(last revised 5/26/2010)
I am a researcher and therapist with a doctorate (Ph.D.) in clinical psychology. I have studied the lasting effects of child abuse and have expertise in several related areas. These include issues unique to men, the brain bases of emotion regulation problems, and how mindfulness and meditation can benefit people with histories of child abuse (and their therapists).
I am an Instructor in Psychology at Harvard Medical School, and an independent consultant in several areas. If you are interested in my professional services, including workshops, talks, forensic services, therapy or private consultation, please visit that page.
As a licensed clinical psychologist, for over 15 years I have been a therapist to men and women abused in childhood, providing individual and group treatment. (I do not work with children or their caregivers, but see Resources for Parents & Caregivers below).
The contents of this page reflect my level of experience and expertise, as well as opinions I have formed over the years.Finally, I would like to highlight my page, Mindfulness and Kindness: Inner Sources of Freedom and Happiness. It explains the many benefits of cultivating mindfulness and provides resources for learning to be more mindful. Simply reading it could open a door to new and healing ways of thinking about and experiencing memories, emotions, and interactions with others.
Table of Contents
Child Abuse Statistics
Introduction - Unavoidable Controversies & Biases, in Historical Contexts
Sources of Statistics - Official Numbers, Actual Numbers, & Estimates
Statistics Are Human Creations - Tools to Avoid Being Confused & Misled
I've already mentioned (Introduction) that historical and cultural factors have created and shaped the concept of "child abuse" as most of us understand it today. The same is true of our relationship to statistics: it is embedded in historical and cultural patterns, particularly how science and statistics are used to define important social problems, shape debates about them, and decide public policies.
Unfortunately, our healthy respect for scientific research, empirical data and quantifiable knowledge is often untempered by critical thinking:
Keep in mind that the authors of these books, like everyone else, have their biases. The trick is to take what they can teach you (quite a lot), and use it to detect and critically evaluate those biases, even when they are presented as obvious truths.
The 3 parts of this section:
Murray, D., Schwartz, J., & Lichter, S. R. (2001). It Ain't Necessarily So: How Media Make and Unmake the Scientific Picture of Reality
This book is the longer of the two, and more focused on how the media can generate confusion and mislead people. However, it covers much of the same territory as Best's book (below), in terms of how to think critically about the statistics we encounter every day, and has more discussion of child abuse statistics (excerpts below).
Praise from the book jacket:
"Fake statistics flood the news media these days. This book is the essential antidote." - John Leo, U.S. News & World Report"Risk and uncertainty plague our daily lives, especially when they drive media headlines. But savvy consumers of news have a new ally with the appearance of this timely and entertaining read that manages to take the process apart and show us the guts of how news is really made." - John D. Graham, Harvard Center for Risk Analysis
First excerpts on child abuse statistics from It Ain't Necessarily So - Is the trend really down?
"A group of researchers conducted two surveys of child abuse, in 1975 and 1985. Their second survey found that reports of child abuse had dropped by almost 50 percent. In 1975, respondents were interviewed in their homes whereas in 1985 respondents were interviewed on the phone. Could this change in interviewing technique have contributed to the decrease? Or would the change have made an increase in reports more likely?
Second excerpts on child abuse statistics from It Ain't Necessarily So - Is the trend really up?
"Secretary of Health and Human Services Donna Shalala recently declared that 'between 1986 and 1993, the number of children who were physically abused nearly doubled.' She based this claim on an increased number of reports of child abuse. But do more reports clearly show that conditions are worsening? Could they also indicate that even though behavior has not worsened, the standards by which it is judged have become more strict?" (page 133)."Stricter Standards for Child Abuse
Best, J. (2001). Damned Lies and Statistics: Untangling Numbers from the Media, Politicians, and Activists.
This book has extremely clear and concise explanations of how activists, the media, experts and other key players like politicians and the staff of government agencies create good and bad statistics. The author gives you lots of tools for critical thinking about how statistics are created by people and organizations.
In fact, Best gives you some good critical tools for seeing his own biases, which come across when he addresses issues like child abuse and sexual assault. Still, we would cheat ourselves of much knowledge if we failed to learn from people we don't agree with - and Best has a lot of valuable things to teach about the social and political creation and uses of statistics. Just reading the excerpts will be very informative.
Praise from the book jacket:
"A real page turner. Best is the John Grisham of sociology." - James Holstein, coauthor of The New Language of Qualitative Method"In our era, numbers are as much a staple of political debates as stories. And just as stories so often turn into fables, so Best shows that we often believe the most implausible of numbers–to the detriment of us all." - Peter Reuter, coauthor of Drug War HeresiesExcerpt 1: "The Rise of Social Statistics""[T]he first 'statistics' were meant to influence debates over social issues. The term acquired its modern meaning – numeric evidence – in the 1830s. . . The forerunner of statistics was 'political arithmetic'; these studies – mostly attempts to calculate population size and life expectancy – emerged in seventeenth-century Europe, particularly in England and France. Analysts tried to count births, deaths, and marriages because they believed that a growing population was evidence of a healthy state; those who conducted such numeric studies – as well as other, nonquantitative analyses of social and political prosperity – came to be called statists. Over time, the statists' social research led to the new term for quantitative evidence: statistics.
". . . . From year to year, they discovered, the number of births, deaths, and even marriages remained relatively stable; this stability suggested that social arrangements had an underlying order, that what happened in a society depended on more than simply its government's recent actions, and analysts began paying more attention to underlying social conditions.
"By the beginning of the nineteenth century, the social order seemed especially threatened: cities were larger than ever before; economies were beginning to industrialize; and revolutions in America and France had made it clear that political stability could not be taken for granted. The need for information, for facts that could guide social policy, was greater than ever before. A variety of government agencies began collecting and publishing statistics.... Scholars organized statistical societies to share the results of their studies and to discuss the best methods for gathering and interpreting statistics. And reformers, who sought to confront the nineteenth-century's many social problems. . . found statistics useful in demonstrating the extent and severity of suffering. Statistics gave both government officials and reformers hard evidence – proof that what they said was true. . . .
"During the nineteenth century, then, statistics – numeric statements about social life – became an authoritative way to describe social problems. There was growing respect for science, and statistics offered a way to bring the authority of science to debates about social policy. In fact, this had been the main goal of the first statisticians – they wanted to study society through counting and use the resulting numbers to influence social policy. They succeeded. . . But, beginning in the nineteenth century and continuing through today, social statistics have had two purposes, one public, the other often hidden. Their public purpose is to give an accurate, true description of society. But people also use statistics to support particular views about social problems. Numbers are created and repeated because they supply ammunition for political struggles, and this political purpose is often hidden behind assertions that numbers, simply because they are numbers, must be correct. People use statistics to support particular points of view, and it is naive to simply accept numbers as accurate, without examining who is using them and why" (pages 11-13).
Excerpt 2: "Creating Social Problems"
"[S]ocial problems are products of what people do.
"This is true for two reasons. First,. . . . social problems have their causes in society's arrangements. . . . Most people understand that social problems are social in this sense.
"But there is a second reason social problems are social. Someone has to bring these problems to our attention, to give them names, describe their causes and characteristics, and so on. Sociologists speak of social problems as 'constructed' – that is, created or assembled through the actions of activists, officials, the news media, and other people who draw attention to particular problems. 'Social problem' is a label we give to some social conditions, and it is that label that turns a condition we take for granted into something we consider troubling. . . .
"The creation of a new social problem can be seen as a sort of public drama, a play featuring a fairly standard cast of characters. Often, the leading roles are played by social activists – individuals dedicated to promoting a cause, to making others aware of the problem. . . .
"Successful activists attract support from others. The mass media – including both the press (reporters for newspapers or television news programs) and entertainment media (such as television talk shows) – relay activists' claims to the general public. Reporters often find it easy to turn those claims into interesting stories. . . . Activists need the media to provide that coverage, just as the media need activists and other sources for news to report.
"Often activists depend on the support of experts – doctors, scientists, economists, and so on – who presumably have special qualifications to talk about the causes and consequences of some social problem. . . Activists use experts to make claims about social problems seem authoritative, and the mass media often rely on experts' testimonies to make news stories about a new problem seem more convincing. In turn, experts enjoy the respectful attention they receive from activists and the media.
"Not all social problems are promoted by struggling, independent activists; creating new social problems is sometimes the work of powerful organizations and institutions. Government officials who promote problems range from prominent politicians trying to arouse concern in order to create election campaign issues, to anonymous bureaucrats proposing that their agencies' programs be expanded to solve some social problem. And businesses, foundations, and other private organizations sometimes have their own reasons to promote particular social issues. . . .
"Statistics play an important role in campaigns to create – or defuse claims about – new social problems. Most often, such statistics describe the problem's size. . . When social problems first come to our attention, we're usually given an example or two (perhaps video footage of homeless people living on city streets) and then a statistical estimate (of the number of homeless people). Typically this is a big number. The media like to report statistics because numbers seem to be 'hard facts' – little nuggets of indisputable truth. Activists trying to draw media attention to a new social problem often find that the press demands statistics. . . Experts, officials, and private organizations commonly report having studied the problem, and they present statistics based on their research. Thus, the key players in creating new social problems all have reasons to present statistics" (pages 14-18).
Excerpt 3: "The Public as an Innumerate Audience"
"Most claims drawing attention to social problems aim to persuade all of us – that is, the members of the general public. We are the audience, or at least one important audience, for statistics and other claims about social problems. If the public becomes convinced that prostitution or homelessness is a serious social problem, then something is likely to be done: officials will take action, new policies will begin, and so on. Therefore, campaigns to create social problems use statistics to help arouse the public's concern.
"This is not difficult. The general public tends to be receptive to claims about new social problems, and we rarely think critically about social problems statistics. Recall that the media like to report statistics because numbers seem to be factual, little nuggets of truth. The public tends to agree; we usually treat statistics as facts.
"In part, this is because we are innumerate. Innumeracy is the mathematical equivalent of illiteracy; it is 'an inability to deal comfortably with the fundamental notions of number and chance.' Just as some people cannot read or read poorly, many people have trouble thinking clearly about numbers.
"One common innumerate error involves not distinguishing among large numbers. . . . Because many people have trouble appreciating the differences among big numbers, they tend to uncritically accept social statistics (which often, of course, feature big numbers).
"Innumeracy – widespread confusion about basic mathematical ideas – means that many statistical claims about social problems don't get the critical attention they deserve. This is not simply because an innumerate public is being manipulated by advocates who cynically promote inaccurate statistics. Often, statistics about social problems originate with sincere, well-meaning people who are themselves innumerate; they may not grasp the full implications of what they are saying; reporters commonly repeat the figures their sources give them without bothering to think critically about them.
"The result can be social comedy. Activists want to draw attention to a problem. . . The press asks for statistics. . . Knowing that big numbers indicate a big problems and knowing that it will be hard to get action unless people can be convinced a big problem exists (and sincerely believing that there is a big problem), the activists produce a big estimate, and the press, having no good way to check the number, simply publicizes it. The general public – most of us suffering from at least a mild case of innumeracy – tends to accept the figure without question" (pages 19-21).
Excerpt 4: "Organizational Practices and Official Statistics"
"One reason we tend to accept statistics uncritically is that we assume that numbers come from experts who know what they're doing. Often these experts work for government agencies.... Data that come from the government – crime rates, unemployment rates, poverty rates – are official statistics. There is a natural tendency to treat these figures as straightforward facts that cannot be questioned.
"This ignores the way statistics are produced. All statistics, even the most authoritative, are created by people. This does not mean that they are inevitably flawed or wrong, but it does mean that we ought to ask ourselves just how the statistics we encounter were created....
"[C]onsider a... complicated example: statistics on suicide. Typically, a coroner decides which deaths are suicides. This can be relatively straightforward: perhaps the dead individual left behind a note clearly stating an intent to commit suicide. But often there is no note, and the coroner must gather evidence that points to suicide – perhaps the deceased is known to have been depressed, the death occurred in a locked house, the cause of death was an apparently self-inflicted gunshot to the head, and so on. There are two potential mistakes here. The first is that the coroner may label the death 'suicide' when, in fact, there was another cause (in mystery novels, at least, murder is often disguised as suicide). The second possibility for error is that the coroner may assign another cause of death to what was, in fact, a suicide. This is probably a greater risk, because some people who kill themselves want to conceal that fact (for example, some single-car automobile fatalities are suicides designed to look like accidents so that the individual's family can avoid embarrassment or collect life insurance benefits). In addition, surviving family members may be ashamed by a relative's suicide, and they may press the coroner to assign another cause of death, such as accident.
"In other words, official records of suicide reflect coroners' judgments about the causes of death in what can be ambiguous circumstances. The act of suicide tends to be secretive – it usually occurs in private – and motives of the dead cannot always be known. Labeling some deaths as 'suicide' and others as 'homicides,' accidents,' or whatever will sometimes be wrong, although we cannot know exactly how often. Note, too, that individual coroners may assess cases differently; we might imagine one coroner who is relatively willing to label deaths suicide, and another who is very reluctant to do so. Presented with the same set of cases, the first coroner might find many more suicides than the second.
"It is important to appreciate that coroners view their task as classifying individual deaths, as giving each one an appropriate label, rather than as compiling statistics for suicide rates. Whenever statistical reports come out of coroners' offices (say, total number of suicides in the jurisdiction during the past year), are by-products of their real work (classifying individual deaths). That is, coroners are probably more concerned with being able to justify their decisions in individual cases than they are with whatever overall statistics emerge from these decisions.
"The example of suicide records reveals that all official statistics are products – and often by-products – of decisions by various officials: not just coroners, but also the humble clerks who fill out and file forms, the exalted supervisors who prepare summary reports, and so on. These people make choices (and sometimes errors) that shape whatever statistics finally emerge from their organization or agency, and the organization provides a context for those choices.... In other words, official statistics reflect what sociologists call organizational practices – the organization's culture and structure shape officials' actions, and those actions determine whatever statistics finally emerge" (pages 21-25).
Excerpt 5: "Thinking About Statistics as Social Products"
"The lesson should be clear: statistics – even official statistics such as crime rates, unemployment rates, and census counts – are products of social activity. We sometimes talk about statistics as though they are facts that simply exist, like rocks, completely independent of people, and that people gather statistics much as rock collectors pick up stones. This is wrong. All statistics are created through people's actions: people have to decide what to count and how to count it, people have to do the counting and the other calculations, and people have to interpret the resulting statistics, to decide what the numbers mean. All statistics are social products, the result of people's efforts.
"Once we understand this, it becomes clear that we should not simply accept statistics by uncritically treating numbers as true or factual. If people create statistics, then those numbers need to be assessed, evaluated. Some statistics are pretty good; they reflect people's best efforts to measure social problems carefully. But other numbers are bad statistics – figures that may be wrong, even wildly wrong. We need to be able to sort out the good statistics from the bad. There are three basic questions that deserve to be asked whenever we encounter a new statistics.
"1. Who created the statistic? Every statistic has its authors, its creators.... In asking who the creators are, we ought to be less concerned with the names of the particular individuals who produced a number than their part in the public drama about statistics. Does a particular statistic come from activists, who are striving to draw attention to and arouse concern about a social problem? Is the number being reported by the media in an effort to prove that this problem is newsworthy? Or does the figure come from officials, bureaucrats who routinely keep track of some social phenomenon, and who may not have much stake in what the numbers show?
"2. Why was this statistic created? The identities of the people who create statistics are often clues to their motives....
"3. How was this statistic created? We should not discount a statistic simply because its creators have a point of view, because they view a social problem as more or less serious. Rather, we need to ask how they arrived at the statistic. All statistics are imperfect, but some are far less perfect than others.... Once we understand that all statistics are created by someone, and that everyone who creates statistics wants to prove something (even if that is only that they are careful, reliable, and unbiased), it becomes clear that the methods of creating statistics are key. The remainder of this book focuses on this third question" (pages 26-28).
The June 8, 2001, "Science Friday" show of National Public Radio's "Talk of the Nation" included an interview with David Murray and Joel Best, authors of the books above. The piece was called "Suspect Statistics," and all 47 minutes are available as RealAudio files.
Official Statistics: United States
By far the best site for official United States statistics on child abuse is the Child Welfare Information Gateway, a service of the Children's Bureau in the Administration for Children and Families, which is part of the US Department of Health and Human Services. (See the Gateway's About Us page for more information about its mission, resources, etc.)
Before following the links below, read the official definitions of maltreatment. If possible, look at the law which codified those definitions, the 1996 Federal Child Abuse Prevention and Treatment Act (CAPTA) (223 KB PDF).
CWIG collects and reports the statistics from two studies conducted using different methods.
Official Statistics: Canada
Official Canadian statistics on child abuse are available from the Public Health Agency of Canada.
In Canada, national statistics on child abuse and neglect first became available in 2001, with the publication of the first Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2001). Before then they had not been compiled, largely due to the challenge posed by varying definitions of child abuse across the country's provinces and territories.
Canadian Incidence Study of Reported Child Abuse and Neglect - 2003 (CIS-2003) HTML - PDFThe National Clearinghouse on Family Violence (NCFV) web site is another great resource for information on child abuse and neglect for Canadians, including the overview publication, Child Maltreatment in Canada.
The NCFV site has an extensive Publications section, including many on issues related to Child Abuse and Neglect, Child Sexual Abuse, and Family Violence. The Frequently Asked Questions page has information about how to order publications. Below are direct links to some very informative "overview papers" and "fact sheets."
Official Statistics: Australia
The best site for official statistics on child abuse is the National Child Protection Clearinghouse. The Clearinghouse is a great site with many full-text articles on child abuse and its effects. It is funded by the Commonwealth Department of Family and Community Services, under the auspices of the National Child Protection Council, as part of the National Strategy for the Prevention of Child Abuse and Neglect. (See About the Clearinghouse for more information about its mission, functions, resources, etc.)
It's not easy to find the Child Protection Statistics page, but it provides excellent information - on where the official statistics come from, how to make sense of them, and links to the two most recent national studies. After reading the introductory paragraphs on that page, you can access the following:
Official Statistics: England
The best place for official statistics is not a web site dedicated to these issues, but a few pages with reports of studies conducted in a collaboration between the Office for National Statistics and the Department of Health. Links to these pages can be found under the "Children" heading of Section C - Personal and Social Services of the Health and Personal Social Services Statistics page of the Statistical Publications web site.
Every year since 1989, the Department of Health has collected and reported statistics on child abuse and neglect in the publication, "Children and Young People on Child Protection Registers." The statistics are "derived from the statistical returns submitted to the Department of Health by local authorities and include data for individual local authorities and England estimates."
Summary information and tables from the last four annual surveys are available for free on the web. (Only the full publication "contains detailed commentary and comprehensive explanation of the figures at both England and local authority level." It is available for a charge of £8 from the Department of Health, PO Box 777, London, SE1 6XH. Fax: 01623 724 524.)
Before looking at any findings from these studies, it is important to understand some limitations of the data. The following statement is from the Statistics Division of the Department of Health:
Here are links to the last 2 of these studies:
Official Statistics: International
On October 11, 2006 the United Nations (UN) released the first UN Secretary-General’s Study on Violence Against Children, which addresses violence against children within the family, schools, alternative care institutions and detention facilities, places where children work, and communities. The study took years to complete, and was supported by the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), and the Office of the High Commissioner on Human Rights (OHCHR).
As noted in the report's introduction, the study is a "first" in two important ways:
Here are links to the web sites devoted to the study:
Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18, 409-417.Abstract: "Surveys of child sexual abuse in large nonclinical populations of adults have been conducted in at least 19 countries in addition to the United States and Canada, including 10 national probability samples. All studies have found rates in line with comparable North American research, ranging from 7% to 36% for women and 3% to 29% for men. Most studies found females to be abused at 1.5 to 3 times the rate for males. Few comparisons among countries are possible because of methodological and definitional differences. However, they clearly confirm sexual abuse to be an international problem."
Retrospective Survey Research Methods - Tools for Critical Understanding
This section is focused on sexual abuse and the sexual abuse of boys largely because I have conducted research in these areas. Another reason is that research on the abuse of male children was once my main area of expertise, and the sexual abuse of males remains virtually unacknowledged throughout the world.
This is a long section (4 printed pages). But please consider reading it before reading (or reading about) studies of child abuse prevalence. It will take some time, but reading this will help you to understand this kind of research, and to think more critically about opinions you encounter in the popular media.
When it comes to measuring prevalence - that is, how many children are sexually abused in childhood? - the methods used by researchers are absolutely crucial.
Five important methodological issues are covered below:
I do not attempt or claim to address the definitional issue completely or authoritatively. Indeed, this is a most complex and controversial (methodological) issue, not only among researchers but in society as a whole, and not only in terms of sexual abuse but physical and emotional abuse as well. Thus I will only touch on a few important points, though certainly the definitions of "sexual abuse" applied by researchers to study data have decisive effects on estimates of the prevalence of sexual abuse.1. An important methodological issue has to do with the population (group of people) from which a sample, or selected group of a population actually researched, is drawn. Different prevalence rates have been found in samples of: college students; clinical populations or people receiving psychological treatment; and community populations or whoever lives in some area (e.g., a city, state, or country). Other methods being equivalent, compared to samples of people receiving mental health treatment, broad community samples will yield lower prevalence rates and provide more accurate data about the rate of child sexual abuse in a society.
2. Whatever the population and sample, researchers have to ask questions. They can ask questions by interviewing research subjects, over the phone or face-to-face. They can also ask questions by giving people questionnaires, typically anonymous ones. Some have argued that anonymous questionnaires are better for research on men, who may be less willing to acknowledge unwanted sexual experiences in the presence of another person. Some who conduct interview studies disagree, and there is not yet sufficient evidence to make this judgement. Whichever of these methods is employed, there are other methodological issues related to the nature of the questioning; for example, whether or not a subject must answer "yes" to an initial "gate question" in order to be asked more questions, the wording of the questions, and the number of questions asked. These are important methodological parameters that have had significant effects on the prevalence rates researchers have found.
For some studies researchers have used gate questions, in which a subject is only asked a series of questions about possible abuse experiences if he or she answers "yes" to an initial question. Not surprisingly, these studies have tended to find lower rates of sexual abuse in their samples. For example, someone may answer "no" to this question: "Before the age of 16, did you ever experience unwanted sexual contact with someone more than 10 years older than you?" But one minute later this same person may reply "yes" to this question: "Before age 16, did anyone more than 10 years older than you use threats or force to get you to fondle his or her genitals?" If subjects in a research study are not asked further questions after answering "no" to a general question about unwanted sexual experiences in childhood, many of those who were in fact sexually abused will be categorized as never sexually abused.
3. The wording of research questions is extremely important, and can dramatically skew prevalence rates. Imagine that an interviewer or even an anonymous questionnaire begins by asking, "Were you ever sexually abused before age 16?" This question requires subjects to scan their memories, and to decide whether or not to label any memories that come up as "abuse," which would be to accept the identity of "sexual abuse victim." Obviously most people, especially men, will automatically resist doing these things, even if they have experienced unwanted and emotionally harmful sexual experiences in childhood. So any study that uses the words "sexual abuse" will wrongly categorize some people who have been sexually abused--but don't label their experience that way--as not having been sexually abused.
This methodological issue, the wording of questions, touches on the issue of definition, and all the attendant controversy. Some people given attention by the popular media have focused on the wording of questions in ways that misrepresent research on sexual abuse and rape. Major publications like The New York Times Magazine have given cover-story treatment to people who have minimal understanding of social science methodology, and apparently even less interest in the truth about rates of abuse and assault in our country. These people have claimed that researchers "make up" abuse that never happened by labeling subjects' experiences as abusive even though the subjects might not.
This charge has been made against Mary Koss, an accomplished researcher who has conducted studies on prevalence rates of rape among college women (and has found that one in four have experienced rape or attempted rape since age 14). In constructing her questionnaire items, Koss made a good faith effort to use language that fit the legal definition of rape in the state where she lived when she conducted the research. Yet she has been accused of irresponsibly mislabeling her subjects' experiences and exaggerating rates of rape. (Decide for yourself: read Koss, M., Gidicz, C., & Wisniewski, N. . The scope of rape: Incidence and prevalence of sexual aggression and victimization in a national sample of higher education students. Journal of Consulting and Clinical Psychology, 55, 162-170.) One way that Koss has answered this critique is by referring to an analogous situation. I will paraphrase her argument. Imagine yourself questioning an alcoholic: Do you have more than six alcoholic drinks in one sitting several times a week? Yes. Do you often wake up with such a hangover that you can't go to work? Yes. Have friends and family members repeatedly tried to help you stop drinking? Yes. Do you suffer from withdrawal symptoms when you stop drinking? Yes. Are you an alcoholic? No.
The point here is that good prevalence research must use behavioral descriptions to which definitions like "alcoholic" or "sexual abuse" may be applied. Researchers should not rely on people defining themselves as alcoholics or defining their sexual experiences as abusive. Such definitions can only be uninterpretable and unreliable. Again, for many people who have been sexually exploited and hurt by others in childhood--especially men, who aren't supposed to be victims--it's very painful to acknowledge what has happened. Researchers must not ignore the effects this can have on subjects' responses to questions about childhood experiences that may have been abusive.
For these reasons, researchers seeking to determine prevalence rates should not use the word "abuse" in their interviews or questionnaire items. Instead, they should provide clear behavioral descriptions of experiences to which subjects can answer "yes" or "no". When an answer is yes, further information should be elicited, including: the age of the subject and the other person involved; the nature of the relationship (parent, sibling, friend, priest, etc.); the level of coercion or violence; the number of times and period of time over which the experience happened; and the person's emotional appraisal of the event when it occurred and at the time of the research.
Here are two examples of questionnaire items employing behavioral descriptions and follow-up questions. Both are from research on the sexual abuse of males conducted by David Lisak and his colleagues (Lisak & Luster, 1994; Lisak, Hopper, & Song, 1996; see Recommended Books and Articles section of Sexual Abuse of Males for complete citations):
As noted already, the definition of child sexual abuse employed in a prevalence study may be the most important methodological parameter. I will only make a few points here, to suggest some of the definitional issues in prevalence research. For example, it's easy to imagine the differences in prevalence rates the very same data will yield when categorized with each of these definitional criteria:
Though they will never all agree, researchers have become increasingly sensitive to the need for carefully considered, and clearly articulated, definitions of child sexual abuse. Unfortunately, this has not been the case for most commentators and critics given attention by the popular media.
5. Finally, the number of questions asked of subjects in a research study can have a large effect on prevalence rate findings. Sadly, there are many ways to sexually abuse a child. Thus only a number of specifically worded behavioral descriptions of possible experiences (probably at least 10 to 15), will suffice for researchers trying to determine whether a person was sexually abused in childhood. Having subjects answer a number of questions also increases the likelihood that some memory of an abusive experience will be accessed. For example, a subject may read several questions before remembering and reporting an experience of sexual abuse, even though earlier questions described aspects of the same experience. Thus only by using multiple questions consisting of clear behavioral descriptions can researchers generate sufficient data to which definitions of abuse may be applied. Obviously, studies that ask fewer questions will yield lower prevalence rates for childhood sexual abuse.
These are some of the most important methodological issues in research conducted on adults to estimate prevalence rates of child sexual abuse. Keeping these issues in mind, and the built-in biases of certain methods, will help you to understand the research below or any other studies you read about, and to think more critically about what you encounter in the popular media--especially from people who claim abuse rates are exaggerated and base their claims on uninformed or misleading critiques of research conducted by social scientists.
And there is one more very important point to keep in mind:
Any research study, even one with the most effective methodology, is likely to underestimate the actual prevalence of sexual abuse in the population being investigated.Why?
There is evidence emerging that as many as one in three incidents of child sexual abuse are not remembered by adults who experienced them, and that the younger the child was at the time of the abuse, and the closer the relationship to the abuser, the more likely one is not to remember. Please see the section on Linda Williams' research on my Web page, Recovered Memories of Sexual Abuse: Scientific Research & Scholarly Resources.
Prevalence of the Sexual Abuse of Boys
For the most recent and authoritative evidence supporting the 1 in 6 prevalence estimate, read the study of 17,000 California residents, Long-term consequences of childhood sexual abuse by gender of victim, published in 2005 by Shanta Dube and colleagues in the American Journal of Preventive Medicine.
Please note: This section and the one above are nearly identical to sections of my page, Sexual Abuse of Males: Prevalence, Lasting Effects, and Resources. That page also contains a list of references to all the articles and books cited in this section, as well as others addressing lasting effects and links to Web pages for men who were sexually abused in childhood.
The following review is grouped into three sections, according to the sample studied:
As noted above, please keep in mind: All of the rates below are likely to be underestimates of the actual prevalence of the sexual abuse of boys in our society. This is so because:
There is evidence emerging that as many as one in three incidents of child sexual abuse are not remembered by adults who experienced them, and that the younger the child was at the time of the abuse, and the closer the relationship to the abuser, the more likely one is not to remember. Please see the section on Linda Williams' research on my Web page, Recovered Memories of Sexual Abuse: Scientific Research & Scholarly Resources.1. Studies of male college students have found prevalence rates from 4.8% to 28%. At the lower extreme of 4.8% is a study by Fritz, Stoll and Wagner (1981) in which 412 students responded to a self-report questionnaire that required them to label their experiences as "abusive"--a method guaranteed to cause under-reporting (see discussion in section above). Risin and Koss (1987) obtained a rate of 7.3% in a national sample of 2,972 male college students. They used eight self-report behavioral descriptions about sexual behaviors before age 14. As pure behavioral descriptions, none of the items included the word "abuse." Finkelhor (1979) used a similar list of behavioral self-report items in a study of 266 college students and found an 8.3% prevalence rate; he included non-contact experiences and used specific age criteria (if under 14 there had to be a 5 year age difference with the perpetrator, if 14-15, a 10 year difference).
Higher prevalence rates of 20% and 24% came from Fromuth and Burkhart's (1987) study of students in two separate schools. They compared the effect of different definitions of sexual abuse on prevalence rates. However, their questionnaire utilized a gate question. The highest rates of 20% and 24% came from the most inclusive definition: the same as Finkelhor's 1979 study (including non-contact and age differential criteria), but with the addition that sexual contact between peers involving force or threat was categorized as abuse.
Research on college students also has been conducted by David Lisak and his colleagues, including myself (Lisak & Luster, 1994; Lisak, Hopper, & Song, 1996). The college samples in these studies were not typical, but consisted of men who commuted to an urban university, were an average of 25 years old, and from socioeconomic background more typical of the surrounding community than many college student populations used in this research. This work yielded prevalence rates of:
Non-contact experiences (e.g., a relative exposing her or his genitals to a child) were investigated because such acts are sexually exploitive and can have negative long-term psychological and interpersonal effects. However, this definition also includes experiences, like a single "flashing" episode involving a stranger, that many would argue are not abusive because the subject suffered no significant or lasting harm, if any at all. As clarified below, Lisak and his colleagues (1994, 1996) deliberately chose to weight their definition of sexual abuse in terms of the power differential accompanying significant age differences and the older person's presumed deliberate sexual use and exploitation of the younger subject. So long as significant differences in age and power existed, Lisak and his colleagues defined incidents as abusive, regardless of subjects' emotional appraisal or lasting effects (the latter were not measured).
Lisak and his colleagues (1994, 1996) used an anonymous questionnaire which has 17 behavioral descriptions of possible experiences and an 18th item for "other" experiences subjects describe. If subjects endorsed an item, they were then directed to provide further information about the experience, which was used to categorize the experience as abusive or not. If the subject was age 13 or younger when the incident occurred and the other person was at least 5 years older, the incident was classified as sexually abusive. If the subject was age 13 or younger when the incident occurred and the other person was less than 5 years older, two criteria had to be met for the incident to be classified as abusive: the subject reported feeling "negative" about it and reported that some degree of coercion was used by the other person. Similar principles apply to incidents occurring when the subject was age 14-15: the incident was classified as abusive if the other person was at least 10 years older; if the other person was less than 10 years older, the abuse classification was assigned only if the subject reported feeling negative about it and reported some level of coercion by the other person.
Though the definitional criteria in Lisak and his colleagues' studies are complex, they address two important issues.
Lisak and his colleagues argue that the criteria they employed to assess sexual abuse are clear and relatively conservative in their treatment of the issues of power and subjects' responses.
A prevalence rate similar to the Lisak et al. studies was found in another study of college males. Collings (1995) used an anonymous questionnaire and defined sexual abuse as "unwanted" sexual experiences taking place before the age of 18. The term "unwanted" is likely to bias rates downward, as noted above, but the inclusion of subjects aged 16 and 17 is likely to increase the found prevalence rate. Not surprisingly, Collings found that 29% of the 284 male respondents had been sexually abused, with 20% reporting non-contact abuse and 6% reporting abuse experiences involving physical contact.
2. Studies with community samples have ranged in their prevalence rates from 2.8% to 16%. Again, methodology has been crucial. Kercher and McShane (1984) mailed a single self-report question including the word "abuse" to a random sample of Texas drivers. They found a prevalence rate of 3%. Given the wording of their single question, this rate is not surprising.
Two random-sample telephone interview studies by Murphy (1987, 1989, cited in Urquiza & Keating, 1990) also demonstrate the profound effects of single questions including the word "abuse" rather than instruments with multiple behavioral descriptions. In one of the studies (1987) the former method was employed, and it produced a rate of 2.8% with a sample of 357; in the other study (1989) the latter method yielded a prevalence rate of 11% with a sample of 777.
Bagley, Wood and Young (1994) conducted a community study of men aged 18 to 27 in the Canadian city of Calgary. They first contacted subjects by phone, then administered anonymous questionnaires in their homes via programs on portable computers. Their questionnaire asked about "unwanted" experiences before the age of 17. This wording is likely to result in under-reporting because people who have been sexually abused, but especially males, are sometimes convinced that they wanted and were responsible for the sexual contact. Bagley and his colleagues found a prevalence rate of 15.5%, and that 6.9% of their subjects had experienced multiple episodes of sexual abuse. Interestingly, this rate for multiple episodes was identical to that found for women in a previous study that employed the same methodology, despite the fact that the prevalence rate for any unwanted sexual experiences in that study was 32%, or double that found for males (Bagley, 1991).
The highest community-sample prevalence rate of 16% was found in a random telephone survey of 2,626 men, known as the "L.A. Times survey" (Finkelhor, 1990). However, these findings are very difficult to interpret, since the wording of the questions would be expected to produce contradictory effects: each question used the word "abuse," but ended with the phrase, "or anything like that?"
In contrast to studies with women, published studies using face-to-face interviews with men have yielded very low prevalence rates, perhaps due to subjects' adherence to stereotypes about males not being victims (Urquiza & Keating, 1990). Finkelhor's (1984) face-to-face interview with Boston-area fathers yielded a rate of 6%. Siegel and colleagues (1987), using gate-question interviews with 1,480 Los Angeles-area men, found a prevalence rate of 3.8%. Baker and Duncan (1985) used a single question that described various sexual acts and found the highest face-to-face prevalence rate of 8% in their random sample of 970 men in Great Britain.
3. Studies with clinical samples have obtained prevalence rates from 3% to 23%. The lowest rate was reported from a study that used psychological records of 954 male and female patients of a large regional medical center (Belkin, Greene, Rodrique, & Boggs, 1994). In a chart review of emergency room records of a Buffalo, New York hospital, Ellerstein and Canavan (1980) found an 11% prevalence rate. DeJong and colleagues (DeJong, Emmett, & Hervada, 1982) reviewed several clinical studies and found rates from 11% to 17%, and in their own hospital population found a rate of just under 14% (1982). Metcalfe and his associates (1990) found a prevalence of 23% in their survey of 100 male psychiatric inpatients.
However, it is important to note here that assessment for sexual abuse histories in hospitals has traditionally been extremely poor, and remains so in many settings. Thus these rates, based on reviews of records, are likely to be vast underestimates. For example, Briere and Zaidi (1989) reviewed intake reports on women presenting to an urban psychiatric emergency room. They randomly reviewed 50 charts before and 50 after the intake staff were instructed to question clients about previous sexual victimization. The first 50 charts had recorded rates of 6%, and the second set, 70%.
Effects of Child Abuse
There are many web sites with information about possible effects of child abuse, including findings from solid research. Unfortunately, too often these are "laundry lists" of problems and symptoms, which can lead people to believe that almost every case of child abuse inevitably leads to permanent damage and great long-term suffering. Of course child abuse can lead to problems and suffering, but it's not that simple. My aim here is to provide some basic information that helps people appreciate the complexity of this issue and avoid unnecessarily pessimistic beliefs as they seek for knowledge and understanding.
You may be wondering: "Why do I have problems dealing with emotions, relating to friends, getting close to people? Could it be related to abuse I experienced as a child? Will I (my child, husband, friend, etc.) be forever damaged by the abuse?"
I have three basic answers, or at least beginnings of answers to these questions:
Child Abuse and the Human ConditionIt is important to consider these issues in relation to what some people refer to as "the human condition." By this I mean:
The Effects of Child Abuse Depend on a Variety of FactorsWe have learned from many people's experiences and a great deal of research that the effects of abuse and neglect depend on a variety of factors. Below I group these effects into those which research has shown to influence negative outcomes, and a variety of other factors that are harder to measure for research purposes and/or may be very important for some people but not others.
Factors research has shown to influence the effects of abuse:
In summary, it is important to appreciate that these issues are very complex, and to be familiar with how abuse and neglect can - depending on a variety of other factors - affect various aspects of a person's life. Keep this in mind as you search the web for information and understanding about the effects of child abuse.
Finally, you may find it helpful to keep in mind what I have presented above while reading the following articles:
About Therapy & Recovery - Resources to Inform Your Search
For many people, recovery from significant effects of child abuse requires consultation or therapy with a trained professional; this can also be true for those who want to effectively support someone else in his or her healing. But it is not always clear how to go about finding good professional help. You can greatly increase the odds of finding and benefiting from qualified help if you learn about the stages of recovery from the effects of abuse, about how people successfully change problem behaviors in general, and about how and where to find qualified help. Providing some of this knowledge is my goal for this section.
This section is primarily addressed to adults who experienced abuse as children, though it also has useful information for teenagers, those subjected to violence in adulthood, and people seeking help for loved ones who have been abused or assaulted.
(For more information about seeking help for a spouse, partner, friend, boyfriend, etc., see Resources for Spouses, Partners, Friends, etc. For information about finding help for children and adolescents, see the National Child Traumatic Stress Network's How to Find Help) page, and especially their Network Members page, which lists centers and clinics all around the US, each of which will know of excellent resources in their area.)
This section can be downloaded and printed as a MS Word file (with working hyperlinks), and has four subsections:
1. Stages of treatment for child abuse trauma
Among experts in the treatment of people who have suffered from extreme child abuse and other traumas, since the early 1990s there has been a consensus on two points: treatment and healing from the effects of abuse takes place in stages, and there are fundamental principles of good treatment which apply at every stage. In this section, I address the stages of treatment and recovery. My discussion borrows heavily from Judith Herman's classic book, Trauma and Recovery, which goes into great depth on these stages and principles.
In this section, I mention particular types of treatment. The "Specific resources" section below (#4 within this overall subsection) has additional information about these treatments and how to find therapists experienced with them.
The first stage of healing and of any helpful therapy or counseling is about:
Of course, everything is not always so perfectly ordered and sequential. For example, during the first stage it may be necessary to discuss the contents of abuse memories that are disrupting one's life. This may be required to help manage the memories, or to understand why it is hard to care for oneself (the abuser suggested unworthiness of care or love, etc.). However, in this case addressing memories is not the focus of therapy, but a means to achieving safety, stability, and greater ability to take care of oneself.
Most important, the key to healing from child abuse is achieving these "stage-one" goals of personal and interpersonal safety, genuine self-care, and healthy emotion-regulation capacities. Once these have become standard operating procedures, great progress and many new choices become possible.
Depending on the person, the first stage of treatment may also involve:
The second stage of recovery and treatment is often referred to as "remembrance and mourning." Even before saying what this stage is about, it is important to note that some people may decide to postpone working on "stage-two issues," and some may decide never to address them (at least in therapy).
The main work of stage two involves:
For those who do choose to focus on abuse memories, or need to because the memories are still disrupting their lives, there are several therapeutic methods available for "processing memories" in the second stage of treatment. In general, these methods involve "exposure" to the traumatic memories within a safe and healing therapy setting. These treatment approaches can be very effective at ending the influence that abuse memories have over one's daily life, emotions, sense of identity, and self-understanding.
There are different psychological theories about what is involved in processing traumatic memories, and discussing these in detail is beyond the scope of this section. (One theory is that successful treatment involves "extinguishing" habitual and maladaptive fear responses to trauma reminders, and replacing them with adaptive responses. Another is that treatment "transforms" traumatic memories consisting of intense fragmentary sensations and emotions into more normal and integrated memories, ones characterized by verbal narratives rather than vivid sensations and intense emotions. Also, these theories are not incompatible.)
Theories are much less important than this fact: there are very effective therapy methods that have been proven, through years of clinical experience and extensive research, to bring great relief and healing by tranforming how people experience memories and reminders of child abuse. (Please note: such treatments do not "erase" memories, and are not designed or used to "recover" memories; if you have personal questions about this issue, see the "Words of Caution II" section on my page, Recovered Memories of Sexual Abuse).
The two most studied and research-supported treatment approaches for processing traumatic memories are:
What happens in EMDR sessions, and how it is different from what happens in Prolonged Exposure sessions:
Additional Information about EMDR
Because EMDR is still a "controversial" treatment in some ways, it is helpful to provide some information relevant to the controversy. Though I would rather not get into this issue, it is necessary because of the risk that some may decide not to try this very effective treatment due to misleading or inaccurate information in the popular media, on the web, even in scholarly publications. The points below are intended to explain how the controversy arose and to demonstrate that the main criticism of EMDR is not based on facts.
The theory behind how PE works is the Emotional Processing Model of Edna Foa and Michael Kozak. These authors have presented this model in several influential papers, particularly these:
Foa, E.B., & Kozak, M.J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35.Foa, E.B., & Kozak, M.J. (1998). Clinical applications of bioinformational theory: Understanding anxiety and its treatment. Behavior Therapy, 29, 675– 690.While these are long and fairly technical papers, some people may find reading them to be useful. Their theory can be summarized briefly as follows:
Importantly, I have focused on these two highly-researched treatments for changing one's relationshp to traumatic memories, but there are certainly others that people with child abuse histories have found helpful. One common component is exposure to distressing aspects of the memory in a safe and structured setting. Again, the main point here is that there are effective and relatively rapid methods for dealing with intensely distressing memories. People do not have to be tortured by them for years.
The third stage of recovery and treatment focuses on reconnecting with people, meaningful activities, and other aspects of life.
I am not going to describe this stage further. Instead, I recommend Judith Lewis Herman's classic book, Trauma and Recovery, which describes the three stages of recovery in depth and detail.
2. Stages of voluntary behavioral change
Over the past two decades very important work has been conducted on the stages of change that people go through in order to voluntarily change their own behavior. This work emerged from those studying how people quit addictive behaviors, but is applicable to other habitual behaviors that people have a hard time quitting. Two of the best known people who have conducted and presented this work are Carlo DiClemente and James Prochaska.
Generally speaking, experienced and skilled therapists understand the stages of change, even if they do not think about them in terms of this model. They are also skilled at matching what they say, and the treatment methods they provide, to where their clients are (in relation to particular "problem behaviors") in the stages described below.
Before describing the stage model, it's important to note that this work is particularly relevant to people in the first stage of recovery.
3. Principles of treatment for child abuse trauma
There are several important principles of treatment that anyone seeking good professional help in dealing with the effects of child abuse should know about. I cannot list them all or spell them out in great detail. However, in this section some crucial ones are introduced and described, to aid with interviewing potential therapists or consultants and reflecting on one's experiences in treatment. Reflecting on these principles can be particularly helpful at the beginning of therapy, while establishing trust, as well as during other difficult phases.
Competence. Not all professional therapists are competent to provide treatment to people with histories of severe child abuse, or with particular sorts of problems that can result from extreme forms of abuse. Competence requires but is not guaranteed by extensive experience and training in work with survivors of child abuse, or ongoing supervision with a more senior and qualified therapist. (Section 4 below has resources for interviewing therapists to gather information about their likely level of competence.)Empowerment. The core experience of child abuse, like all severe traumas, is disempowerment: one's needs, wishes and choices (including not to be abused) are ignored and trampled upon. Because child abuse involves violation and betrayal of trust by a more powerful person, it is essential that the therapist and therapy not repeat these patterns.Much more could be said about principles of treatment. The point here has been to spell out a few that are particularly relevant to people with abuse histories. Please know it is your right to ask potential therapists to describe the principles of treatment that guide them in their work with people who have experienced child abuse.
4. Specific resources for finding, interviewing, choosing, and evaluating therapists
The Sidran Foundation has an extensive list of therapists and clinics around the country that specialize in treating people with histories of severe child abuse. See their page About the Help Desk. Neither I nor the Sidran Foundation can vouch for every therapist on the list; but they can usually, at a minimum, provide some good leads.
The Sidran site also has the web page, Therapy for Post-Traumatic Stress and Dissociative Conditions: What to Look for and How to Choose a Therapist,which has excellent information about the nature of helpful therapy, how to find potential therapists, and how to determine if one is right for you.
As described above, EMDR is a therapy proven to help people decrease the distress associated with memories of traumatic experiences. It is also practiced by thousands of therapists around the world, many if not most of whom are very experienced with stage-oriented treatment of people who were abused as children. You can find EMDR therapists through the Find a Therapist service of the EMDR International Association. EMDRIA's primary objective is to "establish, maintain and promote the highest standards of excellence and integrity in Eye Movement Desensitization and Reprocessing (EMDR) practice, research and education."
There are some more general resources on the web about how to choose a therapist. Here are two that complement each other well:
Resources for Spouses, Partners, Friends, etc.
You may have come to this page seeking understanding of someone you love, including how his or her past abuse history is affecting your relationship. You may be wondering how you can be more supportive and helpful when your loved one's abuse memories or relational dynamics get "triggered." Maybe you're wondering how you can help someone find professional help, or make the commitment to seek help and follow through. Or maybe you're looking for books that could help you better understand what your partner or friend is going through, and how to best manage your own responses and relate most effectively.
In this section I have some comments and suggestions relating to challenges often facing partners and friends of those with child abuse histories. (For more resources for adults with histories of child abuse, see the Additional Resources section.)
First, I recommend these two books:
Allies in Healing: When the Person You Love Was Sexually Abused as a Child, by Laura Davis. Perrenial Books, 1991.Outgrowing the Pain Together: A Book for Spouses and Partners of Adults Abuse As Children, by Eliana Gil. DTP, 1992.Trying to be supportive and helpful to someone you love who is suffering from the effects of child abuse can be very difficult and challenging. Just knowing what they went through can bring up feelings of sadness, helplessness, frustration, and anger. If they clearly could benefit from some professional help but reject that as an option, or say they'll get help but never follow through, it can become very frustrating. And it can be scary, if the well-being of your relationship or family seem to depend on what they choose.How to help someone you love who has mixed feelings about seeking help? How to discuss the issue without taking sides in your loved one's inner conflict over whether or not to seek help – especially when you have so much at stake on their decisions and actions?
Much of it comes down to managing your own feelings, and managing your impulses to push them to make decisions or take action. But it also requires sorting through your own thoughts, feelings and needs, and figuring out how you can most effectively discuss these issues with your partner or friend. There may be options for communicating that you don't yet realize exist.
The vast majority of people who could benefit from seeking professional help have very mixed feelings about doing so. On the one hand, they may hope that someone could really understand and help them make changes they would like to make in their lives. On the other hand, they may fear that a therapist won't understand, won't be able to help, or will see them as "crazy." They may fear that a therapist won't really care and will just use them to make money from their suffering. They may not feel worthy of being helped, or fear that it would be just too painful or humiliating to confront their suffering and problems in therapy. These mixed feelings and fears are quite normal for people who were abused and betrayed in childhood.
In trying to help a partner or loved one struggling with such mixed feelings, one of the most common traps to fall into, though totally understandable and often done without realizing that it's happening, is this: trying to "show" or "convince" or otherwise push them into "admitting" they need help, that they "must" go into therapy, etc. Unfortunately, this doesn't work. In general, when people have mixed feelings about something and someone else does all the talking (and pushing) for one side, it puts the other person in the unbalanced position of "holding the other side" and thinking and talking about the reasons they don't want or need to change.
Also, when the person who fears that change might have some serious drawbacks is someone who was abused as a child, being pushed to change can repeat dynamics of coercion and experiences of disempowerment that characterized their child abuse experiences. Of course, you may be genuinely trying your best, and pushing out of love and concern (not just growing fear and desperation). But the fact is – as you've probably already begun to realize, even if you still don't quite know what else to do – this approach is not likely to work. The fact is, it tends to polarize things further, and to increase resistance to change, including seeking professional help.
The reasons that such communication styles do not work are very well explained by the therapists and researchers who developed "motivational interviewing." This style of therapy, or way of being with clients, was developed to help people with substance use problems, who often have very mixed feelings about stopping or dramatically reducing substance use and are seen by others as being "in denial." But the principles of motivational interviewing apply to any situation where one person is trying to help another person resolve their mixed feelings about making a positive behavior change or committing to taking positive action. As the developers of motivational interviewing, William Miller and Stephen Rollnick, have written:
"Constructive behavior change seems to arise when the person connects it with something of intrinsic value, something important, something cherished. Intrinsic motivation for change arises in an accepting, empowering atmosphere that makes it safe for the person to explore the possibly painful present in relation to what is wanted and valued. People often get stuck, not because they fail to appreciate the down side of their situation, but because they feel at least two ways about it. The way out of that forest has to do with exploring and following what the person is experiencing and what, from his or her perspective, truly matters."To learn some very effective ways of communicating with people who have mixed feelings and fears about seeking help and making positive changes in their behavior, visit the Clinical Issues section of the Motivational Interviewing web site and read the following pages:
Basically, it often makes sense for you to get some consultation, support and help in dealing with the difficult situation you are in, so you can maximize your chances of helping your partner or friend make her or his own decisions and commitments about seeking help and making changes for the better. Ultimately, it's up to them. But how other people discuss these issues with them, particularly you, can make a big difference.
Resources for Parents & Caregivers
In this section I provide some basic resources for parents and caregivers – not only those with children who have experienced abuse, but allparents and caregivers, including those who themselves were abused as children.
As discussed in the section Effects of Child Abuse, the effects of child abuse can be increased or decreased by key relationships in the child's life. More than anyone else (including therapists), parents and caregivers can help children recover from abuse and its effects.
The sections before this one, About Therapy & Recovery and Resources for Spouses, Partners, Friends, etc., have information that is helpful for understanding and relating to older children and teenagers. The Additional Resources section below has some useful information and links to resources as well.
If you want immediate information, including on how to find professional help for a child or adolescent, see the National Child Traumatic Stress Network's How to Find Help page, and especially their Network Members page, which lists centers and clinics all around the US, each of which will know of excellent resources in their area.
Though I am a parent myself, working with children and parents is not my specialty. So I have consulted with trusted colleagues who have specialized training and years of experience working with abused children and their caregivers. Below are their recommendations.
First, two relatively brief and free resources on the web: Children and Trauma, a handout by Drs. Margaret Blaustein and Kristine Kinniburgh, authors ofTreating Traumatic Stress in Children and Adolescents, and Helping Traumatized Children: A Brief Overview for Caregivers, by Dr. Bruce Perry, Director of theChildTrauma Academy.
Book and video recommendations for parents and caregivers of children who have been abused.
Your Body Belongs to You, by Cornelia Maude Spelman and Teri Weidner (Illustrator). Albert Whitman & Co, 2000. (This book is for parents and teachers of young children, and more focused on prevention.)Children and Trauma: A Guide for Parents and Professionals, by Cynthia Monahan. Jossey-Bass, 1993.For parents wondering what's appropriate vs. concerning sexual behavior in children (not only their own, but other children who are playing with them), I highly recommend the booklet, Understanding children's sexual behaviors: What's natural and healthy. It's by Dr. Toni Cavanagh Johnson, an internationally respected expert, only 26 pages long, written in simple language for all parents (educators, etc.), and cheap ($2.50). You can order it there. See also, Do Children Sexually Abuse Other Children, a free online 'guidebook' published by Stop It Now.On the prevention of sexual abuse, here are books that parents can read and discuss with their 4 to 8 year old children: My Body Belongs to Me, My Body Is Private, Your Body Belongs to You, Those are MY Private Parts, and The Right Touch.
If you are the parent or caregiver of a child or teen with sexual behavior problems, Stop It Now publishes an excellent newsletter, PARENTtalk. It is written by and for parents of children and teens with sexual behavior problems, and offers "an opportunity to break the isolation surrounding this issue and offer support to each other through personal stories." All issues are free online.
Finally, I'd like to recommend a few books that – based on what I've learned as a father, researcher and therapist – I believe any open-minded parent can benefit from reading and putting into action.
Confident Parents, Remarkable Kids: 8 Principles for Raising Kids You'll Love to Live With, by Bonnie Harris. Adams Media, 2008.When Your Kids Push Your Buttons, And What You Can Do About It, by Bonnie Harris. Grand Central Publishing, 2004.
This section consists primarily of links to Web sites, but I also suggest three hotlines, a referral service that can help you find a therapist in your area, three books, and an article on the international prevalence of child sexual abuse. (For resources specifically for parents and caregivers of abused children, scroll up to the section just above this one.)
If you are looking for a therapist or counselor in the United States, even if only for a couple of consultations, the Sidran Foundation has an extensive list of therapists and clinics around the country that specialize in treating people with histories of severe child abuse. See their page About the Help Desk.
If you need immediate information about and/or connection to resources in your own community, here are four 24-hour toll-free hotlines that you can call, three in the US and one in the UK:
In terms of books, these are my top recommendations:
How Long Does It Hurt? A Guide to Recovering from Incest and Sexual Abuse for Teenagers, Their friends, and Their Families, by Cynthia Mather, Kristina Debye, Judy Wood, and Eliana Gill.The following two books offer a wealth of helpful information, including explanations of post-traumatic stress disorder and related problems, and many great techniques for managing trauma-related emotions, memories and various other symptoms and problems commonly struggled with by people who were abused as children.
The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms, by Mary Beth Williams and Soili PoijulaPost-Traumatic Stress Disorder Sourcebook, by Glenn Schiraldi
If you are looking for books and/or articles on the sexual abuse of males, please see the Recommended Books and Articles section of my page, Sexual Abuse of Males: Prevalence, Lasting Effects, and Resources. There's a lengthy listing of books and articles. Some are reviewed, and some can be ordered.
If you are looking for books on recovered memories of sexual abuse, please see the Books on Recovered & Traumatic Memories section of my page,Recovered Memories of Sexual Abuse: Scientific Research & Scholarly Resources.
There are numerous Web sites with content addressing child abuse and recovery issues in addition to those already mentioned on this page. Below is a sampling. (All links open in new windows.)
If reading material on these issues may disturb or upset you, remember to take care of yourself, and that you can always come back to this page or any of the links below when you feel prepared.
This mission of 1in6 is "to help men who have had unwanted or abusive sexual experiences in childhood live healthier, happier lives." Their website has many resources for the men they serve, and for people who care about them.
Center for Sex Offender Management
This is a Project of the U.S. Department of Justice's Office of Justice Programs. "Established in June 1997, the Center for Sex Offender Management's (CSOM) goal is to enhance public safety by preventing further victimization through improving the management of adult and juvenile sex offenders who are in the community." CSOM's goals are carried out through three activity areas, including information exchange. In addition to an "Ask COSM" feature, theirDocuments section has a wealth of informative html and pdf materials, including "Myths and Facts About Sex Offenders" in html and pdf formats, and "Recidivism of Sex Offenders," also in html and pdf. Finally, their Reference Library has a searchable documents database and a topically organized list ofNational Resource Group Recommended Readings. Finally,
Childhelp USA is a non-profit organization "dedicated to meeting the physical, emotional, educational, and spiritual needs of abused and neglected children." Its programs and services include a hotline (800-422-4453) that children can call with complete anonymity and confidentiality. To know what to expect when you call, see see What to Expect When Calling. From the site: "The Childhelp USA® National Child Abuse Hotline is open 7 days a week, 24 hours a day. Don't be afraid to call. No one is silly or unimportant to us. If something is bothering you or you want information, CALL!" To learn more about reporting child abuse or neglect in your state, see Local Phone Numbers.
This organization, Directed by Dr. Bruce Perry, "focuses on service, training and research in the area of child maltreatment." The site has a number of articles by Dr. Perry, including explanations of child abuse effects and Helping Traumatized Children: A Brief Overview for Caregivers.
Child Welfare Information Gateway
Official U.S. site with a wealth of great resources, including an excellent searchable catalog of publications (try searching with terms like "bibliography," "fact sheet," "prevention," and "webliography"). Many publications are available in Spanish. For help with accessing their statistical information, see above, Official Statistics: United States.
This site has a wealth of scholarly resources, including an online journal, Child Welfare Review, and information about the Oxford University Press Series in Child Welfare Practice, Policy and Research.
Common Responses to Trauma - And Coping Responses
This two-page handout, by Dr. Patti Levin, provides excellent and helpful information and suggestions. Dr. Levin's site has other helpful handouts and excellent information on how to choose a therapist. (The above link is to a PDF file, and it's also available as a web page.)
Court Appointed Special Advocates (CASA)
"Volunteer Court Appointed Special Advocates (CASA) are everyday people who are appointed by judges to advocate for the best interests of abused and neglected children. A CASA volunteer stays with each child until he or she is placed into a safe, permanent and nurturing home." More than 900 CASA programs are in operation across the United States, with 52,000 women and men serving as CASA volunteers. This website of National CASA explains what CASA's do, how to become one, etc.
Crimes Against Children Research Center
"The mission of the Crimes against Children Research Center (CCRC) is to combat crimes against children by providing high quality research and statistics to the public, policy makers, law enforcement personnel, and other child welfare practitioners." The center is directed by Dr. David Finkelhor, a sociologist and internationally recognized expert on child victimization, including child sexual abuse. The site has many good resources, including aPublications section with the paper, The Decline in Child Sexual Abuse Cases, and a classic 1993 scholarly review paper, The impact of sexual abuse on children: A review and synthesis of recent empirical studies.
Darkness to Light
Darkness to Light's mission is to shift responsibility for child sexual abuse prevention from children to adults, reduce child sexual abuse through adult-based education and awareness, and provide adults with information to prevent, recognize and react responsibly. Site includes many useful resources, articles, etc.
David Baldwin's Trauma Info Pages
These pages are loaded with scholarly resources and references to work on Posttraumatic Stress Disorder, especially from neuropsychological and cognitive-behavioral perspectives.
Eye Movement Desensitization and Reprocessing (EMDR) has been proven to be an effective and efficient treatment for posttraumatic stress disorder (PTSD), which can be an effect of childhood abuse. It can be particularly helpful at transforming intrusive and upsetting memories of abuse, and does not require one to talk about what happened in detail (fors those avoiding therapy for this reason). In recent years, therapists have learned how to use EMDR with children. The EMDR Institute provides referrals to EDMR-trained therapists around the country (by zipcode) and around the world; follow the link from the home page.
You can also find EMDR therapists through the Find a Therapist service of the EMDR International Association, whose primary objective is to "establish, maintain and promote the highest standards of excellence and integrity in Eye Movement Desensitization and Reprocessing (EMDR) practice, research and education."
"FaithTrust Institute is an international, multifaith organization working to end sexual and domestic violence. We provide communities and advocates with the tools and knowledge they need to address the religious and cultural issues related to abuse. FaithTrust Institute works with many communities, including Asian and Pacific Islander, Buddhist, Jewish, Latino/a, Muslim, Black, Anglo, Indigenous, Protestant and Roman Catholic." Their site has a number of resources on the issue of Sexual Abuse by Clergy.
Jennifer J. Freyd's Trauma, Memory, and Betrayal Trauma Research
This page has links to reviews of Dr. Freyd's books and web pages on which she discusses several clarifying perspectives on these issues, including her theory of why it is adaptive for some children not to remember childhood abuse experiences.
Healing from Childhood Sexual Abuse: Book Reviews
Scott Abraham reviews eight books for men who were sexually abused in childhood. Good review, very helpful. If you're considering buying a book, read this first.Healing Self-Injury
Ruta Mazelis, former editor of The Cutting Edge newsletter, is now editing this web site with resources for people struggling with self-injury and those who care about them.
isurvive.org - Abuse Survivors Learning to Thrive
This volunteer-run web site and non-profit organization has many great resources – the most valuable being the people who help each other by sharing their experiences, struggles and hard-earned wisdom. There are online chats and forums for survivors of child abuse, including those struggling with addiction and abusing others, as well as friends and family members. It also has a great resources page with many not listed here.
Legal Resources for Victims of Sexual Abuse
This section of Attorny Susan Smith's web site has extensive resources on remedies for victims, statutues of limitations, and mandatory child abuse reporting laws in most states of the U.S.
Making Daughters Safe Again
This organization and its web site, founded and directed by a graduate student in clinical psychology, provide "support for survivors of mother-daughter sexual abuse."
MaleSurvivor: National Organization against Male Sexual Victimization
Their mission: "We are committed to preventing, healing, and eliminating all forms of sexual victimization of boys and men through treatment, research, education, advocacy, and activism." Their site has many helpful resources.
Pat McClendon's Clinical Social Work Home Page
These are general mental health pages with a focus on abuse and trauma resources, especially those related to dissociation.
National Child Protection Clearinghouse (NCPC)
Great official Australian site with an exceptional Publications section, including full-text articles on child abuse, its effects, and how to prevent it - some quite in-depth, sophisticated, and scholarly. For help with accessing NCPC statistical information, see above, Official Statistics: Australia.
National Child Traumatic Stress Network (NCTS)
This network of treatment centers was created by an initiative of the US Congress just a few years ago. Their mission is "To raise the standard of care and improve access to services for traumatized children, their families and communities throughout the United States." The site has many great resources, including for parents, caregivers, and school personnel. For example, to find professional help for a child or adolescent, see the How to Find Helppage, and the Network Members page, which lists centers and clinics all around the US, each of which will know of excellent resources in their area.
National Clearinghouse on Family Violence (NCFV)
Official Canadian site with several "fact sheets" and an extensive Publications section addressing Child Abuse and Neglect, Child Sexual Abuse, andFamily Violence, Intimate Partner Abuse Against Men, and Intimate Partner Abuse Against Women. The NCFV also has a collection of videos available to the general public and professionals. For help with accessing statistics on child abuse and neglect in Canada, see above, Official Statistics: Canada.
National Crime Victim Bar Association
An organization of attorneys who work for victims of crime, including child abuse, to pursue civil cases against perpetrators and other parties who may be found liable for physical and mental injuries suffered. See "Info for Victims," which includes information about how to find a qualified local attorney through their service.
Publicizing Child Molester's Prison Release
This site belongs to Mark Welch, a California lawyer who has publicized the release from prison of his brother, who has admitted to sexually abusing him in childhood. This is clearly a very controversial issue. Mr. Welch provides a thoughtful essay on publicizing the release of one's perpetrator, including various ethical considerations.
Rape, Abuse & Incest National Network (RAINN)
RAINN has a 24-hour National Sexual Assault Hotline (800 656-4673) and a National Sexual Assault Online Hotline (chat) staffed with trained volunteers and paid staff members who also have knowledge of sexual abuse issues and services (though sometimes they are not adequately prepared to refer male callers). All calls are confidential, and callers may remain anonymous if they wish.
Safer Society Foundation
The Safer Society Foundation, Inc. (SSF) is a nonprofit agency and national research, advocacy, and referral center for the prevention and treatment of sexual abuse. The SSF provides training and consultation to individuals, agencies, states and organizations. Their Web site has a list of Safer Society Press books and videos. For information about their "Treatment Referrals Program" for sexual abuse perpetrators, see their Contact Us page.
Dr. Kristin Neff's site includes scholarly research and exercises for how to increase self-compassion. People who have experienced abuse in childhood often have a difficult time being compassionate toward themselves, and instead get caught in being judgmental toward themselves, self-pitying, and/or self-indulgent. This site provides a healthier, healing alternative, and is written for "students, researchers, and the general public."
The Sexual Assault Information Page
This site is now only available in archive format (last version of October 2001, but is still very useful with its over 400 links to information and resources on child abuse and neglect, as well as the sexual assault of adults.
This is a national non-profit organization that offers services to helps people understand, recover from, and treat traumatic stress (including PTSD), dissociative disorders, and co-occurring issues, such as addictions, self injury, and suicidality. There are many excellent resources here, including a What Are Traumatic Memories? and pages with Resources for Survivors and Loved Ones and Information for Students.
This page has links to several resources addressing sexual abuse and exploitation by coaches, particularly of figure skaters.
STOP IT NOW!
"Stop It Now! believes that all adults must accept the responsibility to recognize, acknowledge and confront the behaviors that lead to the sexual abuse of children. We offer adults tools they can use to prevent sexual abuse - before there’s a victim to heal or an offender to punish. In collaboration with our network of community-based Stop It Now! programs, we reach out to adults who are concerned about their own or others’ sexualized behavior toward children."
SNAP - Survivors Network of those Abused by Priests
"SNAP is a national self-help organization of men and women who were sexually abused by Catholic priests (brothers, nuns, deacons, teachers, etc). Members find healing and empowerment by joining with other survivors."
Survivors of Childhood Sexual Abuse - A Guide for Primary Care Providers
This is a great resource with sections addressing potential "triggers" in medical procedures and doctor-patient interactions, as well as recommendations for how to manage patients responses most sensitively and effectively. It specifically addresses several areas of practice: Obstetrics & Gynecological Care; In Office PT or Physical Exams; Oral Exams; Ultrasounds & Mammograms; Counseling Substance Abuse Behaviors; Treating Depression & other Psychiatric Illnesses.
The Trauma Center
The Trauma Center, founded by Bessel van der Kolk, an leading expert in the field of traumatic stress studies, is a clinic affiliated with the Boston University School of Medicine. The site includes pages on the work of Dr. van der Kolk, including links to his articles on the web and psychological traumaassessment instruments.
Tips for Abuse Survivors and Their Dentists
As indicated by its name, this page at Dental Fear Central was written for abuse survivors and their dentists, and has some helpful advice on dealing with many of the issues and difficulties that can arise.
Frequently Asked Questions
No one can be an expert in everything related to child abuse and neglect, and I do not have enough time to share everything I do know via this web page. But I would like to make this page as useful as possible, including for the thousands of students who visit every day, looking for more information than I can provide directly.
One question that I'm often asked is this: "How do I get my husband/wife/partner/boyfriend/girlfriend/friend to get some therapy?" This is one that I attempt to answer on this page, though not in the way you may expect. See below, Resources for Spouses, Partners, Friends, etc.
I often receive emails from parents of children who are or may be being abused, for example by the other parent, and who are looking for good local help for themselves and their child (that is, therapy, and sometimes legal help). See the National Child Traumatic Stress Network's How to Find Help) page, and especially their Network Members page, which lists centers and clinics all around the US, each of which will know of excellent resources in their area. (See also the Resources for Parents & Caregivers section of this page for recommended books, etc.)
The rest of the questions below I am most frequently asked in emails from students. For each one, I have a couple of links to excellent resources on that issue, almost exclusively from the web site of the United States' Child Welfare Information Gateway.
I have one request of you: Please email me suggested additions to this section. When you find something really helpful, send me the address of the page. Your fellow students and other visitors to this page from around the world will appreciate it.
What are the (main) causes of child abuse?
Risk and protective factors for child abuse and neglect
What are the signs and symptoms of child abuse?
Recognizing Child Abuse and Neglect: Signs and Symptoms - PDF Version
What are the effects of child abuse and neglect on children?
Impact of Abuse and Neglect
Treatment for Abused and Neglected Children: Infancy to Age 18 - PDF Version
Long-term Effects of Child Sexual Abuse
Acts of Omission: An Overview of Child Neglect
See also the section of this page, Effects of Child Abuse
How are alcohol and substance abuse related to child abuse?
No Safe Haven: Children of Substance-Abusing Parents - PDF version
Fact Sheet on Family Violence and Substance Abuse
What treatment is there for children who have been abused?
Effective Treatments for Youth Trauma
National Child Traumatic Stress Network Empirically Supported Treatments and Promising Practices
How can we prevent child abuse?
Preventing Child Abuse and Neglect
Participants age 18 and older are needed for a research study developing a computerized survey of quality of family relationships and relational traumatic events during childhood. The survey can be completed by following this link to a confidential survey hosted at SurveyMonkey.com. This study, conducted by Dr. Paul Frewen at the University of Western Ontario, has been approved UWO's Research Ethics Board.
The Boston Police Department's Crimes Against Children Unit is seeking Boston Victims of Dr. William Ayres.
They are looking for anyone who was sexually abused by child psychiatrist Dr. William Ayres at Judge Baker Guidance Center between 1959-1963.
Additional Pages At This SiteContents
This page is maintained by Jim Hopper, Ph.D., as are these related pages:
Mindfulness and Kindness: Inner Sources of Freedom and Happiness
© 1996-2010 Jim Hopper
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