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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 purposes of sexual gratification. This term includes a variety of sexual offenses, including:

• sexual assault – a term defining offenses in which an adult touches a minor for purposes of sexual gratification; for example, rape, sodomy, fondling, and sexual penetration with an object.) Most U.S. states include in their sexual assault definitions any penetrative contact of a minor’s body, however slight, if the contact is performed for the purpose of sexual gratification.
• sexual molestation – a term defining offenses in which an adult performs non-penetrative activity with a minor for purposes of sexual gratification; for example, exposing a child to pornography or to the sexual acts of others.
• 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.

Pedophilia is a psychiatric diagnosis describing a disorder in which a person experiences intense, recurring, sexually arousing fantasies or urges toward a child, or who engages in sexual activities with a child. The diagnosis also requires that the fantasies or urges cause clinically significant distress, or impairment in social, occupational, and other areas of functioning. This condition must persist for least six months; the person must be at least sixteen years of age, and at least five years older than the target of the fantasies, urges, or conduct. For individuals in late adolescence with Pedophilia, no precise age difference is specified, and clinical judement must be used. A person with pedophilia is a pedophile.

The legal term child sexual offender refers to a person who has been convicted for one or more child sexual abuse offenses. The term therefore describes a person who has committed child sexual abuse, without regard to the perpetrator’s motivation.

The term "pedophile" is used colloquially to refer to child sexual offenders, but not all child sexual offenders meet the DSM diagnostic criteria of pedophilia and not all pedophiles act on their fantasies or urges (See DSM diagnostic criteria below). Law enforcement and legal professionals have begun to use the term predatory pedophile, a phrase coined by children's attorney Andrew Vachss to describe pedophiles who commit child sexual abuse.

Legal Responses to Child Sexual Abuse

In the United States

Child sexual abuse is a type of child maltreatment, and is illegal, first recognized in U.S. federal law after the initial Congressional hearings on child abuse in 1973. Among the states, the specifics of child sexual abuse laws vary, but certain features of these laws are common to all states; these are discussed below.

Minors' Inability to Consent

Between adults, most sexual activity does not constitute a criminal offense, unless one of the adults does not consent to the activity. In contrast, minors are unable to give consent under the law. Indeed, the term minor denotes a person who has not yet reached majority, the age at which one may give consent in any legal matter (for example, a minor cannot make a valid contract). Consequently, an adult who performs a sexual activity with a minor commits child sexual abuse.

Many states include in their penal code a so-called "Romeo and Juliet" exception for cases where sexual activity occurs between a young adult and a minor whose ages are within a few years of each other. This exception typically bars charging the young adult with a sex offense, if the young adult did not use force or coercion on the minor and the minor is an older teen.

Penalties for Child Sexual Abuse

Penalties for child sexual abuse vary with the specific offenses for which the perpetrator has been convicted. Criminal penalties may include imprisonment, fines, registration as a sex offender, and restrictions on probation and parole. Civil penalties may include liability for damages, injunctions, involuntary commitment, and, for perpetrators related to their victims, loss of custody or parental rights.

During the last three decades many state legislatures have increased prison terms and other penalties for child sex offenders. This trend toward more stringent sentences generally targets those perpetrators who are repeat offenders, who victimize multiple children, or who stood in a position of trust with respect to their victims, such as a guardian, parent, pastor, or teacher.

Intrafamilial Child Sexual Abuse

Intrafamilial child sexual abuse refers to child sexual abuse offenses where the perpetrator is related to the minor, either by blood or marriage. Such crimes are most commonly addressed in family courts, as opposed to criminal courts, although there no laws prohibit simultaneous proceedings in both forums.

Incest refers to sexual activity between related persons, without regard to their ages. Incest is a criminal offense in most states. In the majority of states with incest laws, a perpetrator of intrafamilial child sexual abuse may be prosecuted for incest instead of child sexual abuse offenses. A related perpetrator, if convicted under the state's incest law, will receive a significantly lower penalty for the committing the same acts which constitute criminal child sexual abuse in that state. Recognizing this loophole, some states have altered their penal codes to prohibit prosecution of intrafamilial child sexual abuse under the incest statutes. In these states, which include Arkansas, California, Illinois, New York, and North Carolina, all perpetrators of sexual offenses against children are prosecuted under the same laws, without regard to whether they are related to their victims. These states retain their incest laws only for their original purpose: to sanction sexual activity between those too closely related by blood.

Outside the United States

In the United Kingdom

The United Kingdom rewrote its criminal code in the Sexual Offences Act of 2003. This act includes definitions and penalties for child sexual abuse offenses, and applies to England, Scotland, and Wales.

International Law

One hundred and forty nations are signatories to the United Nations Convention on the Rights of the Child. This international treaty defines a set of protections which signatories agree to provide for the children of their respective countries. Articles 34 and 35 requires that signatories protect their nations’ children from all forms of sexual exploitation and sexual abuse. This includes outlawing the coercion of a child to perform unlawful sexual activity, the prostitution of children, and the exploitation of children in creating pornography. Signatories also agree to prevent abduction, sale, or trafficking of children.

Medical Responses to Child Sexual Abuse

The American Psychological Association defines child sexual abuse as contact 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 another person.

Effects of Child Sexual Abuse

Depending on the age and size of the child, and the degree of force used, child sexual abuse may cause infections, sexually transmitted diseases, or internal lacerations. In severe cases, damage to internal organs may occur, or, in extreme cases, death. Psychological damage may occur even when physical effects are absent. Long term negative effects on development, leading to revictimization in adulthood, can also occur. Child sexual abuse has been identified as a predictor of future psychopathology. The severity of the effects may vary and the level of harm associated with the abuse may correlate with other factors.

Kendall-Tackett et al. (1993) and other studies found that a wide range of psychological, emotional, physical, and social effects are associated with child sexual abuse, including depression, post-traumatic stress disorder, anxiety, poor self-esteem, somatoform disorders, complex post-traumatic stress disorder, emotional dysregulation, neurosis, and other more general dysfunctions such as sexualized behavior, school/learning problems, behavior problems and destructive behavior. Kendell-Tackett et al. also found that one third of the children were symptom-free, and comparisons between sexually abused children and children in treatment who were not sexually abused showed the sexually abused children were less symptomatic for all measured symptoms except sexualized behavior. A minority of abused children have been found to be healthy and asymptomatic, which appears to be related to the strength of social support, family stability, and other factors. Caffaro-Rouget et al. (1989) found that 51% of their sample was symptomatic; in Mannarino and Cohen (1986), 69% of forty-five assessed children were symptomatic; 64% of Tong, Oates, and McDowell's (1987) forty-nine child sample were not within the normal range on the child behavior checklist; and in Conte and Schuerman (1987), whose assessment included both very specific and broad items such as 'fearful of abuse stimuli' and 'emotional upset,' 79% of the sample was symptomatic.

Rind et al.'s disputed 1998 meta-analysis of studies using college student samples concluded that the relationship between poorer adjustment and child sexual abuse is generally found nonsignificant in studies which control for these variables. Other more current studies, however, 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. After controlling for possible confounding variables, Widom (1999) found that child sexual abuse independently predicts the number of symptoms for PTSD a person displays. 37.5% of their sexually abused subjects, 32.7% of their physically abused subjects, and 20.4% of their control group met the criteria for a diagnosis of PTSD. The authors concluded, "Victims of child abuse (sexual and physical) and neglect are at increased risk for developing PTSD, but childhood victimization is not a sufficient condition. Family, individual, and lifestyle variables also place individuals at risk and contribute to the symptoms of PTSD."

It has been suggested that young children who are abused sexually by adult females may incur double traumatization due to the widespread denial of female-perpetrated child sexual abuse by non-abusing parents, professional caregivers and the general public. One study found that most men formerly involved in woman-boy sexual relations, however, evaluate their experience as positive upon reflection. Turner and Maryanski in Incest: Origins of the Taboo (2005), suggest that mother-son incest causes the most serious damage to children in comparison to mother-daughter, father-daughter and father-son child incest. Crawford asserts that our socially repressed view of female and maternal sexuality conceals both the reality of female sexual pathologies and the damage done by female sexual abuse to children.

Several studies have indicated that some children regard their sexual abuse positively. A meta-analysis of 15 studies using college students by Rind et al. found that boys reacted positively in 37% of the cases, while girls reacted positively in 11% of the cases. The methodology of this study has been criticized by Dallam et al. (2002); see Rind et al. (1998). There is evidence that children who initially report positive feelings will sometimes go on to reassess their abuse in a negative light. 38% of the 53 men studied by Urquiza (1987) said that they viewed their experience as positive at the time, but only 15% retained this attitude. According to Coffey et al. (1996), this may be due in part to the stigma attached to child sexual abuse. Children may also report positive experiences even if their abuse was accompanied by negative emotions: in Okami (1991), for example, 41% of the 63 'positive' subjects recalled feelings of guilt, 35% said they were frightened at the time, and 29% reported feelings of shame. Russell (1986) speculated that the perception of a sexually abusive event as 'positive' could stem from a mechanism for coping with traumatic experiences. Some researchers, such as John Money, David Finkelhor, and Gabriel Holguin, have opined that the presumption of trauma or damage can itself cause iatrogenic harm to child victims. Browne and Finkelhor (1986) warn "advocates not exaggerate or overstate the intensity or inevitability of consequences." Berlin (2002) asks, "How many youngsters have been inadvertently hurt, treated as if they must inevitably have become 'damaged goods,' because of a failure to distinguish between having been wronged versus having been harmed?"

Neurological differences in clinical research

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.

A study by Gilbertson found that individuals with a smaller hippocampal volume are more disposed to the development of PTSD. This is supported by studies which show that those who have shown damage also have a history of neurocognitive abnormalities. McNally gave his view on the recent research into this area in his book Remembering Trauma:

Another myth debunked by recent research is the notion that elevated cortisol in PTSD has damaged the hippocampi of survivors. Not only is cortisol seldom elevated in PTSD, but smaller hippocampi in those with the disorder are best tributed to genetic factors, not traumatic stress. A smaller hippocampus may constitute a vulnerability for the disorder among those exposed to trauma.

King et al. (2001), studying 5 to 7 year old girls who had been abused within the last two months, found victims of early sexual abuse had significantly lower cortisol levels than control subjects. However, other studies have found an increase in cortisol levels among victims of child sexual abuse and trauma and damage to various parts of the brain. "Fear literally arises from the core of the brain, affecting all brain areas and their functions in rapidly expanding waves of neurchemical acticity...also important is a stress hormone called cortisol.", p. 64.

A short-term longitudinal study of hippocampal volume in thirty-seven trauma survivors by Bonne et al. found no progressive reduction of the hippocampus between 1 week and 6 months after the traumatic incident. Regarding this, they speculated that structural changes to the hippocampus may only occur if the victim's exposure to traumatization is prolonged; that it may take longer than 6 months for any change in volume to manifest; or that a change in volume may have taken place in the period between the incident and the first assessment. They also found that there was no significant difference between the hippocampal volume of survivors of trauma who developed PTSD and those who did not. Because of these findings, they concluded that "smaller hippocampal volume is not a necessary risk factor for developing PTSD and does not occur within 6 months of expressing the disorder." This study did not specifically focus on child sexual abuse victims.

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," which, they say, "could be a consequence of reduced corpus callosal area." 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. The authors hypothesized that the development of brain regions which myelinate over decades (such as the corpus callosum and hippocampus) may be disturbed by stress, because stress hormones such as cortisol suppress the final mitosis of granule cells and thereby the production of the oligodendrocytes and Schwann cells that form the myelin sheath.

Epidemiology

Based on a literature review of 23 studies, Goldman & Padayachi found that the prevalence of child sexual abuse varied between 7-62% for girls and 4-30% for boys. A meta-analytic study by Rind, Tromovitch, and Bauserman found that reported prevalence of abuse for males ranged from 3% to 37%, and for females from 8% to 71% with mean rates of 17% and 28% respectively. Bert Kutchinsky argues that most prevalence rates are overexaggerated and claim that the real prevalence of child sexual abuse may be as low as 1-2%. A study on incest between fathers and daughters found prevalence rates of 0.2% for biological fathers and 0.5% for step-fathers.

In US schools, "nearly 9.6% of students are targets of educator sexual misconduct sometime during their school career" according to the US Department of Education. 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% or 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 steoreotyping, 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 under-reporting 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" and because female sexual abuse of males is often seen as 'desirable' and/or beneficial by judges, mass media pundits and other authorities.

Offenders

Offenders are more likely to be relatives or acquaintances of their victim than strangers. 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 female sex offenders have showed mixed results with rates between 4% to 43% of female offenders. 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 aids (in that order) totaling 69% of the offenders.

Typology

Typologies for child sex offenders have been used since the 1970s. Male offenders are typically classified by their motivation, which is usually assessed by reviewing their offense's characteristics. Phallometric tests may also be used to determine the abuser's level of pedophilic interest. Groth et al. proposed a simple, dichotomous system in 1982 which classed offenders as either "regressed" or "fixated."

Regressed offenders

Regressed offenders are primarily attracted to their own age group but are passively aroused by minors.

• The sexual attraction in minors is not manifested until adulthood.
• Their sexual conduct until adulthood is aligned with that of their own age group.
• Their interest in minors is either not cognitively realized until well into adulthood or it was recognized early on and simply suppressed due to social taboo.

Other scenarios may include:

• Not associating their attractions as pedosexual or ephebosexual in nature due to cultural differences.
• Age of consent laws were raised in their jurisdiction but mainstream views toward sex with that age group remained the same, were acted upon, then they were charged with a crime.
• The person's passive interest in children is manifested temporarily upon the consumption of alcohol and acted upon while inhibitions were low.

Fixated offenders

Fixated offenders are most often adult pedophiles who are maladaptive to accepted social norms. The etiology of pedophilia is not well-understood. The sexual acts are typically preconceived and are not alcohol or drug related.

Maletzky (1993) found that, of his sample of 4,402 convicted pedophilic offenders, 0.4% were female.

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See also

• Age of consent
• Child abuse
• Child grooming
• Commercial sexual exploitation of children
• False allegation of child sexual abuse
• Incest
• Megan's Law
• Pedophilia
• Rape
• Roman Catholic sex abuse cases
• Scouting sex abuse cases

External links

Published Articles

• American Academy of Child and Adolescent Psychiatry, Child Sexual Abuse, Facts for Families, vol. 9, 2004.
• American Psychological Association, Disclosure of Child Sexual Abuse, Psychology, Public Policy, and Law. vol. 11, 2005.
• Andrew, R., Child Sexual Abuse and the State, UC Davis Law Review, vol. 39, 2006.
• U.S. Dept. of Health and Human Services, Executive Summary of the Third National Incidence Study of Child Abuse and Neglect, 1996.
• U.S. Dept. of Justice, Sexual Assault of Young Children as Reported to Law Enforcement, 2000.
• U.S. Dept. of Justice, Sexually Transmitted Diseases and Child Sexual Abuse, 2001.
• Vachss, A., The Incest Loophole, New York Times, Nov. 20, 2005.
• Vigil, et al., A Life History Assessment of Early Childhood Sexual Abuse in Women, Developmental Psychology, 2005.

Organizations

• List of State Sexual Assault Coalitions
• National Sex Offender Public Registry
• The Awareness Center, Inc. (Jewish Coalition Against Sexual Abuse/Assault)
• ChildHelp US (National Child Abuse Hotline)
• MaleSurvivor: National organization against Male Sexual Victimization
• PROTECT: The National Organization to Protect Children
• RAINN (Rape, Abuse, Incest, National Network)
• SNAP (Survivors Network of those Abused by Priests)
• VOICES In Action (Victims of Incest Can Emerge Survivors)
• Help for Adult Victims Of Child Abuse

• Child abuse
• Sexual abuse