When a shy,
frightened pre-school victim
was asked if her grandfather
had hurt her when he touched her,
she responded, "Only in my heart."
Pandora's Box
During an initial therapy session with a senior citizen, I asked one of my
routine interview questions: "Have you ever been sexually abused?"
She paused, then nodded slowly. Although she had been in therapy most of her
adult life, there was no record of sexual victimization in her overflowing
patient file. Her response, "No one ever asked."
Parents of sexually abused children or children brutally murdered at the hands
of molesters -- left to a lifetime of grief and confusion -- wonder why their
children didn't tell.
Too often, we do not ask. We survey school children on alcohol use, drug use,
suicidality, depression, physical abuse, and sometimes consensual sexual
contact. But we fail to ask about sexual victimization. Why? Are we afraid to
open Pandora's Box?
Secrecy
The nature of the crime constituting child sexual abuse is intertwined with the
issue of victim secrecy.
Research began exposing sexual abuse of children as a problem of sizable
proportions in the late 1960s and early l970s (Watson, 1984). One theme remains
consistent in the research: sexual abuse is extensively undisclosed and
underreported (Bagley, 1992; Courtois & Watts, 1982; Finkelhor &
Browne, 1986; Slager-Jorne, 1978; Swanson & Biaggio, 1985; Tsai &
Wagner, 1978).
There are many factors relating to the dynamics of the insufferable crime that
may impact victim failure to disclose. Victims of sexual abuse frequently
experience feelings of shame, guilt, isolation, powerlessness, embarrassment,
and inadequacy (Bagley, 1992; Courtois & Watts, 1982; Herman &
Hirschman, 1977; Swanson & Biaggio, 1985). They may even accept responsibility
for the abuse by blaming themselves (Johnson, 1987).
Victims may also have a feeling that "something is wrong with me," or
that the abuse is their fault (Johnson, 1987; Tsai & Wagner, l978). They
may be embarrassed or reluctant to answer questions about sexual aspects of the
abuse (Berlinger & Barbieri, 1984).
Children often fail to report because of fear that disclosure will bring
consequences even worse than being victimized again. The victim may feel guilty
for creating consequences to the perpetrator and may fear subsequent
retaliatory actions from the perpetrator (Berlinger & Barbieri, 1984;
Groth, 1979; Swanson & Biaggio, 1985).
Based on research, it could be expected that victims' perceptions of guilt and
self-blame would interfere with their decision to identify themselves through
disclosure.
Clinical Implications
Investigation and research on undisclosed sexual abuse has important clinical
implications.
Sexual abuse research suggests at least an associative relationship between
sexual abuse and other disorders, if not a causal relationship based on the
sexual trauma (Bagley, 1992; Courtois & Watts, l982; Farrell, 1988;
Finkelhor & Browne, 1986; Herman & Hirschman, 1977; Whitlock &
Gillman, 1989). According to Farrell (1988), a sexual abuse victim may develop
serious psychological problems as a result of the victimization.
Finkelhor and Browne (1986) acknowledged that effects of the molestation may be
delayed into adulthood. Long-term effects that are frequently reported and
associated with sexual abuse include depression, self-destructive behavior,
anxiety, feelings of isolation and stigma, poor self-esteem, difficulty in
trusting others, tendency toward revictimization, substance abuse, and sexual
maladjustment (Courtois & Watts, l982; Finkelhor & Browne, 1986, Herman
& Hirschman, 1977; Tsai & Wagner, l978).
Early identification of sexual abuse victims appears crucial to reduction of
suffering, enhancement of psychological development, and for healthier adult
functioning (Bagley, 1992; Bagley, 1991; Finkelhor et al. 1990; Whitlock &
Gillman, 1989). Sorensen and Snow (1991) suggested that policies and procedures
geared only to those children who have disclosed fail to recognize the needs of
the majority of victims.
As long as disclosure continues to be a problem for young victims, then fear,
suffering, and psychological distress will, like the secret, remain with the
victim.
Prevention Efforts
According to Gilbert (1988), education and prevention programs have been
implemented, but they have not been entirely successful. Gilbert identified
some of the reasons for disappointing results of preventive programs: a)
programs not geared to the cognitive level of young audiences; b) erosion of
learning over time; c) elusive subject matter; d) difficulty in transference of
learning to real life events; and e) the brief attention span and limited
ability of young children to grasp complex ideas. Gilbert also noted the
approach of the offender may so subtle that it may not be easily recognizable
by even a knowledgeable child.
Many sexual abuse education and prevention programs are pursued without
adequate research to determine effectiveness. Or, effectiveness research has
relied primarily on pre- and post-studies to determine acquired knowledge by
young participants. Follow-up research leads us to believe knowledge acquired
from prevention programs is transitory and fades rapidly, and many victims do
not internalize and act on information they receive. In other words, many
victims hear the information, but still do not disclose.
How do we know if prevention programs are eliminating victimization? Like drug
education programs, we know children heard the information -- and can repeat
the information -- but countless victims remain silent. If we still have victims
who have not disclosed, are the programs really working? How long should we
continue to applaud ourselves for prevention efforts when we do not know the
frequency of today's silent victims in our own communities?
We need to step back and review our efforts to reach silent, fearful victims.
Research is imperative to liberating these children from their prisons of
secrecy and pain.
Research
Finkelhor et al. (1990) conducted the first national telephone survey of men
and women. Of the 2,626 Americans questioned regarding prior sexual abuse,
victimization was reported by 27 percent of the women and 16 percent of the
men. One of the major findings was that many of those who were victims never
disclosed the experiences to anyone. Of those participants who confirmed sexual
abuse, 42 percent of the women and 33 percent of the men acknowledged never
having disclosed.
Based on his extensive research on sexual abuse, Bagley (1990b) affirmed child
sexual abuse is much more frequent than previously assumed. Bagley (1990a)
reported 32 percent of the sampled adult females in his community study
responded they experienced child sexual abuse, with sexual abuse greater for
women born after 1960 than before.
Psychologists, researchers, social workers, law enforcement officers,
educators, welfare workers, child advocates, and the media have emphasized the
hidden crime of sexual abuse, studied the potential disastrous psychological
implications for victims, and labored over the problem of secrecy (Bagley,
1992; Courtois & Watts, 1982; Groth, 1979; Herman & Hirschman, 1977;
Johnson & Johnson, 1984; Swanson & Biaggio, 1985).
Despite these efforts, research on the prevalence of child sexual abuse and
timely interventions for victims have been difficult to execute because of the
pervasive tendency toward non-disclosure by victims (Bagley, 1992; Finkelhor
& Browne, 1986; Sorensen & Snow, 1991). As Bagley (1991) succinctly
stated in a publication of his study on sexual abuse, "It is assumed that
measurement errors will err in the direction of understatement and
concealment."
After more than two decades of research on child sexual abuse, questions remain
unanswered regarding the frequency of non-disclosure and the effectiveness of
preventive programs. Public awareness has been raised, prevention programs
implemented, research conducted, and progress made in increasing the number of
annual disclosures; however, the secrecy of child sexual victimization may be
continuing at an alarming rate.
Opening Pandora's Box
According to Whitlock and Gillman (1989), "Studies to date concerning
possible short- and long-term effects of child sexual abuse have focused
primarily on the experiences of women abused as children." "Much of
the important scientific knowledge about the nature, prevalence, and impact of
child sexual abuse has come from community surveys of adults, reporting on
their histories of abuse" (Finkelhor et al. 1990).
As evidenced in the literature, the majority of published research on the
extent of undisclosed child sexual abuse were surveys of adults regarding
sexual abuse which may have occurred many years ago. These retrospective
studies have neither reached nor addressed the immediate needs of the masses of
young victims currently living with undisclosed abuse, nor have they adequately
addressed the issue of whether young victims understand they have been sexually
abused (Finkelhor & Browne, l986).
Continued research on non-disclosure and provisions for the availability of
supportive and timely interventions for young victims has been widely
recommended (Bagley, 1992; Bagley, 1991; Farrell, 1988; Finkelhor et al. 1990;
Groth, 1979; Sorensen & Snow, 1991; Tsai & Wagner, 1978; Whitlock &
Gillman, 1989).
Finkelhor and Browne (1986) recommended that since sexual abuse is extensively
underreported and intervention is subsequently delayed, there be new studies of
victims who have not disclosed or sought treatment. They recommended these
studies be conducted more proximate to the age of victimization.
The problem and extent of underreporting, or non-disclosure, is a primary
obstacle in determining frequency of child sexual abuse. Bagley (1992)
acknowledged that the issue of whether child sexual abuse is increasing or
decreasing is difficult to determine in the absence of current data. He
confirmed there is logic in beginning attempts to assess the frequency of
distressed students in school settings.
Although substance abuse studies have been widely received and implemented in
schools, there remains significant controversy regarding assessing sexual abuse
issues. School administrators are reluctant to permit surveys of sexual abuse,
even when these surveys may help save a child years of suffering. According to
Johnson (1987), some parents and professionals are so uneasy they view preventive
education as a witch-hunt or as the opening of a Pandora's Box.
Give children the right --
and a way to speak out
How many sexually victimized, traumatized, and fearful children are sitting
silently through prevention programs? How do we help them?
Why do we provide anonymous sexual victimization surveys only for adults? If
children are more vulnerable than adults, more afraid to speak out than adults,
why do we not also give children the right and a way to express their needs
without being inhibited by fear of identification? Do children not deserve the
same opportunities to speak out?
Bagley (1992) administered anonymous questionnaires on stress to 14- through
16-year old adolescents in two western Canadian junior high schools. He posited
that children and adolescents may be reluctant to report some experiences
directly or through a questionnaire in which they have to identify themselves.
Bagley contended that adolescents in school settings are willing to anonymously
report various kinds of stress, including physical, emotional, and sexual
abuse.
An instrument or procedure is needed that will allow young victims to
anonymously provide us with current, targeted information on the frequency of
undisclosed sexual abuse. In response to this need, unanswered questions, and
the continuing problem of sexual abuse, this investigator devoted three years
to the development and implementation of research to anonymously survey young
adolescents (Faulkner, 1996).
Since no known school based method or instrument existed to efficiently and
comprehensively survey students on sexual victimization, this research included
the development of an instrument entitled Sexual Abuse Recognition and
Non-Disclosure Inventory (SARANDI).
SARANDI:
Sexual Abuse Recognition
and Non-Disclosure Inventory
The SARANDI was developed for classroom surveys of young adolescents in the age
range of 12 through 15. The research presentation and survey were written in
terms that could be accepted by school administrators for use with young
adolescents.
A brief "Body Safety" presentation and survey administration
instructions were on an 11 minute video tape. Administration of the anonymous
survey took less than 30 minutes.
Participants were assured anonymity with regard to their responses. Students
could elect voluntarily to respond to the survey, or return the sealed response
cards unanswered. At the conclusion of the survey, information on where to get
help was provided and on-site counselors were available.
SARANDI:
Goals and Results
Unlike retrospective studies of adults, this research attempted to assess the
extent of current victimization in the community in which it was occurring.
Objectives included assessment of the prevalence of undisclosed child sexual
abuse proximate to time of victimization, not years later, so information could
be provided to increase community awareness and for the enhanced development of
targeted and timely preventive programs and interventions.
In this study, an attempt was made to assess the frequency of young adolescents
who had been sexually abused but who had not disclosed, and to assess the
frequency of young adolescents who were uncertain if they were victims.
The most outstanding result of the research was of those students who responded
they had been sexually abused, 100% responded they had not disclosed the abuse
to an adult. Additionally, six percent of the young adolescents in the study
responded "I don't know" to the question of whether they had been
sexually abused, confirming there are young adolescents who are uncertain about
having been sexually abused.
It is also noteworthy that two administrations of the SARANDI with a one month
interval did not generate any false reports of sexual victimization between
administrations, or during the month following the second administration.
There were schools who declined participation in this study for fear of
stimulating false reports of sexual abuse. For adults and schools officials who
are afraid to open the "Pandora's Box" of sexual abuse, the results
of this study gave no indication that surveys and questionnaires on sexual
victimization administered to middle school students would produce false
accusations of abuse.
Conclusions
Reported cases of child sexual abuse reached epidemic proportions with a
reported 322 percent increase from 1980 to 1990 (Sorensen & Snow, 1991). To
make the national crisis of sex crimes against youth even more alarming,
Janssen (1984) contended there may be at least 10 times as many cases that go
unreported.
According to Gilbert (1988), most experts agree that many, if not most cases,
go unreported. As suggested by Janssen (1984), "Only the tip of the
iceberg has been touched concerning the incidence of child sexual abuse."
Although the SARANDI school survey is not the final solution, it is a move
toward assessing the needs of sexual victims in the school system, singularly
the best place to reach the greatest number of children. As continued research
is conducted and investigators analyze their findings in an attempt to reach
statistical significance, it is important to remember -- providing protection
and safety for even one child is significant.
References
Bagley, C. (1992). Development of an adolescent stress
scale for use of school counsellors. School Psychology International, 13,
31-49.
Bagley, C. (1991). The prevalence and mental health
sequels of child sexual abuse in a community sample of women aged 18 to 27.
Canadian Journal of Community Mental Health, 10, 103-116.
Bagley, C. (1990a). Development of a measure of
unwanted sexual contact in childhood, for use in community mental health
surveys. Psychological Reports, 66, 401-2.
Bagley, C. (1990b). Validity of a short measure of
child sexual abuse for use in community mental health surveys. Psychological
Reports, 66, 449-450.
Berlinger, L. & Barbieri, M. K. (1984). The
testimony of the child victim of sexual assault. Journal of Social Issues, 40,
(2), 125-137.
Courtois, C. A. & Watts, D. L. (1982). Counseling
adult women who experienced incest in childhood or adolescence. The Personnel
and Guidance Journal, January, 275-279.
Farrell, L. R. (1988). Factors that affect a victim's
self-disclosure in father-daughter incest; student manuscript winner. Child
Welfare, 67, 462-8.
Faulkner, N. (1996). Sexual Abuse Recognition and
Non-Disclosure Inventory of Young Adolescents. Ann Arbor, MI: UMI.
Finkelhor, D. & Browne, A. (1986). Impact of child
sexual abuse: a review of the research. Psychological Bulletin, 99, 66-77.
Finkelhor, D., Hotaling, G., Lewis, I. A., & Smith,
C. (1990). Sexual abuse in a national survey of adult men and women:
Prevalence, characteristics, and risk factors. Child Abuse & Neglect, 14,
19-28.
Gilbert, N. (1988). Teaching children to prevent sexual
abuse. The Public Interest, 93, 3-15.
Groth, A. N. (1979). Men Who Rape. New York: Plenum
Press.
Herman, J. & Hirschman, L. (1977). Father-daughter
incest. Signs, 2, (4), 735-756.
Janssen, M. R. (1984). Incest: Exploitive Child Abuse.
The Police Chief, 51, 46-7.
Johnson, B. B. (1987). Sexual abuse prevention: A rural
interdisciplinary effort. Child Welfare, 66, 165-73.
Johnson, R. & Johnson, T. (1984). Are you raising a
victim? FBI Law Enforcement Bulletin, February, 10-14.
Slager-Jorne, P. (1978). Counseling sexually abused
children. Personnel and Guidance Journal, October, 103-105.
Sorensen, T. & Snow, B. (1991). How children tell:
The process of disclosure in child sexual abuse. Child Welfare League of
America, 70, 3-15.
Swanson, L. & Biaggio, M. K. (1985). Therapeutic
perspectives on father-daughter incest. American Journal of Psychiatry, 142,
(6), 667-674.
Tsai, M. & Wagner, N. N. (1978). Therapy groups for
women sexually molested as children. Archives of Sexual Behavior, 7, 417-427.
Watson, R. (1984). A hidden epidemic. News-week, May
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Whitlock, K. & Gillman, R. (1989). Sexuality: a
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"Sexual Abuse Recognition and Non-Disclosure of Young Adolescents"
can be obtained either by ordering it through: EMI, 300 North Zeeb Road, P.O.
Box 1346, Ann Arbor, MI 48106-1346, 1-800-521-0600; or, by requesting it
through the International Database interlibrary loan OCLC#35693021. This 150
page research document details the SARANDI study, rationale, literature review,
ethical considerations, methodology, results, conclusions, and implications.