Title: A Review of the Short-Term Effects of Child Sexual Abuse
Author(s): Joseph H. Beitchman, K. Zucker, J. Hood, G. DaCosta, & D. Akman
Affiliation: Child and Family Studies Center, Clarke Institute of Psychiatry, University of Toronto
Citation: Beitchman, J., Zucker, K., Hood, J., DaCosta, G., & Akman, D., “A Review of the Short-Term Effects of Child Sexual Abuse,” Child Abuse and Neglect, vol. 15, 1991, pp. 537-556.
The authors reviewed a wide range of studies of the short-term effects of child sexual abuse (CSA) on children. These studies typically measured effects that occurred during childhood immediately after the CSA experience, as separate from those that might only develop in the long term. Since effects may have differed according to age, the studies were divided into three categories based on the ages of the children observed: pre-schoolers, school-aged children, and adolescents.
There was not a great deal of evidence of significant short-term effects among the youngest children. The studies suggested that, on average, sexual abuse victims of this age group tended to demonstrate more withdrawn behavior than other children, and to act out less. However, one factor that complicated interpretations of these findings was that CSA victims were more likely to be girls than boys, and girls at this age (whether they experience sexual abuse or not) tend to be more passive than boys. Thus, the results could have merely reflected a gender difference rather than effects of CSA. The studies did not control for this possibility.
Many studies noted that CSA victims suffered from academic problems at school. Their skills and performance were measurably below grade/age level in a number of cases. However, the authors noted that none of these studies used control groups, so it was not possible to determine whether the difficulties were attributable to sexual abuse per se. Furthermore, the authors wrote that causality could have operated in the reverse direction: children who were developmentally delayed may have been at greater risk for sexual abuse. The studies did not investigate this possibility.
The studies also yielded ambiguous results regarding the hypothesis that children who experienced CSA had a higher incidence of behavioral or emotional problems. It was unclear whether they manifested any general psychopathologies more frequently than the general population of school-age children.
The one effect for which CSA seemed to be implicated was increased sexual behavior among school-age children. Sexually abused children of both sexes were more likely to manifest inappropriate sexual behaviors (e.g.; excessive masturbation, sexual preoccupation, and sexual aggression) than did both normal and clinical controls.
The authors made the general observation:
Since the majority of studies examining the short-term effects of child sexual abuse were based on samples drawn from child protective services or psychiatric facilities, they may overestimate the prevalence and severity of symptomatology associated with child sexual abuse in the general population. With the exception of sexualized behavior, most of the symptoms found in child and adolescent victims of sexual abuse were characteristic of clinical samples in general.
One study found that adolescent CSA victims experience depression, low self-esteem, suicidal feelings, truancy, alcohol or drug abuse, and promiscuity, and run away from home at higher rates than other adolescents. However, victims of CSA in that study tended to come from lower income families than is typical in the general population of children this age, so it is unclear to what extent family background rather than CSA might account for some of these differences.
Another study showed that adolescent boys who experienced CSA were more likely to be involved in “sex rings,” use drugs, compulsively masturbate, engage in prostitution, fight, and commit crimes. The study also reported that these boys were more likely to be homosexual later on, but it was not clear whether a developing homosexual orientation itself predisposed boys to homosexual contact with adults.
Links between CSA and post traumatic stress disorder (PTSD), examined in several studies, were weak. The studies varied in how they defined PTSD, and reliability procedures were weak or nonexistent.
Findings about the age of the child at onset of CSA were inconclusive, but some studies found differences between experiences of boys and girls:
The difference in effects of CSA for boys and girls was unclear because no study attempted to examine this issue systematically.
The following factors were highly associated with negative effects of CSA experiences:
The authors concluded with the following general comment on the studies they reviewed:
[There is] a high prevalence of family breakdown and psychopathology in the histories of sexual abuse victims. Since many of the symptoms reported in the literature tend to characterize children and adolescents from disturbed families in general, to attribute outcomes in these samples solely to effects of sexual abuse is difficult. Matching of sexually abused and control subjects on family and demographic variables is necessary if we are to fully comprehend the impact of sexual abuse over and above the effects of a disturbed home environment.