Child sexual abuse: what we know from practice and research
An in-depth look at the issue of the sexual abuse of children
12 December 2012
Jon Brown, our sexual abuse lead, talks in-depth about the prevalence of child abuse in the UK, why it happens and the impact it has on the victims.
The scale of the problem
Child sexual abuse is fundamentally driven by the abuse of power combined with a sexual interest in children. It is a crime that is usually only witnessed by the abuser and the victim and because of this the majority of it goes unreported, undetected and unprosecuted.
Therefore, the majority of perpetrators in our communities are not known to the authorities. Estimates from international research studies show that between 60-90% of child sexual abuse never comes to the attention of the police.
In 2000 the NSPCC published the first comprehensive study into the prevalence of child abuse in the UK. A further prevalence study was then published in 2010. In this study young adults aged 18-24 and children aged 11-17 were interviewed. This showed that 11.3% (1 in 9) of young adults said they had experienced contact sexual abuse during their childhood. 4.8% (1 in20) of 11-17 year olds had experienced contact sexual abuse.
In the 2000 study 72% of sexually abused children did not tell anyone about the abuse at the time and 27% told someone later. Approximately one third (31%) still had not told anyone about their experience(s) by early adulthood.
These statistics should be regarded as significant underestimates because of the extent to which child sexual abuse is not disclosed and reported. In the UK and in elsewhere across the world we are faced with the visible peak of a much larger problem.
The challenge of child sexual abuse is preventable but the extent to which it is under-reported should always be taken into account. In addition to this we know that even when it is reported as little as one in 10 cases will result in a criminal conviction of the offender.
Who perpetrates child sexual abuse and what motivates them?
The great majority of child sexual abuse is perpetrated by males (well over 90%) but the actual prevalence of abuse (as distinct from criminal justice statistics) by females is not accurately known.
Approximately one third of all sexual offences against children are perpetrated by children and young people under the age of 18. The great majority of these children and young people with harmful sexual behaviour with the appropriate support, treatment and guidance will not develop into adult sex offenders.
A key assessment task is to identify that relatively small group of children and young people who represent a higher risk. Not all perpetrators begin the offending against children when they are children or young people, some do and others will start to offend as adults.
Girls are approximately six times more likely to be sexually abused then boys. Other factors increasing the risk of sexual abuse are: a history of previous sexual abuse, being disabled, experiencing "poly victimisation" (other forms of abuse such as domestic abuse, neglect, physical abuse), coming from a lower socio economic group.
These factors can increase risk, particularly when clustered, however it should also be recognised that children from all backgrounds and in all communities are sexually abused.
A number of factors contribute to the development of sexually abusive behaviour. It is important to note that it is not disease that can be cured and people are not born as child sexual abusers. Rather than cure the emphasis should be on risk reduction, addressing specifically the factors that have contributed to the offending.
Paedophilia is one facet of child sexual abuse and can be defined as a primary sexual interest in pre-pubescent children. The majority of sex offenders are not paedophiles although this term is used frequently and often inaccurately.
Factors contributing to child sexual abuse can be broadly catagorised as biological (sexual drive is a deep seated and basic human urge alongside, for example, the desire to eat), developmental (a disrupted attachment to a primary care giver is often evident with child sex offenders), systemic (family and community norms and expectations are a significant influence) and situational (even with all the other factors present, unless a potential abuser creates or finds himself in a situation where he can abuse, he may never move from the potential to actual abuse).
It's often argued that there is a link between someone being abused and then going on to be an abuser themselves in later life. Whilst some sexual abusers will have been abused as children themselves, current research does not support the contention that being sexually abused increases the chances of someone becoming a perpetrator. But with up to 40% of sex offenders also being victims there is clearly a need for more research.
What are the patterns of perpetrator behaviour?
Child sexual abuse is most commonly perpetrated in circumstances where the victim is known and sometimes related to the perpetrator, this is often termed intra-familial sexual abuse.
Recent research undertaken by the NSPCC shows that over 70% of sexual offences against children were perpetrated by abusers known or related to the victim Boys are most often (although not exclusively) abused outside of the family, for example in residential, sports and other social settings.
Abusers will look for weak spots in a family, a community or an organisation where they will be able to gain unsupervised access to children and where their chances of not being detected are greatest.
Child sexual abuse is thought out and planned and is usually driven by sexual fantasy in which the abuse is rehearsed.
The fact that the cognitive and behavioural patterns which precede and inform sexual abuse are relatively predictable means that treatment programmes can and have been developed which can specifically target these patterns.
Generally, in order for abuse to take place the abuser has to overcome their own internal inhibitions; they usually know what they are doing is wrong and have to convince themselves through a process of cognitive distortions (rationalisations) that the abuse not causing harm and that the victim wants the sexual contact. Sadistic and psychopathic offenders do not go through this process or it is very truncated. These sorts of (very dangerous) offenders are relatively rare.
As well as targeting potential victims and planning abuse, abusers will also engage in a process of grooming, of the child, the child's family and the child's environment.
This process of grooming can often leave the child victim feel very confused and sometimes culpable. The more they are made to feel in some way to blame for the abuse the more difficult disclosure of the abuse can be.
Therefore, understanding the specific ways in which grooming has taken place and the ways in which the child has been silenced by threats, both implicit and explicit and by being made to feel in some way to blame for the abuse is key to designing an effective treatment programme for the child as well as for the abuser.
Because of often strong feelings of guilt, shame and fear victims will often not disclose sexual abuse for a long time and will sometimes never be able to talk about what they have been through. We have seen this graphically illustrated by recent televised interviews with some of the victims of Jimmy Savile and of the Bryn Estyn Children's Home in north Wales.
Child sexual exploitation is part of child sexual abuse although more needs to be understood about some of its specific elements, particularly in relation to perpetrators of this form of sexual abuse. The offending of Jimmy Savile over four decades illustrates elements of both extra familial child sexual abuse and child sexual exploitation.
Whilst definitions of various types of abuse are important it is also important that these meanings do not distract from the biggest goal of identifying, disrupting and preventing child sexual abuse in the UK in all its forms.
What is the impact of child sexual abuse?
The impact of child sexual abuse on the victim can be long term and devastating. The duration and proximity of the abuse and the abuser (i.e. a close family member) are important factors that can influence the extent of the impact.
Child sexual abuse often will leave few physical scars and where there is physical injury this will often heal relatively quickly.
Far more enduring are the emotional and psychological impacts on the victim. Children who have been sexually abused may display significant behavioural changes, they may become withdrawn, clingy, anxious; they may display sexual precociousness and/or aggression and may display some physical signs such as bed wetting, recurring thrush or other sexually transmitted diseases, bleeding from the vagina and/or anus.
Older children and adults often display depression, anxiety, feelings of uncontrollable rage, obsessive behaviours, eating disorders, regular suicidal thoughts, alcohol and substance misuse and addiction, an inability to form and maintain long term consenting and equal adult friendships and relationships; driven by on-going feelings of betrayal, stigmatisation and powerlessness.
The annual health costs of child sexual abuse in our child and adult population run to many millions of pounds a year.
How is child sexual abuse best treated?
Treatment of child victims of sexual abuse typically lasts for several months following a period of assessment and is based on a variety of cognitive behavioural and psychodynamic approaches to help them understand how they were tricked, groomed and coerced, crucially that they are not to blame for the abuse and that they can lead lives that are not dominated by what was done to them.
Treatment of perpetrators is aimed at helping them to understand how they actively created situations to abuse and that it did not "just happen". Treatment also focuses on the addictive and habitual nature of the behaviour and helps them understand that they can lead fulfilling and abuse free lives. Research has clearly shown that punishment alone will not stop perpetrators reoffending.
Child sexual abuse is a public health problem that requires a response which addresses deterrence, treatment and primary prevention (information and education).
Research and practice experience over the last three decades shows us that it is this, delivered cross agency and cross discipline and with communities at the centre that offers the most optimistic prospect of making a significant impact on the incidence of child sexual abuse in the UK and further afield.
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