Sex differences in childhood sexual abuse characteristics and

victims emotional and behavioral problems: Findings from a

national sample of youth
Andrea Kohn Maikovich-Fong
a
and Sara R. Jaffee
b
a
University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA 19104, USA
b
Institute of Psychiatry, Kings College London, London, U.K
Abstract
ObjectiveThe first objective of this study was to test for sex differences in four childhood
sexual abuse characteristics---penetration, substantiation, perpetrator familial status, and multi-
maltreatment---in a national sample of youth. The second objective was to test for sex differences
in how these abuse characteristics were associated with victims emotional and behavioral
problems.
MethodsThe sample was drawn from the National Survey of Child and Adolescent Well-
Being, a sample of children investigated by United States child welfare services. Youth in the
current study (n =573, including 234 adolescents) were investigated for alleged sexual abuse.
Logistic regression and multivariate analysis of covariance were used to test for sex differences in
abuse characteristics, and to determine whether sex moderated associations between abuse
characteristics and emotional and behavioral problems.
ResultsGirls were more likely than boys to have their abuse substantiated and to experience
penetrative abuse (although differences in penetration status did not emerge among adolescents).
Substantiation status and child age were positively associated with caregiver-reported internalizing
and externalizing symptoms. Sex did not moderate the relationship between abuse characteristics
and youth emotional and behavioral problems.
ConclusionsSexual abuse characteristics might not be highly predictive factors when making
decisions about services needs. Furthermore, there may not be a strong empirical basis for
operating on the assumption that one sex is more vulnerable to negative consequences of abuse
than the other, or that abuse affects girls and boys differently. The processes explaining why some
victims exhibit more impairment than others are likely complex.
Introduction
Although childhood sexual abuse (CSA) was an unacknowledged and rarely studied
phenomenon until approximately thirty years ago, research has now firmly established that it
is a significant public health concern (e.g. Finkelhor, Hotaling, Lewis, & Smith, 1990).
Correspondence to: Andrea Kohn Maikovich-Fong.
The information and opinions expressed herein reflect solely the position of the authors. Nothing herein should be construed to
indicate the support or endorsement of its content by ACYF/DHHS.
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Author Manuscript
Child Abuse Negl. Author manuscript; available in PMC 2011 J une 1.
Published in final edited form as:
Child Abuse Negl. 2010 June ; 34(6): 429437. doi:10.1016/j.chiabu.2009.10.006.
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Many victims experience pervasive developmental problems such as enuresis, somatic
complaints, sexually reactive behavior, and academic delays (Beitchman, Zucker, Hood, da
Casta, & Ackman, 1991; Kendall-Tackett, Williams, & Finkelhor, 1993; Trickett &
McBride-Chang, 1995), and sexual abuse victims are especially at risk for psychopathology
(Putnam, 2003; Trickett & McBride-Chang, 1995). While estimates vary widely, it is likely
that around 1 in 5 girls and 1 in 6 boys are victimized prior to age 18 (Centers for Disease
Control, 1997). However, despite evidence that a substantial number of victims are boys,
sexual abuse research findings are based disproportionately on female samples.
Consequently, the extent to which findings generalize to male victims is unclear. In addition,
the clinical utility of much of the existing literature is limited by heavy reliance on adult
retrospective reports of childhood abuse, and on case studies or qualitative studies whose
findings have not been empirically validated with quantitative research. The objectives of
the present study are to briefly review these limitations, and then to test empirically in a
national sample whether 1) there are sex differences in four childhood sexual abuse
characteristics---penetration versus non-penetration, substantiation status, perpetrator
familial status, and experiencing multiple forms of maltreatment, and 2) whether there are
sex differences in how these sexual abuse characteristics are associated with victims
emotional and behavioral problems (as measured by internalizing, externalizing, and trauma
symptoms).
Limitations to the extant literature
Preponderance of female samplesMuch of what is known about the developmental
correlates and sequelae of childhood sexual abuse is based on samples of exclusively female
victims (Bailey & McCloskey, 2005; Finkelhor, 1984; Valente, 2005). Due in large part to
the historical under-reporting and subsequent lack of awareness of male CSA, it was not
until the 1980s that researchers began to make concerted efforts to include male victims in
their samples (Finkelhor, 1984). Most sexual abuse researchers agree that the sexual abuse
of boys is still grossly under-reported (Briggs & Hawkins, 1995; Cermak & Molidor, 1996;
Porter, 1986). At least three factors likely contribute to this under-reporting. First, when the
abuser is male, boys may not report the abuse for fear they will be identified as gay (Cermak
& Molidor, 1996; Valente, 2005). Second, if the abuser is female, boys might interpret the
abuse as a culturally condoned sexual initiation experience for which they should feel
lucky rather than victimized (Dimock, 1988; Hunter, 1990). Third, sexual offenders
typically utilize more force and threats of violence with male than with female victims when
warning them not to report the abuse (Pierce & Pierce, 1985), so boys might feel more
intimidated than girls about reporting.
Although studies of sexually abused boys are becoming more common, exclusively male
samples are rare, usually consist of fewer than thirty participants (Feiring, Taska, & Lewis,
1999), and typically comprise adult men reporting retrospectively on their childhood abuse
experiences (Briggs & Hawkins, 1995; Dhaliwal, Gauzas, Antonowicz, & Ross, 1996;
Etherington, 1995). Furthermore, due to the low frequency with which males report sexual
abuse outside of a therapeutic or research setting (Valente, 2005), male sexual abuse
samples often comprise specialized groups such as incarcerated pedophiles, prison inmates,
and members of institutions such as the armed forces or boarding schools (Darves-Bornoz,
Choquet, Ledoux, Gasquet, & Manfredi, 1998), which are not necessarily representative of
the population of male victims.
Finally, due to small sample sizes of male victims, many current theories about how sexual
abuse affects boys and how various features of the abuse experience affect girls and boys
differently have been generated from case studies, anecdotal reports, and qualitative studies
(Dimock, 1988; Durham, 2003; Gilgun & Reiser, 1990; Krug, 1989). This important, in-
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depth work has generated many useful observations and hypotheses; however,
complementary quantitative research is needed to test these hypotheses empirically.
Retrospective reporting of childhood sexual abuseMany studies of CSA and its
negative developmental sequelae have involved adults retrospectively reporting childhood
abuse (Finkelhor et al., 1990). Although these studies are valuable because they may include
individuals who never reported abuse as children (Kendall-Tackett & Becker-Blease, 2004),
Widom and others have highlighted the importance of also conducting research with youth
samples because findings often differ from those of retrospective studies (Raphael, Widom,
& Lange, 2001; Widom, Weiler, & Cottler, 1999). Moreover, Hardt and Rutter (2004)
identified significant measurement error in retrospective studies, particularly when
individuals were asked to recall how they felt about events at the time they were happening.
As many studies aim to identify associations between the experience of CSA and
psychological well-being, there is clearly a need for additional studies in this field that
utilize youth samples.
Current research needs
Some evidence suggests that sexual abuse might affect boys and girls differently, and that
the prevalence of certain characteristics of the sexual abuse experience might differ for boys
and girls (Bauserman & Rind, 1997; Darves-Bornoz et al., 1998; Feiring et al., 1999;
Finkelhor et al., 1990; Fontanella, Harrington, & Zuravin, 2000; Friedrich, Urquiza, &
Beilke, 1986; Gold, Elhai, Lucenko, & Swingle, 1998; Kendall-Tackett & Simon, 1992). For
example, female adolescent sexual abuse victims have been shown to display more somatic
complaints and mood disorders than male victims, whereas males have been shown to
display more behavioral problems than females (Darves-Bornoz et al., 1998). However,
some researchers have not found sex differences in the effects of CSA (Calam, Horne,
Glasgow, & Cox, 1998; Young, Bergandi, & Titus, 1994), and at least one study has found
that male adolescent victims tend to exhibit more emotional, behavioral, and suicidal
problems than their female counterparts (Garnefski & Diekstra, 1997).
Characteristics of the abuse experience have also been shown to differ for girls and boys.
One review paper found that the estimated percentage of male victims perpetrators who are
themselves male ranges from 18 to 97, depending on the study, and that the estimated
percentage of male perpetrators for female victims ranges from 80 to 100 (Dhaliwal et al.,
1996). Another study of early childhood victims found that boys were more likely to
experience fondling and oral intercourse than girls, whereas girls were more likely to
experience penetrative abuse (Fontanella et al., 2000). Finally, girls may be more likely to
be sexually abused by family members, whereas boys may be more likely to be abused by
strangers (Finkelhor et al., 1990; Gold et al., 1998). Existing studies suggest that certain
characteristics of the abuse experience, including the use of force and coercion, penetration,
familial perpetrators, and longer duration of abuse, are associated with more negative
outcomes (Beitchman et al., 1991; Browne & Finkelhor, 1986; Estes & Tidwell, 2002;
Friedrich et al., 1986; Molnar, Buka, & Kessler, 2001).
In short, given how little is known about male sexual abuse victims in general, and how little
is known about sex differences in the experience and consequences of childhood sexual
abuse, it is important to test empirically whether potentially important abuse characteristics
differ in their rates and consequences for males and females in a national sample of victims
still in their youth. Social workers and clinicians working with sexually abused children
within the confines of limited time and resources need a solid body of evidence to which
they can refer in order to implement the most empirically-grounded assessments and
treatments possible. Furthermore, some researchers and clinicians continue to operate on the
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assumption that boys are, in general, less adversely affected by childhood sexual abuse than
are girls, but this may be a potentially dangerous assumption to operate on without solid
empirical supporting evidence.
While it is important to examine how abuse characteristics affect boys and girls differently
across childhood, it may be especially important to focus on the subpopulation of
adolescents, as it is during this stage of life that youth experience the normative emergence
of sexuality and sexual identity. These processes may be compromised and complicated by
sexual abuse, leading to symptoms of psychopathology (Berliner & Conte, 1990; Durham,
2003). Furthermore, adolescence is a time of emerging self-identity and self-awareness
(Erikson, 1968), and adolescents may question their own motives more and experience more
self-blame for abuse than younger children (Celano, 1992; Myers, 1989).
The current study addresses the questions of whether the prevalence of different abuse
characteristics differs for male and female victims, and whether there are sex differences in
the association between sexual abuse characteristics and youth emotional and behavioral
problems. We first examine these questions in a sample of children ranging in age from 4 to
16 years, and then focus on youth aged 11 years and older. In light of the existing literature,
we predict that girls will experience higher rates of penetrative abuse and will more
frequently have familial perpetrators than boys, and that because these are the characteristics
most associated with psychopathology, girls will have higher rates of psychopathology
symptoms than boys. However, we also predict that child sex will not moderate the
association between different abuse characteristics and childrens difficulties (i.e., that these
characteristics will be equally associated with psychopathology in boys and girls).
Nonetheless, given the limitations to the existing literature in this field, this study is largely
exploratory.
Method
Participants
The National Survey of Child and Adolescent Well-Being (NSCAW) is a nationally-
representative sample of United States children who have had contact with Child Protective
Services (Dowd et al., 2004). The full cohort includes 5,501 children (50% female), less
than 1 year to 16 years of age when sampled, who were subjects of child abuse or neglect
investigations conducted by CPS from October 1999 to December 2000. Participants in the
NSCAW study gave informed consent to enroll in the study, and the study procedures were
approved by the participating universities Institutional Review Boards. Additional
information about sample composition is available from Dowd and colleagues (Dowd,
Kinsey, Wheeless, & NSCAW Research Group, 2004). The present studys sample is
restricted to children who, according to caseworker reports, were investigated as alleged
victims of sexual abuse. Interviews were collected 26 months following the close of the
CPS investigations. Children who were members of the same household as a previously
selected child were not eligible to participate in the study, in order to limit the burden on
families. Therefore, there are not any siblings included in the NSCAW sample.
Analyses were conducted with two subsets of youth. The first subset, the child and
adolescent sample (n =573; 72% female), comprised children 4 years or older (M =9.46
years; SD =3.28). Fifty percent of children in the child and adolescent sample were White
(non-Hispanic), 23% were Black (non-Hispanic), 18% were Hispanic, and 8% were of other
races or ethnicities. The second subset, the adolescent sample (n =234; 82% female),
consisted of youth 11 years or older (M =12.82 years; SD =1.28). Forty-eight percent of
children in the adolescent sample were White (non-Hispanic), 26% were Black (non-
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Hispanic), 20% were Hispanic, and 7% were of other races or ethnicities. 90% of caregivers
in the sample were female, and the average annual income of families was $19,000.
Measures
Internalizing and externalizing symptomsCaregivers were administered the Child
Behavior Checklist (CBCL), which includes an externalizing scale comprising delinquent
and aggressive behavior domains, and an internalizing scale comprising withdrawn
behavior, somatic complaints, and anxious/depressed domains (Achenbach, 1991a).
Caregivers were asked 113 questions on a 3-point Likert-type scale (0 =not true, 1 =
somewhat or sometimes true, 2 =very true or often true). Internal consistency reliabilities
were high for both externalizing ( =.92) and internalizing ( =.90) scales. Childrens age-
and gender-standardized T scores were used in all analyses. T scores at or above 65 are
considered clinically significant because this cut-off has been shown to significantly
discriminate between children referred for mental health treatment and matched children
who are not referred (Achenbach & Rescorla, 2001).
Youth in the adolescent sample were administered the Youth Self-Report (Achenbach,
1991b), which contains 113 questions similar to those in the CBCL. Internal consistency
reliability was high ( =.90 externalizing, =.90 internalizing). Youths age- and gender-
standardized T scores were used in all analyses. The correlation between caregiver and
youth reports of externalizing symptoms in the adolescent sample was 0.40, and the
correlation for internalizing symptoms was 0.39 (both significant at the p <.01 level). This
magnitude of agreement among informants is standard (Achenbach, McConaughy, &
Howell, 1987). Given that parent and child reports of psychopathology do not correlate
perfectly, and that adolescents may be in a better position to report on their own emotional
and behavioral functioning than caregivers, it is important to examine both youth and
caregiver reports of psychological functioning when available.
Trauma symptomsYouth in the adolescent sample were administered the Post
Traumatic Stress Disorder section of a version of the Trauma Symptom Checklist for
Children adapted for NSCAW (Briere, 1996). The measure included ten questions asking
children to describe how often they experienced various symptoms (1 =never; 2 =
sometimes; 3 =lots of times; 4 =almost all of the time). For example, youth were asked
how often they have bad dreams or nightmares, and how often scary ideas or pictures just
pop into [their] head. Internal consistency reliability on this measure was adequate ( =
0.84). Again, youths age- and gender-standardized T scores were used in all analyses, and T
scores at or above 65 are considered clinically significant (Briere, 1996).
Abuse characteristicsCaseworkers indicated whether or not the alleged abuse was
substantiated (0 =no; 1 =yes). They also categorized the nature of the childs sexual abuse
experience, which we transformed into a dichotomous variable indicating whether the abuse
was penetrative (1) or non-penetrative (0). Penetrative abuse included vaginal/anal
intercourse, digital penetration of the vagina/anus, and oral copulation of an adult if the
perpetrator was male. Non-penetrative abuse included fondling/molestation, masturbation,
oral copulation of the child, oral copulation of an adult if the perpetrator was female, and
other less severe types. Finally, caseworkers indicated other types of maltreatment
children experienced. We transformed this information into a dichotomous variable
indicating whether children experienced multiple forms of maltreatment (physical, neglect,
or emotional in addition to sexual; 1) or only sexual abuse (0). Caseworkers also indicated
who the alleged perpetrator was, from which we classified them as familial (1) or non-
familial (0). Familial perpetrators included mothers, fathers, step-mothers, step-fathers,
grandmothers, grandfathers, aunts, uncles, brothers, sisters, and other relatives. Non-familial
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perpetrators included mothers boyfriends, neighbors, strangers, friends, and child care
providers.
Analysis approach
Logistic regression was used to test the hypotheses that girls were more likely than boys to
have experienced penetrative abuse and to have familial perpetrators. Two multivariate
analyses of covariance (MANCOVAs) were conducted to test whether there were sex
differences in the association between abuse characteristics and youth emotional and
behavioral problems in the child and adolescent sample and the adolescent sample.
Statistical approaches that require omnibus test significance before examining specific
contrasts are most appropriate when the research question has yielded limited and/or mixed
results in the extant literature (Burchinal & Clarke-Stewart, 2007), such as the current
research question. This type of conservative analysis approach minimizes the risk of Type I
error, unlike alternative a priori comparison approaches such as regression (Kirk, 1982).
Given that the NSCAW weights are highly variant whole sample weights, they are not
appropriate to use with small subsamples, and so were not used in these analyses. All
analyses were conducted using SPSS 14.0 (2005).
Results
Missing data
Missing data ranged from less than 1% for measures of emotional and behavioral problems
to 26% for characteristics of the sexual abuse. Because analyses based on listwise-deleted
data have been shown to generate biased and inefficient parameter estimates (Schafer &
Graham, 2002), multiple imputation was used to generate a set of complete observations for
all sample members. Five multiply imputed data sets were created using the Stata 9.0
(StataCorp, 2005) user-written add-on program ICE (Imputation by Chained Equations)
(Royston, 2005). ICE imputes missing values using an iterative regression switching
procedure (Royston, 2004; Royston, 2005). By default, ICE uses linear regression to
estimate values for any incomplete continuous variable, and logistic regression to estimate
values for any incomplete dichotomous variable. The imputed values are obtained by
sampling from the distribution of the incomplete variable, given the observed values and
explanatory variables included in the predictive model. One advantage of ICE is that it does
not assume normality of the joint multivariate distribution of variables, so different types of
variables (e.g., continuous, categorical) can be imputed simultaneously. For a description of
how ICE combines the estimates and obtains standard errors, see Carlin, Li, Greenwood, and
Coffey (2003).
Descriptive data and correlations among variables
Tables 1 and 2 provide descriptive statistics for abuse characteristics and childrens
psychopathology symptoms. Table 3 provides a correlation matrix displaying relationships
among all analysis variables. Statistically significant correlations were small in magnitude,
indicating that multicollinearity was not a problem.
Sex differences in the likelihood of experiencing different abuse characteristics
Logistic regression analyses revealed some sex differences in the likelihood of experiencing
different sexual abuse characteristics. Girls in the child and adolescent sample had
significantly higher odds of having their abuse substantiated and of experiencing penetrative
abuse (Table 1). Girls and boys were equally likely to have a familial perpetrator and to
experience multiple forms of maltreatment. In the adolescent sample, girls were more likely
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than boys to have their abuse substantiated, but did not differ from boys on any of the other
three abuse characteristics.
Sex differences in associations between abuse characteristics and youth emotional and
behavioral problems
The MANCOVA conducted with the child and adolescent sample included the dependent
variables of caregiver-rated internalizing and externalizing symptoms. The childs age was
entered as a covariate, and five variables were entered as fixed effects: child sex, penetration
status, substantiation status, perpetrator familial status, and multiple maltreatment status.
The multivariate test (Wilks Lambda) was significant for substantiation status and child age
(Table 4). The univariate tests of substantiation and age were significant for externalizing
and internalizing symptoms. Children with substantiated abuse cases had higher
externalizing (M =60.75, SD =12.09) and internalizing (M =57.96, SD =11.35) scores than
children with unsubstantiated cases (externalizing M =57.84, SD =12.64; internalizing M =
55.31, SD =11.74). Older children had more externalizing and internalizing symptoms than
younger children. No other multivariate test for main or interactive effects was significant.
A second MANCOVA was conducted to investigate sex differences in the association
between abuse characteristics and youth emotional and behavioral problems within the
adolescent sample. The dependent variables were caregiver-reported internalizing and
externalizing symptoms and youth-reported internalizing, externalizing, and trauma
symptoms. Covariates and fixed effects were identical to those in the analysis of the child
and adolescent sample. No multivariate test for main or interactive effects was significant,
with the exception of one uninterpretable result. Specifically, the multivariate test (Wilks
Lambda) was significant for penetration. However, the univariate test of penetration was not
significant for any outcome measure (full analyses available upon request).
Discussion
This study contributes to the limited body of quantitative research that examines sex
differences in the experience and psychological sequelae of childhood sexual abuse in youth
samples. The study had several methodological strengths. First, the samples were relatively
large by sexual abuse sample standards, and were drawn from a national sample of children
involved with the United States CPS system. Second, the samples included enough male
victims to allow for tests of sex differences in the rates and correlates of specific abuse
characteristics. Third, the NSCAW dataset included information about a number of
potentially important sexual abuse characteristics. Fourth, the sample was large enough to
allow for tests of sex differences in the effects of abuse specifically among adolescents, for
whom issues of sexual identity are especially salient. Youth reports of their own emotional
and behavioral functioning were also available for adolescents in this sample.
Implications for future research
The analyses revealed sex differences in the prevalence of two abuse characteristics: girls
were more likely than boys to have their abuse substantiated, and girls in the child and
adolescent sample were more likely to experience penetrative abuse. The sex differences in
substantiation rates is interesting, and might reflect either a true sex difference, or a bias in
what types of cases end up substantiated by CPS. While differentiating between these two
potential explanations is outside the scope of the present paper, it is an important question to
examine in future studies because there may be a subset of victims, such as boys,
particularly at-risk for having their abuse unsubstantiated. Furthermore, there may be a
subset of victims at risk for having their abuse undetected and/or unreported in the first
place. For example, perhaps young boys who experience penetrative abuse are particularly
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at-risk for not having their abuse detected and reported to CPS, due in part to societal lack of
awareness of sexual abuse of young boys, and/or perpetrators more concerted efforts to
hide their abuse of boys.
Despite some sex differences in the prevalence of abuse characteristics, there were not any
sex differences in the severity of internalizing, externalizing, or trauma symptoms. Although
other studies have shown that males and females respond differently to sexual abuse (e.g.,
Bauserman & Rind, 1997; Friedrich et al., 1986), many of those studies identified sex
differences in specific symptoms like nightmares and somatic complaints (Darves-Bornoz et
al., 1998), whereas the present study examined broad categories of mental health symptoms.
Thus, there may be sex differences in the association between sexual abuse and specific
psychopathology symptoms, but not many differences at more global levels. Methodological
differences among studies could also account for discrepant findings. Many studies that have
found sex differences either utilized child samples with smaller age ranges than the present
sample (Fontanella et al., 2000), or used samples of adults reporting retrospectively on
childhood abuse (Bauserman & Rind, 1997; Dhaliwal et al., 1996). Although these
methodological differences make cross-study comparisons difficult, the present results,
combined with those from other studies that failed to find sex differences in how sexual
abuse affects childrens mental health (Calam et al., 1998; Young et al., 1994), suggest that
further study is needed before researchers, social workers, and clinicians can conclude that
sexual abuse is more psychologically damaging for one sex than the other.
Furthermore, it is possible that small sample sizes have detracted researchers from
publishing studies about sex differences in the experience and consequences of sexual abuse.
For example, if analyses that yield null results have been attributed to small sample sizes
and have remained unpublished, and if the few studies that have yielded sex differences
(true differences or those produced as a result of Type I error) have been published, then the
literature base in this field may be biased. In other words, it is possible that the file drawer
problem, in which researchers fail to publish non-significant findings (Rosenthal, 1979),
may be operating within this field due to the small sizes of samples that include males. It is
important, then, that more studies such as the present one enter the literature base not only
for the information they contain individually, but also to inform future meta-analyses.
This study did not examine the role of perpetrator sex in sexually abused girls and boys
symptomatology, because information on perpetrator sex was missing for many children and
the number of youth with known female perpetrators was very small. However, researchers
with access to samples that include more youth with female perpetrators should test the
qualitatively-derived hypothesis that having a male perpetrator may be particularly
damaging for male adolescent victims because they are in a stage of development in which
issues related to sexuality are normatively expected to emerge (Durham, 2003; Erikson,
1968). For example, in one practitioner study, male victims sexually abused by men during
adolescence expressed significant concerns about their sexuality, and fear that their peers
would learn of the abuse and consider them gay as a result of it (Durham, 2003). Given that
there is a natural biological increase in sexual drives and sexual awareness during
adolescence (Moore & Rosenthal, 1993), male victims sexually abused by men often report
feeling some physical pleasure during the abuse, which is associated with extreme shame
and confusion about the experience, their sexuality, and their sexual identities (Durham,
2003). Furthermore, it is possible that boys sexually abused by women may be particularly
unlikely to report their abuse. Thus, this is an important domain of study for future research
efforts.
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Implications for clinical intervention
Although victims in the child and adolescent sample whose abuse was substantiated had
more externalizing and internalizing symptoms than victims with unsubstantiated abuse,
these results did not replicate within the adolescent sample. Furthermore, neither familial
perpetrator status nor multiple maltreatment predicted differences in emotional or behavioral
problems in either sample, despite the relatively large sample sizes. These findings suggest
that it may be problematic to assume that a child is a low priority for intervention services
because he/she did not have his/her abuse substantiated (especially among adolescents), or
because the abuse did not fit a profile of what is typically perceived of as more severe.
Assuming that an adolescent is less at risk for behavioral, emotional, and social difficulties
because their sexual abuse was not substantiated, for example, may result in missing
multiple survivors in need of treatment.
The present study also tested whether the association between sexual abuse characteristics
and emotional and behavioral problems differed in males and females. In the child and
adolescent sample and in the adolescent sample, there were no significant interactions
between child sex and sexual abuse characteristics. Thus, although certain characteristics of
sexual abuse are more common in females than males, these characteristics appear to affect
girls and boys similarly. In sum, this study suggests that it may not be particularly
straightforward to design abuse severity profiles for risk assessments based on abuse
characteristics or victim sex alone or in combination. Furthermore, it is important for
clinicians to assess for various types of psychopathology as comprehensively in males as in
females, given that child sex does not appear to be a moderator of the relationship between
abuse characteristics and child outcomes. Finally, although age was not a focal variable of
this study, age did emerge as a significant predictor of childrens psychopathology
symptoms. This suggests that it may be important to ensure that young adolescents mental
health needs are not neglected, and that age-appropriate treatments for older youth continue
to be developed and implemented.
Limitations
Although the sample sizes were relatively large by previous study standards, power to detect
sex differences in emotional and behavioral problems, abuse characteristics, and the
association between abuse characteristics and emotional and behavioral problems was still
limited in the adolescent subsample. Second, while this study considered four characteristics
that can differ among sexual abuse experiences, there are other potentially important
characteristics that were not examined, such as duration, age-of-onset of abuse, and
perpetrator sex. Third, it is likely that the children in this sample were also experiencing
other types of stressors, such as poverty and community violence, that may also have been
contributing to their emotional and behavioral problems, and that may have been
differentially predictive for males and females. This study does not tease apart the unique
contribution of sexual abuse or shed any light on how childrens contexts further moderate
experiences of abuse on their psychological well-being. Fourth, this study examined
childrens emotional and behavioral symptoms, not explicit diagnoses.
Fifth, there was not enough statistical power to consider how girls and boys of different
races and ethnicities were affected by characteristics of the abuse experience, and the only
variable related to race or ethnicity in the NSCAW dataset was the childs race, identified by
caregivers as one of a limited set of forced choices. The cultures in which children of
different races and ethnicities grow up may shape very different understandings of sexual
abuse experiences, and the balance of risk and protective factors that characterize sexually
abused boys and girls may vary greatly as a function of race and ethnicity. Thus, it is not
clear that our findings will generalize to racial and ethnic subgroups. Whereas child sex did
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not emerge as a moderator in this study, it is possible that other demographic and contextual
factors---such as the childs ethnicity and/or culture---may serve as moderators. Sixth, the
imputation procedure we used assumes that data are missing completely at random
(MCAR). To the extent that this is not true, our results may be biased. Seventh, one of our
hypotheses (that child sex will not moderate the association between abuse characteristics
and childrens difficulties) was a null hypothesis. One possibility is that this hypothesis was
confirmed due to limited power to detect a moderating effect, rather than a true lack of
moderation.
Despite these limitations, the present study provides new quantitative data on sex differences
in the likelihood of experiencing different sexual abuse characteristics, and the ways in
which sex moderates the association between these characteristics and childrens emotional
and behavioral problems. The national nature of the sample, the samples size, and the fact
that victims in the sample were still in their youth contribute to the novelty and strength of
the study. Nonetheless, significantly more research on sex differences in childrens
responses to sexual abuse (and other types of abuse and trauma) is needed before clinicians
and intervention specialists can design and implement the most empirically-grounded
assessments and treatments possible for this vulnerable population of youth. Given the
inherent dangers of the file drawer problem, in which researchers fail to publish findings that
show few significant differences (Rosenthal, 1979), it is crucial that studies such as the
present one enter the literature base.
Acknowledgments
This work was supported by grant HD050691 fromthe National Institute of Child Health and Human Development
to S. J affee. This document includes data fromthe National Survey of Child and Adolescent Well-Being, which
was developed under contract with the Administration on Children, Youth, and Families, U.S. Department of
Health and Human Services (ACYF/DHHS). The data have been provided by the National Data Archive on Child
Abuse and Neglect.
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