK), November 11, 2001.
- "Baby rape sparks outrage". abcnews.com. July 30. Retrieved 2011-07-12.
- "Child rape in South Africa". Medscape. Retrieved 2010-12-31.
- Child rape on the rise in eastern Congo
- DR Congo child rape victim dies
- Kendall-Tackett KA, Williams LM, Finkelhor D (January 1993). "Impact of sexual abuse on children: a review and synthesis of recent empirical studies". Psychological Bulletin 113 (1): 164–80. doi:10.1037/0033-2909.113.1.164. PMID 8426874.
- Finkelhor D (1993). "Epidemiological factors in the clinical identification of child sexual abuse". Child Abuse & Neglect 17 (1): 67–70. doi:10.1016/0145-2134(93)90009-T. PMID 8435788.
- Goldman, Juliette D. G.; Padayachi, Usha K. (November 2000). "Some methodological problems in estimating incidence and prevalence in child sexual abuse research". Journal of Sex Research 37 (4): 305–14. doi:10.1080/00224490009552052.
- Gorey, Kevin; Leslie, DR (April 1997). "The prevalence of child sexual abuse: Integrative review adjustment for potential response and measurement biases". Child abuse and neglect 21 (4): 391–398. doi:10.1016/S0145-2134(96)00180-9. PMID 9134267.
- Radford ; Lorraine ; Corral ; Susana ; Bradley ; Christine ; Fisher ; Helen ; Bassett ; Claire ; Howat ; Nick and Collishaw ; Stephan (2011). "Child abuse and neglect in the UK today" (PDF). NSPCC. p. 5.
- Baker, AW; Duncan, SP (1985). "Child sexual abuse: a study of prevalence in Great Britain". Child Abuse and Neglect 9 (4): 457–67. doi:10.1016/0145-2134(85)90054-7. PMID 4084825.
- "NSPCC says child sex abuse has risen to 64 crimes a day" BBC News. 26 May 2011. Retrieved February 4, 2012.
- "60 sex offences against children a day - NSPCC" BBC News. 25 January 2010. Retrieved February 4, 2012.
- Rind, B; Tromovitch, P., & Bauserman, R. (1998). "A meta-analytic examination of assumed properties of child sexual abuse using college samples". Psychological Bulletin 124 (1): 22–53. doi:10.1037/0033-2909.124.1.22. PMID 9670820.
- "ACF Questions and Answers Support". Administration on Children and Families. US Department of Health and Human Services. Retrieved December 26, 2007.
- "Child Maltreatment 2005". Administration on Children and Families. US Department of Health and Human Services. Retrieved December 26, 2007.
- "Child Sexual Abuse". Facts for Families, No. 9. American Academy of Child and Adolescent Psychiatry. May 2008.
- Child Sexual Abuse Fact Sheet. (PDF). Emily M. Douglas and David Finkelhor.
- "Correlates of Adolescent Reports of Sexual Assault: Findings From the National Survey of Adolescents". (PDF). Child Maltreatment Volume:8 Issue:4 Dated:November 2003 Pages:261 to 272
- Herman, Judith (1981). Father-Daughter Incest. Cambridge, Massachusetts: Harvard University Press. p. 282. ISBN 0-674-29506-4.
- Sariola, H. & Uutela, A. (1996). The prevalence and context of incest abuse in Finland. Child Abuse & Neglect, Volume 20, Issue 9, September 1996, Pages 843–850.
- Keuhnle, K., Assessing Allegations of Child Sexual Abuse, Professional Resources Press, Sarastota, FL, 1996
- pg7., In. Keuhnle, K., Assessing Allegations of Child Sexual Abuse, Professional Resources Press, Sarastota, FL, 1996
- Shakeshaft, C, "Educator Sexual Misconduct: A Synthesis of the Literature", U.S. Department of Education, 2004
- Shakeshaft, C, "Educator Sexual Misconduct: A Synthesis of the Literature", U.S. Department of Education, 2004, p26.
- Watkins, B.; Bentovim, A. (1992). "The sexual abuse of male children and adolescents: a review of current research". Journal of Clinical Psychology & Psychiatry 33 (10): 197–248. doi:10.1111/j.1469-7610.1992.tb00862.x. PMID 1737828.
- Shakeshaft, C, "Educator Sexual Misconduct: A Synthesis of the Literature", U.S. Department of Education, 2004, p22.
- Denov, Myriam S. (2004) "Perspectives on Female Sex Offending: A Culture of Denial"
- Cathy Young (2002). "Double Standard". The Boston Globe. The article may currently be viewed for free on Reason.com.
- "Study on Child Abuse: India 2007" (PDF). Published by the Government of India, (Ministry of Women and Child Development).
- "Women's Rights by Amy Steiner". Georgetown University.
- "Budget Analysis for Child Protection" (PDF). Published by the Government of India, (Ministry of Women and Child Development).
- "Parliament passes bill to protect children from sexual abuse". NDTV. May 22, 2012.
- Yen, Cheng-Fang; Yang, Mei-Sang; Yang, Ming-Jen; Su, Yi-Ching; Wang, Mei-Hua; Lan, Chu-Mei (2008). "Childhood physical and sexual abuse: Prevalence and correlates among adolescents living in rural Taiwan". Child Abuse & Neglect 32 (3): 429–438. doi:10.1016/j.chiabu.2007.06.003.
- Dirty Diplomacy, Craig Murray, Scribner, 2007
- Levesque, Roger J. R. (1999). Sexual Abuse of Children: A Human Rights Perspective. Indiana University Press. pp. 1,5–6,176–180. ISBN 0-253-33471-3. "The world community recently has recognized every child's fundamental human right to protection from sexual maltreatment. This right has been expressed in recent declarations, conventions, and programs of action. Indeed, the right to protection from sexual maltreatment is now entrenched so strongly in international human rights law that no country can relinquish its obligation."
- "United Nations Convention on the Rights of the Child". Office of the United Nations High Commissioner for Human Rights. 1989. "Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse... States Parties undertake to protect the child from all forms of sexual exploitation and sexual abuse. For these purposes, States Parties shall in particular take all appropriate national, bilateral and multilateral measures to prevent: (a) The inducement or coercion of a child to engage in any unlawful sexual activity; (b) The exploitative use of children in prostitution or other unlawful sexual practices; (c) The exploitative use of children in pornographic performances and materials."
- Black's Law Dictionary 8th Edition. child, "at common law, a person who has not reached the age of 14." See also definition under rape "carnal knowledge of a child is frequently declared to be rape by statute."
- United Nations Convention on the Rights of the Child.
- United Nations Treaty Collection. Convention on the Rights of the Child . Retrieved on 26 November 2008.
- Child Rights Information Network (2008). Convention on the Rights of the Child. Retrieved on 26 November 2008.
- Amnesty International USA (2007). Convention on the Rights of the Child: Frequently Asked Questions. Retrieved on 26 November 2008.
- Masson, Jeffrey Moussaieff (1984). Assault on the Truth. New York: Farrar Straus. pp. 15–25. ISBN 978-0-374-10642-3.
- Paula Reavey, Sam Warner (2003). New feminist stories of child sexual abuse: sexual scripts and dangerous dialogues Routledge, pp. 2 (or more). ISBN 0-415-25944-4, ISBN 978-0-415-25944-6
- Francis J. Turner (2011). Social Work Treatment: Interlocking Theoretical Approaches Oxford University Press, pp. 215 (or more). ISBN 0-19-539465-8, ISBN 978-0-19-539465-8
- "Conversation with History; Dr. Judith Lewis Herman". Conversations with History: Institute of International Studies. UC Berkeley. Retrieved December 22, 2007.
- Herman, JL (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. Basic Books. pp. 119–121.
- Megan's Law
- From Generation to Generation: Understanding Sexual Attraction to Children, p.15
- B.J. Cling (2004). Sexualized Violence Against Women and Children: A Psychology and Law Perspective. Guilford Press. p. 177. ISBN 1-59385-061-1.
- The Church Child Sex Abuse Scandal Widens and Deepens
- Cifarelli, T.A.,Shielding Minors, Los Angeles Daily Journal, (October 10, 2001).
- "When A Girl Student Stands Up and Wins", Women News Network – WNN, August 11, 2008
- World Health Organization Report on Sexual Violence, 2002
- "World's Largest Ring of Child Abusers Arrested", The World Reporter – TWR, March 16, 2011
- Lew, Mike (2004). Victims No Longer (Second Edition) : The Classic Guide for Men Recovering from Sexual Child Abuse. Perennial Currents. ISBN 0-06-053026-X.
- Cynthia Crosson-Tower (2008). Understanding child abuse and neglect. Boston: Pearson/Allyn & Bacon. ISBN 0-205-50326-8.
- Asa Don Brown (2009). Posttraumatic stress disorder in childhood. New Orleans: Family and Marriage Counseling, FMC.
- Lascaratos, J; Ascaratos J; Poulakou-Rebelakou, E (2000). "Child Sexual abuse: Historical cases in the Byzantine Empire (324–1453 A.D.)". Child Abuse& Neglect 24 (8): 1085–1090. doi:10.1016/S0145-2134(00)00156-3.
- Durkin, KF; Clifton DB (1999). "Propagandizing pederasty: A thematic analysis of the on-line exculpatory accounts of unrepentant pedophiles". Deviant Behavior 20 (2): 103–127. doi:10.1080/016396299266524.
- Zimring, Franklin E. (2009). An American Travesty: Legal Responses to Adolescent Sexual Offending. University of Chicago Press. ISBN 978-0-226-98358-5.
- American Academy of Child and Adolescent Psychiatry: factsheet on Child Sexual abuse
- Child Abuse: Sexual Abuse at the Open Directory Project
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