Levels of support for legislative bans to end physical punishment in schools and homes in a national sample.

OBJECTIVES: Physical punishment of children remains quite common and yet has only negative effects on children's health, making it an important public health problem. This study was designed to assess positive attitudes about and perceived normative support for the use of physical punishment with children, as well as attitudes regarding prohibition of physical punishment in homes and schools. STUDY DESIGN: This was a cross-sectional national survey of a diverse sample of US adults (N = 3049). METHODS: This survey, conducted in Fall 2020, assessed attitudes and perceived norms regarding physical punishment use using continuous measures as well as support and perceived support for policies prohibiting physical punishment in homes and schools in the United States. RESULTS: Respondents who had positive attitudes toward physical punishment (39%) and who perceived normative support for physical punishment (41%) were not in the majority. While 65% agreed that there should be a federal ban on physical punishment in public schools, only 18% perceived that most US adults would support such a ban. Persons who were older (aged ≥55 years), men, living in the southern United States, or who themselves were hit more frequently as children were significantly less likely than their counterparts to support a federal ban in schools. CONCLUSIONS: Based on a national sample, there is strong support for a federal ban on physical punishment in US schools; yet this normative belief is unrecognized. Social norms campaigns should capitalize on this pluralistic ignorance to increase mobilization toward policy reform and reduction of harm to children through bans of physical punishment in public schools.

Impact of sexual abuse on children: a review and synthesis of recent empirical studies.

A review of 45 studies clearly demonstrated that sexually abused children had more symptoms than nonabused children, with abuse accounting for 15-45% of the variance. Fears, posttraumatic stress disorder, behavior problems, sexualized behaviors, and poor self-esteem occurred most frequently among a long list of symptoms noted, but no one symptom characterized a majority of sexually abused children. Some symptoms were specific to certain ages, and approximately one third of victims had no symptoms. Penetration, the duration and frequency of the abuse, force, the relationship of the perpetrator to the child, and maternal support affected the degree of symptomatology. About two thirds of the victimized children showed recovery during the first 12-18 months. The findings suggest the absence of any specific syndrome in children who have been sexually abused and no single traumatizing process.

Children as victims of violence: a national survey.

OBJECTIVE: The goal of this study was to gain a more comprehensive perspective on the scope, variety, and consequences of child victimization, which has been obscured by a fragmentation into specific problems like sexual abuse or kidnapping. METHODS: Two thousand children aged 10 to 16 years were interviewed in a national telephone survey of children. RESULTS: In the previous year, a quarter of the children had experienced a completed victimization, one in eight had experienced an injury, and one in a hundred required medical attention as a result. Nonfamily physical assaults were the most numerous. Contact sexual abuse occurred to 3.2% of girls and 0.6% of boys. There were also substantial numbers of incidents of attempted kidnappings and violence directed to children's genitals. CONCLUSION: The victimization of children occurs to a greater extent than has been previously reported and is poorly represented in official statistics. IMPLICATION: The authors argue for a more comprehensive interest in children's victimization including better national statistics about the problem.

Research on the treatment of sexually abused children: a review and recommendations.

OBJECTIVE: To review findings and conclusions from 29 studies that evaluated with quantitative outcome measures the effectiveness of treatments for sexually abused children. RESULTS: The studies overall document improvements in sexually abused children consistent with the belief that therapy facilitates recovery, but only five of them marshal evidence that the recovery is not simply due to the passage of time or some factor outside therapy. There has yet to be a true large-scale, randomized trial of treatment versus control. The studies suggest that certain problems, such as aggressiveness and sexualized behavior, are particularly resistant to change and that some children do not improve. A number of considerations that merit special attention in future sexual abuse therapy outcome research are identified, including (1) the diversity of sexually abused children, (2) the problem of children with no symptoms, (3) the possible existence of serious "sleeper" effects, (4) the importance of family context on recovery, (5) the utility of abuse-focused therapy and targeted interventions, (6) the optimal length of treatment, (7) the problem of treatment dropouts, and (8) the development and use of abuse-specific outcome measures. CONCLUSIONS: The need for more treatment outcome research is highlighted by the rising demand for accountability in the health care system that will increasingly require professionals in the field of sexual abuse treatment to justify their efforts and their methods.

The victimization of children: recommendations for assessment and instrument development.

The study and treatment of juvenile victimization would greatly benefit from instruments that are comprehensive, methodologically sound, and relevant to settings such as health and mental health clinics, criminal justice institutions, and child protection agencies. Toward these ends, this article makes 20 recommendations. Among other things, instruments should (1) allow victimization to be mapped onto conventional crime and child protection system categories; (2) adequately assess victimization by family and other nonstranger perpetrators; (3) ask about crimes specific to childhood, such as nonviolent sexual offenses and neglect; (4) allow for comparisons between juvenile and adult victimizations; (5) collect self-report data with children as young as age 7 years; (6) use simple, behaviorally specific language; (7) protect privacy during data collection; (8) attend to potential ethnic, class, and gender differences; and (9) prepare procedures to assist children in danger. Comprehensive and well-researched instrumentation could greatly advance the study and treatment of juvenile victimization.

Is youth victimization related to trauma symptoms and depression after controlling for prior symptoms and family relationships? A longitudinal, prospective study.

The common finding linking symptoms such as posttraumatic stress disorder (PTSD) and depression with youth victimization (e.g., sexual abuse) might well be artifactual if preexisting psychopathology or disturbed family relationships create a common risk for both later victimization and later symptoms. This study used a longitudinal, prospective design to examine this issue. In a national random sample telephone survey, children 10 to 16 years old were interviewed and then reinterviewed approximately 15 months later about psychological problems, family relationships and victimization experiences that had occurred in the interim. Victimization in the interim was associated with PTSD-related symptoms and depression measured at Time 2, even after controlling for these symptoms and the quality of the parent-child relationship at Time 1. The association was particularly strong for sexual abuse, parental assault, and kidnapping experiences. However, these data also suggest that some of the apparent association found in cross-sectional studies between victimization and psychopathology may be due to prior psychopathology (but not parent-child relationship problems), which puts children at risk for both victimization and later symptoms.

Psychosocial sequelae of violent victimization in a national youth sample.

In a national telephone sample of youths aged 10-16 years, over one third reported having been the victims of an assault. Victimized respondents displayed significantly more psychological and behavioral symptomatology than did nonvictimized respondents (more symptomatology related to posttraumatic stress disorder, more sadness, and more school difficulties), even after controlling for some other possible sources of distress. Sexual assault was associated with particularly high levels of symptomatology. However, victims of other forms of assault--nonfamily assaults involving weapons or physical injury (aggravated assaults), assaults by parents, violence to genitals, and attempted kidnappings--also evidenced levels of distress that were not statistically lower than those suffered by victims of sexual assault. The findings suggest that substantial mental health morbidity in the general child and adolescent population is associated with victimization.

Victimization of children.

Children suffer more victimizations than do adults, including more conventional crimes, more family violence, and some forms virtually unique to children, such as family abduction. On the basis of national statistics, these victimizations can be grouped into three broad categories: the pandemic, such as sibling assault, affecting most children; the acute, such as physical abuse, affecting a fractional but significant percentage; and the extraordinary, such as homicide, affecting a very small group. They can also be differentiated by the degree to which they result from the unique dependency status of children. A field called the victimology of childhood should be defined that adopts a developmental approach to understanding children's vulnerability to different types of victimizations and their different effects.

The international epidemiology of child sexual abuse.

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 1/2 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.

Epidemiological factors in the clinical identification of child sexual abuse.

The main finding from epidemiological literature on child sexual abuse is that no identifiable demographic or family characteristics of a child may be used to exclude the possibility that a child has been sexually abused. Some characteristics are associated with greater risk: girls more than boys, preadolescents and early adolescents, having a stepfather, living without a natural parent, having an impaired mother, poor parenting, or witnessing family conflict. Class and ethnicity appear not be associated with risk. In any case, none of these factors bear a strong enough relationship to the occurrence of abuse that their presence could play a confirming or disconfirming role in the identification of actual cases.

Sexual abuse: a sociological perspective.

How have contemporary social changes affected the problem of child sexual abuse? The rapid rise of this problem to public attention in the United States is in part due to the mobilization around the problem by the women's movement and the child welfare movement there. But factors shown by research to be associated with the problem--social isolation and patriarchal authority--are so widespread as to suggest that this is a problem of international proportions, as well. The rising divorce rate in the U.S. and worldwide, would appear to put more children at risk at the same time that it has also made it easier for children and their mothers to escape from the most oppressive and intolerable family situations. The sexual revolution and the erosion of external controls on sexual behavior have also in all likelihood aggravated the problem, too. Sexual abuse needs to be seen as a problem distinct from physical child abuse--characterized by the preponderance of offenders who are males. This suggests searching for the sources of the problem in male sexual socialization rather than in problems of inadequate and disaffected parenting.

Removing the child--prosecuting the offender in cases of sexual abuse: evidence from the national reporting system for child abuse and neglect.

Sexual abuse has come to public attention so rapidly and is such a difficult problem to deal with that many observers are concerned that the quality of child protective intervention in these cases has been haphazard and indiscriminate. This article analyzes data on all 6,096 cases of child sexual abuse which were "officially reported" in 1978 to see what kinds of intervention were made. The data show that foster placement occurred in more cases of sexual abuse than physical abuse, and was concentrated among cases of older children who reported their own victimization. Criminal action was taken almost five times more often in cases of sexual abuse than in cases of physical abuse, and occurred more often among cases which were directly reported to police and involved offenders with prior criminal records. Black families and poorer families did not seem to be the objects of obvious discrimination in the disposition of these cases.

Child abuse as an international issue.

This paper provides a background and suggests a strategy for an international approach to policy development concerning child abuse. First, child abuse is defined in a way that makes it applicable across cultures and national boundaries as that portion of harm to children that results from human action that is proscribed, proximate and preventable. A number of other dimensions, such as the degree of social sanction or social censure, are outlined that also affect the likelihood that given harm will be regarded as child abuse. Cross-cultural research also reveals that certain categories of children--such as those in poor health, females, unwanted children and those born under difficult circumstances or with disvalued traits or under conditions of rapid socioeconomic change--are more vulnerable to maltreatment in many countries. The paper argues for a two-pronged international strategy that first urges individual countries to make a priority of the particular types of abuse that are in most urgent need of attention in their society as well as participating at the same time in a concerted international focus on three widely occurring forms of child abuse: parental child battering, selective neglect, and sexual abuse.

Sexual abuse in the National Incidence Study of Child Abuse and Neglect: an appraisal.

The National Incidence Study of Child Abuse and Neglect was a major, government sponsored effort to collect data on reported and unreported child abuse. It used a systematic representative sample methodology and very precisely developed definitions of child abuse. This paper review some of the main limitations of the study in regard to findings on sexual abuse. First, there is probably less "new" data in the study on sexual abuse than on other forms of abuse, since so many of the study cases of sexual abuse were "officially reported' cases. In addition, the study limited its definition of sexual abuse only to cases where a caretaker was the perpetrator , a definition that is much more restrictive than what is used in many treatment programs. Finally, the data on perpetrators has a number of problems that stem from the study's definitions of sexual abuse. The paper makes suggestions for future incidence type studies of sexual abuse.

Victimization prevention programs: a national survey of children's exposure and reactions.

The National Youth Victimization Prevention Study interviewed a representative sample of 2,000 U.S. children and their caretakers about the children's experience with child abuse and victimization prevention programs. Two-thirds of the children reported being exposed to at least one program at some time, 37% within the last year. Programs that gave children a chance to practice, that prompted discussions with parents, and that included information on dealing with bullies were more likely to result in utilization of the program skills. Although satisfaction levels were generally high for all groups, girls, black children, and children from lower socioeconomic status families, as well as their parents, had more positive reactions and reported more skill utilization. Some children did report, and their parents confirmed, more worry about abuse and fear of adults. However, the children with increased worry and fear were also the children who themselves and their parents reported the most positive feelings about the programs and the most skill utilization. This suggests that the level of worry and fear induced by the programs was appropriate to the subject.

Prior victimization: a risk factor for child sexual abuse and for PTSD-related symptomatology among sexually abused youth.

The experience of prior victimization (sexual and nonsexual) was found to increase children's risk for experiencing later child sexual abuse (CSA) in a national random sample of 2,000 American children aged 10-16 years. Prior victimization predicted subsequent CSA even when background variables (child's gender, race, age, geographic location, quality of relationship with parents, and relative level of violence in the home community) were controlled for. In addition, the prior victimization of a family member also predicted later CSA. Among children who experienced CSA, prior victimization increased the level of post-traumatic stress symptomatology, even after demographic factors and characteristics of the CSA episode (e.g., severity of the assault, severity of injury, fear of death or serious injury) were included in the model. These results suggest that prior victimization is a factor that needs to be addressed by educators who design CSA prevention interventions and by mental health professionals who counsel child victims of sexual abuse.

How does receiving information about sexual abuse influence boys' perceptions of their risk?

This research tested the influence of two common sources of information on boys' perceptions of their risk for sexual abuse. In this sample exposure to prevention education programs was associated with a lower perceived likelihood of being sexually abused, and discussion of child sexual abuse with parents was associated with a higher perceived likelihood. The authors suggest that the information provided in prevention education programs emphasizes controllability of sexual abuse to a greater extent than do discussions with parents, so that boys exposed to these programs see their risk as reduced. The potential consequences of these findings are discussed in relation to controversies surrounding the teaching of information about sexual abuse to children.

The effectiveness of victimization prevention instruction: an evaluation of children's responses to actual threats and assaults.

This study examined whether instruction in school and at home about how to prevent victimization has any impact on children's behavior in situations of real victimization threat. Telephone interviews were conducted in 1992 with a nationally representative sample of 2,000 youths age 10 to 16 and their caretakers. More comprehensive school programs had mixed, small but overall positive effects. Children exposed to such school-based prevention programs performed better on a short test of knowledge about sexual victimization; when victimized or threatened were more likely to use the self-protection strategies recommended by prevention educators; were more likely to feel that they had been successful in protecting themselves; and were more likely to disclose to someone about the victimization attempts. They were not better able to limit the seriousness of the assaults and, in fact, they experienced more injuries in the course of sexual assaults. Comprehensive parental instruction also had positive effects on knowledge, the use of preferred self-protection strategies and the likelihood of disclosure. Children with comprehensive parental instruction were more likely to limit the seriousness of assaults.

Why is sexual abuse declining? A survey of state child protection administrators.

OBJECTIVES: Cases of substantiated sexual abuse have declined approximately 39% nationwide from 1992 to 1999, according to estimates from the National Child Abuse and Neglect Data System (NCANDS). Despite the dramatic nature of the decline, little discussion of the trend has occurred at either the national or the state level. Aims of the research were to: (1) gather state-level information about possible sources of the sexual abuse decline, (2) identify child protection trends that might be contributing to the decline, and (3) assess the level of awareness of the decline in state child protection offices. METHODS: Telephone interviews were conducted with child protection administrators in 43 states. RESULTS: More than half of the officials in states with large declines were unaware of any discussion of the declines within their agency or in the public at large within their state. State officials cited a diverse array of possible causes for the decline, including: (1) increased evidentiary requirements to substantiate cases, (2) increased caseworker caution due to new legal rights for caregivers, and (3) increasing limitations on the types of cases that agencies accept for investigation. More than half also mentioned the effectiveness of prevention programs, increased prosecution, and public awareness campaigns, implying that a portion of the decline may result from a real decline in occurrence. CONCLUSIONS: Responses from child protection officials have inherent biases, but they are useful in generating hypotheses for further study in trying to account for the decline. The results suggest that further discussion and increased analysis of child maltreatment system data are important next steps.

Sexually abused children in a national survey of parents: methodological issues.

In a national survey of 1,000 parents, which primarily concerned disciplinary practices and violence toward their children, two questions were asked about whether the children had been sexually abused. This was to assess the feasibility of epidemiological research on contemporaneous sexual abuse using parental interviews rather than the usual adult retrospective approach. From these questions, rates of sexual abuse for children currently 0-17 were estimated at 1.9% in the last year and 5.7% ever. The cases making up these rates included a nearly equal number of boys and girls and no female victims between the ages of 9 and 12, a distribution different from those generally obtained by other epidemiological methods, but due possibly in this case to normal sampling variation. Cases were more likely to be disclosed for children whose parents had themselves been sexually abused, who were from lower income households, or who were living with only one biologic parent. Although some of the findings suggest caution in generalizing about child sexual abuse from survey samples of parents, the method is worthy of exploration if only to gain better epidemiologic data about parent knowledge, reaction, reporting, and coping strategies.