Elsevier

Journal of Pediatric Health Care

Volume 24, Issue 6, November–December 2010, Pages 358-364
Journal of Pediatric Health Care

Article
Child Sexual Abuse: Consequences and Implications

https://doi.org/10.1016/j.pedhc.2009.07.003Get rights and content

Abstract

Sexual abuse is a problem of epidemic proportions in the United States. Given the sheer numbers of sexually abused children, it is vital for pediatric nurse practitioners to understand both short-term and long-term consequences of sexual abuse. Understanding consequences of sexual abuse can assist the pediatric nurse practitioner in anticipating the physical and mental health needs of patients and also may assist in the identification of sexual abuse victims. Sexual abuse typically does not occur in isolation. Implications for practice will be discussed.

Section snippets

Sexualized Behaviors

All forms of child abuse have been linked with the development of a variety of behavioral problems in children. Sexualized behaviors in children have been linked most closely with child sexual abuse (Putnam, 2003). Children who exhibit sexualized behavior tend to be younger and to have been sexually abused at a younger age (Mullers & Dowling, 2008; Putnam). Many sexual behaviors exhibited by children are a part of normal development; however, numerous studies have found that sexually abused

Other Behavioral Concerns

Child sexual abuse has been linked to the development of problematic behaviors. Symptoms of attention deficit hyperactivity disorder (ADHD) can develop as a result of sexual abuse, and the child may be misdiagnosed as having ADHD (Mullers & Dowling, 2008). The symptoms are actually the result of the trauma of sexual abuse and are more accurately diagnosed as post-traumatic stress disorder (PTSD) or anxiety. Briscoe-Smith and Hinshaw (2006) reported that girls with ADHD were at increased risk of

Psychiatric Disorders

Child sexual abuse has been linked with a variety of psychiatric disorders in childhood and continuing into adulthood. Martin, Bergen, and Richardson (2004) report that the incidence of psychiatric diagnoses occurring over a lifetime is 56% for women and 47% for men who have disclosed a history of child sexual abuse. However, when no history of child sexual abuse is reported, the rates of psychiatric disorders are much lower, at 32% for women and 34% for men. Depression, suicidal ideation,

Obesity

Noll, Trickett, Harris, and Putnam (2008) note an association between child sexual abuse and the later development of obesity. Both child sexual abuse and obesity often occur in conjunction with depression, behavioral impulsivity, drug and alcohol use, difficulties with peers, and poor self-esteem. Obese children most often become obese adults, which places their children at increased risk for the development of childhood obesity and diabetes. Childhood obesity places the child at risk for a

Adult Revictimization

A history of sexual abuse places an individual at increased risk for sexual re-victimization in adolescence and adulthood, especially for women. Fillipas and Ullman (2006) found adult sexual abuse to be almost four times more likely for individuals who suffered sexual abuse as a child. Significantly higher PTSD symptoms have been found in victims who have experienced both child and adult sexual assault. Dubowitz and associates (2001) speculate that the effects of early abuse and the subsequent

Effects on Parenting

Children born to sexually abused mothers are at increased risk to be abused (physically, emotionally, and sexually) by their mothers or by other individuals who are allowed access to vulnerable children.

Given the preceding discussion linking sexual abuse with the development of multiple behavioral and psychiatric disorders including depression, substance abuse, and PTSD, it is no wonder that a history of child sexual abuse can negatively affect the individual's ability to parent and thus have

Implications for Practice

Recognition of sexual abuse is crucial for PNPs. Prompt recognition of sexual abuse coupled with reporting of concerns to the appropriate CPS agency can assure safety for the child. All well-child appointments should include a few developmentally appropriate screening questions for sexual abuse. Children and parents should be separated for the screening questions if possible. See the Box 1 for examples of questions to ask children and parents concerning sexual abuse. The well-child examination

Gail Hornor, Nationwide Children's Hospital, Center for Child and Family Advocacy, Columbus, OH

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      It is important to examine some of these behaviors from the perspective of hegemonic masculinity. Existing research indicates that boys and men are slightly more likely to display externalizing behaviors vis-à-vis CSA (e.g., aggression) as compared to girls and women who tend to display more internalizing behaviors (e.g., depression) (Hornor, 2010; Romano & De Luca, 2001). Since boys in patriarchal societies tend to receive more positive messages about sex as compared to girls (Aaron, 2012) and are allowed greater sociocultural permissiveness about sex, including in India (Daruwalla, Mishra, Karandikar, Pantvaidya, & Osrin, 2018), it is likely that boys and men who have experienced CSA may try to externalize the trauma of sexual abuse through behaviors such as elevated sexual desire, sexual compulsivity, and high-risk sexual activity (Aaron, 2012; Sigurdardottir, Halldorsdottir, & Bender, 2014).

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    Gail Hornor, Nationwide Children's Hospital, Center for Child and Family Advocacy, Columbus, OH

    Conflicts of interest: None to report.

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