Child abuse is not just about sexual abuse but that's an important part

The issues of child sexual abuse are rarely far from the news headlines. Recent accusations against Peter Hollingworth about his alleged failure to deal effectively with sexual abuse claims concerning a priest in his jurisdiction at the time has added yet more fuel to the fire on the issue of protecting our children from this form of harm.

In recent postings, the issues of accessing child pornography have been debated. Although Greg Barns was not promoting child pornography, he took a civil libertarian view, emphasising that the criminals were those producing the pornography. However Hetty Johnston and Ingrid Fjastad pointed out that by contributing to demand (and therefore encouraging supply of new pornographic material to meet this demand), purveyors of child pornography are also responsible for the abuse of children.

This debate raises a number of questions:

• Is child sexual abuse really harmful?
• If so, what is it about sexual abuse that is harmful?
• Does our focus on sexual abuse of children distract our attention from other equally - or more damaging - forms of maltreatment?
• Where should we target our efforts in order to best protect children from harm?

Is child sexual abuse really harmful?

It's risky to suggest that we ask the question - but as a social scientist, my training demands that I do: Is child sexual abuse really harmful? The data that we have from clinicians, from survivor groups, and retrospective reports of those who experienced sexual abuse as a child or adolescent would suggest a resounding "YES" (although there is still a large amount of variability).

In part, it depends on how you define sexual abuse (with definitions ranging from being asked to do something sexual, through to penetration of some kind; and the differences in the size of the age-differential required). However, when you also include those who have never consulted a clinician for treatment (i.e., when you look at national probability samples), a different, more diverse picture is painted.

Bruce Rind and his colleagues from the US have come under enormous criticism for publishing their meta-analytic review of research studies of child sexual abuse that used college samples and national probability samples. Overall, they found a prevalence rate of approximately 19 per cent for females and 11 per cent for males. A greater proportion of females reported negative reactions to their sexual experiences (two-thirds) than males (two-fifths). However, females were generally younger, their experiences more likely to involve coercion, and to occur at the hands of a family member. They drew a qualified conclusion that sexual abuse is not necessarily harmful. In many cases it is harmful, but the impact is not always severe, and is not always long-lasting. The effects of sexual abuse depend on factors such as the use of force, the relationship of the young person to the perpetrator, their gender, sexual orientation, whether the sexual interaction was 'wanted', and other familial factors.

Their work highlights for us an important distinction: just because we find something morally wrong, does not necessarily mean that it is always harmful. And we end up doing ourselves - and science - an injustice by presuming that sexual activity between an adult and a minor must always result in severe and lasting harm. It is better to ask, from a scientific question: Who is harmed? Under which circumstances is harm more likely? What form does that harm take? Is it severe or long lasting?

This does not in any way prevent us taking social action to prevent the risk of harm - as clearly, sexual abuse is often associated with harm. Therefore I strongly believe that children need to be protected from this risk of harm, even though evidence shows that not all would necessarily be harmed.

There is also the possibility that labelling someone as a victim of sexual abuse may be destructive per se. A famous researcher and protagonist in the debates over repressed memories, Elizabeth Loftus, has shown that sometimes our zeal to believe in the literal truth of all reports of sexual abuse can blind us to other circumstances. She chronicles the circumstances around a famous case study - Jane Doe - that has been used as evidence for the existence of massive repression of childhood sexual abuse. Her analysis of this case calls into question many of the facts, the bias that may have entered into the way it was reported, and the possibility that the young girl in question was harmed by being led to believe she was a victim of sexual abuse at the hand of her mother (the allegations were raised by her father and step-mother in the context of a court battle over Jane's custody).

What is it about sexual abuse that is harmful?

Although we can debunk the myth that sexual contact between an adult and a younger person must always cause harm, it leaves the question as to what it is about the nature of this sexual contact that can be harmful. Is it age-inappropriate (precocious) sexual involvement per se, or other elements that cause the harm?

Clinicians and researchers make it clear that the basis of the interaction that is abusive it the breach of trust that is involved. An older person - whether a family member, someone else in a position of authority, or simply someone who is more responsible due to their age - breaches the duty of care that society places as an obligation on adults, particularly those in a position of responsibility when they engage a minor in sexual activity.

In turn, the breach of trust is predicated on the notion that the younger person is unable (or has diminished ability) to give informed consent, to evaluate risks, and to take responsibility for their actions. We do the same thing in relation to purchasing alcohol, or driving a vehicle. Even though there may be some people under the age of 18 who can responsibly make choices and negotiate the consequences of being in control of a motor car - or of purchasing and consuming alcohol - we minimise the risk by not allowing these events until the young person reaches the age by which we as a society assume the risk has diminished to an acceptable level.

Another important factor that may help explain the harm associated with child sexual abuse is that it coincides with other forms of child maltreatment. Physical abuse, psychological (or emotional) maltreatment, physical neglect, and exposure to domestic violence have all been shown to be harmful for children - both in the immediate aftermath, as well as affecting their long-term psychological adjustment as adults. This raises the question: Are we always sure that the diverse range of adjustment problems presumed to be the consequence of sexual abuse in fact not caused by one of these other forms of abuse or neglect that may also be present in the young person's life?

Does our focus on sexual abuse of children distract our attention from other equally - or more damaging - forms of maltreatment?

It was actually a serendipitous finding that sparked my interest in the role of family functioning - and particularly other forms of family violence - in influencing the psychological wellbeing of sexual abuse victims. In my first research study, which was published in The Journal of Sex Research in 1994, I found that the level of violence- both verbal, physical - either experienced or witnessed within families was a better predictor of poor adjustment than was the presence, frequency, or severity of sexual abuse. This really made me sit up and think. Have we as researchers being missing the obvious? Is our concern about sexual abuse (about which-I want to emphasise-I think we should be concerned!) blinding us to the trauma that other forms of family violence cause?

Part of the answer is that it should not be a case of 'either/or'.

Although researchers often examine maltreatment types as if they are independent of each other, the various types of child abuse and neglect may, in fact, be related. In fact, where researchers have bothered to ask about participants' experiences of other forms of maltreatment, they almost invariably find that 'pure' forms of maltreatment are atypical. My colleagues and I have demonstrated that those people who have experienced more than one form of child abuse or neglect ('multi-type maltreatment') generally have more trauma symptoms (e.g., depression, anxiety, sleep disturbance, etc.) and lower self-esteem than both those who experienced just one maltreatment type, and those who experienced no maltreatment.

Also, the promise of finding abuse-specific outcomes has not materialised. There are no exclusive predictors, nor any psychological problems that are exclusively associated with child sexual abuse.

We also have a growing body of evidence that it is not just discrete traumatic events (e.g., acts of physical or sexual abuse), patterns of negative interactions towards the child (e.g., emotional or psychological abuse), or the consistent absence of parental supervision or care (neglect, or exposure to domestic violence) that are associated with maladjustment in the long term. In the past, the first of these factors (particularly sexual abuse) were seen as the most important. However, since the mid 1990s, we have seen that as well as these specific parental acts, the nature of general family environment is an important predictor of psychological wellbeing. Its importance is two fold: firstly, in influencing the likelihood of specific acts of maltreatment occurring, but also in influencing adjustment, independent of specific acts of abuse or neglect.

In other words, it is also the quality of the family environment that counts. In our latest study reported in the Journal of Family Violence, we provide data showing that negative parenting styles and beliefs (e.g., very traditional and punitive attitudes towards sexuality, the role of women and children within the family, etc.) and dysfunctional family dynamics (rigid, rule-bound structures and poor sense of connection between family members) are more strongly associated with poor psychological adjustment than the experience of abuse or neglect - including sexual abuse.

Where should we target our efforts in order to best protect children from harm?

In a paper entitled "Multi-type Maltreatment and the Long-term Adjustment of Adults" published in Child Abuse Review in 2000, I argued that children coming from families that are rigid and inflexible and lack a sense of cohesion as a family unit are more likely to experience multi-type maltreatment. Therefore, the risk of trauma resulting from such experiences of multiple types of abuse and neglect may be reduced if we are able to assist families develop healthy communication skills, and foster a greater sense of flexibility, unity and interconnection among family members. Children re-victimised by multiple forms of maltreatment (who are at particular risk of adjustment problems) should be identified for special intervention as a means of preventing further multi-type victimisation. In this way, treatment programs or other interventions can be used as an opportunity to engage in primary prevention of other maltreatment types.

Let us work to protect children from all forms of harm, not just the risk of harm associated with sexual contact with adults.