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From the American Academy of Child and Adolescent Psychiatry
Child Sexual Abuse
No. 9; Updated July 2004
Child sexual abuse has been reported up to 80,000 times a year, but the number of unreported instances is far greater,
because the children are afraid to tell anyone what has happened, and the legal procedure for validating an episode is difficult.
The problem should be identified, the abuse stopped, and the child should receive professional help. The long-term emotional
and psychological damage of sexual abuse can be devastating to the child.
Child sexual abuse can take place within the family, by a parent, step-parent, sibling or other relative; or outside the
home, for example, by a friend, neighbor, child care person, teacher, or stranger. When sexual abuse has occurred, a child
can develop a variety of distressing feelings, thoughts and behaviors.
No child is psychologically prepared to cope with repeated sexual stimulation. Even a two or three year old, who cannot
know the sexual activity is wrong, will develop problems resulting from the inability to cope with the overstimulation.
The child of five or older who knows and cares for the abuser becomes trapped between affection or loyalty for the person,
and the sense that the sexual activities are terribly wrong. If the child tries to break away from the sexual relationship,
the abuser may threaten the child with violence or loss of love. When sexual abuse occurs within the family, the child may
fear the anger, jealousy or shame of other family members, or be afraid the family will break up if the secret is told.
A child who is the victim of prolonged sexual abuse usually develops low self-esteem, a feeling of worthlessness and an
abnormal or distorted view of sex. The child may become withdrawn and mistrustful of adults, and can become suicidal.
Some children who have been sexually abused have difficulty relating to others except on sexual terms. Some sexually abused
children become child abusers or prostitutes, or have other serious problems when they reach adulthood.
Often there are no obvious physical signs of child sexual abuse. Some signs can only be detected on physical exam by a
physician.
Sexually abused children may develop the following:
- unusual interest in or avoidance of all things of a sexual nature
- sleep problems or nightmares
- depression or withdrawal from friends or family
- seductiveness
- statements that their bodies are dirty or damaged, or fear that there is something wrong with them in the genital area
- refusal to go to school
- delinquency/conduct problems
- secretiveness
- aspects of sexual molestation in drawings, games, fantasies
- unusual aggressiveness, or
- suicidal behavior
Child sexual abusers can make the child extremely fearful of telling, and only when a special effort has helped the child
to feel safe, can the child talk freely. If a child says that he or she has been molested, parents should try to remain calm
and reassure the child that what happened was not their fault. Parents should seek a medical examination and psychiatric consultation.
Parents can prevent or lessen the chance of sexual abuse by:
- Telling children that if someone tries to touch your body and do things that make you feel funny, say NO to that person
and tell me right away
- Teaching children that respect does not mean blind obedience to adults and to authority, for example, don't tell children
to, Always do everything the teacher or baby-sitter tells you to do
- Encouraging professional prevention programs in the local school system
Sexually abused children and their families need immediate professional evaluation and treatment. Child and adolescent
psychiatrists can help abused children regain a sense of self-esteem, cope with feelings of guilt about the abuse, and begin
the process of overcoming the trauma. Such treatment can help reduce the risk that the child will develop serious problems
as an adult.
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A FACT SHEET ABOUT CHILD SEXUAL ABUSE What is child sexual abuse? Child sexual abuse is any form of sexual
activity imposed upon a child by an adult or other child in a position of power, authority, or influence. Child sexual abuse
can involve touching the intimate parts of a child’s body, enticing or forcing the child to have sexual relations, or
participating in nontouching offenses, such as obscene phone calls or taking pornographic photos. The
child victim may be a boy or girl; in most cases knows and trusts the abuser; may be an infant, toddler, preschooler, or school-aged
child up to age 18; may come from any socioeconomic background, ethnic, or religious group; is usually afraid to tell about
the sexual abuse for fear of being blamed or punished; and rarely is abused by a stranger. Over 56,000 cases of child
sexual abuse were reported and substantiated in 2007.1 As many as one in three girls and one in seven boys will be sexually abused
at some point in their childhood.2 In as many as 93% of child sexual abuse cases, the child knows the person that
commits the abuse.3 Most perpetrators are acquaintances, but as many as 47% are family or extended
family.4 Approximately 30% of cases are reported to authorities.5 (Bureau of Justice Statistics, “Sexual Assault of Young Children as Reported to Law Enforcement,” 2000) Information collected from the states through the National Child Abuse and Neglect
Data System reveals that the 1999 sexual abuse rate was 1.6 for every 1,000 female
children and 0.4 for every 1000 male children. (U.S. Department of Health and Human Services, “Child Maltreatment,” 1999) A compilation of 1991-1996 National Incidence Based Reporting System
master files from twelve states shows that 67% of victims of sexual assault reported
to law enforcement were under age 18 and 34% were under 12. One in seven victims was under age 6. (Bureau of Justice Statistics, “Sexual Assault of Young Children as Reported to Law Enforcement,” 2000, p. 2) The
estimated number of sexually abused children in the United States rose from 119,200
in 1986 to 217,700 in 1993. This estimate is based on a nationally representative
sample of 5,600 professionals and 842 agencies. Results of this study also suggest
that girls’ disproportionately greater risk for sexual abuse has been stable
over time. (U.S. Department of Health
and Human Services, “Third National Incidence Study of Child Abuse and Neglect,”
1996) In cases reported to the police from 1991
to 1996, 34% of child sexual assault offenders were family members of the victim. The offender
was a family member in 49% of the cases where the victim was under age 6, 42% of cases where the victim was
age 6 to 11 and 24% of cases where the victim was age 12 to 17. (Bureau of Justice Statistics, “Sexual Assault of Young Children as Reported to Law Enforcement,” 2000, p. 10) A review of 166 studies between 1985 and 1997
found that, compared to males who were never abused,sexually abused males were four times more likely to suffer from major
depression, three times more likely to be bulimic, and at least two times more likely to have antisocial personality disorder,
behavioral problems,low self image, or runaway behavior. In addition, sexually abused males were one and a half to fourteen
times more likely to attempt suicide.
A review of 166 studies between 1985 and 1997 found that, compared to males who were never abused,sexually abused
males were four times more likely to suffer from major depression, three times more likely to be bulimic, and at least two
times more likely to have antisocial personality disorder, behavioral problems,low self image, or runaway behavior. In addition,
sexually abused males were one and a half to fourteen times more likely to attempt suicide. (Holmes, William C., “Sexual Abuse of Boys: Definition, Prevalence, Correlates, Sequelae,
and Management,” Journal of the American Medical Association, 1998, No. 21, p 1858)
From 1991 to 1996, the relative proportion of female victims increased with
age in cases of sexual assaults reported to the police. Sixty-nine percent of victims under 6 were female, while 73% of victims
under 12 were female and 82% of victims under 18 were female. (Bureau of Justice Statistics, “Sexual Assault of Young Children as Reported to Law Enforcement,” 2000,
p. 4)
National Incidence Based Reporting
System data from 12 states. Twenty-three percent of these parents and other caretaker crimes were cases of sexual abuse of
the child.. (U.S. Department of Justice,
Office of Juvenile Justice and Delinquency Prevention, “Child Abuse Reported to the Police,” 2001, p. 2)
According to law enforcement data, between
1991 and 1996 40% of offenders who sexually assaulted children under age 6 were juveniles. (Bureau of Justice Statistics, “Sexual Assault of Young Children as Reported to Law Enforcement,”
2000, p. 8)
Male offenders
were responsible for three-quarters of the 1997 child abuse incidents reported to the police,including
92% of sexual assaults of children. (U.S.
Department of Justice, Office of Juvenile Justice and Delinquency Prevention, “Child Abuse Reported to the Police,”
2001, p. 2)
There were arrests in
29% of child sexual assault cases reported to the police from 1991 to 1996. (There were arrests in 22% of adult sexual assault
cases reported to the police). (Bureau of
Justice Statistics, “Sexual Assault of Young Children as Reported to Law Enforcement,” 2000, p. 11)
Parents and other caretakers committed 26% of the sexual assaults
on juveniles reported to the police in1997. (U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention, “Child Abuse Reported to
the Police,” 2001, p. 3)
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