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

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.