The Impact of Sexual Abuse Committed by a Child on Mental Health in Adulthood

Abstract

Numerous research studies document the negative mental health outcomes associated with the experience of childhood sexual abuse. In addition, factors such as one’s relationship with the perpetrator and the severity of the abuse predict the likelihood of future mental health problems. Less attention, however, has focused on the age of the perpetrator, and recent years have seen an increased interest in children who display sexual behavior problems. College students completed measures of mental health functioning and retrospective reports of maltreatment histories. Participants were categorized as abused by an adult (n = 48), teenager (n = 39), or another child (n = 37), and non-abused (n = 219). Victims of abuse, regardless of perpetrator age, displayed higher levels of mental health problems than non-abused participants. There were no differences between the abused groups on any of the mental health outcomes; however, individuals who were abused by other children were less likely to label their experiences as abuse.

Keywords

sexual abuse sexual problems physical abuse neglect

Significant attention has been dedicated to investigating the psychological sequelae that stems from allegations of childhood sexual abuse (CSA). In fact, various studies have reported emotional and behavioral problems at various stages of development as a result of CSA (see Kendall-Tackett, Williams, & Finkelhor, 1993, and Putnam, 2003, for reviews). The evidence demonstrates that young adults with sexual abuse histories experience higher incidences of mental health problems such as depression, anxiety, posttraumatic stress, and anger/aggression. In addition, a multitude of studies have demonstrated that sexual abuse characteristics such as relationship with the perpetrator, severity, and frequency of abuse, among others, modulate the emotional and behavioral difficulties experienced by the survivor (see Yancey & Hansen, 2010, for a review). One sexual abuse–related factor often ignored in the research is the age of the perpetrator. Although less recognized and studied, children may be perpetrators of sexual abuse against other children (Berliner, 2011). Current estimates are that one out of every eight incidents of CSA is committed by a child under 12 years of age (Finkelhor, Ormrod, & Chaffin, 2009).

Seminal research by Friedrich and colleagues (Friedrich, Grambsch, Broughton, Kuiper, & Beilke, 1991; Friedrich, 1997) clearly demonstrated that a minority of children may display sexually violent behaviors, including attempting to force sexual intercourse on peers. Some studies have documented potential causes of the development of sexual behavior problems in children, including sexual abuse (Friedrich, 1997; Gray, Pithers, Busconi, & Houchens, 1999), physical abuse, and neglect (Merrick, Litrownik, Everson, & Cox, 2008); however, the impact of these children’s sexual behaviors on the victim is less well known. In addition, there is a noted concern that many in the general public may perceive sexual behavior among children as normal exploration and not recognize the potential harm of coerced sexual activity (National Center on Sexual Behavior of Youth, 2003).

Only two identified studies have examined the impact of child-on-child sexual abuse on victims. Shaw, Lewis, Loeb, Rosado, and Rodriguez (2000) assessed 194 sexually abused, clinically referred children and their families. They compared the emotional and behavioral presentations of children who were sexually abused by individuals younger than 17 years of age (juveniles) with those of children who were victimized by individuals older than 18 years (adults). Of the 194 children, 26% (n = 51) and 74% (n = 143) were victimized by juveniles and adults, respectively. Their findings suggested that children victimized by juveniles and adults experience similar levels of emotional and behavioral distress, including depression, anger, anxiety, and posttraumatic stress, regardless of whether the reporter was the child or caregiver. However, results indicated that children victimized by juveniles more frequently displayed higher levels of sexual concerns, especially preoccupation with thoughts related to sexual issues.

A significant limitation of the (Shaw et al., 2000) study was the consideration of all children whose perpetrators were under the age of 18 as a singular group. Particularly for younger children, it may be difficult to distinguish between a perpetrator who is a teenager versus one who is an adult. In essence, this study is unable to answer questions pertaining to the impact of sexual abuse perpetrated by another child of similar age. In addition, the study was focused on the presentation of children referred for a mental health evaluation, which does not provide information on functioning in later life and relies on a sample pre-selected based on the likelihood of existing emotional and/or behavioral problems. Finally, no control group was used to compare the abused children with non-abused peers.

The second study to examine this research question (Sperry & Gilbert, 2005) utilized archival data to evaluate the impact of sexual victimization perpetrated by a child on emotional and behavioral problems in later life. The sample was divided into three groups: sexually abused prior to age 13 by another child younger than 13 (n = 25), sexually abused prior to age 13 by someone who was 13 years of age or older (n = 36), and non-abused controls (n = 36). They noted that those who were abused by adolescents/adults reported more invasive and intrafamilial sexual abuse experiences than those abused by other children. The authors noted that less than half of the sample responded to a study-specific questionnaire examining many of the relevant mental health outcomes. As such, only analyses of a short-form version of the Minnesota Multiphasic Personality Inventory (MMPI) are discussed here. These analyses suggested that those abused by adolescents/adults were more likely to demonstrate signs of psychosis compared with the other two groups, and were more likely to report anxiety symptoms than the control group. This study was limited by the lack of separate groups for those victimized by adolescents and adults, as well as being unable to examine a number of relevant variables as a result of missing data.

The current study extends the findings of these previous studies and attempts to address some of the previously noted limitations. First, the current study divided participants experiencing child sexual abuse into three separate groups depending on the age of the perpetrator (child peer, teenager, adult) and includes a non-abused control group. Second, other child maltreatment and traumatic experiences were assessed, so the impact of these experiences could be examined on mental health outcomes. Third, characteristics of the sexual abuse and post-abuse events and perceptions were compared across the abuse groups.

Method

Sampling Procedure

A sample of undergraduate students from a university in the southern United States participated in a study assessing factors that influence personality traits and relationships. Participants self-selected into the study and were compensated with research participation credit for use in a psychology course. Participants completed all measures using an online-based survey administration program, allowing measures to be completed at a time and location of their choosing. No identifying information linking the participant to his or her responses was collected. There were no exclusion criteria for potential participants, and non-abused participants were not screened out prior to participating in the study. A subsample of participants completed additional surveys asking specifically about sexual abuse histories prior to the age of 12. This age cutoff was used to delineate abuse that occurred in childhood as compared with experiences occurring after the beginning of adolescence/teenage years. The questions were presented in behavioral terms and no reference to “sexual abuse” was made. A total of 363 participant surveys were considered complete and usable for this study.

Measures

Sexual Abuse Experiences Questionnaire

Participants completed a multi-part questionnaire pertaining to previous sexual abuse experiences. The use of a web-based survey platform allowed for questions to be tailored to the participant based on answers to previous questions. The first part of this questionnaire asked participants: “Before you were 12 years old, did someone touch you in a sexual way even though you did not want them to, or did you touch someone else in a sexual way even though you did not want to?” Participants who denied this question did not complete other parts of this questionnaire; however, those who endorsed such an experience were presented with another question asking if the other individual(s) involved in the act(s) were 12 years old or younger (Child). If answered “yes,” the participant was presented with a series of follow-up questions that asked about numerous aspects of the abuse: relationship with the other child (e.g., sibling/step-sibling, friend), the severity of the abuse (e.g., hand-genital contact, oral-genital contact, genital-genital or anal-genital intercourse), coercion (e.g., “threaten you with physical harm,” “threaten loved one with physical harm,” “threaten to say shameful things about you,” “used force to make you engage in the acts”), if they told an adult about these unwanted acts, and if they considered the acts to be sexual abuse. Only this final question made reference to the phrase “sexual abuse.”

To standardize answers, all questions provided a menu of options from which the participant could choose, and they could endorse all applicable options. This process was repeated for parts of the questionnaire asking if individual(s) in the act(s) were (a) between the ages of 13 and 17 (Teen), or (b) 18 years old or older (Adult). When either of these questions were endorsed, the participant was presented with a follow-up questionnaire similar to the one described above, with minor wording changes to reflect the different age ranges. After each of these parts was completed, participants responded to a single question asking whether they had ever received mental health services, therapy, or treatment.

Trauma Symptom Checklist–40 (TSC-40)

The TSC-40 is a self-report measure assessing posttraumatic stress and other symptomology in adults who experienced child or adulthood traumatic experiences (Briere, 1997). It is composed of 40 items asking participants to rate the frequency with which they experience a variety of symptoms on a 4-point Likert-type scale ranging from 0 (never) to 3 (often). The TSC-40 items are summed to produce six subscales: anxiety, depression, dissociation, sexual abuse trauma index, sexual problems and sleep disturbance, as well as an overall symptom score. The current study utilized the anxiety, depression, and sexual problems scales. Previous studies have demonstrated that the TSC has adequate internal reliability; for example, Elliott and Briere (1992) produced Cronbach alpha averages between .62 and .77 for the subscales and .90 for the total scale. Internal reliability estimates (Cronbach’s alpha) for the current study ranged from .70 (depression) to .72 (sexual problems). Gold, Milan, Mayall, and Johnson (1994) compared the TSC-40 scores of women who had been sexually assaulted or abused with those who had not experienced sexual trauma. Results supported the validity of the TSC-40 as an indicator of sexual trauma.

Posttraumatic Stress Checklist–Civilian Version (PCL)

The PCL is a self-report instrument that assesses the symptoms associated with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 2000) diagnostic criteria for posttraumatic stress disorder (PTSD; Weathers, Litz, Huska, & Keane, 1994). It is composed of 17 items asking participants to rate the severity of symptoms on a 5-point Likert-type scale ranging from 1 (not at all) to 5 (extremely). The PCL displays excellent internal consistency, with Cronbach’s alpha for the total scale score reported as high as .94 (Ruggiero, Del Ben, Scotti, & Rabalais, 2003). The PCL demonstrated excellent internal reliability during the current study (Cronbach’s α = .92). High correlations between PCL scores and other measures of PTSD symptomology have been reported (Ruggiero et al., 2003).

Comprehensive Child Maltreatment Scale (CCMS)

The CCMS is a self-report measure that asks respondents to identify how frequently they experienced each of a number of acts of maltreatment during childhood (Higgins & McCabe, 2001). Questions are answered on a 0 (never or almost never) to 4 (very frequently) point Likert-type scale. They report the frequency with which each act was committed by a primary maternal figure (e.g., mother, step-mother), primary paternal figure (e.g., father, step-father), and another older adolescent or adult (e.g., relative, babysitter). Responses are then summed to compute a scale score for psychological abuse, physical abuse, neglect, and sexual abuse scales. The current study utilized each of these scales, except sexual abuse. Previous studies have demonstrated acceptable internal consistency for the CCMS (Allen, 2011) as well as acceptable concurrent validity (Higgins & McCabe, 2001). The current study obtained Cronbach’s alpha estimates ranging from .75 (neglect) to .83 (psychological abuse).

Trauma History Questionnaire (THQ)

Participants completed a study-specific questionnaire assessing the experience of traumatic events other than maltreatment. Participants were asked to identify whether or not they had experienced each of the following during their life: (a) Someone trying to take something from you by force, such as a mugging or stick-up, (b) been in a serious accident at work, in a car, or somewhere else, (c) experienced a natural or man-made disaster where you or someone you loved were in danger of death or injury, (d) engaged in combat during military service, (e) been attacked and seriously injured, and (f) been in any other situation where you were seriously injured or feared that you may be seriously injured or die. The number of “yes” responses was summed to produce a total score for the number of traumatic events experienced by each individual.

Data Analyses

Following demographic analyses and screening data for normality, two separate sets of analyses were performed. First, analyses examined potential mental health differences between the sexually abused groups (Child, Teen, Adult) and the non-abused group. Possible confounding variables, such as histories of other forms of maltreatment, were examined and included as covariates when found to be significantly different between the groups. To reduce test-wise alpha inflation, multivariate tests with post hoc comparisons were used when possible. Second, analyses were performed examining differences of sexual abuse characteristics and perceptions of the abuse among the sexually abused groups. This set of analyses was undertaken to determine if the groups differed on variables that may impact later mental health functioning, as suggested by previous research (e.g., abuse committed by a peer child may be less invasive). As before, analyses made use of multivariate methods with post hoc comparisons when possible.

Results

Participant Characteristics

Of the 363 participants, 144 participants (39.6%) endorsed a history of unwanted sexual contact prior to age 12. Participants endorsing a history of sexual abuse were asked to indicate the age of their perpetrator(s). Thirty-seven participants (25.7% of the abused sample) reported their offender was a child peer, 39 (27.1%) reported abuse by a teenager, and 48 (33.3%) reported abuse by an adult offender. Participants who failed to identify the age of their perpetrator (n = 9, 6.3%) or who reported being abused by perpetrators from more than one of the age categories (n = 11, 7.6%) were removed from analyses. To compare results from the abused groups with a non-abused group, all participants denying a history of undesired sexual contact prior to age 12 were included in analyses as a control group (n = 219).

Overall, the sample was composed primarily of females (n = 254, 74%) and of individuals from a European/Caucasian ethnic heritage (n = 214, 62.3%). The majority were not married (n = 284, 82.7%) and the average age was 21.9 years (SD = 5.19). In addition, the majority came from families with an estimated total annual income below US$50,000 (n = 203, 59.1%). Although this may seem like a disproportionally low economic status for the participants, it is reflective of the broader student body of the university from which the students were sampled. The university involved primarily serves low-income, first-generation, or non-traditional students.

Analyses were performed to determine the presence of any demographic differences between the groups. As expected, the sexually abused groups were composed of significantly more females than the non-abused control group, χ² = 23.6, p < .001. No differences were observed for the variables of ethnicity, marital status, or family income (see Table 1). As a result of using a college sample, the data for age were significantly positively skewed and descriptive statistics were heavily influenced by the presence of older participants. To correct for this skewness and to account for the qualitative differences between younger and older students, the age variable was partitioned into four distinct levels (18 years old, 19 years old, 20 years old, and 21 years old and older). Using this method, no differences between the sexually abused and non-abused groups were noted for age.

Table 1.

Demographic Characteristics.

Variable	Group
	Child	Teen	Adult	Control
	(n = 37)	(n = 39)	(n = 48)	(n = 219)
Gender (n, female)	28 (76%)	37 (95%)	44 (92%)	145 (66%)
Ethnicity (n)
White/Caucasian	23 (62%)	21 (54%)	28 (58%)	142 (65%)
Black/African American	6 (16%)	6 (15%)	9 (19%)	33 (15%)
Hispanic/Latin American	8 (22%)	8 (21%)	11 (23%)	38 (17%)
Other	0	4 (10%)	0	6 (3%)
Marital status (n, never married)	32 (86%)	26 (67%)	31 (65%)	195 (89%)
Estimated family income (n, US$)
Less than 25,001	17 (46%)	20 (51%)	17 (35%)	91 (42%)
25,001-50,000	4 (11%)	6 (15%)	13 (27%)	35 (16%)
50,001-75,000	8 (22%)	4 (10%)	7 (15%)	37 (17%)
More than 75,000	7 (19%)	9 (23%)	11 (23%)	56 (26%)
Not reported	1 (3%)	0	0	1 (<1%)
Age (years): M (SD)	22.4 (5.0)	23.8 (7.5)	24.3 (7.7)	20.9 (3.5)

Note. Participants who reported experiencing sexual abuse, but who did not report the age of the perpetrator (n = 9), or who reported experiencing abuse by perpetrators from more than one age group (n = 11), were not included in analyses.

Screening of Data

Analyses examined the normality of the data for each of the primary variables. Results revealed significant positive skew for the following variables: TSC-Anxiety, TSC-Depression, TSC-Sexual problems, PCL, CCMS-Psychological abuse, CCMS-Neglect, and CCMS-Physical abuse. An examination of the data revealed that much of the observed non-normality was due to these scales having an absolute “0” and the majority of scores clustered near the lower ends of the scales. The CCMS-Physical abuse, CCMS-Neglect, and TSC-Sexual problems scales underwent inverse transformation, while the CCMS-Psychological abuse and PCL were transformed using logarithmic procedures. The TSC-Depression and TSC-Anxiety scales demonstrated only moderate skew and square root transformations were used. The transformed variables were used for future parametric analyses.

Differences between Sexually Abused and Non-Abused Groups

To examine the impact of other previous traumatic events on mental health outcomes, a multiple analysis of variance (MANOVA) was computed using the CCMS-Physical abuse, CCMS-Psychological abuse, CCMS-Neglect, and THQ scores as the dependent variables. Significant results were obtained (λ = .90, p = .001) and univariate analyses of variance (ANOVAs) revealed that the groups differed on the psychological abuse (F = 5.68, p = .001, η² = .05) and neglect (F = 5.52, p = .001, η² = .05) scales. These two variables were entered as covariates in subsequent analyses.

Next, a MANOVA was performed examining differences in mental health outcomes, using the depression, anxiety, posttraumatic stress, and sexual behavior problem scales as the dependent variables. Results were significant (λ = .91, p = .002) with differences observed on each of the outcome variables: posttraumatic stress (F = 5.41, p = .001, η² = .05), depression (F = 8.89, p < .001, η² = .08), anxiety (F = 5.52, p = .001, η² = .05), and sexual problems (F = 3.64, p = .013, η² = .03). Post hoc analyses, using the least significant difference (LSD) method, revealed significantly greater scores for the Teen group than the non-abused group (p < .001) on posttraumatic stress, while differences between the non-abused group and the Child (p = .056) and Adult groups (p = .069) approached significance. For depression and anxiety, each of the abused groups obtained higher scores than the non-abused group (all ps < .05). As for sexual problems, the Child (p = .022) and Teen (p = .007) groups demonstrated greater problems than the non-abused group. In none of the above cases did the abused groups differ from each other. All results of between-groups analyses are provided in Table 2.

Table 2.

Group Differences of Emotional Symptoms and Trauma Histories.

Variable	Group				F	η²
	Child	Teen	Adult	Control
	M (SD): 95% CI	M (SD): 95% CI	M (SD): 95% CI	M (SD): 95% CI
CCMS-Physical abuse	4.8 (4.4): [3.3, 6.3]	3.8 (3.9): [2.5, 5.0]	5.5 (5.9): [3.7, 7.2]	4.0 (3.7): [3.5, 4.2]	1.68	.02
CCMS-Psych. abuse	9.1 (6.4): [6.9, 11.2]^a	9.5 (7.5): [7.0, 11.9]^a,b	10.9 (8.0): [8.5, 13.3]^a	6.7 (5.4): [6.0, 7.5]^b	5.68**	.05
CCMS-Neglect	3.8 (3.6): [2.6, 5.1]^a	3.4 (4.3): [2.0, 4.8]^a	5.4 (6.9): [3.3, 7.5]^a	2.7 (4.3): [2.1, 3.3]^a	5.52**	.05
THQ-Total	1.4 (1.4): [.9, 1.8]	1.5 (1.3): [1.1, 2.0]	1.2 (1.3): [.8, 1.6]	1.1 (1.1): [.9, 1.2]	1.53	.01
PSC-Total⁺	39.1 (14.9): [34.1, 44.2]^a,b	42.6 (13.6): [38.2, 47.0]^a	38.4 (14.7): [34, 42.8]^a,b	33.9 (11.8): [32.3, 35.5]^b	3.37*	.03
TSC-Anxiety⁺	7.5 (4.4): [6.0, 9.0]^a,b	8.4 (4.2): [7.1, 9.8]^a	7.5 (4.7): [6.1, 8.9]^a,b	5.9 (3.8): [5.4, 6.4]^b	3.38*	.03
TSC-Depression⁺	9.7 (4.8): [8.1, 11.3]^a	10.7 (4.9): [9.1, 12.3]^a	9.4 (4.9): [7.9, 10.8]^a,b	7.0 (4.3): [6.4, 7.6]^b	5.46**	.05
TSC-Sex problems⁺	5.4 (3.9): [4.1, 6.8]^a,b	6.3 (4.4): [4.8, 7.7]^a	5.2 (5.1): [3.6, 6.7]^a,b	3.7 (3.5): [3.2, 4.2]^b	2.59*	.02

Note. CI = confidence interval; PSC = Posttraumatic Stress Checklist; TSC = Trauma Symptom Checklist–40; CCMS = Comprehensive Child Maltreatment Scale; THQ = Trauma History Questionnaire. Values with the same superscript did not differ.

Psychological abuse and neglect were controlled in these analyses.

p < .05. **p < .01.

To examine differences among the groups once other trauma history was accounted for, a multiple analysis of covariance (MANCOVA) was computed controlling for psychological abuse and neglect and using each of the mental health outcomes as dependent variables. The omnibus test for perpetrator age was significant (λ = .93, p = .027). Univariate ANCOVAs demonstrated significant differences on all of the outcome variables: posttraumatic stress (F = 3.37, p = .019, η² = .03), depression (F = 5.46, p = .001, η² = .05), anxiety (F = 3.38, p = .019, η² = .03), and sexual problems (F = 2.59, p = .05, η² = .02). Post hoc comparisons showed that the Teen group continued to score significantly higher on posttraumatic stress than the non-abused group (p = .002). However, only the Child and Teen groups scored higher than the non-abused group on depression (ps < .05) and only the Teen group scored higher than the non-abused group on anxiety (p = .002). Similarly, only the TEEN group demonstrated more sexual problems than the non-abused group. Importantly, as before, the sexually abused groups did not differ from each other on any of the outcome variables.

Differences Among the Sexually Abused Groups

Analyses were performed to examine differences among the groups for abuse characteristics and post-abuse events. A series of chi-square analyses demonstrated no differences between the groups on whether the child was threatened with force or embarrassment (χ² = .5, p = .78) and whether physical force was used (χ² = 5.5, p = .06). However, as one might expect, significant differences were noted based on whether the perpetrator was a family member (χ² = 6.87, p = .03), with the Adult group showing a greater likelihood of related perpetrators than the Teen group (χ² = 6.12, p = .01). The difference between the Adult and Child groups approached significance (χ² = 3.31, p = .07). In addition, the Child group was less likely to have experienced abuse involving anal or vaginal penetration (omnibus χ² = 7.09, p = .03) than the Teen (χ² = 6.03, p = .01) group. Last, post-abuse characteristics were examined. No differences emerged regarding whether the abuse was disclosed (χ² = 3.74, p = .15) or whether the participant had received mental health treatment since the abuse (χ² = 1.28, p = .53). Interestingly, participants in the Child group were less likely to believe that their experiences constituted sexual abuse (omnibus χ² = 18.58, p < .001) than those in either the Teen (χ² = 10.69, p = .001) or Adult group (χ² = 14.83, p < .001). Results of these analyses are provided in Table 3.

Table 3.

Differences in Sexual Abuse Experiences.

Variable	Group			χ²
	Child	Teen	Adult
	n (%)	n (%)	n (%)
Child threatened				0.5
No	23 (62)	23 (59)	31 (63)
Yes	13 (35)	16 (41)	16 (33)
Use of physical force				5.5
No	31 (84)	25 (64)	31 (63)
Yes	5 (13)	14 (36)	16 (33)
Perpetrator was a family member				6.87*
No	22 (59)^a,b	27 (69)^a	20 (41)^b
Yes	13 (35)	12 (31)	27 (55)
Anal or vaginal penetration				7.09*
No	26 (70)^a	25 (64)^b	37 (76)^a,b
Yes	2 (5)	12 (31)	7 (14)
Abuse was disclosed				3.74
No	27 (73)	21 (54)	29 (58)
Yes	9 (24)	18 (46)	19 (38)
Previous mental health treatment				1.28
No	23 (62)	19 (49)	29 (58)
Yes	13 (35)	18 (46)	19 (38)
Believe that it was sexual abuse				18.58**
No	19 (51)^a	7 (18)^b	7 (14)^b
Yes	16 (46)	32 (82)	41 (84)

Note. Participants who did not provide information were excluded from analyses. As a result, numbers do not equal the total sample sizes and percentages do not sum up to 100. Values with the same superscript did not differ.

p < .05. **p < .001

Discussion

The current study examined the impact on the victim of childhood sexual abuse perpetrated by individuals of different ages, including same-age peers (child-on-child sexual abuse). CSA victims, regardless of the age of the perpetrator, reported more emotional concerns than a control group of non-abused individuals. This finding is consistent with a large body of research indicating the negative sequelae associated with CSA (e.g., Kendall-Tackett et al., 1993, Putnam, 2003). However, once exposure to other maltreatment (i.e., psychological abuse, neglect) was controlled, the negative impact of CSA was greatly attenuated, with only some of the CSA groups demonstrating significant differences from the non-abused group. This finding is similar to other research suggesting that other forms of maltreatment may at least partially explain the often noted connection between CSA and emotional concerns, such as depression and anxiety (Burns, Jackson, & Harding, 2010; Gibb, Chelminski, & Zimmerman, 2007). There were no significant differences among abused subgroups on any analysis examining mental health outcomes. These results suggest that abuse committed by another child may result in similar consequences as abuse committed by older individuals.

To examine potential differences of abuse and post-abuse events, these characteristics were analyzed separately. No differences were found regarding the frequency with which participants reported some potentially aggravating abuse characteristics which could impact later outcomes (i.e., the use of threats or physical force to gain compliance). However, those who reported abuse by a family member were more likely to indicate their abuser was an adult. Furthermore, those abused by adults or teens were more likely to report penetration. No differences in rates of mental health treatment history or disclosure of the abuse were found.

Interestingly, individuals abused by other children were less likely to consider their experiences to be sexual abuse than those abused by teenagers or adults. Finding that individuals may not label their own experiences as abusive is not novel. For instance, Berger, Knutson, Mehm, and Perkins (1988) found that undergraduate students reporting histories indicative of physical abuse generally failed to label those experiences as physical abuse. An important conclusion from these findings is that behavioral descriptions of events provides more accurate histories than using broad labels that are open to one’s interpretation. These results suggest that the undesired sexual act, rather than the age of the perpetrator or the victims’ appraisal of the experience, contributes to emotional distress in adulthood. As such, sexual abuse perpetrated by another child may pose a significant risk to the onset of later mental health issues. The fact that participants victimized by other children were less likely to perceive such experiences as sexual abuse is particularly concerning, and thus warrants the need to increase sexual abuse awareness and teach individuals (specifically children) the difference between developmentally appropriate and inappropriate sexual behavior. In addition, results suggesting that participants abused by other children were less likely to label their experiences as abuse, but experienced comparable emotional adjustment concerns, suggests that whether or not victims perceive their experiences as sexually abusive, they are at increased risk for a variety of later mental health concerns.

These findings lead to a number of important clinical implications. Chief among these is the need for clinicians to be sensitive to the tendencies of some survivors to classify their experiences in ways that might lead mental health professionals to underestimate the long-term impact of these events. Although those abused by child perpetrators may not perceive themselves as CSA victims, they appear to be at equally high risk as victims of teenage and adult perpetrators for poor mental health outcomes later in life. To prevent this under-identification, clinicians should avoid screening for CSA by simply asking if one considers himself or herself to be a victim and, instead, use behavioral terms to maximize the identification of those at risk for negative outcomes. In addition, clinicians are encouraged to ask specifically about sexual experiences that may involve other children. It is not uncommon for clinicians to emphasize inappropriate touching by adults; however, these results suggest that sexual behaviors involving other children should also be assessed as part of the clinical assessment process.

The current study should be viewed in light of its limitations. First, participants provided retrospective reports of abuse experiences. Independent verification of experiences was not possible and the time between the occurrence of the experiences and when individuals participated in this study may have impacted their recollection and subsequent reports. Second, this study utilized a convenience sample of university students who may not represent the broader population of sexual abuse survivors. In particular, it should be noted that the participants in the study were predominantly from families with total income below US$50,000 per year. This may have resulted in a sample that experienced more stressful and challenging circumstances during development than is common in the broader population. Last, individuals with abuse histories involving perpetrators from more than one of the three age groups examined were excluded from these analyses. The multiplicative impact of perpetrators across ages on a single victim is not known.

Nonetheless, the current study concludes that child-on-child sexual abuse can be as detrimental to the victim as CSA committed by older individuals, even if the experience is not identified as or believed to be sexual abuse. Future research should seek to replicate these findings in regard to the impact of child-on-child sexual abuse with other college student samples, and ideally with a prospective approach using a community sample. Increased attention to the identification of and intervention with children abused by other children is also warranted, as is greater focus on effective treatment for children with sexual behavior problems.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Brian Allen, PsyD, is a clinical psychologist at the Center for Safe and Healthy Families at Primary Children’s Hospital in Salt Lake City, Utah. His research focuses on understanding the developmental consequences of child maltreatment, dissemination and implementation of evidence-based treatments, and children with sexual behavior problems.

Alexandra Tellez, MA, is a doctoral student in clinical psychology at Sam Houston State University. Her research interests include forensic psychology and cross-cultural issues in the clinical context.

Amy Wevodau, MA, is a doctoral student in clinical psychology at Sam Houston State University. Her research interests are in the area of forensice psychology, specifically risk assessment and jury decision-making issues.

Carol L. Woods, MA, is a doctoral student in clinical psychology at Sam Houston State University. Her research interests include sex offender treatment and psychopathy.

Amy Percosky, MA, is a doctoral student in clinical psychology at Sam Houston State University. Her research interests include forensic assessment and expert testimony.

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