Sexualy Abused Children Become Victimizers

Child grooming is a deliberate process by which offenders gradually initiate and maintain sexual relationships with victims in secrecy.Show more

Grooming allows offenders to slowly overcome natural boundaries long before sexual abuse occurs. On the surface, grooming a child can look like a close relationship between the offending adult, the targeted child and (potentially) the child’s caregivers.

The grooming process is often misleading because the offender may be well-known or highly regarded in the community. As a result, it’s easy to trust them.

https://www.d2l.org/child-sexual-abuse/

Stage Description Example

Targeting the Child Perpetrators may target and exploit a child’s perceived vulnerabilities including: emotional neediness, isolation, neglect, a chaotic home life, or lack of parental oversight, etc.

The offender will pay special attention to or give preference to a child.
Gaining the Child's & Caregiver's Trust

Perpetrators work to gain the trust of parents/caregivers to lower suspicion and gain access to the child by providing seemingly warm yet calculated attention/support.

The perpetrator gains the child’s trust by gathering information about the child, getting to know their needs, and finding ways to fill those needs.

"I saw you reading the new Superman comic. I'm planning to go see the new movie, I can take you if you want to go."

Filling a Need Once the perpetrator begins to fill the child's needs, they may assume noticeably more importance in the child's life.

Perpetrators utilize tactics such as gift giving, flattery, gifting money, and meeting other basic needs. Tactics may also include increased attention and affection towards the targeted child.

"I know you love jewelry so I got you this watch."
Isolating the Child

The perpetrator uses isolation tactics to reinforce their relationship with the child by creating situations in which they are alone together (babysitting, one-on-one coaching, “special” trips).

The perpetrator may reinforce the relationship with the child by cultivating a sense that they love and understand the child in a way that others, even their parents, cannot.

The adult can start to tell the child that no one cares for them the way they do, not even their parents.

"You can trust me because no one understands you the way I do."

Sexualizing the Relationship

Once emotional dependence and trust have been built, the perpetrator progressively sexualizes the relationship.

This occurs through talking, pictures, and creating situations in which both are naked (swimming).

The adult exploits the child’s natural curiosity and trust using stimulation to advance the sexual nature of the relationship.

"Have you ever masturbated? I can show you how, it feels really good."

Maintaining Control

Once sexual abuse is occurring, perpetrators commonly use secrecy, blame, and threats to maintain the child’s participation and continued silence. In order to maintain control, perpetrators use emotional manipulation; they make the child believe they are the only person who can meet their emotional and material needs.

The child may feel that the loss of the relationship, or the consequences of exposing it, will be more damaging and humiliating than continuing the unhealthy relationship.

"If you tell anyone, we both could go to jail, We won't be able to be together." Or "If you tell anyone, something bad could happen to your family."

https://www.d2l.org/child-grooming-signs-behavior-awareness/

Data shows that adult survivors of childhood sexual abuse are at higher risk of developing:

Heart disease
Cancer
Diabetes
Obesity
STIs

Teen pregnancy

In addition to these direct physical health consequences, the psychological, emotional, and behavioral effects further contribute to poor physical health and associated conditions.

Depression and anxiety can lead to suicide, suicide attempts, and self-injury. Sexual risk behavior can lead to increased rates of STIs, HIV, pregnancy, and abortion.

Substance abuse poses a high risk to physical health in many ways, including an increased risk of:

Lung disease
Heart disease
Liver disease
Kidney failure
Stroke
Cancer
Dental problems
Nerve damage
HIV
Hepatitis C
Heart infection
Skin infection

Eating disorders lead to a wide range of serious physical health conditions, including:

Starvation
Malnutrition
Cardiovascular problems
Gastrointestinal issues
Neurological issues

Hormonal imbalance

The physical effects of childhood sexual abuse are highly complex. Physical health consequences are closely tied to the psychological and behavioral health of a victim. Psychological symptoms can manifest as coping mechanisms for dealing with the unresolved trauma of sexual abuse in childhood.

Child sexual abuse and molestation come with serious long-term effects. Child abuse is known to cause serious harm to a victim’s lifelong mental and emotional health.

These consequences can create a domino effect, rippling outward to affect a victim’s relationships, physical health, educational success, earning ability, and quality of life.

The CDC estimates that 91% of childhood sexual abuse is perpetrated by someone the child knows. Children often do not report sexual abuse. Sometimes, this is out of fear or shame. However, not all child sexual abuse happens in the same way. When a child is molested, they may not realize until adulthood that they were the victim of sexual abuse.

The statutes of limitations for taking legal action over childhood sexual abuse are set on a state-by-state basis. In recent years, there has been a national movement toward re-examining and lengthening the statutes of limitations surrounding childhood sexual abuse. This has led to an increase in adult survivors coming forward decades after the abuse occurred. It’s never too for childhood sexual abuse victims to get help and pursue justice.
What counts as child sexual abuse?

Experiencing childhood sexual abuse or molestation is considered an adverse childhood experience (ACE). An ACE is a traumatizing event that can go on to negatively impact nearly every aspect of a person’s well-being.

Childhood sexual abuse is a complicated issue. It can happen in many different ways, and a victim’s reactions are highly individualized.

Child abuse is identified by the CDC as occurring when a child under 18 is involved in sexual activity that they don’t understand or cannot consent to. Legally, any child under the age of consent is a victim of sexual abuse when they are involved in any type of sexual activity.

Child sexual abuse can be physical or non-physical. Common examples include:

Rape or attempted rape
Sodomy or oral sex
Insertion of fingers or objects
Fondling or inappropriate touching
Being asked to expose or watching another expose themself
Being asked to masturbate or watching another masturbate
Being photographed or recorded while undressed

What counts as child sexual abuse?

Long-term psychological effects of sexual abuse
Long-term behavioral effects of sexual abuse
Long-term interpersonal effects of sexual abuse
Long-term physical effects of sexual abuse

Taking legal action over child sexual abuse

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Long-term psychological effects of sexual abuse

Child sexual abuse and molestation are linked to a range of serious mental health issues. Mental health issues stemming from childhood sexual abuse can begin shortly after the abuse occurs but may not appear until many years later.

Delayed mental health issues related to childhood sexual abuse may be due to the fact that in childhood, a victim might not fully understand what is happening.

Molestation, in particular, might be confusing to a child. When abuse is not painful for a victim, it may not be until adulthood that the victim fully realizes what occurred. Studies increasingly show that adult survivors often do not recall childhood sexual abuse until asked about it.

Whether a victim immediately recognizes the experience as abuse or does not realize it until adulthood, they are at risk of developing similar mental health concerns.

Here are some of the most common mental health issues survivors of childhood sexual abuse face.

PTSD

Post-traumatic stress disorder (PTSD) is one of the most common psychological effects of childhood sexual abuse. Studies show that PTSD related to this type of abuse is more likely to manifest in adulthood. PTSD can manifest differently in different individuals. Common signs of PTSD include:

Reliving the event through flashbacks or memories
Avoidance of intimacy or sexual relationships
Emotional effects like numbness, fear, or shame
Loss of memory of the event

Hyperarousal – easily startled, difficulty with sleep and concentration

PTSD is a complex psychological condition that can increase the likelihood of other issues like depression, anxiety, substance use, and suicide.
Depression

Studies routinely confirm that there is a significant correlation between childhood sexual abuse and adult depression. Depression can have an overwhelming impact on quality of life and can last for short periods or years. Depression manifests in many different ways. Common symptoms of depression include:

Feelings of sadness or emptiness
Anger or irritability
Loss of interest in life activities
Sleep disturbances, insomnia, or sleeping too much
Lack of energy
Loss of appetite and weight loss
Overeating and weight gain
Feelings of shame, worthlessness, and low self-esteem
Cognitive difficulties – thinking, memory, recall

Suicidal ideation or suicide attempts

Depression is a serious mental health condition. Left untreated, it can lead child sexual abuse victims to commit suicide.
Anxiety

Survivors of childhood sexual abuse are also at risk of developing anxiety disorders, both in childhood and in adulthood. Anxiety disorders can manifest in many different ways. One can broadly identify anxiety as feelings of apprehension that have serious effects on thoughts, emotions, actions, and quality of life.

Common signs of an anxiety disorder include:

Feelings of panic or danger
Nervousness or restlessness
Increased heart rate or breathing
Overwhelming worry

Sleep and cognitive issues

Severe anxiety requires medical intervention. If a person with severe anxiety does not receive treatment, the condition can worsen.
Long-term behavioral effects of sexual abuse

The behavioral effects of childhood sexual abuse are closely linked to the psychological effects. In many cases, behavioral effects appear as coping mechanisms to help victims deal with co-occurring mental and emotional issues.
Substance Abuse

Studies consistently find a high correlation between childhood sexual abuse and dependence on alcohol and drugs. One study conducted on adults at an inpatient substance abuse detox center found that 81% of women and 69% of men reported physical childhood sexual abuse.

There’s also a known correlation between childhood sexual abuse and alcohol abuse later in life. This is a particularly complex topic, as it’s believed that family alcohol abuse is likely a contributing factor in the sexual abuse of a child. This suggests that a family history of alcoholism can contribute to both sexual abuse and the likelihood of a victim going on to abuse alcohol.

Substance abuse comes with pervasive effects on every area of life and can lead to serious negative consequences for psychological and physical health. It also negatively impacts relationships, education, and earning ability.
Eating Disorders

Studies have also found a strong correlation between childhood sexual abuse and the development of eating disorders. Eating disorders can take several forms, including:

Anorexia nervosa
Bulimia nervosa
Binge-eating disorder
Rumination disorder

Avoidant or restrictive food intake disorder

One view is that eating disorders can be a dysfunctional coping mechanism that allows victims to establish a sense of control over the body. Eating disorders are highly dangerous and can lead to malnutrition and a host of other physical conditions.
Sexual Risk Behavior

Victims of childhood sexual abuse are more likely to engage in sexual risk behavior. Sexual risk behavior is linked to sexual abuse in childhood and is accompanied by many negative consequences, including:

Higher likelihood of further sexual abuse
Teen pregnancy
STIs

HIV

Sexual risk behavior can take many forms. Some of the most common involve unprotected sex, sex with multiple partners, and sexual activity at an early age.
Long-term interpersonal effects of sexual abuse

Sexual abuse in childhood can lead to a wide range of interpersonal issues. Relationship problems, unstable family dynamics, and sexual issues have all been linked to childhood sexual abuse.
Relationship Issues

Victims of childhood sexual abuse often face high levels of relationship difficulties. Common issues include:

Trust issues
Fear of intimacy
Unstable relationships

High divorce rates

Childhood sexual abuse can affect intimate and romantic relationships as well as parenting and family dynamics. Data shows that childhood sexual abuse victims experience greater difficulty in establishing and maintaining safe, healthy relationships than those without a history of this type of abuse.
Sexual Dysfunction

Adult survivors of childhood sexual abuse routinely report issues with sexual dysfunction in adulthood. Women with a history of abuse report higher levels of difficulty with desire and arousal.

For both men and women, the presence of PTSD symptoms can contribute to the occurrence of issues with sexual desire, arousal, and performance.
Revictimization

Revictimization refers to repeatedly falling victim to the same crime. Victims of child sexual abuse are at high risk for continued abuse. An estimated 50% of child sexual abuse victims experience revictimization.

Victims are at higher risk of further sexual abuse in childhood and adulthood. For adults, the additional psychological and emotional effects of childhood sexual abuse may lead to a decreased ability to perceive danger as an adult. Adult victims may also have a higher tolerance for sexually coercive situations due to the normalization of traumatic sexual experiences in childhood.

Studies have also shown that an estimated 35% of sexual abuse perpetrators were victims of childhood sexual abuse. Men are at a much higher risk of falling into this cycle of abuse than women. Recognizing abuse and getting adequate counseling for a victim can greatly reduce the chances of a victim perpetuating the cycle of abuse.

Childhood sexual abuse is generally defined as a form of child abuse that involves sexual activity.

While varying definitions can be found, the U.S. Centers for Disease Control and Prevention (CDC) defines childhood sexual abuse as “any completed or attempted (noncompleted) sexual act, sexual contact with, or exploitation of a child by a caregiver”

(2). The CDC specifically defines the different types of sexual abuse, differentiating between those involving direct physical contact, with and without penetration, and noncontact sexual abuse, such as voyeurism, exhibitionism, or exposing the child to pornography.

The World Health Organization (WHO) extends the definition of childhood sexual abuse beyond that perpetrated by a caregiver (3):

The involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violate[s] the laws or social taboos of society.

Child sexual abuse is evidenced by this activity between a child and an adult or another child who by age or development is in a relationship of responsibility, trust, or power, the activity being intended to gratify or satisfy the needs of the other person.

This may include but is not limited to: the inducement or coercion of a child to engage in any unlawful sexual activity; the exploitative use of a child in prostitution or other unlawful sexual practices; the exploitative use of children in pornographic performances and materials.

As discussed in their thorough review of childhood sexual abuse worldwide, Murray et al. (4) note that the WHO definition encompasses a broad array of behaviors, and they highlight the fact that children may not even be aware of their victimization (e.g., filming or photographing their images) and that consent may or may not be given by the child.

However, by definition, children are not of legal majority and therefore cannot give consent; thus, any sexual activity with a minor child falls under the definition of childhood sexual abuse.

While prevalence data vary depending on the source, best estimates indicate that approximately 8%−12% of children and adolescents in the United States have experienced at least one type of sexual assault in their lifetime (5, 6).

According to the most recent available data from state child protective services agencies, 676,000 children in the United States were victims of abuse or neglect in 2016, reflecting a rate of 9.1 unique victims per 1,000 children under age 18 (7). Of these reported cases, 8.5% were victims of childhood sexual abuse; this compares with 74.8% who were neglected and 18.2% who were reported for allegations of physical abuse.

While childhood sexual abuse may be less prevalent than other forms of child abuse, it has significant acute and long-term consequences.

It is important to highlight the fact that available statistics are largely dependent on cases reported to authorities, such as law enforcement and child protective services, and are certainly underestimates of the true number of childhood sexual abuse victims (4, 6, 8). As compared with other crimes, rape and sexual assault are less likely to be reported to law enforcement or other authorities.

For example, an analysis of data from the National Crime Victimization Survey (9), which collects information only on persons age 12 and older, indicated that 22.9% of rapes or sexual assaults were reported to law enforcement in 2016; this compares with 54.0% of robberies and 42.2% of physical assaults.

Reasons cited among adults for not reporting their sexual assaults include fear of reprisal, fear of not being believed, shame, and embarrassment. Many of these same reasons are found for delay of disclosure among children and adolescents, including perceived responsibility for the abuse, fear of negative consequences, and being the victim of incestuous abuse (10). In addition, particularly for younger children, there is the added barrier related to their reliance on an adult to make the report. Finally, as noted by Saunders and Adams (6), because national data surveys such as the National Crime Victimization Survey do not collect data on children younger than age 12, limited information is available about this vulnerable age group.

It is also important to recognize that exposure to a single traumatic event or abuse incident is rare. Among children who have experienced abuse or other traumatic events, most have been exposed to multiple traumatic events (11). Furthermore, such exposure heightens the likelihood of childhood sexual abuse and increases risk for adverse mental and physical health. Childhood sexual abuse seems to have a unique impact on children, with consequences such as heightened risk for revictimization, substance abuse, depression, legal problems, and poor physical health extending into adulthood (11–13).
Risk Factors

Certain demographic factors, such as sex and age, can increase risk for sexual victimization, with most studies finding higher rates among girls than boys. For example, the National Survey of Children’s Exposure to Violence, which included a nationally representative sample of 4,000 children ages 0–17, indicated that girls were 1.5 times more likely than boys to report at least one episode of sexual victimization within the past year (5, 14). The National Survey of Adolescents (15) and the National Survey of Adolescents–Replication (16), which also involved nationally representative samples of youths, similarly found higher rates for girls than boys (13% and 3%, respectively). The data thus suggest that the risk of sexual victimization is approximately 3 to 4 times greater for girls than for boys. Data regarding prevalence rates across race and ethnicity generally indicate that minority children, especially those of African American and Latino ethnicity, appear to be at higher risk for sexual victimization (17–20). Other factors associated with increased risk for childhood sexual abuse include lower socioeconomic status, residing in a home with a single parent, being in foster care, parental substance abuse or mental illness, living in a rural area, and domestic violence (19, 21, 22).
Impact

Childhood sexual abuse has been associated with increased risk for a multitude of acute and long-term psychological and physical health problems, including depression, posttraumatic stress, and substance abuse problems, as well as sexual revictimization in adolescence and adulthood (12, 13).

Research consistently demonstrates that certain risk factors increase the severity of childhood sexual abuse–related sequelae, such as abuse that involves penetration, greater frequency, longer duration, use of force, a closer relationship between the child and the perpetrator, physical injury during the abuse, and a lack of caregiver support (23). Conversely, certain protective factors, such as a child’s coping strategies and the availability of stable, supportive caregivers, can ameliorate the adverse impact of childhood sexual abuse (24).
Screening and Identifying Childhood Sexual Abuse

Mental health and other health care providers (e.g., pediatricians, nurses, nurse practitioners) who do not specialize in treating victims of trauma and abuse may be reluctant to screen children for childhood sexual abuse and other forms of child abuse. Reasons may include a belief that such questioning is not indicated unless trauma is the presenting problem; a scope of practice that does not include trauma interventions; lack of knowledge on how to respond to an abuse disclosure; and limited awareness of appropriate referrals for specialized treatment services. There is nevertheless a cogent argument for routine trauma screening across mental health and primary care practice settings, as this offers the opportunity for children and families to access a professional with the knowledge, skills, expertise, and resources to provide needed assistance (25–27). In an article reviewing best practices for identifying, screening, and treating child victims of sexual abuse in primary care settings, Hanson and Adams (28) suggest the use of brief screening tools as a way to identify children who may have experienced childhood sexual abuse.

This can facilitate additional screening and/or referral to skilled providers when warranted. In their review, the authors acknowledge that comprehensive screening can pose challenges, particularly among providers who do not possess the requisite skills and expertise, but they suggest that at least a single question can be asked, such as the one recommended by Cohen et al. (29):

“Since the last time I saw you, has anything really scary or upsetting happened to you or your family?” This can help to identify those children in need of additional screening or referrals and can be easily included as part of routine assessment in an array of primary care and mental health settings.

Regardless of whether or not routine screenings are implemented, it remains critical for mental health and other health care providers to be aware of potential signs or symptoms of sexual abuse and related sequelae (23). These may include visible signs of distress at the time of the office visit, such as anxiety about separation from a caregiver, refusal to get undressed, or unwillingness to be examined by the provider. Caregivers may report concerns about the child’s behavior, such as nightmares, difficulty sleeping alone, a sudden or increased fear of the dark, bedwetting for a child who was previously toilet trained, sadness, withdrawal, irritability, and anger outbursts. Children or caregivers also may report physical symptoms, such as headaches, stomachaches, and fatigue. Additionally, children may display sexual knowledge, language, or behaviors that are inappropriate for their age. Any of these behaviors warrants additional screening and assessment (28).

Children for whom there is a concern for sexual abuse should have a physical examination for injuries and any indicated laboratory testing. It is critical that examiners remember that a normal physical examination does not change the credibility of a disclosure or decrease the likelihood that abuse occurred. Genital mucosa and epithelium heal rapidly, and even children examined acutely after childhood sexual abuse are most likely to have a normal examination. Multiple studies estimate that more than 95% of childhood sexual abuse victims have a normal genital examination. Older age (>13 years), a history of genital penetration, and the acuity of an injury are associated with an increased likelihood of diagnostic findings in childhood sexual abuse (30).

Not all children who experience childhood sexual abuse will develop diagnosable mental health conditions. However, children who are victims of childhood sexual abuse are at risk for posttraumatic stress disorder (PTSD) as well as for other mental health conditions. Awareness of the specific symptoms of PTSD and other childhood sexual abuse–related problems (e.g., depression, anxiety, behavior problems) is important to ensure that children are assessed accurately and receive the appropriate treatment. For example, the hyperarousal symptoms of PTSD can be mistakenly attributed to hyperactivity stemming from attention deficit hyperactivity disorder (ADHD), reexperiencing symptoms (nightmares and flashbacks) may be misdiagnosed as early psychosis, and negative cognitions and beliefs about the world may be mistakenly attributed solely to depression. Providers also must recognize that comorbid conditions, such as depression and PTSD, are not uncommon.
Evidence-Based Mental Health Treatments

Not all victims of childhood sexual abuse will evince symptoms that warrant mental health treatment services. However, for those who are experiencing significant mental health problems related to childhood sexual abuse, referral to providers skilled in the delivery of evidence-based trauma-focused interventions is imperative.

As discussed in several literature reviews (31–33), the majority of trauma-focused treatments that have empirical support for children and adolescents are cognitive-behavioral therapies, with several common cross-cutting elements. These elements include psychoeducation about trauma and its impact (e.g., PTSD); affective modulation skills, such as relaxation and controlled breathing; gradual exposure to trauma memories; and cognitive processing to address unhelpful or inaccurate cognitions, such as guilt or self-blame. Gradual exposure appears to be a particularly important treatment element, given the cumulative evidence regarding its specific impact in reducing PTSD symptoms (34–37). In brief, this involves repeated exposure to details of the trauma as a way to extinguish trauma-related emotional and behavioral responses. This treatment strategy also helps improve cognitive processing of the traumatic event(s), which has been demonstrated to facilitate recovery. As noted with most child mental health treatment interventions, involvement of a supportive caregiver in trauma-focused treatments can be another important element related to positive outcomes, including reduced dropout (38), increased family engagement (39), and improved parent-child relationships (40, 41).

While several evidence-based trauma-focused treatments exist, the most effective and widely disseminated psychotherapy intervention for children and adolescents to date is trauma-focused cognitive-behavioral therapy (CBT) (1, 19, 20, 22, 24, 40). In brief, trauma-focused CBT is a structured, components-based, time-limited (i.e., 12–20 therapy sessions) intervention that includes education about trauma and its impact, strategies to promote relaxation and positive coping skills, techniques to address inaccurate or unhelpful thoughts related to abuse, gradual exposure to enable children to share details of their experience and process their trauma-related thoughts and feelings, joint parent-child sessions to increase open communication about the abuse and its impact, and parenting skills to manage problematic child behaviors that may predate or be exacerbated by the childhood sexual abuse. (For more detailed descriptions of trauma-focused CBT, see Hanson and Jobe-Shields [42] and Pollio et al. [43]). In addition, there are several resources for professionals, youths, and families that provide information about childhood sexual abuse and its impact; some also include descriptions and available empirical support for existing interventions (Table 1).

TABLE 1. Resources and Information on Childhood Trauma and Abuse
Enlarge table
Psychopharmacological Interventions

As noted above, evidence-based trauma-focused mental health treatment interventions are the first line of treatment for symptoms related to childhood sexual abuse. However, for children who have severe or persistent symptoms despite psychotherapy, medications may be warranted, both to ameliorate these difficulties and to generate a more positive treatment response to psychotherapy. As discussed in the review by Hanson and Adams (28), there are no specific protocols to guide pharmacological interventions for childhood sexual abuse specifically. However, recommendations do exist for treatment of children experiencing PTSD symptoms. The American Academy of Child and Adolescent Psychiatry (AACAP) “Practice Parameters for the Assessment and Treatment of Children and Adolescents With Posttraumatic Stress Disorder” (29) suggests selective serotonin reuptake inhibitors (SSRIs) for the treatment of children and adolescents with PTSD but cautions that these medications should be considered only after an adequate trial of evidence-based psychotherapy alone has been found to be ineffective. Stronger evidence exists for the use of SSRIs in adults with PTSD, but data for use in children with PTSD are limited to a few small studies. In contrast, support for the use of medication in children with comorbid PTSD (with disorders such as depression, anxiety, and ADHD) is much stronger, and pharmacotherapy should be considered on the basis of the degree of severity and impairment. Of note, AACAP’s recommendations highlight the importance of including medications as part of a more comprehensive treatment plan, as an adjunct to psychotherapy, and for simultaneous treatment of comorbid psychiatric diagnoses.

A number of small studies have looked at other psychopharmacologic agents for the treatment of PTSD in children, but evidence to guide practice is limited. For example, antiadrenergic agents (guanfacine, clonidine) have theoretical interest, as the neuroendocrine physiology behind hyperarousal and reexperiencing would potentially be mediated by these types of medications. One open-label study of extended-release guanfacine in patients with ADHD and comorbid PTSD showed a decrease in PTSD symptoms of reexperiencing, avoidance, and hyperarousal (44). Multiple studies in adults support the use of prazosin in PTSD, specifically for hyperarousal, although no such data exist in children.

The use of second-generation antipsychotics and mood stabilizers for children with PTSD is not well studied. Although small studies of risperidone, quetiapine, carbamazepine, and valproic acid in children have been reported, studies to date do not provide sufficient data to recommend the use of these agents (45, 46). In most of these studies, the duration of use was brief or children had significant comorbid diagnoses.

There is significant concern about the use of multiple psychotropic medications in children to treat conditions that are not indicated. Several retrospective studies suggest that polypharmacy is particularly common in children who are victims of trauma and abuse and in children who are in foster care (47, 48). These data further highlight the importance of judicious medication prescribing and close attention to the risks, benefits, and indications for any psychotropic medication. Also critical to note in considering prescribing practices for children with PTSD is that a child’s developmental age, his or her exposure to complex, long-standing trauma, and comorbid diagnoses will influence symptoms and degree of impairment. Much more data are needed to reliably recommend use of medications other than SSRIs for the treatment of PTSD in children, and in these cases prescribers must carefully weigh the risks and benefits of each medication (49).
Conclusions

While childhood sexual abuse is not the most prevalent form of child abuse, it nevertheless affects a significant minority of children and adolescents and heightens risk for myriad acute and long-term consequences. While certain risk factors, such as age, sex, and family structure, increase the likelihood of childhood sexual abuse, supportive caregivers, early identification, and receipt of evidence-based treatment interventions when warranted can ameliorate these adverse effects. Initial screening for children across mental health and other health care settings can increase early identification of those who need further evaluation or treatment services. Optimal treatments, specifically those that directly target the childhood sexual abuse and associated symptoms, are associated with positive long-term outcomes for this vulnerable population.
From the National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, and the Department of Pediatrics, Medical University of South Carolina, Charlest

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