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RISK OF SEXUALLY ABUSED CHILDREN BECOMING ADULT ABUSERS LOWER THAN PREVIOUSLY THOUGHT (pp 446, 471; see also Editorial p 443)

February 05, 2003

Issue 8 February 2003
Embargoed 0001 h (London time) 7 February 2003

Authors of a UK study in this week's issue of THE LANCET suggest that most male victims of child sexual abuse do not abuse children later in life-however there are specific factors that increase the chances of sexually abused children becoming abusers.

Sexual maltreatment is one of the most common forms of child abuse. Abusers are usually adolescent or adult males known to their victims; estimates of prevalence of former victims in the general population vary from 3% to 37% in males and from 7 to 53% among females . David Skuse and colleagues from the Institute for Child Health, London, UK, assessed childhood experiences and personal characteristics of male child victims who became abusers in later life in order to identify risk factors for sexually abusive behaviour.

The investigators identified 224 former male victims of sexual abuse whose records of abnormal behaviours relating to their abuse were available from medical and social services records. Evidence of later criminal behaviour-including sexually abusive acts-was obtained from a nationwide search of official records.

26 of the 224 former victims (12%) had subsequently committed sexual offences-in almost all cases with children-mainly outside their families. Several factors during childhood increased the risk (around threefold) of male victims becoming abusers: material neglect, lack of supervision, and sexual abuse by females. A third of abused children who later became abusers had inflicted cruelty on animals during childhood, compared with only 5% of abused children who did not become sexually abusive. Abused children who witnessed violent behaviour within their families were more than three times more likely to become abusers in later life.

David Skuse comments: "Public concern about paedophilia is rising. Our results suggest that other early life experiences can substantially increase the risk of subsequent sexually abusive behaviour, above and beyond the fact of sexual victimisation. With a greater understanding of the potential mechanisms underlying continuities in sexual abuse, from adolescence to adulthood, comes the possibility of designing more effective preventive intervention programmes. Our findings are of potential importance to a wide range of medical and other specialists who become professionally involved with both the victims and perpetrators of child sexual abuse."

An accompanying Commentary (p 446) by Paul Bouvier from Service sante jeunesse, Geneva, Switzerland, focuses on the abused children who do not become abusers later in life as a target for future investigation. He comments: "it would be most interesting to study those victims who became resilient. About 20-44% of previous victims of child sexual abuse seem to experience no symptoms or mental health problems. How did these individuals manage to get out of the circle of repetition of the abuse, to avoid other risks, and to develop a meaningful life in spite of their terrible history? There is much to be learnt from resilient individuals. Resilience, just as vulnerability, is influenced by genetic and environmental factors, which interact, most probably with a contribution of the will of the subject."


This week's Lancet editorial (p 443) comments on Skuse and colleagues' research and the wider issue of childhood neglect based on recent cases that have hit the headlines in the UK. It concludes: 'While lessons must be learned from high-profile examples where child protection has failed, future strategies cannot be based on crisis responses to individual cases. As with any other clinical problem, that of child maltreatment requires the development of a comprehensive research agenda to inform and improve prevention, diagnosis, interventions, and public-health provisions.         

Without such commitment, the true scandal is not the failure of a handful of individual professionals in notorious cases, but the systematic failure of all relevant professions towards the generations of children at risk to come.'

Lancet