Characterizing the sexual abuse experiences of young adolescents

Abstract

The purpose of this descriptive study was to: (a) compare the demographics of maltreated youth initially labeled as sexually abused by the Department of Child and Family Services (DCFS) to maltreated youth classified as sexually abused using current and past case records, (b) identify differences in sexual abuse experiences and types of perpetrators between boys and girls, and (c) provide a detailed description of the sexual abuse experiences for boys and girls. Participants were youth ages 9–12 years old with a recent maltreatment allegation. The Maltreatment Case Record Abstraction Instrument (MCRAI) was used to code child welfare records of 303 maltreated youth of whom 60 experienced sexual abuse. Perpetrators were classified by gender into four categories (biological parent, parental figure, relative, and unrelated) and type of abuse was classified into three categories (penetrative, contact without penetration, and non-contact). Using Chi-Square tests, perpetrator categories and sexual abuse types were compared by child gender for significant differences. Only 23 (38.3%) of the 60 sexually abused youth were labeled as sexually abused in the most recent DCFS report when they entered the study. About three-quarters of the sexually abused youth experienced non-penetrative physical contact, 40% experienced penetration, and 15% experienced sexual abuse without physical contact. Most youth (91.7%) were victimized by a male, and 21.7% were abused by a female. Youth experienced a large range of sexual abuse experiences, the details of which may be important for exploration of consequences of childhood sexual abuse.

Introduction

Just three decades ago, child sexual abuse was considered rare and thus largely understudied. However, in the intervening time, actual prevalence rates have been well documented and research has clearly established the deleterious effects of sexual abuse across the lifespan. The National Child Abuse and Neglect Data System (NCANDS) shows that of the 3.7 million children referred to Child Protective Services in 2011, 9.1% were confirmed as experiencing sexual abuse (U.S. Department of Health and Human Services, 2012). The highest prevalence was found in children age 12–14 years old. Additionally, there is a substantial gender difference in the prevalence of sexual abuse recorded by Child Protective Services (CPS). According to the Fourth National Incidence Study of Child Abuse and Neglect (NIS-4; Sedlak et al., 2010), child welfare records identify the sexual abuse of girls at a rate more than 3.8 times that of boys. This prevalence rate is based on the Endangerment Standard (i.e., evidence that the child had been harmed or was in danger of being harmed by the maltreatment), which includes children who were thought to be endangered as well as those with substantiated or indicated reports in a CPS investigation. Using the Harm Standard (i.e., evidence that the child has been harmed by the maltreatment), which is more stringent, the prevalence for girls is more than 5 times that of boys. Whether this gender disparity is because of fewer actual experiences of sexual abuse by males or to caseworkers substantiating fewer reports of sexual abuse for males is not clear. There is some evidence of the latter, that caseworkers substantiate sexual abuse of girls more often than that of boys (Maikovich, Koenen, & Jaffee, 2009). Additionally, research shows that mental health professionals inquire about sexual abuse infrequently with males (Lab, Feigenbaum, & De Silva, 2000), which may also contribute to this gender disparity.

Generally, sexual abuse, as defined by the Child Abuse Prevention and Treatment Act (CAPTA), refers to the involvement of the child in sexual activity to provide sexual gratification or financial benefit to the perpetrator, including molestation, statutory rape, prostitution, pornography, exposure, incest, or other sexually exploitative activities (Sedlak & Broadhurst, 1996). The bulk of sexual abuse research falls into two categories: (a) studies that follow up with children identified as sexually abused by protective services and (b) retrospective studies that ask individuals to recall sexual abuse experiences earlier in childhood and correlate them with current functioning. There are important definitional differences in these two approaches. Legal definitions of sexual abuse have been used in follow-up studies of childhood abuse when CPS agencies provide the identification of the sexual abuse. On the other hand, retrospective studies rely entirely on the individual's "memories, perceptions, and willingness to disclose" (Trickett, 2006, p.132) and may not use legal definitions of sexual abuse in all instances.

Although the exact definitions may vary by state, they all include sexual assault and sexual exploitation. Sexual assault includes, but is not limited to, oral copulation, sexual penetration, masturbation in the presence of a child, and fondling of genitals or intimate parts. Sexual exploitation includes, but is not limited to, preparing, selling, or distributing obscene matter depicting a minor or employment of minor to perform obscene acts. Despite statutory definitions of sexual abuse being derived from the CAPTA, the sexual abuse experiences included can vary substantially. Therefore, the classification of an individual as sexually abused may include experiences ranging from sexual penetration to witnessing sexual acts to posing for pornographic photographs. For many research studies these heterogeneous experiences are simply grouped into categories of non-contact, non-penetrative contact, and penetrative sexual abuse. In addition, the perpetrators can vary from biological parents to relatives to strangers (Trickett, 2006). In the NIS-4 (Sedlak et al., 2010), 37% of sexually abused children were abused by a biological parent and 23% by a non-biological parent or parent's partner. The remaining 40% were abused by a person other than a parent or parental figure. The majority of perpetrators were males (87%) and were more likely to be male when they were the child's non-biological parent. Female perpetrators were most commonly biological parents.

Retrospective studies often try to use CPS definitions, but they can vary widely in their definition of sexual abuse. For example, questions ranged from whether the individuals had unwanted sexual advances or been sexually abused (Garnefski & Diekstra, 1997; Krahé, Scheinberger-Olwig, Waizenhofer, & Kolpin, 1999), forced or somewhat forced sexual experience (Nereo, Farber, & Hinton, 2002), or penetration and/or genital contact more than 10 times (Mullen, Martin, Anderson, & Romans, 1994; a thorough review of studies can be found in Trickett, 2006). The wide variation in sexual abuse experiences described both between and within studies demonstrates the range of characteristics that sexual abuse encompasses.

Childhood sexual abuse has been found to impact a number of domains including mental and physical health, sexual risk taking, and cognitive abilities (Irish, Kobayashi, & Delahanty, 2010; Putnam, 2003; Trickett, Noll, & Putnam, 2011). The bulk of the literature on the effects of childhood sexual abuse comes from studies with all female samples, and knowledge of the effects on males lags far behind. A recent study of the National Study of Child and Adolescent Well-Being (NSCAW) found that girls were more likely than boys to have sexual abuse substantiated and to experience penetration (Maikovich-Fong & Jaffee, 2010). Girls and boys were equally likely to have a perpetrator that was related to them and did not differ in internalizing or externalizing problems associated with abuse characteristics. Similarly, a meta-analysis of seven studies found no gender differences in psychopathology related to sexual abuse (Tolin & Foa, 2006).

There seems to be substantial inconsistency in the extant evidence linking specific abuse characteristics to negative outcomes. Some studies have found that abuse perpetrated by a father or father figure is most detrimental (e.g., Adams-Tucker, 1982; Briere & Runtz, 1987; DiLillo, 2001; Edwards, Freyd, Dube, Anda, & Felitti, 2012; Molnar, Buka, & Kessler, 2001; Sirles, Smith, & Kusama, 1989), whereas others have not found this link (e.g., Einbender & Friedrich, 1989; Glover et al., 2010; Mennen, 1993; Sciolla et al., 2011). Two more comprehensive, multidimensional studies comparing the effects of various abuse characteristics (while controlling for the others) found that severity of abuse (Mennen & Meadow, 1995; Trickett, Reiffman, Horowitz, & Putnam, 1997) and perpetration by a biological father (Trickett et al., 1997) predicted worse outcomes. Additionally, Trickett and colleagues (2001) found that a profile group comprised of girls sexually abused by their biological fathers for a long duration were the most disturbed in the long term. Results of a meta-analysis suggest that penetrative sexual abuse puts an individual at higher risk for mental health problems than contact or non-contact abuse (Andrews, Corry, Slade, Issakidis, & Swanston, 2004).

The extant evidence demonstrates that there are certain characteristics of sexual abuse that may increase maladjustment, which highlights the need to obtain detailed information about sexual abuse experiences to better define and understand those at highest risk. This descriptive study utilized a methodical system to both identify and categorize the sexual abuse experiences recorded in official child welfare records of young adolescents referred to CPS. The purpose of this study was to (a) compare the demographics of maltreated youth initially labeled as sexually abused by the Department of Children and Family Services (DCFS) to maltreated youth classified as sexually abused using current and past case records, (b) identify differences in sexual abuse experiences and types of perpetrators between boys and girls, and (c) provide a detailed description of the sexual abuse experiences for boys and girls.

Methods

Participants

The youth in this study participated in a longitudinal study of the effects of maltreatment on adolescent development. One of the main aims of the parent study was to provide a refined description and better understanding of neglect and physical and psychological development. Participant recruitment procedures were approved by the University Institutional Review Board, DCFS, and the juvenile court. DCFS referred cases each month from 2002 through 2005 that met the following recruitment criteria: (a) new maltreatment referral to DCFS in the preceding month for any type of maltreatment; (b) child age 9 to 12 years old; (c) child identified as Latino, African-American, or Caucasian (non-Latino); and (d) child residing at the time of referral to DCFS in one of 10 zip codes in urban Los Angeles County. Zip codes were chosen using DCFS statistics on maltreatment rates of children of different ethnicities and census tract information on urban character and diversity of ethnicities. For each caregiver of a referred child, a letter was mailed describing the study and included a postage paid return postcard indicating willingness to participate. All caregivers received a telephone call inviting them to participate 10 days after the letter was sent unless the caregiver returned the postcard indicating an unwillingness to participate. Of the 394 caregivers who received the letter, 303 (76.9%) agreed to participate.

Study assessments were conducted at an urban research university. After assent and consent were obtained from the adolescent and caregiver, respectively, the adolescent was administered questionnaires and tasks during a four-hour protocol. The protocol included hormonal (cortisol), cognitive, psychosocial, physical growth, and behavioral measures. The parent provided demographic information on themselves and the child (Specific details of the study protocol are not presented here because the data for the present study were not obtained from the participant interviews. For a more complete description of the study protocol see Gordis, Granger, Susman, & Trickett, 2006; Mennen & Trickett, 2007). Both the child and caregiver were paid for their participation according to the National Institutes of Health’s standard compensation rate for healthy volunteers.

DCFS Maltreatment Label

Upon enrollment in the study, DCFS provided a maltreatment label that was given to the child based on the allegation of maltreatment that initiated their recruitment into the study. This DCFS label was not based on information from prior case records and was not the final disposition after the investigation was concluded. All youth who were given a label of sexual abuse were included in the DCFS initial report label group (Table 1).

Table 1.

Demographic Characteristics and Other Maltreatment Types of Sexual Abuse Cases by DCFS Initial Report or MCRAI Classification

Characteristics	DCFS Initial Report Label (n = 23)		MCRAI Categorization (n = 60)
Age at Study Entry	m = 11.95 (SD = 1.04)		m = 11.04 (SD = 1.14)
	n	%	N	%
Gender
Male	8	34.78	20	33.33
Female	15	65.22	40	66.67
Ethnicity
Black	13	56.52	24	40.00
White	0	0.00	6	10.00
Latino	8	34.78	23	38.33
Bi-racial	2	8.70	7	11.67
Placement
Remain w/bio parent	12	52.17	29	48.33
Relative placement	6	26.09	12	20.00
Non-relative Foster care	5	21.74	19	31.67
Other Maltreatment Types
Physical Abuse	0	0.00	35	58.33
Emotional Abuse	1	4.35	31	51.67
Neglect	6	26.09	49	81.67
Caregiver Incapacity	0	0.00	36	60.00
Substantial Risk	0	0.00	10	16.67
At-risk Siblings	0	0.00	28	46.67

Note. Labels from the initial DCFS report were categories of maltreatment identified at a specific time. MCRAI classifications of sexual abuse were derived from the systematic coding of four years of DCFS records for each participant. One child was labeled as sexually abused in the initial DCFS report, but not through the MCRAI process.

Development and Use of the Maltreatment Case Records Abstraction System (MCRAI)

Because the maltreatment label given by DCFS was not based on prior case records, all the available case records were obtained to determine the various types of maltreatment that were experienced by the participants. To systematically abstract the large amount of information available in each record, a comprehensive database called the Maltreatment Case Record Abstraction Instrument (MCRAI) was developed using SPSS Data Entry Builder 3.0. Based on the Maltreatment Classification System (MCS; Barnett, Manly, & Ciccetti, 1993) and the LONGSCAN Modified Maltreatment Classification System (MMCS; English & the LONGSCAN Investigators, 1997), a codebook was developed to standardize what information from the case records to include in the database. The MCRAI was designed to include specific data on a child’s experience as detailed in official records to allow the categorization of maltreatment experiences in quantifiable terms (a copy of the MCRAI is available upon request).

The primary adaptation from the MCS and MMCS relevant to the current study was the addition of specific variables to assess details of the sexual abuse experiences. Descriptive categories of childhood sexual abuse experiences from Trickett et al., (1997) were used to determine the twelve types of abuse experiences included in the MCRAI (See subcategories in Table 2). The MMCS codes for sexual abuse subtypes (i.e. exposure, exploitation, molestation, penetration) but does not abstract the details of the abuse. Instead, the details of the sexual abuse experiences are incorporated into a rating of severity in the MMCS. For example, a score of "1" is given to a child who is exposed to explicit sexual stimuli whereas a score of "5" is given for forced intercourse or prostitution of the child. When developing the MCRAI, a choice was made not to have raters code the sexual abuse acts into a severity score but instead to indicate which type(s) of sexual abuse the child had experienced to capture the full range of sexual abuse experiences that may be lost when creating general categories.

Table 2.

Characteristics of Sexual Abuse Experiences

Abuse Type	Total		Boys		Girls
	N	%	n	%	n	%
Non-Contact	9	15.00	4	20.00	5	12.50
Exposing Child to Pornography	6	10.00	2	10.00	4	10.00
Exposing Child to Sexual Actsa	5	8.33	3	15.00	2	5.00
Non-Penetrative Contact	46	76.67	15	75.00	31	77.50
Kissing	7	11.67	0	0.00	7	17.50
Adult Fondles Child	35	58.33	9	45.00	27	67.50
Fondling Genitals	28	46.67	7	35.00	21	52.50
Other Fondlingb	15	25.00	5	25.00	13	32.50
Other Non-Penetrative Sexual Touching	9	15.00	5	25.00	4	10.00
Child Masturbates Adult	1	1.67	0	0.00	1	2.50
Offender’s Mouth on Child’s Genitals	10	16.67	5	25.00	5	12.50
Child’s Mouth on Offender’s Genitals	7	11.67	3	15.00	4	10.00
Penetration	24	40.00	6	30.00	18	45.00
Penetration of Vagina/Rectum with Finger/Object	18	30.00	4	20.00	18	45.00
Anal Intercourse	6	10.00	4	20.00	2	5.00
Vaginal Intercourse	7	11.67	n/a	n/a	7	17.50
Combinations of Sexual Abuse Types (Descending)
Non-Penetrative Contact Only	27	45.00	10	50.00	17	42.50
Non-Penetrative Contact/Penetration	16	26.67	4	20.00	12	30.00
Penetration Only	7	11.67	2	10.00	5	12.50
Non-Contact Only	7	11.67	3	15.00	4	10.00
Non-Contact/Non-Penetrative Contact	2	3.33	1	5.00	1	2.50
Non-Contact/Non-Penetrative Contact/Penetration	1	1.67	0	0.00	1	2.50

Note. n/a = not applicable; The number in each of the main categories of non-contact, non-penetrative contact, and penetration include the number of youth who experienced this type of abuse at least one time. Youth could have experienced more than one subcategory within the three main categories, e.g. under non-contact, a youth could have experienced viewing of pornographic material as well as viewing sexual intercourse, and would be listed under each subcategory as indicated.

^aChildren were exposed to adults engaging in sexual activity (oral sex and vaginal intercourse) or adults masturbating.

^bOther fondling included the fondling of breasts (only female children), buttocks, or general reference to inappropriate sexual touching.

The MCRAI codes four major forms of maltreatment (i.e. physical abuse, sexual abuse, emotional abuse, and neglect) and is based on maltreatment acts inflicted on a child rather than a child’s injury. For example, neglect involved failure to provide basic necessities (e.g. shelter, hygiene, food, medical care, or education) and lack of supervision (e.g. child left alone, child left alone with inappropriate substitute care; Mennen, Kim, Sang, & Trickett, 2010). Furthermore, along with the four forms of maltreatment, two more categories were included in MCRAI. One category included caretaker incapacity (e.g., because of hospitalization, unknown whereabouts, incarceration) and/or caretaker’s inability to provide adequate care for the child (e.g., because of caregiver’s mental illness, substance use, or physical illness). Also, the substantial risk designation was included, as it applied to instances in which no clear allegation of maltreatment existed for the child, but circumstances put the child at risk for maltreatment (e.g. a sibling was abused or neglected).

The database for the MCRAI included the original DCFS categorization of each report of maltreatment (physical abuse, sexual abuse, neglect, emotional maltreatment, substantial risk and caretaker incapacity), the type of reporting party, and the disposition. In addition, the MCRAI was constructed so that following entry of the official data, a data field with each type of maltreatment was listed that incorporated specific information about each. This information included the perpetrator’s relationship to the child, age of child at onset of abuse, frequency, duration, and other specifics of the abuse (e.g., whether hospitalization occurred, whether marks were left). Also entered in the database were all the DCFS allegations of maltreatment and the investigation status (i.e., whether or not the allegations were confirmed). Information about the parents’ functioning in relation to substance abuse, domestic violence, mental and physical health was also part of the system. The detailed information could be entered for each category that was relevant for each specific report of maltreatment. A new record was created for each new report of maltreatment that included all the relevant data for that particular report. Unsubstantiated cases of maltreatment have been noted as differing little from substantiated cases; therefore all maltreatment allegations were included to increase the accuracy of the child’s experience (Drake, 1996; Hussey et al., 2005). To get a full description of each youth’s experience, a new record was created for each new report of maltreatment and included all relevant data for that particular report.

Procedures for abstracting child maltreatment case records

Two retired DCFS supervisors accessed DCFS records and court reports and reviewed all investigation documents on each report of maltreatment. These agency records included emergency referral information, screener’s descriptions, investigation narratives, and contact sheets. The DCFS supervisors provided a summary of each youth’s case along with the full case records. Trained social work masters students and psychology undergraduate students entered the data from the DCFS case records into the MCRAI database. The record reviews included the maltreatment report that led to the child being identified as a potential participant in the study and prior reports of maltreatment for the four years before study entry (the limit of prior records in the current DCFS system). When there were multiple types of maltreatment, the abstractors entered the details of each type of maltreatment in the corresponding section for that type of maltreatment. The child was the unit of analysis, thus even if the same maltreatment occurred for siblings, each youth’s experience was entered individually.

Abstracted data were checked by trained doctoral students with the summary provided by the DCFS consultants to ensure no maltreatment incidents were missed. Original DCFS case records were rechecked when inconsistencies were found. Group decision-making occurred to modify entries when needed. Eighty records were randomly chosen during the data collection process to test interrater agreement among five abstractors. Two different abstractors entered the same report into the MCRAI. Interrater reliability was examined for each type of maltreatment. This yielded good Kappa statistics: .82, .82, .79, and .75 for physical abuse, sexual abuse, emotional abuse, and neglect, respectively.

Data Analysis

Using Chi Square or Fisher’s Exact Test (when the cell size was less than five), we compared characteristics of the youth (i.e., age at entry into the study, gender, ethnicity/race, and type of placement) between the participants with sexual abuse identified in the initial DCFS report upon entry into the study and participants identified as sexually abused using the MCRAI. When contingency tables included cells with zero instances, significance tests were not conducted. Perpetrators were split by gender and categorized into four categories: biological parent, parental figure, relative, and unrelated. We compared the gender of perpetrators (by category) by gender of the youth for significant differences. Using the case record descriptions of sexual abuse experiences, each type of abuse was sorted into one of three categories: penetrative abuse, contact without penetration, and non-contact. Based on the three categories of sexually abusive acts, we identified youth who experienced only one category and youth who experienced multiple categories in order to investigate patterns of co-occurrence. Again, we compared the three types of sexual abuse and co-occurring categories by gender of the youth for significant differences. Finally, to demonstrate the variability in abuse experiences and how the three general categories were created, a table was created with descriptive examples of the types of abusive incidents by gender of the child and gender and type of perpetrator.

Results

DCFS Label Versus MCRAI Classification

Eighty sexual abuse maltreatment reports were identified for 60 youth using the MCRAI system. Of the 60 youth identified through the MCRAI process as sexually abused, only 23 (38.3%) were labeled as sexually abused in the DCFS report obtained when they entered the study. One other child was identified as sexually abused by DCFS, but this finding was not confirmed through the MCRAI process. The demographic and placement characteristics of the youth classified as sexually abused by MCRAI versus in the initial DCFS report were not significantly different (Chi-square test with False Discovery Rate adjustment for Type 1 error). Additionally, there was a noticeable difference in the frequencies of other types of maltreatment in addition to sexual abuse (Table 1). Whereas the MCRAI procedure classified over 50% of the sample as experiencing physical abuse, emotional abuse, or neglect in addition to sexual abuse, DCFS did not identify other types of abuse at rates anywhere near this high. The average age of the youth at onset of MCRAI-identified sexual abuse was 8.1 years old (SD = 2.4).

Characteristics of Sexual Abuse Experiences

We examined the characteristics of the types of sexual abuse experienced by youth overall as well as separately by gender (Table 2). About three-quarters of the sample experienced non-penetrative contact, and 40% experienced penetration. Fifteen percent of the sample experienced sexual abuse that did not involve contact (e.g., exposure to pornography, adults engaging in sexual acts in front of children). Types of sexual abuse were not mutually exclusive, as many youth experienced several. The most common experiences of sexual abuse types included non-penetrative contact only or non-penetrative contact in combination with penetrative contact. A majority of the youth experienced one of the three types of sexual abuse, but 31.67% experienced multiple types of sexual abuse (non-contact, non-penetrative contact and/or penetration). There were no significant differences in the characteristics of the sexual abuse by gender of the child.

Perpetrator Type by Gender

Perpetrators were dispersed across the four categories (i.e. biological parent, parental figure, relative, and unrelated), with the most prevalent perpetrator being unrelated males (Table 3). Most youth (91.7%) were victimized by a male perpetrator and about one-fifth of the youth were abused by a female. Girls were significantly less likely than boys to be abused by women, χ²(1, N = 60) = 9.62, p = .002). Perpetrators categorized as father figures included step-fathers and parents’ live-in romantic partners. Related male perpetrators included siblings, uncles, and cousins. Unrelated male perpetrators included non-live-in romantic partners of parents, other youth, a parent’s coworker, a school bus driver, older siblings’ friends, romantic partners of relatives, and neighbors. The related female perpetrator was a sister. Unrelated female perpetrators included an adolescent friend, another foster child, and another child. Two-thirds of the youth were abused by only one perpetrator, while one-fifth of the youth were abused by two perpetrators, one boy was abused by three perpetrators, and one other boy was abused by four perpetrators.

Table 3.

Perpetrator Frequencies by Gender and Category

	Total		Boys		Girls		Boys vs. Girls
Perpetrator Type	n	%	n	%	n	%
Male	55	91.7	17	85.0	38	95.0
Biological Father	8	13.3	1	5.0	7	17.5
Father Figure	14	23.3	5	25.0	9	22.5
Male Relative	12	20.0	1	5.0	11	27.5
Unrelated Male	27	45.0	12	60.0	15	37.5
Female	13	21.7	9	45.0	4	10.0	**
Biological Mother	10	16.7	7	35.0	3	7.5
Mother Figure	0	0.0	0	0.0	0	0.0
Female Relative	1	1.7	1	5.0	0	0.0
Unrelated Female	3	5.0	2	10.0	1	2.5

^**p< .01

Description of Specific Sexual Abuse Experiences

To describe the variation of sexual abuse experiences for the youth in this study, each incident was organized by perpetrator, type of abuse, and gender of child (Tables 4 and 5). Exploring the data in this way highlighted the wide array of acts and relationships involved in these youth’s experiences of sexual abuse. It was notable that the sexual abuse perpetrated by biological fathers and father figures on female youth frequently involved penetration, while female perpetrators almost never penetrated youth of either gender. Biological mothers most often exposed youth to sexual activity or pornography, rather than touching their child in a sexual manner. Male relatives and unrelated males appeared to engage in the greatest range of abusive acts with youth of both genders.

Table 4.

Detailed Descriptions of Sexual Acts by Male Perpetrators for Boys vs. Girls

Perpetrator	Victim Gender	Abuse Type	Examples
Biological Father	Male	Non-Contact	Exposed to pornography (n = 1)
			Intercourse in front of child (n = 1)
		Non-Penetrative Contact
		Penetration
	Female	Non-Contact	Exposed to pornography (n = 1)
		Non-Penetrative Contact	Kissed and fondled breasts/genitals (n = 2)
			Licked child’s feet (n = 1)
			Fondled, put penis on child, sucked toes (n = 1)
			Fondled genitals (n = 1)
		Penetration	Penetrated with object/finger (n = 2)
			Raped child, resulting in herpes/vaginal tear (n = 1)
Father Figure	Male	Non-Contact	Exposed to pornography (n = 1)
			Intercourse in front of child (n = 1)
		Non-Penetrative Contact	Perpetrator fondled child’s penis (n = 4)
			Perpetrator placed mouth on child’s penis (n = 1)
		Penetration
	Female	Non-Contact
		Non-Penetrative Contact	Kissed and fondled genitals (n = 5)
			Fondled genitals or top (n = 4)
		Penetration	Digital vaginal penetration (n = 4)
			Penetrated with object (n = 2)
			Vaginal intercourse (n = 1)
			Anal penetration and penetration with objects (n = 1)
Male Relative	Male	Non-Contact
		Non-Penetrative Contact
		Penetration	Anal penetration (n = 1)
	Female	Non-Contact	Adult masturbated in front of child (n = 1)
			Exposed to pornography (n = 1)
		Non-Penetrative Contact	Brother forced child to orally copulate (n = 1)
			Cousin fondled child’s top/genitals (n = 1)
			Child was kissed by uncle (n = 1)
			Child’s genitals were fondled (n = 3)
			Uncle “humped” child over clothes (n = 1)
			Put fist between her legs (n = 1)
			“Molested” (n = 1)
		Penetration	Vaginally penetrated with fork (n = 1)
			Vaginal intercourse (n = 2)
			Anal penetration (n = 1)
			Penetrated vagina with penis and fingers (n = 1)
Unrelated Male	Male	Non-Contact	Exposed to pornography (n = 1)
			Oral sex in front of child (n = 1)
		Non-Penetrative Contact	Perpetrator placed penis in child’s mouth (n = 3)
			Perpetrator placed mouth on child’s penis (n = 3)
			Perpetrator fondled child’s penis (n = 2)
			Touching and kissing child (n = 2)
			Touching genitals over clothing (n = 1)
			Grabbing genitals (n = 1)
		Penetration	Sodomized (n = 3)
			Anal penetration (n = 1)
			Anal penetration with a foot (n = 1)
	Female	Non-Contact	Oral sex in front of child (n = 1)
		Non-Penetrative Contact	Fondled child, tried to remove her pants (n = 1)
			Child’s genitals fondled (n = 3)
			Child’s breasts fondled (n = 2)
			Constant touching (n = 2)
			Put fist between her legs (n = 1)
			Neighbor laid on top, tried to kiss child (n = 1)
			A boy tried to orally copulate with girl (n = 1)
			Asked to touch girl’s genitals, kissed her (n = 1)
			“Sexually harassed” (n = 1)
		Penetration	Digital vaginal penetration (n = 1)
			Vaginal intercourse (n = 2)

Table 5.

Detailed Descriptions of Sexual Acts by Female Perpetrators for Boys vs. Girls

Perpetrator	Victim Gender	Abuse Type	Examples
Biological Mother	Male	Non-Contact	Exposed to pornography (n = 2)
			Oral sex in front of child (n = 1)
		Non-Penetrative Contact	Perpetrator fondled child’s penis (n = 1)
			Perpetrator placed mouth on child’s penis (n = 2)
		Penetration	Mother placed drugs in rectum (n = 1)
	Female	Non-Contact	Exposed to pornography (n = 1)
			Sexual activity in front of child (n = 2)
		Non-Penetrative Contact
		Penetration
Mother Figure	Male	Non-Contact
		Non-Penetrative Contact
		Penetration
	Female	Non-Contact
		Non-Penetrative Contact
		Penetration
Female Relative	Male	Non-Contact
		Non-Penetrative Contact	Child’s sister forced her to orally copulate with her (n = 1)
		Penetration
	Female	Non-Contact
		Non-Penetrative Contact
		Penetration
Unrelated Female	Male	Non-Contact
		Non-Penetrative Contact	Child’s sister forced her to orally copulate with her (n = 1)
		Penetration
	Female	Non-Contact
		Non-Penetrative Contact
		Penetration

Discussion

This descriptive study of 60 sexually abused youth illustrates the wide range of abuse experiences and types of perpetrators within a fairly homogeneous group of inner-city youth. The label of sexual abuse given by the DCFS report when the youth entered this longitudinal study identified only a third of the youth who had been sexually abused and also incorrectly labeled a boy who allegedly sexually abused another child. By extracting maltreatment data from past case records, 37 more youth who experienced sexual abuse were identified. This finding demonstrates that if clinicians or researchers simply use the label given by one report, the majority of sexual abuse experiences would be omitted. Also, more than half of the youth with MCRAI-defined sexual abuse had another type of co-occurring maltreatment identified, whereas many fewer of the DCFS-labeled sexual abuse youth had been categorized as having other co-occurring types of maltreatment on that single report. Obtaining maltreatment information from a single report vastly underestimates the prevalence of sexual abuse as well as the co-occurrence of maltreatment types. Using case records for maltreatment research is widely accepted as the superior methodology (Runyan et al., 2005). Yet, despite the clear advantages, many studies rely on single report maltreatment classifications. Additionally, Runyan and colleagues (2005) found that CPS misclassified 10% of physical and sexual abuse as neglect indicating that even information from multiple case records still yields inaccurate maltreatment coding. The results of the current study show that the MCRAI system provided a more complete picture of the complexity of maltreatment experiences for these sexually-abused youth. Additionally, the MCRAI identified the specifics of these youths' sexual abuse history which is important for better defining possible developmental consequences of sexual abuse.

Similar to the findings from the NIS-4 (Sedlak et al., 2010), we found that over 91% of youth in the current study were victimized by a male perpetrator, compared to 87% in the NIS-4. However, only 13% were abused by their biological father, the most common perpetrator (45%) being an unrelated male. We found a similar number of youth were abused by a biological parent (30%) as found in the NIS-4 (37%); additionally, there was a similar pattern of biological mothers being the most common type of female perpetrator. Although not as high as found in the NIS-4 (OR = 3.8), we found that the prevalence of sexual abuse for females was twice that of males. However, estimates of male sexual abuse may be under-reported due to unwillingness of boys to disclose abuse, less likelihood of boys being asked about sexual abuse, and fear of retribution (Holmes & Slap, 1998; Shrier & Johnson, 1988). Boys and girls were equally likely to be abused by a biological parent. More boys than girls were abused by a female, with a preponderance of biological mother perpetrators.

Sexual abuse involving penetration was found for 40% of youth, which is similar to a self-report study of self-identified sexual abuse victims in which 37% reported experiencing penetration (Schaefer, Mundt, Ahlers, & Bahls, 2012). The current analyses found no gender difference in experiencing penetrative abuse, whereas the NSCAW (using caseworker reports) found higher rates for girls, with 50.7 % of girls versus 41.8% of boys experiencing penetrative abuse (Maikovich-Fong & Jaffee, 2010). However, boys are more often sexually abused by an unrelated male (e.g. clergy, troop leaders, coaches), which is reported to police rather than child welfare, perhaps contributing to an apparent gender disparity in sexual abuse victimization (Finkelhor, 1984). Overall, the lack of gender differences demonstrates the sexual abuse experiences of youth in our study to be similar for boys and girls.

Non-penetrative contact abuse was the most prevalent type of sexual abuse, with fondling of the genitals being reported most often. Non-contact abuse was found for only 15% of the youth, which is similar to rates from an online retrospective study where 8% reported non-contact abuse (Schaefer et al., 2012). In the current study, female perpetrators were more commonly the non-contact abusers and males were more likely to perpetrate penetrative abuse. Studies find that non-contact abuse is typically considered the least severe type of sexual abuse and is the lowest risk for maladaptive outcomes (Andrews et al., 2004; Fergusson & Mullen, 1999). Therefore, the high prevalence of more severe forms of abuse in the current sample is concerning for the long-term mental health and behavioral trajectories of these adolescents.

Limitations

This study utilized only official DCFS reports of maltreatment and therefore was not necessarily a comprehensive exploration of the actual experiences of these youth nor of their perceptions of sexual abuse experiences. For youth involved with DCFS, official records may not describe all of the maltreatment that these youth have experienced (Shaffer, Huston, & Egeland, 2008) and may miss incidents of sexual abuse that were never reported or indicated. We reviewed four years of DCFS records prior to the maltreatment allegation that brought the adolescent into the study (a limitation of the DCFS system); however, there could have been sexual abuse experiences prior to the case records that were abstracted. Additionally, some specific information, such as the duration of abuse, could not be ascertained from the DCFS records. Only the DCFS records of those who agreed to participate in the study were reviewed, the experiences of those who did not agree to participate could have been different. The sample for this study included only youth ages 9–12, and the maltreatment experiences of younger children and older adolescents are likely different than the age group studied. Lastly, the small number of sexually abused youth in this sample may have impacted our ability to detect significant group differences, particularly for boys.

Conclusion

Overall the results of this descriptive analysis show that there is substantial variability in the sexual abuse experiences of both boys and girls. Importantly, it is often this variability in sexual abuse experiences that creates individual differences in outcomes. In a longitudinal study of females who had experienced intrafamilial sexual abuse, Noll and colleagues found there to be more variability for the sexual abuse group than the comparison group on 13 different outcomes variables (e.g. depression, substance use; Noll, Trickett, Harris, & Putnam, 2009). This heterogeneity was found despite using extremely narrow inclusion criteria for sexual abuse. Thus, we should expect substantial variability in outcomes within the sexual abuse group in the current study. Clearly, combining all of the sexually abused youth into one group discounts the nuances of their experiences and the impact these different characteristics may have on the development of subsequent problems. Without first examining and describing the characteristics of the sexual abuse that these youth experienced, we may miss certain subgroups of youth who may exhibit resilience to these adverse early life experiences. The next step is to use the information gleaned from these analyses to examine the mental health, physical heath, and behavioral functioning of the sexually abused youth in this sample. Based on the growing evidence, we urge other researchers not to rely on initial classifications by protective services nor to create homogenous categories for sexually abused individuals. This approach will present challenges as the prevalence of sexual abuse is lower than other types of maltreatment. However, these considerations should be at the forefront in order to advance our knowledge of the consequences and treatment of childhood sexual abuse.