“The Silent Epidemic: Child Sexual Abuse”, US News and World Report
By Elaine Cox, M.D., Contributor, June 1, 2018
Nearly 42 million people are living with a history of sexual abuse during childhood.
IMAGINE A CHILD SITTING in a hospital room with a lack of hair and tied to an IV pole. He or she is feeling poorly and looks ill. The child is a victim of cancer. They may be tragically aware their life is to be cut short. All around them, there are adults taking care of them and suffering as well – family members, nurses, doctors and friends. Chaplains, social workers and child life experts are on the lookout for coping mechanisms. It’s a heartbreaking scene for everyone.
Now imagine, if you will, a child who looks despondent. He or she is sitting in a room, alone with darkness around them. They, too, are contemplating a future that is dark and hopeless. Only in this case, the child is alone – likely because no one knows of their suffering. They keep it silent and hidden. They are the victims of child sexual abuse.
Aptly dubbed the silent epidemic, child sexual abuse estimates in the United States are devastating and stunning. In fact, it’s surmised that nearly 42 million people are living with a history of sexual abuse during childhood, roughly twice as many people as are living with cancer. In fact 1 in 4 girls and 1 in 6 boys are likely to experience this type of abuse. In these cases, greater than 90 percent of the perpetrators are someone known to the child, with as many as 40 percent being in the family and another 40 percent by other stronger or older children.
So why does this epidemic continue to rage, seemingly unchecked? There are likely many different reasons. One is that the child is often racked with undeserved guilt that they must have done something wrong or that it is their fault. To an adult, that sentiment clearly seems unwarranted, but we know that children frequently over-identify their roles in circumstances beyond their control, such as the divorce of parents. In addition, the abuser is likely to be a master manipulator, playing on the child’s sense of responsibility and helplessness, reinforcing the guilt in the victim.
Additionally, the child may be fearful that he or she will not be believed. In fact, 1 out of 3 adults are unlikely to believe a disclosure made by a child with regard to sexual abuse. And even if they are believed, they may hesitate due to the collateral damage that will inevitably follow. Since most abusers are known to their juvenile victims, it’s inevitable that telling will result in several secondary victims: the family of the victim, the family of the perpetrator and other members of society who also know.
So, these children and adult survivors suffer in silence way too frequently and for way too long. Shame and uncertainty about how society will react muffle their cries for help. They sit alone, despondent, and consider suicide. In fact, they are 7 to 13 times more likely to commit suicide than the rest of the population. And many will have other difficulties along their life journey based on trust that was violated and a childhood that was stolen away.
If the diagnosis was organic, such as in the case of the child with cancer, we would have a set of symptoms to define, lab tests to confirm and an entire treatment plan laid out within days of presentation. But with child sexual abuse, we don’t identify the symptoms. It may be that we’re not aware of the constellation, or they may be attributed to other things, such as teen angst or hormones. But the symptoms are there – often withdrawal, depression, weight gain and loss of friends and activities. While these may indicate other concerns, we don’t put sexual abuse on our differential. But just like any other history we take, we just need to ask the right questions, and the signs may become clear.
The most important response we can have is to believe the child and support him or her in telling the truth. Immediately changing the situation to protect the child and informing law enforcement will shine a light on the situation and give further facts an opportunity to emerge. Since many abusers have recidivism, there are likely other victims waiting in the shadows.
This is a subject that turns our stomachs, and we so want to believe it isn’t happening to any child we know. But with those statistics, that seems unlikely. We need our children to have someone they can tell – a parent or teacher or another adult that they trust will believe and protect them. In almost every state, there are laws like Jenna’s Law, which ensures those who educate children are made aware of the signs and symptoms of child sexual abuse and know how to identify and assist with cases when they arise.
As a society, we need to know that the first step in dealing with any epidemic is acknowledging its existence and then setting a course of action to eradicate it. While there is no vaccine for child sexual abuse, we must start somewhere. Too many impacted children are sitting alone, suffering in silence. We wouldn’t stand by for any other diagnosis. We need to give that deafening silence a roaring voice.
Dr. Elaine Cox is the Chief Medical Officer of Riley Children’s Health in Indianapolis. She is also the Riley clinical safety officer. Dr. Cox practices as a pediatric infectious disease specialist and also instructs students as a professor of clinical pediatrics at the Indiana University School of Medicine. The former director of the pediatric HIV and AIDS program, Ryan White Center for Pediatric Infectious Diseases at Riley, Dr. Cox helped lead the effort to change Indiana law to provide universal HIV testing for expectant mothers.