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Faculty Publications, Department of Psychology Psychology, Department of

December 2007

Child Sexual Abuse

Andrea R. Perry University of Nebraska-Lincoln

David K. DiLillo University of Nebraska-Lincoln, [email protected]

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Perry, Andrea R. and DiLillo, David K., "Child Sexual Abuse" (2007). Faculty Publications, Department of Psychology. 301. https://digitalcommons.unl.edu/psychfacpub/301

This Article is brought to you for free and open access by the Psychology, Department of at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in Faculty Publications, Department of Psychology by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. Published in Th e Encyclopedia of Domestic Violence, Nicky Ali Jackson, editor. New York & London: Routledge, 2007. Pages 147–156. Copyright © 2007 Taylor & Francis Group LLC. Used by permission.

Child Sexual Abuse

Historical Perspective opposite-sex parent (Bolen 2001; Olafson et al. 1993; Th ar- inger 1990). In one explanation of Freud’s “suppression,” Child sexual abuse (CSA), a social problem of endemic Bolen (2001) highlighted the Victorian social and political proportions, has existed in all historical eras and societ- atmosphere which encased Freud and concluded that he “ef- ies (Conte 1994; Fergusson and Mullen 1999; Wekerle and fectively colluded with a society that wished to deny the ex- Wolfe 1996; Wolfe 1999). Since antiquity, anecdotal records istence of child sexual abuse” (p. 20). (e.g., legal, artistic, philosophical, and literary accounts) have Th is cycle of “recognition and suppression” regarding documented activities that would today be classifi ed as CSA the sexual abuse of children was disrupted in part by two (deMause 1974; Kahr 1991; Olafson, Corwin, and Sum- events more associated with the physical abuse of children. mit 1993). For instance, a sizable portion of adults in an- Th e fi rst of these events was the inception of the child pro- cient Greek and Roman cultures openly engaged in what tection movement in New York State. Imbued within a cul- is now considered pederasty or (deMause 1974; Kahr ture where children were viewed as parental property and 1991). Although adult-child sexual encounters have oc- where family lives were kept discreetly out of public view, curred throughout history, perceptions of such practices the establishment of formal child protection refl ected the have fl uctuated, ranging from societal acceptance (adult- convergence of several salient factors, particularly related to child sex viewed as healthy or justifi able) to rejection (adult- the 1874 case of Mary Ellen, a girl who experienced physi- child sex believed to be inappropriate or abusive) (Barnett, cal and psychological cruelty by her stepmother (MacMil- Miller-Perrin, and Perrin 1997; Kahr 1991; Olafson et al. lan 2000; Wolfe 1999). In contrast to the majority of cases 1993). With this oscillation of cultural ideol ogies, establish- at that time, which went undetected or were ignored, a cul- ing behaviors as sexually abusive has not been an additive or mination of necessary ingredients—including the persistent linear process. Rather, scholars have called to cy- voices of advocates for Mary Ellen, public concern, and a cles of “recognition (or ‘discovery’) and suppression” that, un- political and social atmo sphere more prepared for reform— til the 1970s, largely obscured public awareness of the mag- enabled Mary Ellen’s story to aff ect legal change. Contrary nitude of the problem (Conte 1994; Olafson et al. 1993). to the “suppression” cycle that typically followed, the trag- In the late nineteenth and early to mid-twentieth centuries, edy of Mary Ellen’s case contributed to the founding of the for example, physicians (e.g., Tardieu), psychoanalysts (e.g., New York Society for the Prevention of Cruelty to Chil- Freud), and researchers (e.g., Kinsey) had, to some extent, dren (NYSPCC), which paralleled the already fl ourishing dis covered and documented sexual victimization in their Society for the Prevention of Cruelty to Animals and was patients. Representative of the general sentiment at the the fi rst child protection organization (Barnett et al. 1997; time, however, these fi ndings were subsequently minimized, NYSPCC 2000; Wolfe 1999). Th is late-nineteenth-cen- discounted, or justifi ed, resulting in victim and a cy- tury event signifi ed that the protection of chil dren against cle of “suppres sion” (Bolen 2001; Conte 1994; Olafson et al. physical abuse and neglect was an idea that had begun to 1993). Sigmund Freud’s work perhaps best exemplifi es the take root. “recognition and suppression” cycle (Fergusson and Mul- A second watershed event that ultimately helped to len 1999). Specifi cally, al though Freud initially publicized draw attention to the problem of sexual abuse was the pub- the reality of CSA with his “seduction theory,” he later re- lication of the seminal study by Kempe, Silverman, Steele, scinded this account, indicating that most of the alleged in- Droegemueller, and Silver (1962). Th is study, on the physi- stances were false and that children, via the Oedipal com- cal abuse of children, scientifi cally documented medical in- plex, exhibit a natural and erotic sexual toward their juries resulting from child abuse and focused particular at-

147 148 Perry & DiLillo in The Encyclopedia of Domestic Violence (2007)

tention on the presumed pathology of maltreating parents. ally explicit conduct or simulation of such conduct for the In the aftermath of Kempe et al.’s (1962) landmark publi- purpose of producing a visual de piction of such conduct; cation, several factors (e.g., enhanced societal awareness of or the rape, and in cases of caretaker or interfamilial rela- child maltreatment, the eff ects of the Vietnam war and the tionships, statutory rape, molestation, prostitution, or other concomitant raising of “social ” of the era, the form of sexual exploitation of children, or incest with chil- growth of the women’s movement) coalesced and again pro- dren” (National Center on Child Abuse and Neglect [NC- vided impetus for increased recognition of CSA as a perva- CAN], 2005a, p. 1). In addition to this legal conceptualiza- sive problem for children and adult survivors (Bolen 2001. tion, many researchers distinguish sexual off enses involving p. 21; Fergusson and Mullen 1999; Finkelhor 2002. p. xii; contact (e.g., penetration) or noncontact (e.g., child pornog- Olafson et al. 1993). raphy, exhibitionism) (American Psychological Association Even after the problem of CSA became widely recog- 2001; Hansen, Hecht, and Futa 1998). Defi nitions also en- nized and reached the mainstream of public awareness in compass the age diff erential between the perpetra tor and the the 1970s, the topic has remained con troversial. For in- victim, with victims of CSA (in contrast to those of statu- stance, despite increased media and research attention on tory rape or adolescent sexual assault) generally being under CSA throughout the 1980s and 1990s, these two decades sixteen years of age and perpe trators being at least fi ve years (and onward into the twenty-fi rst century) witnessed a older (Hansen et al. 1998). Notably, the age diff erential be- backlash that engendered skepticism about the magnitude comes less important if force is involved in the sexual abuse and long-term sequelae of CSA (Fergusson and Mullen incident (Berliner and Elliott 2002). 1999; see also the meta-analysis of Rind, Tromovitch, and Bauserman 1998), as well as the validity of CSA allegations Prevalence (Bowen 2001; Olafson et al. 1993). Th e impact of this “child Just as establishing an operational defi nition of CSA is dif- abuse backlash,” which is evidenced via increasingly visible fi cult, obtaining accurate incidence and prevalence rates of and organized “opposition” groups (e.g., attorneys, websites, CSA is also challenging. Data collection methods (e.g., self- and layperson or legal groups specifi cally geared to those report versus interview methodology), measurement varia- who believe they have been falsely accused of perpetrat- tions (e.g., single-item versus in-depth measures of CSA), ing CSA), complicates scien tifi c inquiry and professional study design issues (e.g., prospective versus retro spective de- advocacy/practice (Finkelhor 2002, p. xiv). Despite these sign, sampling techniques), and extrane ous factors (e.g., un- controver sies, however, the sexual abuse of children has derreporting, response rates) all obscure estimates (Gold- been referred to as “one of the defi ning cultural themes of man and Padayachi 2000; Putnam 2003). Despite these our age” (Fergusson and Mullen 1999, p. 1), a phenomenon hurdles, researchers have sought to uncover estimates of that ultimately “emerged from the cloak of social secrecy and CSA in the general population through national incidence [has] become a leading concern of mental health profession- studies and self-report data. als” (Cole and Putnam 1992, p.174). National Incidence Study Defi nition of Child Sexual Abuse Th e government-mandated National Incidence Study Ever since the recognition in the 1970s of the sexual mis- (NIS) represents perhaps the most expansive attempt to treatment of children as a widespread problem, profession- ascertain the incidence of CSA in the United States (Sed- als have wrestled with how to conceptualize and defi ne lak and Broadhurst 1996). Sedlak (2001) points out that CSA (Haugaard 2000). Although formulating a universally children who come to the attention of the legal system as accepted defi nition is complicated by several theoretical and a result of abuse or neglect exemplify only the “tip of the ideological considerations, some agreement has emerged iceberg” (p. 6). For this reason, the third National Inci- among professionals regarding the defi ning fea tures of sex- dence Study (NIS-3) measures maltreatment according to ual abuse. Th ese characteristics are captured by the most re- a fi ve-tier system, which involves sub stantiated child pro- cent Child Abuse Preven tion and Treatment Act (CAPTA), tective services (CPS) reports and the reports of trained which defi nes CSA as “the employment, use, , teachers, courts, police, and hospital personnel, as well as induce ment, enticement, or of any child to en- cases indicated by other agencies. Further, NIS-3 evaluates gage in, or assist any other person to engage in, any sexu- child maltreatment against two standards: the Harm Stan- Child Sexual Abuse 149 dard (i.e., the child has already suff ered known harm as a sults from another national study, utilizing a randomized result of abuse/neglect) and the Endangerment Standard telephone sampling, found that 27 percent of women and (i.e., the child [who has experienced maltreatment] is at 16 percent of men met the most liberal criteria for CSA high risk for developing abuse-related consequences or has (Finkelhor, Hotaling, Lewis, and Smith 1990). Th ese re- yet to evidence known sequelae) (Sedlak and Broadhurst sults were similar to a national sample by Briere and El- 1996). Results from NIS-3 refl ecting 1993–1994 data indi- liott (2003), who indicated that 32.3 percent of women cated that 217,700 children experienced CSA according and 14.2 percent of men were classifi ed as sexually abused. to the Harm Standard and 300,200 via the Endangerment In Finkelhor’s (1993) estimate, sexual abuse is likely to be Standard, both refl ecting substantial increases from NIS-2 present in approximately one in four girls and one in ten (Sedlak and Broadhurst 1996); the most current data col- boys. Finally, although the NIS-3 indicated that CSA rates lection as of this writing (NIS-4) is currently under way had increased substantially in recent years, this fi nding has and will conclude sometime in 2008 (National Incidence not been consistent. Jones, Finkelhor, and Kopiec (2001), Study 4, 2005). Finally, another national database utiliz- for example, discussed contrary indicators that CSA had ing reports to child protective agencies, the National Child declined by 39 percent. Specifi cally, they (among others) Abuse and Neglect Data System (NCANDS) revealed per noted that it is challenging to determine whether the rates capita child maltreatment rates of 12.4 per 1,000 children, of CSA have actually diminished or whether defi nitional with 10 percent of those being sexual abuse victims (NC- criteria and research methodologies are responsible for CAN 2005b). these patterns (Jones et al. 2001; Leventhal 2001).

Self-Report Data Demographic Factors Associated with Child Although NISs provide an indication of the magni- Sexual Abuse tude of CSA, they probably underestimate rates of sex- Victim Characteristics ual victimization because of a heavy reliance on cases that In addition to examining overall prevalence rates, re- come to the attention of the legal and child protective sys- searchers have also explored whether CSA trends emerge tems (e.g., Walch and Broadhead 1992). In contrast, ret- based on various demographic char acteristics. For exam- rospective surveys of adults (particularly with represen- ple, regarding victim gender, the majority of studies indi- tative community samples) may gain access to individuals cate that girls experience sexual abuse at much higher rates whose abuse never came to the attention of the legal sys- than boys. Indeed, girls not only are three times more likely tem. In reviewing sixteen such studies, Gorey and Les- to experience CSA under both the Harm and Endanger- (1997) found that the prevalence of CSA in nonclini- ment Standards used in NIS-3 (Sedlak and Broadhurst cal samples in the United States is 22.3 percent for women 1996), but also are more likely to experience forceful and in- and 8.5 percent for men. When they included only stud- jurious sexual abuse (Levesque 1994). In a study examin- ies with a 60 percent or higher response rate, the percent- ing internatio nal prevalence rates, Finkelhor (1994) found ages for women and men dropped to 16.8 percent and 7.9 that, overall, gender fi ndings tended to parallel those in the percent, respectively (even more conservative rates were United States, with girls experiencing a signifi cantly greater shown with stricter inclusion criteria). Th e authors con- likelihood of being sexually victimized (between one and a cluded that the “truth” likely falls between these estima- half and three times more likely). Despite these trends, it is tions (p. 395). As can be seen, CSA prevalence rates vary, important to note that boys still constitute a signifi cant mi- depending on factors such as the methodology employed, nority of CSA victims and may in fact be under-represented the type of sample, and the instrument used. For example, in studies (Finkelhor 1993). in their review of the literature, which included commu- Similar to relatively consistent gender fi ndings, results nity-based and convenience samples, Fergusson and Mul- concerning age of the victim indicate that CSA risk and age len (1999) estimated that the most inclusive rates of CSA increase simultaneously, with the highest risk being in mid (which included noncontact experi ences) ranged from 8.0 to late childhood, between the ages of six and eleven years to 62.1 percent for women and 3 to 29 percent for men, (Putnam 2003; Sedlak and Broadhurst 1996). In their re- though the majority of studies estimated between 15 and view of the literature, Fergusson and Mullen (1999) indi- 30 percent for women and 3 and 15 percent for men. Re- cated that, for girls, CSA peaks at between ten and twelve 150 Perry & DiLillo in The Encyclopedia of Domestic Violence (2007)

years of age; these authors, however, cautioned that un- se quelae, others appear asymptomatic (Cicchetti and Toth derreporting or undiscovered incidents may be more prev- 2000; Cole and Putnam 1992; Finkelhor 1990; Kendall- alent before that time. Finkelhor (1993) indicated that al- Tackett, Williams, and Finkelhor 1993). Th is variation in though CSA occurs at every age level, risk appears to outcomes can be understood within a developmental frame- manifest around ages six to seven years and be most com- work (Cicchetti and Toth 2000; Cole and Putnam 1992; mon at around age ten. Th us, it appears that middle and DiLillo, Perry, and Fortier, in press; Wolfe 1999). Th at is, as later childhood are the most common times for CSA to on- infants and children progress through various phases of de- set, or at least to be acknowledged or discovered. Socioeco- velopment, they must confront and master a range of stage- nomic status (SES) is an addi tional demographic variable of salient tasks (Cicchetti 1989; Cicchetti and Toth 2000; Cole interest. Most stud ies to date have not substantiated a dras- and Putnam 1992; Wolfe 1999). In the absence of signifi - tic impact of SES (Finkelhor 1993; Putnam 2003). Th us, al- cant environmental or biological adversity, most individuals though CSA may pose a greater risk for girls and children will progress along expected developmental pathways. Early in their middle years, it has been documen ted in every so- sex ual abuse, however, represents a substantial form of in- cial stratum. terpersonal trauma and, as such, may impede nor mal devel- opmental processes, setting the stage for possible short- and Perpetrator Characteristics long-term adjustment diffi culties (Cole and Putnam 1992; As in the case of victim gender, certain trends also have Wolfe 1999). emerged regarding perpetrator gender. Namely, men make up the large majority of perpetrators of sexual abuse both in Short-Term Sequelae the United States (Finkelhor et al. 1990; Sedlak and Broad- Overall, the research has revealed that the immediate hurst 1996) and internationally (Finkelhor 1994). However, aftermath of CSA often engenders a wide array of conse- women do constitute a portion of CSA perpetrators, and quences but that boys and girls, with few exceptions, ap- the role of female perpetrators should not be discounted. In pear to be impacted by CSA in many of the same ways addition to gender, the relationship of the perpetrator to the (Finkelhor 1990). According to Wolfe and Birt’s (1997) victim tends to extend across the gamut of possible relation- review, there are several “sets” of fi ndings related to the ships. In the NIS-3, perpetrators of CSA included birth short-term sequelae of CSA, including: (1) increased in- parents (approximately 25 percent) and individuals other ternalizing and externalizing diffi culties in CSA victims, than biological parents or those serving in parental roles (2) the presence of a range of behavioral and emotional (approximately 75 percent) (Sedlak and Broadhurst 1996). problems that relate directly to the CSA, the home envi- Notably, according to Berliner and Elliott (2002), CSA ronment, or both, and (3) the risk of post-traumatic stress by family members seems to be overrepresented in clinical disorder (PTSD) symptomatology and sexuality diffi cul- settings. ties. A fourth area that may be useful to consider is the diff erentiated mental health and interpersonal sequelae, Consequences of Child Sexual Abuse both of which appear to be impacted even in the imme- Developmental Framework diate after math of CSA. Paralleling the aforementioned Part of the complexity surrounding CSA stems from “sets” of short-term diffi culties are fi ndings that victims ex- the heterogeneity of its short- and long-term correlates. Ac- perience increased depression (e.g., Swanston, Plunkett, cording to Nash, Hulsey, Sexton, Harralson, and Lambert OToole, Shrimpton, Parkinson, and Oates 2003), anxiety (1993), there is no emergent “delimited replicable pattern (e.g., Chaffi n, Silovsky, and Vaughn 2005; Spataro, Mul- of sequelae” associated with early abuse (p. 276). Instead, len, Burgess, Wells, and Moss 2004), personality disorders CSA may impact victims according to a more “nonspecifi c” (Spataro et al. 2004), suicidal ideation (e.g., Martin, Ber- symptom pattern. Th us, the mental health consequences of gen, Richardson, Roeger, and Allison 2004), nightmares CSA cannot be placed into a single diagnostic classifi cation (Mannarino and Cohen 1986; NCCAN 2003), , an- within the Diagnostic and Statistical Manual of Mental Dis- ger, and fear (Barnett et al. 1997), somatization (Emiro- orders (American Psychiatric Association 2000; Finkelhor glu, Kurul, Akay, Miral, and Süha 2004), and attachment- 1990). Furthermore, while some victims experience a wide related problems (e.g., Shapiro and Levendosky 1999). range of adverse emotional, behavioral, and interpersonal PTSD symptomatology appears to be particularly salient Child Sexual Abuse 151 among victims (e.g., Kendall-Tackett et al. 1993; NCCAN lescents (depression, withdrawal, suicidality/self-injurious 2003). In the area of externalizing diffi culties, the experi- behaviors, somatization, illegal activity, running away, and ence of CSA is related to self-injury (Kendall-Tackett et substance use). al. 1993), academic/school trouble (Barnett et al. 1997), behavioral problems (Kendall-Tackett et al. 1993), bed- Long-Term Sequelae wetting (NCCAN 2003), problem eating behaviors (NC- In addition to short-term sequelae, investigators have CAN 2003), delinquency and (Swanston, Par- illuminated a myriad of adult mental health as well as be- kinson, O’Toole, Plunkett, Shrimpton, and Oates 2003), havioral, societal, and physical correlates of CSA (NC- running away (NCCAN 2003), and a range of sexualized CAN 2005c). Among these long-term mental health behaviors (Barnett et al. 1997) (see excellent reviews by sequelae are elevated levels of psychopathological symp- Hecht and Hansen 2001; Kendall-Tackett et al. 1993; and tomatology, such as depression (e.g., Denov 2004; Hill, Paolucci, Genuis, and Violate 2001). Davis, Byatt, Burnside, Rollinson, and Fear 2000; Jack- In addition to these internalizing and externaliz ing diffi - son, Calhoun, Amick, Maddever, and Habif 1990; Hunter culties, CSA sequelae also manifest in the interpersonal and 1991; Roberts, O’Connor, Dunn, Golding, and the AL- physiological realms. Regarding interpersonal functioning, SPAC Study Team 2004), anxiety (Greenwald, Leiten- CSA has been linked to diffi culties in interpersonal relation- berg, Cado, and Tarran 1990; Steel, Sanna, Hammond, ships, including poor social adjustment (Friedrich, Urquiza, Whipple, and Cross 2004), PTSD (Putnam 2003), ob- and Beilke 1986) and developmentally inappropriate sex- sessive-compulsive disorder (Steel et al. 2004), and per- ual behaviors and disturbed attitudes related to sexuality sonality disorder con cerns or diagnoses, including antiso- (Kendall-Tackett et al. 1993; NCCAN 2003; Th aringer cial and borderline (Callahan, Price, and Hilsenroth 2003; 1990). Studies have also documen ted several physiological Putnam 2003). Additional cognitive and behavioral ef- or neurobiological lin kages, such as diminished salivary cor- fects include suicidal ideation and suicide attempts (An- tisol levels in recently abused children (King, Mandansky, derson, Tiro, Price, Bender, and Kaslow 2002; Read, Agar, King, Fletcher, and Brewer 2001), earlier onset of menarche Barker-Collo, Davies, and Moskowitz 2001), dissocia- (Vigil, Geary, and Byrd-Craven 2005), increased sympa- tion (Putnam 2003), substance use/abuse (Denov 2004; thetic nervous system activity, and a range of neurobiolog- Molnar, Buka, and Kessler 2001), somatization (Polusny ical sequelae (see Putnam 2003 for review). and Follette 1995; Putnam 2003), disordered eating be- Th ere is also evidence that certain symptoms are more haviors (Putnam 2003; Smolak and Murnen 2002), risk likely to emerge when the abuse is perpetrated during spe- of aggression toward others, including one’s children (Di- cifi c developmental stages. For example (although perhaps Lillo, Tremblay, and Peterson 2000), diminished self-es- due to methodological/measurement issues), internalizing teem (Hunter 1991; Jackson et al. 1990), and academic/ symptoms such as depression and anxiety are reported less vocational diffi culties (Arias 2004). At a broader soci- frequently in early childhood but emerge with greater fre- etal level, victims of CSA have been found to have higher quency in adolescence (Berliner and Elliott 1996). In a sep- health care costs and lower self-perceptions of good health arate review of childhood versus adolescence fi ndings, Arias (Arias 2004). A meta-analysis conducted by Paolucci et al. (2004) indicated that children were more likely to experi- (2001), for example, found that PTSD, de pression, sui- ence pro blems related to school, attention, social skills, and cide, sexual , victim-perpetrator cycle, and aggression, whereas adolescents were at greater risk for de- poor academic performance all represented, to varying de- linquency/violence, sexual problems, sub stance use, and grees, substantially ele vated risks for CSA survivors. self-injurious behavior. Finally, in Kendall-Tackett and col- More recently, interest has increased in exploring the leagues’ (1993) review of CSA sequelae, the authors over- associations between a history of childhood maltreatment viewed the most commonly occurring symptoms at vari- and adult interpersonal functioning. Within this domain, ous developmental levels, including preschool-aged children adult survivors of child maltreatment are more likely not (anxiety, nightmares, PTSD, internalizing, ex ternalizing, only to display social maladjustment in dating and extra- and inappropriate sexual behavior), school-aged children curricular activities (Jackson et al. 1990), but also to experi- (fear, neurotic/general illness, aggression, nightmares, school ence greater overall relationship dysfunction in com parison diffi culties, hyperactive behaviors, and regression), and ado- with nonmaltreated individuals. Th is dysfunction may in- 152 Perry & DiLillo in The Encyclopedia of Domestic Violence (2007) clude decreased relationship satisfaction and trust, as well Current Controversies Related to CSA as a greater likelihood of infi delity and relationship instabil- Although there is a general consensus that CSA is a prev- ity or termination (Colman and Widom 2004; Denov 2004; alent and deleterious societal phenomenon, several issues, DiLillo 2001; DiLillo and Long 1999; Hunter 1991). Child such as ritualistic/satanic abuse, accuracy of children’s tes- maltreatment also appears to be related to the occurrence timony in court regarding CSA, children’s of physical violence in adult dating and marital relation- and adults’ false memories surrounding CSA experiences, ships (Barnett et al. 1997; DiLillo, Giuff re, Tremblay, and and mul tiple personality disorder, remain controversial or Peterson 2001). DiLillo et al. (2001), for example, found unresolved (Fergusson and Mullen 1999; Wolfe and Birt that women with a history of CSA were more likely to be 1997). Professional groups commenting on each of these involved in relationships characterized by minor and severe “hot topics” demonstrate distinctly polarized viewpoints. forms of interpartner aggression (e.g., breaking things, hit- In the area of recovered memory, for instance, profession- ting/kicking, beating), as well as greater amounts of bidirec- als often display inclinations toward one of two positions, tional, reciprocal (i.e., male-to-female and female-to-male) promoting either the belief that so-called “recovered mem- acts of violence. Re search in this area also suggests that sex- ories” are often accurate representations of the past, or the ual abuse during childhood is associated with problems re- belief that it is essentially impossible to forget (or repress) lated to sexual functioning, including preoccupation with and subsequently recover a memory of early abuse (Far- sexuality, negative attitudes toward sex, fear of intimacy, un- rants 1998). Further complicating this division, research restricted sexual behavior, sexual dissat isfaction, and sex- in the area of recovered memory has both supported and ual maladjustment (Davis, Petretic-Jackson, and Ting 2001; debunked aspects on both sides of this issue, thereby in- Meston, Heiman, and Trapnell 1999; Noll, Trickett, and fl aming each viewpoint (Farrants 1998). In commenting Putnam 2003; Rumstein-McKean and Hunsley 2001). on ritual abuse, Gallagher (2001) notes the paradox that Recent literature has helped to elucidate factors that ac- the various parties involved in the debates regarding CSA company CSA and its correlates. For example, researchers “are passionately committed to upholding the welfare and documented the frequent co-occurrence of maltreatment interests of children and survivors. However, if this is to subtypes (e.g., high overlap between sexual abuse and phys- be done, then all of us working in this area must be equally ical abuse) (Davis et al. 2001; Dong, Anda, Felitti, Dube, committed to fi nding out the truth irrespec tive of our pre- Williamson, Th ompson, Loo, and Giles 2004; Higgins and conceptions and beliefs” (p. 84). Th is comment refl ects the McCabe 2000). Similarly, it appears that the long-term ef- notion that even though the topic of CSA generates pas- fects of CSA are cumulative, with symptom presence and sionate debate, the underlyi ng goals—to prevent abuse severity increasing as more forms of maltreatment are expe- and assist victims—must be achieved by advancing science rienced (Anderson et al. 2002; Clemmons, DiLillo, Marti- and identifying commonalities. nez, DeGue, and Jeff cott 2003; Higgins and McCabe 2000, 2003). Finally, when considering long-term sequelae, there Summary are many concomitant or intervening factors that may me- diate or moderate the impact of the consequences associ- Since antiquity, children have experienced sexual abuse by ated with CSA (e.g., Beitchman, Zucker, Hood, DaCosta, adults. Following a period of alternately being recognized Akman, and Cassavia 1992; Nash et al. 1993; Rind et al. then suppressed, CSA ultimately garnered public atten- 1998). For example, childhood family environment has tion in the aftermath of Kempe et al.’s (1962) study on the been shown to be more chaotic, dysfunctional, and confl ic- physical abuse of children. Since that time, attempts to de- tual in victims of CSA (Bennett, Hughes, and Luke 2000; fi ne CSA have remained diffi cult and fraught with diff er- Long and Jackson 1994). It has been documented that the ing professional opinions. Nonetheless, research focus ing long-term sequelae of CSA diminish in signifi cance after ac- on the prevalence and consequences of CSA has confi rmed counting for family environment issues (Rind et al. 1998). that it is a widespread societal problem with a range of neg- However in most cases, even when these mediating and ative intra- and interpersonal outcomes across the lifes- moderating variables are controlled, an array of CSA se- pan. At the same time, some victims of CSA seem to suff er quelae remain (Molnar et al. 2001; Sachs-Ericsson, Blazer, few ill eff ects. To date, the intersection of research and pol- Plant, and Arnow 2005). icy work has placed CSA in the public consciousness by un- Child Sexual Abuse 153 derscoring its magnitude and adverse correlates. Following ————. “Sexual Abuse of Children.” In Th e AP SAC Hand book on closely behind the widespread recognition of CSA as a seri- Child Maltreatment, 2nd ed., edited by John E. B. Myers, Lucy Berliner, John Briere, C. Terry Hendrix, Carole Jenny, and Th e- ous societal problem, various controversies, such as the exis- resa A. Reid. Th ousand Oaks, CA: Sage Publications, 2002, pp. tence of recovered memories, emerged among professionals 55–78. and laypersons alike. Understanding of CSA and its conse- Bolen, Rebecca M. Child Sexual Abuse: Its Scope and Our Failure. New quences will best be furthered by a com mitment to objective York: Kluwer Academic/Plenum Publishers, 2001. scientifi c inquiry and a focus on commonalities of the var- Briere, John, and Diana M. Elliott. “Prevalence and Psy chological Se- ious parties interested in the protection and well-being of quelae of Self-Reported Childhood Physical and Sexual Abuse children. in a General Population Sample of Men and Women.” Child Abuse and Neglect 27, no. 10 (2003): 1205–1222. Andrea R. Perry & David Dilillo Callahan, Kelley L., Jennifer L. Price, and Mark J. Hilsenroth. “Psy- chological Assessment of Adult Survivors of Childhood Sexual University of Nebraska–Lincoln Abuse Within a Naturalistic Clinical Sample.” Journal of Person- ality Assessment 80, no. 2 (2003): 173–184. Chaffi n, Mark, Jane F. Silovsky, and Christy Vaughn. “Temporal Con- [See also and the Family; Child Abuse and Juvenile Delinquency; cordance of Anxiety Disorders and Child Sexual Abuse: Impli- Child Maltreatment, Interview ing Suspected Victims of; Child Neglect; cations for Direct Versus Artifactual Eff ects of Sexual Abuse.” Incest; Post-Incest Syndrome; Prosecuting Child Abuse; Ritual Abuse- Journal of Clinical Child and Adolescent Psychology 34, no. 2 Torture in Families; ; Victim-Blaming Th eory] (2005): 210–222. Cicchetti, Dante. “How Research on Child Maltreatment Has In- formed the Study of Child Development: Perspec tives from De- velopmental Psychopathology.” In Child Maltreatment: Th eory References and Further Reading and Research on the Causes and Consequences of Child Abuse and American Psychiatric Association. Diagnostic and Statistical Manual Neglect, edited by Dante Cicchetti and Vicki Carlson. New York: of Mental Disorders, 4th ed., text revision. Washington, DC: Au- Cambridge University Press, 1989, pp. 377–431. thor, 2000. Cicchetti, Dante, and Sheree L. Toth. “Developmental Processes in American Psychological Association. “Understanding Child Sexual Maltreated Children.” In 46th Annual Nebraska Symposium on Abuse: Education, Prevention, and Recov ery,” 2001. Motivation: Motivation and Child Mal treatment, edited by Da- http://www.apa.org/releases/sexabuse vid J. Hansen. Lincoln: University of Nebraska Press, 2000, pp. Anderson, Page L., Jasmin A. Tiro, Ann W. Price, Marnette A. 85–160. Bender, and Nadine J. Kaslow. “Additive Impact of Childhood Clemmons, John C., David DiLillo, Isaac G. Martinez, Sarah DeGue, Emotional, Physical, and Sexual Abuse on Suicide Attempts and Michelle Jeff cott. “Co-occurring Forms of Child Maltreat- among Low-Income African American Women.” Suicide and ment and Adult Adjustment Reported by Latina College Stu- Life-Th reatening Behavior 32, no. 2(2002): 131–138. dents.” Child Abuse and Neglect 27, no. 7 (2003): 751–767. Arias, Ileana. “Th e Legacy of Child Maltreatment: Long-Term Health Cole, Pamela M., and Frank W. Putnam. “Eff ect of Incest on Self and Consequences for Women.” Journal of Women’s Health 13, no. 5 Social Functioning: A Developmental Psychopathology Per- (2004): 468–473. spective.” Journal of Consulting and Clinical Psychology 60, no. 2 Barnett, Ola W., Cindy L. Miller-Perrin, and Robin D. Perrin. Fam- (1992): 174–184. ily Violence Across the Lifespan: An Introduction. Th ousand Oaks, Colman, Rebecca A., and Cathy S. Widom. “Childhood Abuse and CA: Sage Publications, 1997. Neglect and Adult Intimate Relationships: A Prospective Study.” Beitchman, Joseph H., Kenneth J. Zucker, Jane E. Hood, Granville A. Child Abuse and Neglect 28, no. 11 (2004): 1133–1151. DaCosta, Donna Akman, and Erika Cassavia. “A Review of the Conte, Jon R. “Child Sexual Abuse: Awareness and Back lash.” Future Long-Term Eff ects of Child Sexual Abuse.” Child Abuse and Ne- of Children 4, no. 2 (1994): 224–232. glect 16, no. 1 (1992): 101–118. Davis, Joanne L., Patricia A. Petretic-Jackson, and Ling Ting. “Inti- Bennett, Susan E., Honore M. Hughes, and Douglas A. Luke. “Het- macy Dysfunction and Trauma Symptomatology: Long-Term erogeneity in Patterns of Child Sexual Abuse, Family Function- Correlates of Diff erent Types of Child Abuse.” Journal of Trau- ing, and Long-Term Adjust ment.” Journal of Interpersonal Vio- matic Stress 14, no. 1 (2001): 63–79. lence 15, no. 2 (2000): 134–157. deMause, Lloyd, ed. Th e History of Childhood: Th e Untold Story of Berliner, Lucy, and Diana M. Elliott. “Sexual Abuse of Children.” In Child Abuse. New York: Peter Bedrick Books, 1974. Th e AP SAC Handbook on Child Maltreat ment, edited by John Denov, Myriam S. “Th e Long-Term Eff ects of Child Sexual Abuse by Briere, Lucy Berliner, Josephine A. Bulkley, Carole Jenny, and Female Perpetrators: A Qualitative Study of Male and Female Th eresa Reid. Th ousand Oaks, CA: Sage Publications, 1996, Victims.” Journal of Interpersonal Violence 19, no. 10 (2004): pp. 51–71. 1137–1156. 154 Perry & DiLillo in The Encyclopedia of Domestic Violence (2007)

DiLillo, David. “Interpersonal Functioning among Women Report- havior Problems in Sexually Abused Young Children.” Journal of ing a History of Childhood Sexual Abuse: Empirical Findings Pediatric Psychology 11, no. 1 (1986): 47–57. and Methodological Issues.” Clinical Psychology Review 21, no. 4 Gallagher, Bernard. “Ritual Abuse: A Response to Colman.” Child (2001): 553–576. Abuse Review 10, no. 2 (2001): 83–84. DiLillo, David, Dawn Giuff re, George C. Tremblay, and Lizette Peter- Goldman, Juliette D. G., and Usha K. Padayachi. “Some Methodolog- son. “A Closer Look at the Nature of Intimate Partner Violence ical Problems in Estimating Incidence and Prevalence in Child Reported by Women with a His tory of Child Sexual Abuse.” Sexual Abuse Research.” Journal of Sex Research 37, no. 4 (2000): Journal of Interpersonal Violence 16, no. 2 (2001): 116–132. 305–314. DiLillo, David, and Patricia J. Long. “Perceptions of Cou ple Func- Gorey, Kevin M., and Donald R. Leslie. “Th e Prevalence of Child tioning among Female Survivors of Child Sexual Abuse.” Journal Sexual Abuse: Integrative Review Adjustment for Potential Re- of Child Sexual Abuse 7, no. 4 (1999): 59–76. sponse and Measurement Biases.” Child Abuse and Neglect 21, DiLillo, David, Andrea R. Perry, and Michelle Fortier. “Child Physical no. 4 (1997): 391–398. Abuse and Neglect.” Chapter to appear in Comprehensive Hand- Greenwald, Evan, Harold Leitenberg, Suzana Cado, and Matthew J. book of Personality and Psychopathology, Volume 3: Child Psycho- Tarran. “Childhood Sexual Abuse: Long-Term Eff ects on Psy- pathology, edited by Robert T. Ammerman and Michel Hersen. chological and Sexual Func tioning in a Nonclinical and Nonstu- New York: John Wiley and Sons, in press. dent Sample of Adult Women.” Child Abuse and Neglect 14, no. DiLillo, David, George C. Tremblay, and Lizette Peterson. “Linking 4 (1990): 503–513. Childhood Sexual Abuse and Abusive Parent ing: Th e Mediat- Hansen, David J., Debra B. Hecht, and Kristine T. Futa. “Child Sex- ing Role of Maternal .” Child Abuse and Neglect 24, no. 6 ual Abuse.” In Handbook of Psychological Treatment Protocols for (2000): 767–779. Children and Adolescents, edited by Vincent B. Van Hasselt and Dong, Maxia, Robert F. Anda, Vincent J. Felitti, Shanta R. Dube, Da- Michel Hersen. Mahwah, NJ: Erlbaum, 1998, 153–178. vid F. Williamson, Th eodore J. Th ompson, Clifton M. Loo, and Haugaard, Jeff rey J. “Th e Challenge of Defi ning Child Sexual Abuse.” Wayne H. Giles. “Th e Interrelatedness of Multiple Forms of American Psychologist 55, no. 9 (2000): 1036–1039. Childhood Abuse, Neglect, and Household Dysfunction.” Child Hecht, Debra B., and David J. Hansen. “Th e Environment of Child Abuse and Neglect 28, no. 7 (2004): 771–784. Maltreatment: Contextual Factors and the Development of Psy- Emiroglu, Fatma Neslihan Inal, Semra Kurul, Aynur Akay, Siiha Mi- chopathology.” Aggression and Violent Behavior 6, no. 5 (2001): ral, and Eray Dirik. “Assessment of Child Neurology Outpa- 433–457. tients with Headache, Dizziness, and Fainting.” Journal of Child Higgins, Daryl J., and Marita P. McCabe. “Multi-Type Maltreatment Neurology 19, no. 5 (2004): 332–336. and the Long-Term Adjustment of Adults.” Child Abuse Review Farrants, Jacqui. “Th e ‘False Memory’ Debate: A Critical Review of 9, no. 1 (2000): 6–18. the Research on Recovered Memories of Child Sexual Abuse.” ————. “Maltreatment and Family Dysfunction in Childhood and Counselling Psychology Quarterly 11, no. 3 (1998): 229–238. the Subsequent Adjustment of Children and Adults.” Journal of Fergusson, David M., and Paul E. Mullen. Childhood Sexual Abuse: Family Violence 18, no. 2 (2003): 107–120. An Evidence Based Perspective. Th ousand Oaks, CA: Sage Pub- Hill, Jonathan, R. Davis, M. Byatt, E. Burnside, L. Rollinson, and lications, 1999. S. Fear. “Childhood Sexual Abuse and Aff ective Symptoms in Finkelhor, David. “Early and Long-Term Eff ects of Child Sexual Women: A General Population Study.” Psychological Medicine Abuse: An Update.” Professional Psychology:Research and Practice 30, no. 6 (2000): 1283–1291. 21, no. 5 (1990): 325–330. Hunter, John A., Jr. “A Comparison of the Psychosocial Maladjust- ————. “Epidemiological Factors in the Clinical Identifi cation of ment of Adult Males and Females Sexually Molested as Chil- Child Sexual Abuse.” Child Abuse and Neglect 17, no. 1 (1993): dren.” Journal of Interpersonal Violence 6, no. 2 (1991): 205–217. 67–70. Jackson, Joan L., Karen S. Calhoun, Angelynne E. Amick, Heather M. ————. “Th e International Epidemiology of Child Sexual Abuse.” Maddever, and Valerie L. Habif. “Young Adult Women Who Re- Child Abuse and Neglect 18, no. 5 (1994): 409–417. port Childhood Intrafamilial Sexual Abuse: Subsequent Adjust- ————. “ Introduction.” In Th e AP SAC Handbook on Child Mal- ment.” Archives of Sexual Behavior 19, no. 3 (1990): 211–221. treatment, 2nd ed., edited by John E. B. Myers, Lucy Berliner, Jones, Lisa M., David Finkelhor, and Kathy Kopiec. “Why Is Sexual John Briere, C. Terry Hendrix, Carole Jenny, and Th eresa Abuse Declining? A Survey of State Child Protection Adminis- A. Reid. Th ousand Oaks, CA: Sage Publications, 2002, pp. trators.” Child Abuse and Neglect 25, no. 9 (2001): 1139–1158. xi–xvi. Kahr, Brett. “Th e Sexual Molestation of Children: Histori cal Per- Finkelhor, David, Gerald Hotaling, I. A. Lewis, and Christine Smith. spectives.” Journal of Psychohistory 19, no. 2. (1991): 191–214. “Sexual Abuse in a National Survey of Adult Men and Women: Kempe, C. Henry, Frederic N. Silverman, Brandt F. Steele, William Prevalence, Characteristics, and Risk Factors.” Child Abuse and Droegemueller, and Henry K. Silver. “Th e Battered-Child Syn- Neglect 14, no. 1 (1990): 19–28. drome.” Journal of the American Medical Association 181, no. 1 Friedrich, William N., Anthony J. Urquiza, and Robert L. Beilke. “Be- (1962): 17–24. Child Sexual Abuse 155

Kendall-Tackett, Kathleen A., Linda M. Williams, and David Finkel- Noll, Jennie G., Penelope K. Trickett, and Frank W. Putnam. “A Pro- hor. “Impact of Sexual Abuse on Children: A Review and Syn- spective Investigation of the Impact of Childhood Sexual Abuse thesis of Recent Empirical Studies.” Psychological Bulletin 113, on the Development of Sexual ity.” Journal of Consulting and Clin- no. 1 (1993): 164–180. ical Psychology 71, no. 3 (2003): 575–586. King, Jean A., Deborah Mandansky, Susie King, Kenneth E. Fletcher, Olafson, Erna, David L. Corwin, and Roland C. Summit. “Modern and Judith Brewer. “Early Sexual Abuse and Low Cortisol.” Psy- History of Child Sexual Abuse Awareness: Cycles of Discov- chiatry and Clinical Neurosciences 55, no. 1 (2001): 71–74. ery and Suppression.” Child Abuse and Neglect 17, no. 1 (1993): Leventhal, John M. “A Decline in Substantiated Cases of Child Sex- 7–24. ual Abuse in the United States: Good News or False Hope?” Paolucci, Elizabeth O., Mark L. Genuis, and Claudio Vio late. “A Child Abuse and Neglect 25, no. 9 (2001): 1137–1138. Meta-Analysis of the Published Research on the Eff ects of Child Levesque, Roger J. R. “Sex Diff erences in the Experience of Child Sexual Abuse.” Journal of Psychology 135, no. 1 (2001): 17–36. Sexual Victimization.” Journal of Family Violence 9, no. 4 (1994): Polusny, Melissa A., and Victoria M. Follette. “Long-Term Corre- 357–369. lates of Child Sexual Abuse: Th eory and Review of the Empiri- Long, Patricia J., and Joan L. Jackson. “Childhood Sexual Abuse: An cal Literature.” Applied and Preventive Psychology 4, no. 3 (1995): Examination of Family Functioning.” Jour nal of Interpersonal Vi- 143–166. olence 9, no. 2 (1994): 270–277. Putnam, Frank W. “Ten-Year Research Update Review: Child Sexual MacMillan, Harriet L. “Child Maltreatment: What We Know in Abuse.” Journal of the American Academy of Child and Adolescent the Year 2000.” Canadian Journal of Psychiatry 45, no. 8 (2000): Psychiatry 42, no. 3 (2003): 269–278. 702–709. Read, John, Kirsty Agar, Suzanne Barker-Collo, Emma Davies, and Mannarino, Anthony P., and Judith A. Cohen. “A Clinical-Demo- Andrew Moskowitz. “Assessing Suicidality in Adults: Integrat- graphic Study of Sexually Abused Children.” Child Abuse and ing Childhood Trauma as a Major Risk Factor.” Professional Psy- Neglect 10, no. 1 (1986): 17–23. chology: Research and Practice 32, no. 4 (2001): 367–372. Martin, Graham, Helen A. Bergen, Angela S. Richardson, Leigh Rind, Bruce, Philip Tromovitch, and Robert Bauserman. “A Meta- Roeger, and Stephen Allison. “Sexual Abuse and Suicidality: Analytic Examination of Assumed Properties of Child Sexual Gender Diff erences in a Large Community Sample of Adoles- Abuse Using College Samples.” Psycho logical Bulletin 124. no. 1 cents.” Child Abuse and Neglect 28, no. 5 (2004); 491–503. (1998): 22–53. Meston, Cindy M., Julia R. Heiman, and Paul D. Trapnell. “Th e Re- Roberts, Ron, Tom O’Connor, Judy Dunn, Jean Golding, and the AL- lation between Early Abuse and Adult Sexu ality.” Th e Journal of SPAC Study Team. “Th e Eff ects of Child Sexual Abuse in Later Sex Research 36, no. 4 (1999): 385–395. Family Life; Mental Health, Par enting and Adjustment of Off - spring.” Child Abuse and Neglect 28, no. 5 (2004): 525–545. Molnar, Beth E., Stephen L. Buka, and Ronald C. Kessler. “Child Sex- ual Abuse and Subsequent Psychopathology: Results from the Rumstein-McKean, Orly, and John Hunsley. “Interpersonal and National Comorbidity Survey.” Amer ican Journal of Public Health Family Functioning of Female Survivors of Childhood Sexual 91, no. 5 (2001); 753–760. Abuse.” Clinical Psychology Review 21, no. 3 (2001): 471–490. Nash, Michael R., Timothy L. Hulsey, Mark C. Sexton, Tina L. Sachs-Ericsson, Natalie, Dan Blazer, E. Ashby Plant, and Bruce Ar- Harralson, and Warren Lambert. “Long-Term Sequelae of now. “Childhood Sexual and Physical Abuse and the 1-Year Childhood Sexual Abuse: Perceived Family Environment, Psy- Prevalence of Medical Problems in the National Comorbidity chopathology, and Dissociation.” Journal of Consulting and Clini- Survey.” Health Psychology 24, no. 1 (2005); 32–40. cal Psychology 61, no. 2 (1993): 276–283. Sedlak, Andrea J. A History of the National Incidence Study of Child National Clearinghouse on Child Abuse and Neglect. Recognizing Abuse and Neglect. Washington, DC: US Department of Health Child Abuse and Neglect: Signs and Symp toms. Washington, D C : and Human Services, 2001. US Department of Health and Human Services, 2003. Sedlak, Andrea J., and Diane D. Broadhurst. Executive Summary of the ————. Defi nitions of Child Abuse and Neglect: State Sta tutes Series Th ird National Incidence Study of Child Abuse and Neglect. Wash- 2005. Washington, DC: US Department of Health and Human ington, DC: Department of Health and Human Services, 1996. Services, 2005a. Shapiro, Deborah L., and Alytia A. Levendosky. “Adolescent Survivors ————. Child Maltreatment 2003. Washington, DC: US Depart- of Childhood Sexual Abuse: Th e Mediating Role of Attachment ment of Health and Human Services, 2005b. Style and Coping in Psychological and Interpersonal Function- ing.” Child Abuse and Neglect 23, no. 11 (1999): 1175–1191. ————. Long-Term Consequences of Child Abuse and Neglect. Wash- ington, DC: US Department of Health and Human Services, Smolak, Linda, and Sarah K. Murnen. “A Meta-Analytic Examina- 2005c. tion of the Relationship between Child Sexual Abuse and Eat- ing Disorders.” International Journal of Eating Disorders 31, no. 2 National Incidence Study (NIS) 4. Website, 2005. (2002): 136–150. https://www.nis4.org/nishome.asp (accessed August 14, 2006). Spataro, Josie, Paul E. Mullen, Philip M. Burgess, David L. Wells, New York Society for the Prevention of Cruelty to Children and Simon A. Moss. “Impact of Child Sexual Abuse on Mental (NYSPCC). “NYSPCC 125th Anniversary, 2000.” Health: Prospective Study in Males and Females.” British Journal http://www.nyspcc.org/betaj-iistory/indexjiistory.htm of Psychiatry 184, no. 5 (2004): 416–421. 156 Perry & DiLillo in The Encyclopedia of Domestic Violence (2007)

Steel, Jennifer, Lawrence Sanna, Barbara Hammond, James Whip- Vigil, Jacob M., David C. Geary, and Jennifer Byrd-Craven. “A Life ple, and Herbert Cross. “Psychological Sequelae of Childhood History Assessment of Early Childhood Sexual Abuse in Sexual Abuse: Abuse-Related Characteris tics, Coping Strate- Women.” Developmental Psychology 41, no. 3(2005): 553–561. gies, and Attributional Style.” Child Abuse and Neglect 28, no. 7 Walch, Anne G., and W. Eugene Broadhead. “Prevalence of Lifetime (2004): 785–801. Sexual Victimization among Female Patients.”Journal of Family Swanston, Heather Y., Patrick N. Parkinson, Brian I. O’Toole, An- Practice 35, no. 5 (1992): 511–516. gela M. Plunkett, Sandra Shrimpton, and R. Kim Oates. “Juve- Wekerle, Christine, and David A. Wolfe. “Child Maltreatment.” In nile Crime, Aggression and Delinquency after Sexual Abuse.” Child Psychopathology, edited by Eric J. Mash and Russell A. Bar- British Journal of Criminol ogy 43, no. 4(2003): 729–749. kley. New York: Guilford Press, 1996, 492–537. Swanston, Heather Y., Angela M. Plunkett, Brian I. O’Toole, San- Wolfe, David A., ed. Child Abuse: Implications for Child Development dra Shrimpton, Patrick N. Parkinson, and R. Kim Oates. “Nine and Psychopathology. Th ousand Oaks, CA: Sage Publications, Years after Child Sexual Abuse.” Child Abuse and Neglect 27, no. 1999. 8 (2003): 967–984. Wolfe, Vicky V., and Jo-Ann Birt. “Child Sexual Abuse.” In Assess- Th aringer, Deborah. “Impact of Child Sexual Abuse on Developing ment of Childhood Disorders, 3rd ed., edited by Eric J. Mash and Sexuality.” Professional Psychology: Re search and Practice 21, no. 5 Leif G. Terdal. New York: Guilford, 1997, pp. 569–623. (1990): 331–337.