This was achieved through rigorous quantitative analysis of individual-level data for 9,042 users of child sexual exploitation services in the United Kingdom. One third of the sample were boys, and gender was associated with statistically significant differences on many variables.

One of our most striking findings is also one of the simplest: One third of our sample was boys. The proportion of boys was markedly higher than in prior national studies into various forms of CSE in the United Kingdom or its constituent nations.

Whatever the reason for it, the very fact that nearly 3,000 boys were supported by Barnardo’s for CSE emphasizes the importance of better incorporating their needs into research, policy, and practice

 

United Nations Convention on the Rights of the Child (United Nations, 1989), “children” refers here to individuals aged 17 years or younger.

 

A particular knowledge gap around sexual exploitation involving boys has been highlighted, usually accompanied by calls for targeted research (e.g., Child Exploitation and Online Protection Centre, 2011)

 

Cashmore & Shackel, 2014: largely unsurprising that much of the literature is filtered “through the prism of victim as female and perpetrator as male”

 

Alaggia, 2005: Although recent years have seen a gradual expansion of the literature on male victims, it remains the norm to focus on female victims.

 

Smallbone & Wortley, 2000: large analyses of child sexual abuse have factored in gender as a variable, it has typically been in relationship to risk of victimization or to the consequences of abuse.

 

Feiring, Taska, & Lewis, 1999: Unlike girls, boys have been found to be more likely to be sexually abused in extra-familial than intra-familial contexts.

 

Finkelhor, 1986: A higher (albeit still relatively low) proportion of boys than girls are sexually abused by female offenders

 

Overall, however, “there is limited research that specifically compares the experiences of male and female victims” (Cashmore & Shackel, 2014, p. 76). As a result, considerable knowledge gaps persist in respect to the interplay between victim gender and their individual characteristics, the abuse process, and official responses to them.

 

There are clear empirical and theoretical reasons why victim gender could be an important factor to consider in understanding and responding to CSE. Yet, little has changed since Lillywhite and Skidmore (2006) highlighted the “persistent invisibility of boys” in public, political, practitioner, and academic discourse (p. 352). Amid the rapidly evolving landscape around CSE in the United Kingdom, a constant is the tendency to conceptualize the phenomenon as something perpetrated by men (or boys) against girls (see, for example, Cockbain, 2013). On one hand, the lack of research into the association between children’s gender and sexual exploitation might simply reflect the generalized underdevelopment of the CSE research literature. On the other hand, recent national studies into CSE in the United Kingdom that involved mixedgender samples have missed the opportunity to investigate gendered differences (Child Exploitation and Online Protection Centre, 2011; Office of the Children’s Commissioner for England, 2012). Instead, descriptive analyses have been based on the samples as a whole, meaning the aggregate findings may inaccurately represent the characteristics of the male minorities of 13% (n = 271; Child Exploitation and Online Protection Centre, 2011) and 11% (n = 265; Office of the Children’s Commissioner for England, 2012), respectively.

 

 

http://www.barnardos.org.uk/reducing_the_risk_report.pdf 

There is a gender difference of victims as demonstrated by the majority of research, which depicts higher proportions of females as victims, rather than males. 

For example, Finkelhor(1994) found males:female ratios that fell between 1:1.5 and 1:3 as prevalence rates changed from 7% to 36% for girls and 3% to 29% for boys. More recent research showed a marked increase again as Cockbain’s (2015) found that a third of their sample were male providing a male:female ratio of 1:2 during their large scale exploration of gender differences in child sexual exploitation service users. 

Cross cultural meta analyses performed by Stoltenborgh et al (2011) found another set of European prevalence rates where 13.5% of girl were affected and 5.6% of boys. Females were more likely to become victims across all wider continents besides South America. In the same year, Radford et al (2011) completed interview based research surrounding child sexual abuse. From 2275 responses, 2.6% of males and 7% of females were victims, further supporting the notion that females are at higher risk than male to become victims of child sexual exploitation. 

However, in some instances boys are more likely to fall victim to this crime. Feiring, Taska and Lewis (1999) found that unlike girls, boys are more likely to abused in extrafamilial rather than intrafamilial contexts.  

Additionally, higher proportions of boys are abused by female perpetrators (Finkelhor, 1986). But to understand how relevant this finding is, we must observe the proportions of gender differences in perpetrators. 

Due to this gender difference in victimization, Cashmore and Shackel (2014) found a broad consensus in diverse epidemiological studies that males constitute a minority and are at less risk than females for child sexual exploitation. They also criticise the current knowledge on the topic as little research actual compares the experiences of male and female victims. Furthermore, they display that the literature focuses on female victims (Alaggia,2005) and consistently show the victim to be female and the perpetrator as male (further supported by Cockbain, 2015) 

Further studies have exhibited the imbalance of genders in child exploitation research, treatment and so on which is supported by Lillywhite and Skidmore (2006) who highlight the persistent invisibility of boys in discourse. Forrest (2007) argue that there is inadequate service, additional stigma, homophobia, female-centric assessment tools and limited awareness amongst professional concerning male sexual victimisation. Moreover, the services provided within the UK have been described as targeted towards young women rather than men, so male needs are overlooked and underserved (Lowe and Pearce, 2006).

Estimates 

Child sexual exploitation is increasingly recognised among many which will improve the reliability if more is found out about it. The estimates of the proportion of male and females as victims are generally reliable, as it has been found by a lot of research that females are perceived as the victims more than males are.  The findings show quite a considerable difference between the two, which can be viewed as reliable. Cross cultural studies provide the same findings which suggest reliability. Furthermore, it is becoming widely accepted that the numbers of males as victims is increasing.

However, the estimates can be seen as not very reliable as most research focuses more on females being classed as the victims and males as the perpetrators because this is more widely known and accepted and is considered the norm, which is not reliable as it ignores the possibility of investigating further the reason behind the number of male victims. Therefore this may sway people’s views and produce biased results which is not considered reliable. Also, there has been some evidence provided that the number of male victims can fall higher than the number of female victims which suggests some uncertainty and that there must be different conditions to provide different answers.

https://www.sciencedirect.com/science/article/pii/S0272735896000475 

Proportion of Males:Females as Perpetrators

Female sex offenders (N = 18) were compared with male sex offenders (N = 332) and with females who were not sex offender (N = 215) on various experiences in their personal histories. Female sex offenders who were victims of sexual abuse were compared to female sex offenders who were not. The present study is part of a comprehensive, seven-year research project described elsewhere (Miccio-Fonseca 1995, 1996). The project dealt with comparative experiences and characteristics of adult and adolescent sex offenders, victims, and their families. The groups in the present study were analyzed with regard to an array of variables, including psychological, medical, gynecological urological, drug, law enforcement, and homicidal and suicidal histories Other variables studied were sexual difficulties and dysfunctions, sexu al health, and life stressors. Female and male sex offenders differed significantly on numerous psychological, life-stressor, and sexual variables. Female sex offender differed significantly from females who were not sex offenders on the same sets of variables, and they were significantly younger. Implications for clinical practice with this population are discussed.

Research on sex offenders has historically focussed mainly on male offenders. The U.s department of justice(2002) found statistics that females comprise only 1.2 percent of arrests for rape, and 8.0 percent of arrests in all other sex offenses, with the majority of cases committing women of rape are found to be against children. The first account of women sex offenders arose in the 1980’s/ female sex offending is not considered as serious as males (Hetherton 1999). 

Vandiver and Walker’s  2002 study found the only account of assessment of female registered sex offender to date. This study involved identifying a typology of offending patterns, including victim and offender characteristics. Characteristics were almost all were white, mean age 31 at the time of offense, female victims were the slight majority 55%, all had juvenile victims and less serious criminal recorders than male counterparts. 64% of the victims were related to offender, but could not concluded how many of female sex offender were related to victims. 

Tewksbury results concluded that registered female sex offenders are frequent to experiencing collateral consequences that may have serious effects on their social, economic and physical well-being. One in 3 (or more) female registered sex offenders report loss of job, lost or refused living environment, lost friends and been personally harassed.

 Van Arsdale, A. (2010). Is adolescent female sex offending a true paradox? A comparative study of gender differences in sex offending and delinquency. University of Florida.                                                         From a study aiming to determine adolescent female sex offenders constitute a unique group in terms of exposure to psychosocial risk factors, findings concluded that , significantly more sex offending girls than boys had experienced sexual abuse and depression/anxiety and had been diagnosed with a mental disorder. When compared with delinquent girls, sex offending girls had experienced more sexual abuse and trauma, although no difference was found between these groups regarding depression anxiety and suicidality. Although a substantial proportion of both sex offending and delinquent girls had experienced poly-victimization, nearly one third had not experienced any trauma or victimization.

 Vandiver, D. M., & Teske Jr, R. (2006). Juvenile female and male sex offenders: A comparison of offender, victim, and judicial processing characteristics. International journal of offender therapy and comparative criminology, 50(2), 148-165.

From a study assessing 61 Juvenile female sex offending compared to 122 juvenile male sex offenders, they were compared in regards to their offending patterns, demographics and victim characteristics. Results found that females were typical younger than males at the time of their arrest for a sex offense. In regards to the sex of their victims, females choose male and female victims proportionately, differing from males whose victims were predominantly female. From a logistic regression analysis, 2 significant predictors of the offense sex included the victim’s sex and length of sentencing, identifying different precautions for males and females offense characteristics which lead to different sex determined management strategies.

Results from the National Child Abuse and Neglect data system included all reports from child protective services for 49 states, Washington DC, and Puerto Rico, and was analysed from a one year period (October 1st 2009-September 30th 2010). It only included cases where the gender of the perpetrator was known – this amounted to a sample of 66,765 cases. Results showed that in 21% of cases, a female perpetrator was involved, complying with further research that suggests whilst men tend to be shown to commit more child sexual abuse, women have been shown to commit such acts also, as it is not unheard of - there were 13,492 substantiated reports of women sexually abusing children in the US alone in 2010. Also, in cases where two perpetrators were identified for a given crime, women represented the co-offender in 42% of them, suggesting a much higher rate of female participation in sexual abuse cases than previously thought.

Risk Factors 

Finkelhor, D. (1980). Risk factors in the sexual victimization of children. Child Abuse & Neglect, 4(4), 265-273. 

Found the key risk factors in childhood sexual abuse were that more girls from lower-income groups experienced victimization. Also those from socially isolated backgrounds were more likely to experience victimisation. Girls from stepfather families were five times more likely to experience victimisation. Another risk factor was if a girl had ever lived at some point without her mother, or even if her mother had substantially lower education than her father, or if her mother was particularly punitive about sexual matter. Over 50% of girls with four or more of these risk factors suffered sexual victimisation. Need to be careful not to see the high vulnerability as a cause to blame the victim.

Butler, A. (2013). Child sexual assault: Risk factors for girls. Child Abuse & Neglect, 37(9), 643-652. 


Looked at risk factors for girls and found several factors, these were: absence of one or both parents, maternal education less than college, an income below the poverty threshold, low caregiver warmth, Child internalising or externalising factors, impulsivity, low achievement scores. As well as this having been classified by their school as needing special education was a risk factor. Girls with behavioural health problems and learning challenges are at heightened risk for sexual assault. Research on behavioural health consequences of sexual assault should control for preexisting SA risk factors to more accurately estimate the impact of child sexual assault on subsequent behavioural health.



Klatt, T., Cavner, D., & Egan, V. (2014). Rationalising predictors of child sexual exploitation and sex-trading. Child Abuse & Neglect, 38(2), 252-260. 


Only four variables significantly predicted sexual exploitation. These were: running away, poverty, drug/alcohol abuse and having friends or family members in prostitution. Running away was found to significantly decrease the risk of being involved in sexual exploitation.  some risk factors (e.g. physical and emotional abuse, early delinquency, and homelessness) for becoming involved in sexual exploitation are common but are part of the problematic milieu of the individuals affected and not directly associated with sex trading itself.

Reid, J., & Piquero, A. (2014). Age-Graded Risks for Commercial Sexual Exploitation of Male and Female Youth. Journal Of Interpersonal Violence, 29(9), 1747-1777. 

The research found several risk factors for childhood sexual abuse. African American male youth were at heightened risk, female youth of all races/ethnicities were of a similar risk to African american males. For both males and females, maternal substance use and earlier age of first sex were associated with early age commercial sexual exploitation.for males, experiencing rape and substance use dependency were risks. Psychotic symptoms and lower educational attainment were also associated. Finally substance use dependency was linked to late age onset for female youth.
.
Mian, M., & Collin-Vézina, D. (2017). Adopting a public health approach to addressing child sexual abuse and exploitation. Child Abuse & Neglect, 66, 152-154.


Females were of a higher risk of sexual abuse and exploitation. Being an adolescent (12-18) was itself a risk factor that predisposed adolescents to sexual abuse. Having a father with a lower education level was also a risk. Adolescents with higher levels of childhood sexual abuse had higher risks in their past of exposure to violence, neglect, psychological victimization and physical punishment compared to those scoring low on childhood sexual abuse and sexual solicitation.


Silmi, K., Said, N., Kingori, C., Bianco, J., Pavey, L., Jamu, L., & Marape, M. (2015). Sexual violence among orphaned children in Botswana: identifying risk and protective factors for effective prevention and response. Annals Of Global Health, 81(1), 119. 

The risk factors for sexual violence included household dysfunction (absence or insufficient parental care, lack of family cohesion), economic limitations including: poverty, economic dependence on the perpetrator and sociocultural rules/expectations (children lack a “voice” in society; prohibition on discussing sexual matters). These were all found to increase the risk of children experiencing sexual abuse.

Davies, E. A., & Jones, A. C. (2013). Risk factors in child sexual abuse. Journal of forensic and legal medicine, 20(3), 146-150.

Objectives

The records of children involved in sexual abuse allegations presenting over a 12 month period were reviewed retrospectively. Potential risk factors such as alcohol or drug use, being ‘looked after’, physical disability, learning disability, previous consensual sexual intercourse, past psychiatric history, and history of psychiatric support were compiled. 

They demonstrated a higher incidence in females and most complainants were of White British origin. Most of the cases were of first allegations and the assailant relationship was most frequently an acquaintance. The incidence was highest in January. The modal age was 15 years and age distribution was positively skewed. Of the potential risk factors studied, alcohol and drug use was the most prevalent. Prevalence increased with age for the majority of factors studied.Alcohol and drug use may be an area in which preventative strategies would be beneficial. Ethnic minorities may hold a large amount of unreported cases.

Euser, S., Alink, L. R., Tharner, A., IJzendoorn, M. H., & Bakermans‐Kranenburg, M. J. (2016). The prevalence of child sexual abuse in out‐of‐home care: Increased risk for children with a mild intellectual disability. Journal of Applied Research in Intellectual Disabilities, 29(1), 83-92.

Children without disabilities in out-of-home care have a higher risk of child sexual abuse [CSA (Euser et al. 2013)]. In this study, we examined the year prevalence of CSA in out-of-home care for children with a mild intellectual disability, and compared it with the prevalence in out-of-home care for non-disabled children and children in the general population.

In out-of-home care for children with a mild intellectual disability, 9.8 per 1000 children were victims of CSA. This prevalence was significantly higher than in regular out-of-home care and in the general population. Children with a mild intellectual disability in out-of-home care have an increased risk of CSA. Adequate education and support for both children and caregivers is necessary to recognize and prevent further sexual abuse.

More research has looked at females specifically. But overall some common risk factors emerge as well as more gender specific. Overall, absence of a parent, or lack of close family members appears to be a significant risk factor in increasing the risk of childhood sexual abuse. Having a parent (some suggest mother, some specifically father) with a much lower education than the other parent is also a significant risk factor. Children with histories of drug or alcohol use (either in themselves or parents) has also been a common risk factor. Being raised in a lower income household also increased the risk of childhood sexual abuse. Finally, a common factor among race and ethnicity appears to show that males from African American backgrounds have a higher risk, compared with females who all appear to be of a higher risk regardless of race or ethnicity.

Psychological Responses 

It looks into online sexual grooming and talks about the current knowledge and understanding of it. The term ‘‘grooming’’ has generally been used to describe offenders’ actions during the preparatory stages of sexual abuse (McAlinden, 2006) defined as ‘‘the situation whereby a potential offender will set up opportunities to abuse by gaining the trust of the child in order to prepare them for abuse’’. 

Finkelhor’s (1984) Precondition Model, highlights four preconditions that may lead to sexual offending against children. The model proposes that an offender’s motivation to sexually abuse a child is associated with three distinct motives: (a) emotional congruence refers to an offender’s emotional identification with children as a result of meeting his or her needs more optimally than adults; (b) deviant sexual arousal to children; (c) blockage refers to the inability to meet emotional and sexual needs in adaptive ways as a result of stressful or unusual situations.

According to O’Connell (2003), various stages during sexually exploitative interactions provide important information about the patterns of offenders’ behavior and their underlying motivation. These identified stages are (a) friendship-forming stage, (b) relationship-forming stage, (c) risk-assessment stage, (d) exclusivity stage, (e) sexual stage, and (f) the concluding stage in the form of damage limitation and the ‘‘hit-and-run’’ tactic.

A range of incentives have been identified to be offered by offenders in order to incite children to follow requests of a sexual nature (CEOP, 2008). These included money and gifts, such as concert tickets, day trips, cell phones as well as games. However, an increase in offenders’ use of blackmailing and coercive strategies in order to ensure compliance was also highlighted (CEOP, 2008).

They engage in general chat such as hobbies, daily activities and interests. 

Most pose as children around the same, however, there are some that pose as adults and the victim are usually aware they are interacting with someone older.

Offender characteristics a meta-analysis found that online offenders tended to be Caucasian males who were younger than off-line offenders and more likely to be unemployed when compared to the general population, although online offenders did not differ from the general population in terms of educational level. Online offenders tended to have fewer offense-supportive attitudes, less emotional identification with children, and greater victim empathy (i.e., an offender’s awareness and understanding of the impact of sexual offending on the victim).

Coie, J. D., Watt, N. F., West, S. G., Hawkins, J. D., Asarnow, J. R., Markman, H. J., . . . Long, B. (1993). The science of prevention: A conceptual framework and some directions for a national research program. American Psychologist, 48(10), 1013-1022. 

A conceptual framework for prevention which consists of factors that can be considered in the science of prevention. Emerging themes from the study of human development, in general, need to be incorporated in the models for explaining and preventing serious problems of human adaptation. The article concludes with a set of recommendations for a national prevention research agenda.

The overall aim of the study was to use the learning from serious case reviews to improve multi-agency practice at all levels of intervention. It also aimed to analyse the ecological-transactional factors (which we also refer to as inter-acting risk factors) for children who became the subject of serious case reviews. The ecological-transactional perspective (Cicchetti and Valentino 2006) requires a dynamic, not a static understanding and assessment of children and their families.

How did families and practitioners work together? In many cases parents were hostile to helping agencies and workers were often frightened to visit family homes. These circumstances could have consequences on practitioners, hampering their ability to reflect, make judgments, act clearly, and to follow through with referrals, assessments or plans. Apparent or disguised cooperation from parents often prevented or delayed understanding of the severity of harm to the child and cases drifted. Where parents made it difficult for professionals to see children or engineered the focus away from allegations of harm, children went unseen and unheard. When reluctant family engagement was coupled with frequent moves of home, records were often sketchy or inaccurate and practitioners would not be aware of the sequences of events or behaviours which might be indicative of serious risks of harm to the child or children. 

Burns, B. J., Phillips, S. D., Wagner, H. R., Barth, R. P., Kolko, D. J., Campbell, Y., & Landsverk, J. (2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child & Adolescent Psychiatry, 43(8), 960-970. 

The study assessed the relationship between the need for and use of mental health services among a sample of children who were investigated by child welfare agencies after reported maltreatment.
Nearly half of the youths aged 2 to 14 years with completed child welfare investigations had clinically significant emotional or behavioral problems. Youths with mental health needs were much more likely to receive mental health services than lower scoring youth; still, only one fourth of such youths received any specialty mental health care during the previous 12 months. Clinical need was related to receipt of mental health care across all age groups.Sexually abused preschool children were approximately four times more likely to receive mental health services than children of similar age who had experienced neglect. Adolescents living at home were also less likely to receive services, whereas having a parent with severe mental illness increased the likelihood of service use.
Routine screening for mental health need and increasing access to mental health professionals for further evaluation and treatment should be a priority for children early in their contact with the child welfare system.
Sexually abused youths may also be more likely than physically abused youths to receive direct treatment (i.e., therapy for the children), whereas services for physically abused youths are more likely to target parents (Kolko et al., 1999).

Barnitz, L. (2001). Effectively responding to the commercial sexual exploitation of children: A comprehensive approach to prevention, protection, and reintegration services. Child Welfare, 80(5), 597-610. 

Discusses world approaches to solve the problem of commercial sexual exploitation of children. Participants in the 1996 Congress, held in Stockholm, Sweden, came to a consensus that action needed to be taken to end this abuse of children. Representatives from 124 countries agreed that action in the following areas should take priority: coordination and cooperation among local, national, regional and international levels; prevention; protection; recovery and reintegration; and child participation. While encouraging non-governmental organizations (NGOs) to advocate for and monitor the implementation of points included in the Agenda for Action, the 1996 Congress also encouraged governments to develop, by 2001, "National Plans of Action" to address CSEC.
According to one of the primary organizing groups behind the World Congress, End Child Prostitution, Child Pornography, and Trafficking in Children for Sexual Purposes (ECPAT International),11 by the last quarter of 2000, only 29 countries had developed national plans to address CSEC. Three of those countries were not signatories to the Stockholm Declaration. Eight other countries that signed the Declaration have adopted general plans of action on the welfare of children that include specific clauses on CSEC. Twenty-one additional countries have taken action to develop national plans on CSEC, but these plans are in various stages of development. In addition, several countries that do not have national plans do have innovative grassroots programs against CSEC, but these programs often lack the support needed to realize their full potential. The small number of national plans developed by governments that committed their countries to action on the issue is a clear indicator that much more attention needs to be paid by official leaders and decisionmakers.
In North America, only Mexico has developed a national plan on CSEC. Both Canada and the United States have not done so. Both countries cite size, coordination difficulties, and the decentralized nature of their governments as reasons for not having such plans. Canada developed a follow-up committee to the 1996 World Congress12 to coordinate information from several levels of government and from NGOs. Canada maintains that CSEC is an issue that the provincial governments, rather than the national government, must tackle.

This Rapid Evidence Assessment was commissioned by the Independent Inquiry into Child Sexual Abuse in England and Wales which is investigating whether public bodies and other non-state institutions have taken seriously their duties to care for and protect children and young people from child sexual abuse and exploitation.

Changing attitudes and behaviour by education or awareness raising - There is good evidence from Canada and the USA that pre-school and school based education programmes on child sexual abuse are effective at teaching children to recognise inappropriate behaviour and improving their knowledge of self protection. Research in Australia and the USA supports whole school approaches and involving parents, faith and community groups. Public education and social marketing campaigns to prevent abuse are commonly used but poorly evaluated.
Situational prevention – The UK has led primary prevention and early identification efforts online and there is evidence of successful take-down, site blocking, extensive take up of online safety resources and considerable international collaboration through the work of CEOP, the National Crime Agency, and participation in the Global Alliance and WePROTECT. In other organisational contexts, efforts have been more limited covering pre-employment checks, vetting and barring. While important, these only exclude the minority of offenders already known or convicted. Inquiries in the USA, Germany, the Netherlands, Belgium and Ireland on institutional child abuse in churches show we need a wider focus on organisational safety and the opportunities for unmonitored contact.
Reducing vulnerabilities - Very little evidence could be found on the best approaches to reduce the vulnerabilities of children to sexual abuse and exploitation in the jurisdictions covered. Some promising evidence from the UK, Canada and the Netherlands was found from Stop It Now which aims to reduce offending among those not previously identified as offenders.

Adult women with a history of childhood sexual abuse show greater evidence of sexual disturbance or dysfunction, homosexual experiences in adolescence or adulthood, depression, and are more likely than nonabused women to be revictimized.
Anxiety, fear, and suicidal ideas and behavior have also been associated with a history of childhood sexual abuse.
Male victims of child sexual abuse show disturbed adult sexual functioning.
Greater long-term harm is associated with abuse involving a father or stepfather and abuse involving penetration.
Longer duration is associated with greater impact, and the use of force or threat of force is associated with greater harm.
The role of family variables, such as marital conflict and parental psychopathology, are thought to have an important impact on the child’s response to the abuse and on the long-term outcome. Evidence suggests that parental attitudes towards the child and toward the child’s role in the event are important determinants of the long-term impact of CSA. The child’s interpretation of the experience and the child’s perception of the mother’s response to the child and to the abuse may also be important. The long-term impact of the timing, circumstances, and manner of disclosure are not known and may require further research.

Meta-analysis looked into posttraumatic stress disorder (PTSD), depression, suicide, sexual promiscuity, victim-perpetrator cycle, and poor academic performance within the context of child sexual abuse.
Thirty-seven studies published between 1981 and 1995 involving 25,367 people were included.
A substantial effect of CSA on PTSD outcome (d = .40), depression (d = .44), suicide (d = .44), sexual promiscuity (d = .29), sexual perpetration (d = .16), and academic achievement (d = .19) was found.
The analyses provides clear evidence confirming the link between CSA and subsequent negative short- and long-term effects on development.

Reviews research on the impact of sexual abuse. Initial effects in the victim population include fear, anxiety, depression, anger and hostility, aggression, and sexually inappropriate behavior.
Long-term effects include depression and self-destructive behavior, anxiety, feelings of isolation and stigma, poor self-esteem, difficulty in trusting others, a tendency toward revictimization, substance abuse, and sexual maladjustment.
The kinds of abuse that appear to be most damaging are experiences involving father figures, genital contact, and force.

Reports on meta-analysis of child sexual abuse to adult psychological adjustment. Results indicated significant relationships between the experience of child sexual abuse and difficulties in psychological adjustment (as measured by psychological symptomatology, depression, and self-esteem). So, it support the hypothesis of a positive relationship between childhood sexual abuse and impaired adult psychological adjustment.

Among adolescents, commonly reported sequelae include sexual dissatisfaction, promiscuity, homosexuality, and an increased risk for revictimization.
Depression and suicidal ideation or behaviour also appear to be more common among victims of sexual abuse compared to normal and psychiatric nonabused controls. Frequency and duration of abuse, abuse involving penetration, force, or violence, and a close relationship to the perpetrator appear to be the most harmful in terms of long-lasting effects on the child.
The high prevalence of marital breakdown and psychopathology among parents of children who are sexually abused makes it difficult to determine the specific impact of sexual abuse over and above the effects of a disturbed home environment.
Children from disadvantaged or disturbed families often displayed behavior problems, difficulties at school, and low self-esteem.

Evidence states that the experience of maltreatment can have major long-term effects on all aspects of a child’s health, growth and intellectual development and mental well being and that it can impair their functioning as adults.
The impact of child maltreatment includes a wide range of many complex social and economic problems, with an increased likelihood of mental disorders, health problems, education failure and unemployment, substance addiction, crime and delinquency, homelessness and an intergenerational cycle of abuse and neglect.
Depression, severe anxiety, panic attacks and post-traumatic stress disorder (PTSD) are the most common mental health consequences of abuse: the literature suggests that between 30 and 50 per cent of sexually abused children meet the full criteria for a PTSD diagnosis (Widom 1999; Darves-Bornoz et al. 1998), and up to 80 per cent experience at least some ‘post-traumatic’ symptoms (McLeer et al, 1992; Cuffe et al, 1998). These symptoms include hyper-vigilance, intrusive thoughts, and sudden intrusive flashbacks of the abuse experience.
Sexual abuse is linked to disturbed mental health resulting in self-harm, inappropriate sexualised behaviour, sadness, depression and loss of self-esteem. These adverse effects may endure into adulthood.
Adolescents who have experienced sexual abuse are more likely to experience ongoing health problems such as chronic pelvic pain and other gynaecologic problems, gastrointestinal problems, headaches, and increased obesity (Springer et al, 2007). Both physical and sexual abuse are associated with a doubling of the risk of attempted suicide for young people by the time they reach their late twenties (Gilbert et al, 2008). 

Negative experiences of care and family life are known to create vulnerabilities which can lead to a higher risk of sexual exploitation as children become adolescents, for boys as well as girls.
Heterosexual boys who have been exploited by males can experience confusion about their sexuality which induces guilt, fear and distress. This can represent a significant barrier to disclosure and seeking help.
Gay, bisexual or questioning boys who are made vulnerable through discrimination within their homes and communities can be at risk of entering same-sex relationships which are exploitative.

Under ‘Children and Family DIrect’ is a way of accessing family support and safeguarding services. They have a “one stop shop” protocol so all of their services are accessible through one number. NCS also have a partnership website in this section to aid in these services : 

Themes across psychological responses

Ferreira, F. A., Martins, P. C., & Gonçalves, R. A. (2011, June). Online sexual grooming: A cross-cultural perspective on online child grooming victimization. In 20th World Congress for Sexual Health.

Whittle, H., Hamilton-Giachritsis, C., Beech, A., & Collings, G. (2013). A review of online grooming: Characteristics and concerns. Aggression and violent behavior, 18(1), 62-70. 

Shannon, D. (2008). Online sexual grooming in Sweden—Online and offline sex offences against children as described in Swedish police data. Journal of Scandinavian Studies in Criminology and Crime Prevention, 9(2), 160-180. 

Cashmore, J., & Shackel, R. (2014). Gender differences in the context and consequences of child sexual abuse. 

The current review aims to outline the existing understanding of sexual grooming. Issues of poor definition, the adoption of the term “grooming” and the prevalence of sexual grooming will be discussed. Consideration will be given to how prominent theories of child sexual abuse often neglect sexual grooming. This will be followed by a detailed account of the existing knowledge within the literature. Three types of sexual grooming were thus identified: self-grooming, grooming the environment and significant others and grooming the child. Based on these findings, a new definition of sexual grooming is suggested. Furthermore, the findings correspond well with current models of the sexual offence process. A more comprehensive understanding of sexual grooming is required to facilitate a preventative approach to child protection. 

Boys seem to have a particularly difficult time dealing with sexual abuse as they are even

MCALINDEN: PERSONAL, FAMILIAL & INSTITUTIONAL GROOMING 347

less likely to report it than girls (Hunter et al., 1992; Watkins and Bentovim, 1992). As discussed earlier, a complex range of emotions such as fears of retribution or abandonment, and feelings of complicity, embarrassment, guilt and shame all conspire to silence children and inhibit their disclosures of abuse.

The victims were afraid to disclose the abuse; or when they did, no action was taken, either because there was a conspiracy to keep allegations quiet or a ready acceptance of the denial by the alleged perpetrator (Sullivan and Beech, 2002: 161). 

Whittle, H. C., Hamilton-Giachritsis, C., & Beech, A. R. (2013). Victims’ voices: The impact of online grooming and sexual abuse. Universal Journal of Psychology, 1(2), 59-71.

Our interpretations of the grooming process have been primarily anecdotal, based on the accounts of child victims and predators who might recall gifts given, and tactics used to gain trust and establish confidence.

It is often characterized as a seduction, involving a slow and gradual process of learning about a child and building trust.

Grooming is also a deceptive process in which a child is unprepared to interpret cues which signal danger of risk. Predators are skilled at gaining the trust of a child before luring them into interactions. The process of grooming through the formation of a close bond.

In addition to attention and friendship, the seduction can include the sharing of gifts and special activities or trips. The pedophile often preys on the child’s loneliness or emotional neediness. Once the predator has developed an alliance with the child, he or she may begin gradually exposing the youth to pornography and subsequently suggest photographing the child in sexually seductive poses. This process is intended to desensitize the child to nudity, stimulate the child’s curiosity about sex, and validate adult-child sexual relations.

Case study example:

Initially she professed her continued love and adoration for her abductor; however, after extensive therapeutic support she began revealing details of sexual and physical torture, became suicidal, and required psychiatric hospitalization. Her recovery process has been very gradual, but her experience and trauma will be unforgettable.

This article aims to outline current responses to sexual grooming; specific attention will be given to new legislation introduced in England and Wales under the Sexual Offences Act 2003. Following an outline of this new legislation, consideration will be given to its effectiveness, including practical difficulties that are likely to restrict its scope. Issues to be discussed include: poor definition and understanding of sexual grooming, scope of legislation in relation to non-Internet grooming, difficulties in identifying sexual grooming, and a failure of the new legislation to be truly preventative. The article concludes by supporting Richard Laws’s suggestion that the most effective prevention of child sexual abuse would result from adopting a public health approach.

Whittle, H.C., Hamilton-Giachritsis, C., Beech, A.R. (2013). Victims’ Voices: The Impact of Online Grooming and Sexual Abuse. Universal Journal of Psychology, 1(2), 59 - 71.

http://www.mdpi.com/2076-0760/3/3/404/htm - this article is good for a background on grooming. 

A small number of victims discussed that, with hindsight, some of the offenders’ lies did not make sense; therefore teaching young people to objectively evaluate online friendships and relationships, regardless of emotional attachment may help them to identify risks which would be otherwise overlooked. If the victims had had a better understanding of the intricacies of online grooming techniques, how quickly it can progress and the consequences, there is a greater possibility they would have been suspicious and better equipped to resist the abusers. Young people learning directly from the experiences of young victims could assist them in understanding these subtleties and being able to recognize the warning signs among their peers. On the occasions when the victims in this sample did feel worried about the relationship (e.g., when Chloe was being blackmailed to send more photos), they were not equipped with the knowledge of how to stop the cycle. Educating young people about how to report concerns about online relationships, at any stage, is imperative.

Whittle, H.C., Hamilton-Giachritsis, C., Beech, A.R. (2014). “Under His Spell”: Victims’ Perspectives of Being Groomed Online. Social Sciences, 3(3), 404-426.

With recent literature highlighting the serious long term psychological effects of child sexual exploitation such as anxiety, fear and suicidal ides (Beitchman 1992), this highlights a need for recovery to be tailed towards helping individuals mentally recover. In adult women, a history of childhood sexual abuse shows greater evidence of sexual disturbance or dysfunction, homosexual experiences in adolescence or adulthood, depression, and are more likely than non-abused women to be revictimized. Whilst in male victims of child sexual abuse show disturbed adult sexual functioning. This suggests a need to treat males and females equally but separately for their recovery, to ensure coping mechanisms are put together to help deal with these specific gender problems. With the commercial sexual exploitation of children is one of the most destructive forms of abuse Barnitz, L. (2001), it is essential to understand the implications and long term effects this has on children to help produce sufficient coping resources to target each individual.

Greater long-term harm is associated with abuse involving a father or stepfather and abuse involving penetration. Longer duration is associated with greater impact, and the use of force or threat of force is associated with greater harm – This suggests to not deal with each individual on a similar scale but to worth with everyone individually to harbour effective treatment.

http://dera.ioe.ac.uk/7190/1/dcsf-rr023.pdf Serious case reviews are carried out when abuse and neglect are known or suspected factors when a child dies (or is seriously injured or harmed), and there are lessons to be learnt about inter-agency working to protect children (HM Government 2006a). The review should establish what improvements can be made to the way in which professionals and agencies work together to safeguard children and identify how these will be acted upon. At least every two years, an overview analysis of serious case reviews in England is commissioned to draw out themes and trends, so that lessons learnt from these cases as a whole can inform both policy and practice. This is the third such overview analysis. The 161 reviews studied were notified during the period April 2003 - March 2005

The science of prevention: A conceptual framework and some directions for a national research program - 

The concept of prevention as it is used in public health has been taken seriously in the mental health field only in the last few decades (G. Caplan, 1964; Sarason, Levine, Goldenberg, Cherlin, & Bennett, 1966). In the last decade particularly, interest in general human development has converged increasingly with examination of causes and remedies for psychological disorder. A new research discipline, which we term prevention science, is presently being forged at the interfaces of psychopathology, criminology, psychiatric epidemiology, human development, and education. The purpose of this article is to provide a description and working definition of prevention science and to offer general principles that outline its conceptual framework. The final section of the article offers some suggestions about future directions for a national program of prevention research. Definition of Prevention Science The goal of prevention science is to prevent or moderate major human dysfunctions. An important corollary of this goal is to eliminate or mitigate the causes of disorder. Preventive efforts occur, by definition, before illness is fully manifested, so prevention research is focused primarily on the systematic study of potential precursors of dysfunction or health, called risk factors and protective factors, respectively. Risk factors are variables associated with a high probability of onset, greater severity, and longer duration of major mental health problems. Protective factors, in contrast, refer to conditions that improve people's resistance to risk factors and disorder. Current etiological models emphasize complex interactions among genetic, biomedical, and psychosocial risk and protective factors. Prevention science research explicitly addresses the complex biomedical and social processes believed to influence the incidence and prevalence of mental illness. Preventive interventions aim to counteract risk factors and reinforce protective factors in order to disrupt processes that contribute to human dysfunction. Ideally, there is a complementary interplay of science and practice. Basic research on risk and protective factors should inform the design of preventive interventions. Field trials of these interventions, in turn, should yield insights about the causes of disorder and the developmental processes that contribute to risk or recovery.  

What are the consequences of sexual abuse for the child victim?
Sexually abused children may experience a wide range of emotional and behavioral reactions to the abuse. The nature and severity of these difficulties may depend upon the age of the child, the identity of the perpetrator, the circumstances of the abuse, and the family's reaction to the child's disclosure. Children may exhibit symptoms similar to anxiety and distress, such as wetting the bed, nightmares, difficulty in school, and running away, which are similar to problems exhibited by children who have experienced any kind of a trauma. Children may also exhibit symptoms that are more specific to inappropriate sexual exposure, such as repetitive sexual talk and play, and fears of specific situations or people that remind them of the abuse. Some children may not exhibit any difficulties as a result of their traumatic experience. And, sometimes, problems will not become apparent for years, when the child has grown up.
Once the abuse is disclosed, and stopped, some children return to relatively normal behavior and emotions. The support and protection of the people close to them is really important in helping children get back to normal. However, some children have symptoms that persist long after the abuse itself has ended. In fact, a significant number of sexually abused children suffer a serious and often chronic disorder known as posttraumatic stress (PTSD). That's why it's important for the sexually abused child to undergo a psychological evaluation and, if necessary, receive treatment. It is important that parents recognize that children may experience different problems related to their sexually abusive experiences as they go through different developmental stages. Therefore, although a child may have successfully completed therapy soon after the abuse was disclosed, or may not have had difficulties previously, he/she may need to go to counseling at some later time.

There is little information about specific treatment strategies for victims of statutory rape or Internet-initiated sex crimes. For youth who do not experience offenses as traumatic and do not have histories of sexual abuse or maltreatment, standard treatment models for sexual abuse like Trauma-Focused Cognitive Behavioral Therapy may not be applicable, at least without major modification. Some youthful victims may feel love and allegiance toward offenders and,at the same time, victimized by authorities and parents, whom they may blame for any stigma or embarrassment they experience. Some victims may be in crisis about sexual orientation issues. Some may not wish to cooperate with law enforcement or mental health providers. The trauma of some may be compounded by an awareness that sexual pictures of themselves are circulating online. Mental health practitioners need protocols for assessing the needs of these youth, who are likely quite diverse. Practitioners also need strategies for building alliances that will encourage victims to accept assistance when they need it. Developmental issues are also a consideration. Older adolescents may be more capable of understanding the intricacies of relationships than youth in the early stages of sexual development (Ponton & Judice, 2004). Practitioners may find it harder to get through to younger adolescents, who may, in general, experience more negative consequences than older teens. One approach that has been used with adolescent victims in these situations is to conceptualize treatment in terms of the stages of change model that has been used with drug addiction and victims of domestic violence (Burman, 2003; Prochaska & Prochaska, 2002). This requires assessing where youth are along a continuum of readiness to change and what elements of their situation they regard as problematic; taking a motivational enhancement approach (e.g., being non-judgmental, identifying what would make a behavior a problem requiring change, weighing pros and cons); then seeing if there are specific concerns for which a component of cognitive-behavioral therapy or skill teaching might apply (L. Berliner, personal communication, July 17, 2007). In addition, forms of family intervention – focusing on family conflict, parent-child relationships, supervision – that have proven effective with delinquent youth may be useful with some parts of this population (Alexander, et al., 1998; Henggler, et al., 1998). Connecting youth with positive sources of mentoring and education around sexual and relationship issues may also be helpful. Some practitioners may also have important roles in gathering forensic evidence from victims and obtaining their cooperation with law enforcement. Such practitioners need to develop skills for building rapport with adolescents and explaining the function of law enforcement in protecting other youth (Finnegan, 2006).

Family therapy

The essential goal of any family sex abuse treatment program has to be the immediate cessation of all forms of abuse within the family. This goal will take precedence over all others and may determine the structure of therapy and the timing of interventions. For example, if the child is at risk for further abuse because the abusing family member denies the abuse, then removal of the abusive family member would be in order. Another goal is that the family’s vulnerabilities to abuse must be reduced so that there is little if any likelihood of future abuse in the family. These vulnerability factors exist in all the contexts where the family exists.

Stage 1: Creating a Context for Change - context of safety and hopefulness is created. The family members commit to work toward change. A collaborative relationship between client and professionals is built to assess the problem and determine the therapeutic goals. A detailed treatment plan is determined between professionals and consumers. 

Stage 2: Challenging Old Patterns and Expanding New Alternatives - the family is encouraged to creatively challenge problematic thoughts, feelings, and behaviors which are no longer useful, giving way to more adaptive healthier alternatives. Therapeutic interventions are designed based on the family’s strengths. During Stage 2, family members may actively participate in group, individual, family, or couple sessions 

Stage 3: Consolidation - in this stage, the family consolidates the positive, adaptive new behaviors they have made so that they will sustain. The family prepares for future situations and plans how to continue to make adaptive choices to insure that no further abuse takes place in their life or future generations of their family.

Utilization of Cognitive-Behavioral and Psycho-Educational Strategies

The family learns to recognize the repetitive and dysfunctional patterns that might characterize their family and which may make them more vulnerable to abuse. Once these are recognized, the family learns ways to disrupt these patterns and establish new, healthier interactions.

Restoration versus Retribution

One of the most controversial differences between the traditional child advocacy and systemic approaches to treating child sexual abuse is the role of family intervention and whether or not a family can be reunited. Retribution in therapy means designing treatment to punish the behavior. This may include forbidding contact among some family members during therapy, threatening the removal of children for excessively long periods of time, and operating under the belief that sexually abusive behavior is impossible to eradicate. Restorative therapy is geared to create change within the family, by encouraging healthy, non-abusive family systems. The underlying view is that people are basically good, and that this goodness can be restored to encourage strong, positive-valued, abuse-free interactions. This restoration does not necessarily mean reunification; rather it means the restoring of some type of safe, non-abusive relationships.

These contexts include larger systemic vulnerability factors, such as a family living in a cultural system that may offer tacit approval of sexuality within the family; family system vulnerabilities, such as extreme enmeshment leading to social isolation; and individual vulnerability factors, such as specific paraphilias on the part of the abusing family member.

Strength-Based and Solution-Focused Interventions

Families and their members are seen as competent, complex, human beings rather than as mere “labels,” such as “offender” or “victim.” Most interventions are framed in a strength-based, resiliency manner. Family members are encouraged to engage in behaviors which build on their strengths and interests, and at the same time preclude abuse.

 

Psychotherapy — or talk therapy — is often successful at treating victims of sexual abuse. The therapy revolves around the one on one relationship with the victim and the therapist. In the early stages of therapy, the therapist is more inclined to just listen which ensures that the victim moves at a pace in which they are comfortable with while developing trust in the process, and the therapist himself. This trust leads to the victim being more open and vocal about the situation so that the therapist can assess and determine the best course of treatment.
Medication – such as anti-depressants – are often used in accordance with therapy for victims of sexual abuse and/or assault. While these are rarely prescribed without on-going psychotherapy, the medication often helps to reduce thoughts of suicide or self-harm in the most extreme cases. This is typically used alongside other therapy such as CBT.
On-going support — such as group therapy — is typically the next step in the process. As the patient begins to heal the mental and physical wounds brought on by sexual misconduct, the therapist will often suggest group therapy as a supplemental therapy to their one-on-one sessions. Hearing the stories of other sexual abuse survivors as well as being able to provide support in a safe setting often helps the victim to put the pieces of their life back together and form new relationships.

Trauma-focused cognitive behavioral therapy (TF-CBT) - psychosocial treatment model designed to treat posttraumatic stress and related emotional and behavioral problems in children and adolescents; initially developed to address the psychological trauma associated with child sexual abuse. TF-CBT is comprised of education about childhood trauma and PTSD; emotion education and emotion regulation skills; relaxation and stress management; connecting thoughts, feelings, and behaviors related to the trauma; direct discussion or sharing of the traumatic event
Group therapy - it has been identified as the treatment of choice when working with sexually abused adolescents. Groups create an environment where survivors of sexual abuse can meet and interact with other individuals who faced with similar presenting problems
Eye Movement Desensitization and Reprocessing - a method used to treat the symptoms of trauma as well as other emotional conditions. EMDR was originally developed to treat adults with PTSD; however, it is also used to treat other conditions and children. EMDR reduces the long-lasting effects of stressful memories by developing more adaptive coping mechanisms. The therapy uses an eight-phase approach that includes having the client recollect distressing images while receiving one of several types of bilateral sensory input, such as side to side eye movement.

THE MARY POTTER CENTRE 

ST ANN’S VALLEY CENTRE 

THE OPEN DOOR PROJECT 

SHARED LIVES 

CHILDREN and FAMILIES DIRECT - also on Nottingham Children’s Partnership 

Intervention in the problem of sexual abuse is a complicated art that depends on many aspects of the case and the situation, including the age of the child, the nature of the abuse, the reaction of the family and the resources of the community. Even if the problem itself were similar, for example, in Japan to what it is in the U.S., the institutional structure is not. Certainly one needs to develop systems of intervention that are specifically tailored for the institutions, professional practices and laws of the particular country. However, I can mention to you several principles of intervention that we have arrived at in the United States after much experience that you might want to incorporate as much as possible in your own approach:

 Few children when they decide to disclose are able to anticipate the unpleasant gauntlet of reactions and results that will ensue. Mostly they want to stop the abuse or to have someone to talk to about it. Then, the unanticipated consequences of disclosure – the interviews, the hearings, the disruption in their lives – and the reactions of others – the denials, the outrage, the confrontations, the ostracism, these are often more upsetting to them than the abuse. Thus every effort needs to be made to minimize the impact of these reactions and interventions. This means, for the professionals, keeping interventions to the minimum necessary to get information and protect the child. It also means respecting the child, the child’s needs and the child’s autonomy. Thus every effort is made to limit the number of times a child has to be interviewed about the abuse. The child’s living arrangement and schedule should be preserved as much as possible. The child’s confidentiality must be protected. In addition, it is important that all procedures be explained in detail to the child so that he or she knows exactly what to expect. Children must be given options and choices, so they do not feel like victims of a huge adult-run bureaucracy. And a resolution of the process needs to come quickly. Studies have demonstrated that the longer it takes for an investigation and court process to occur, the harder it is for the child to begin the recovery process.

 has also demonstrated that the most consistent predictor of the impact of sexual abuse on a child is the amount of support that the child receives from family members. Unfortunately, many kinds of sexual abuse result in an alienation of a child from his or her family. At the very least, family members feel guilty for allowing the abuse to occur. At the worst, they do not believe the child or they ally with the perpetrator, who may be their father, husband or some other cherished family member. Perhaps the most important of all principles of intervention is to try to maintain a positive bond between the victim and non-abusive family members. This means that the professionals need to treat these individuals with respect and concern and involve them in the process and decision-making as much as possible. It means providing family members with information to make sense of what happened and to encourage them to believe and support the child. It also means providing counseling for them and giving them an opportunity to deal with their own feelings about the situation, without venting them on the child. They also need to be considered victims of the situation. Support groups for parents of sexually abused children have been useful. Sometimes it is necessary to help parents deal with their own histories of sexual abuse that they have never before disclosed.

In addition to these principles of intervention, I would also like to mention three components of a community-wide response to sexual abuse that I believe are very important for a successful comprehensive response to the problem. First is an effort to increase the level of general professional awareness about the problem. Diagnosing and intervening in sexual abuse require us to draw upon a lot of community personnel, and these personnel will be more helpful and available if they have been exposed to information about sexual abuse and have been encouraged to abandon their prejudices and discomforts. So, for example, people as diverse as teachers, clergy, recreation leaders, journalists and lawyers all need to be well educated about sexual abuse. This can be done through workshops, books, articles in popular magazines, and professional publications. Second, there is a pressing need for specialized professionals who can play a crucial role in the process of diagnosis and intervention. For example, I have mentioned specialized pediatricians and pediatric gynecologists who can perform medical examinations. It is also important to have specialized police officers who are trained in child development and are capable of doing effective criminal investigations in these cases. It is also useful to have specialized therapists who are familiar with some of the current therapies for treating sexual abuse offenders. It has been fairly conclusively established that conventional psychotherapeutic techniques do not work with sexual offenders and untrained therapists get into grave difficulties. We have also arrived at a consensus that group family therapy with the offender as the exclusive modality of treatment is inadequate. Offenders, even incest offenders and juvenile offenders, need individual evaluation and treatment by therapists with specialized training in work with offenders. When communities give access to specialists in these areas, the process of diagnosis and intervention is much another and more effective. Finally, communities need to have sexual abuse prevention education for children. In North America, most schools nowadays have programs that teach primary school children how to recognize sexual abuse, and how to avoid such activities, and that encourage children to tell adults. Such programs, which often include games, films, plays and exercises to practice, have become very popular among children and educators in the U.S. We do not yet know how effective they are in actually preventing abuse, although there are many encouraging anecdotes. But these programs have been demonstrated to help promote early disclosures, and they also do a great deal to educate parents and professionals in the community at large. Some have criticized these programs for unnecessarily frightening children. But the evidence from research is that they are well liked by children and have few negative effects.

https://www.sciencedirect.com/science/article/pii/S0890856709634031 

Treatment outcome for sexually abused preschool-age children and their parents was assessed, comparing the effectiveness of a cognitive-behavioral intervention to nondirective supportive treatment.

Method

Sixty-seven sexually abused preschool children and their parents were randomly assigned to either (1) cognitive-behavioral therapy adapted for sexually abused preschool children (CBT-SAP) or (2) nondirective supportive therapy (NST). Treatment consisted of 12 individual sessions for both the child and parent, monitored for integrity with the therapeutic model through intensive training and supervision, use of treatment manuals, and rating of audio taped sessions. Parents completed the Child Behavior Checklist, the Child Sexual Behavior Inventory, and the Weekly Behavior Report to measure a variety of emotional and behavioral symptoms.

Results

Within-group comparison of pretreatment and posttreatment outcome measures demonstrated that while the NST group did not change significantly with regard to symptomatology, the CBT-SAP group had highly significant symptomatic improvement on most outcome measures. Repeated-measures analyses of variance demonstrated group × time interactions on some variables as well. Clinical findings also supported the effectiveness of the CBT-SAP intervention over NST.

Conclusions

Findings provide strong preliminary evidence for the effectiveness of a specific cognitive-behavioral treatment model for sexually abused preschool children and their parents.

James, A. C., James, G., Cowdrey, F. A., Soler, A., & Choke, A. (2013). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev, 6.

CBT is significantly more effective than no therapy in reducing symptoms of anxiety in children and young people.
No clear evidence indicates that one way of providing CBT is more effective than another (e.g. in a group, individually, with parents).
CBT is no more effective than other ’active therapies’ such as self-help books.
The small number of studies meant the review authors could not compare CBT with medication.
Only four studies looked at longer-term outcomes after CBT. No clear evidence showed maintained improvement in symptoms of anxiety among children and young people.

What kind of treatment is available for victims and nonoffending parents?
Many therapy formats have been applied to sexual abuse cases including individual, family and group therapy. Cognitive behavioral therapy, in both individual and group settings, effectively decreases the problems experienced by sexually abused children.
Both the sexually abused child as well as his/her nonoffending parent(s) can benefit from cognitive behavioral interventions. The cognitive behavioral therapist may help nonoffending parents cope with their own thoughts and feelings about their children's abuse, while also teaching parenting skills that will help them respond more effectively to their children's disclosures and abuse-related difficulties. Cognitive behavioral interventions for the child should be individually tailored to target the particular child's difficulties. However, educational, coping skills, and gradual exposure exercises are generally incorporated into the treatment plan. Gradual exposure refers to exercises that encourage children to confront memories, thoughts, and innocuous reminders (e.g. bathrooms, sleeping alone, undressing, showering, etc.) of the abuse in a gradual fashion over time. This may be done by guided imagery, doll play, drawing, reading, writing, poetry, singing, etc. By reducing the anxiety associated with abuse-related discussion, gradual exposure exercises help sexually abused children to express their thoughts and feelings more openly, thereby enhancing their ability to understand and emotionally process the abusive experience(s).

PTSD Treatment Option #1:
Eye Movement Desensitization and Reprocessing (EMDR)
According to www.webmd.com, EMDR “does not rely on talk therapy or medications. Instead, EMDR uses a patient’s own rapid, rhythmic eye movements. These eye movements dampen the power of emotionally charged memories of past traumatic events.”

This treatment method requires a mental health clinician with specialized training

PTSD Treatment Option #2: Cognitive-Behavioral Therapy (CBT)
This form of treatment has been around for many years. Clinical social worker Elisa Nebolsine defines CBT as “a problem-focused type of intervention. Rather than an in-depth focus on past experience, cognitive behavioral therapy (or CBT) seeks to teach children to become their own therapist.

CBT helps kids recognize their thought patterns and identify where and when those patterns help and where they hurt. Using problem solving strategies and skill building techniques the child, parent, and therapist work together to change dysfunctional thoughts and replace them with more proactive thoughts and behaviors.”

This treatment is usually administered in weekly sessions of 45 minutes to an hour over several months. Children need higher level thinking skills to participate in this therapy, so it’s usually better for older children. 

PTSD Treatment Option #3: Play Therapy
Play therapy is most commonly used with children from ages 3–8. Dr. Tom McIntyre, Professor of Special Education and coordinator of the graduate program in Behavior Disorders at Hunter College of the City University of New York offers this definition of play therapy. “Play therapy is a technique whereby the child’s natural means of expression, namely play, is used as a therapeutic method to assist him/her in coping with emotional stress or trauma.”

Play therapy sessions usually last about 45 minutes a week for several months. Again, any therapist working with your child should be trained in play therapy. 

PSTD Treatment Option #4: Intensive  Trauma Therapy (ITT)
Intensive Trauma Therapy, Inc (ITT) is located in Morgantown, West Virginia is an outpatient treatment clinic that works with children and adults living with PTSD. They accept patients as young as age 3 through adolescence. The clinicians use art therapy, play therapy, guided imagery and an externalized dialogue as well as individual psychotherapy to help children process trauma without reliving it.  Depending on the magnitude and frequency of trauma experienced by children, as well as their ages, clinicians work with them individually for 1–2 weeks, 3–6 hours per day.

The lack of focus on male victims, as highlighted by Lillywhite and Skidmore (2006), is shown across research, services and general awareness. Even though studies have demonstrated a clear gender   differences in that higher proportions of victims are female (Cockbain, 2015; Finkelhor, 1984; Radford et al, 2011; Stoltenborgh et al, 2011), this does not reduce the fact that child sexual exploitation does still happen to males. 

Due to the skew towards female victims in the data,  this area has been critiqued for being female centric meaning having biased research, methods and services, including within the UK meaning males are overlooked and underserved (Lowe and Pearce, 2006; Forrest, 2007). Assessment tools and processes for victims may be tailored more towards the female majority as a result, showing gender bias.  This leads to the inappropriate assessment and handling of male child sexual exploitation victims as they should not go through the same protocols as female victims. As there has been little research on the experiences of male and female victims (Cashmore and Shackel, 2014) so it would be unsuitable to assume such similarity that both genders could be assessed using the same methods.  

A review of the long-term effects of child sexual abuse. Beitchman, J. H., Zucker, K. J., Hood, J. E., DaCosta, G. A., Akman, D., & Cassavia, E. (1992). A review of the long-term effects of child sexual abuse. Child abuse & neglect, 16(1), 101-118. http://www.sciencedirect.com/science/article/pii/014521349290011F

With recent literature highlighting the serious long term psychological effects of child sexual exploitation such as anxiety, fear and suicidal ides (Beitchman 1992), this highlights a need for recovery to be tailed towards helping individuals mentally recover. In adult women, a history of childhood sexual abuse shows greater evidence of sexual disturbance or dysfunction, homosexual experiences in adolescence or adulthood, depression, and are more likely than non-abused women to be revictimized. Whilst in male victims of child sexual abuse show disturbed adult sexual functioning. This suggests a need to treat males and females equally but separately for their recovery, to ensure coping mechanisms are put together to help deal with these specific gender problems. With the commercial sexual exploitation of children is one of the most destructive forms of abuse Barnitz, L. (2001), it is essential to understand the implications and long term effects this has on children to help produce sufficient coping resources to target each individual.

Greater long-term harm is associated with abuse involving a father or stepfather and abuse involving penetration. Longer duration is associated with greater impact, and the use of force or threat of force is associated with greater harm – This suggests to not deal with each individual on a similar scale but to worth with everyone individually to harbour effective treatment.

http://dera.ioe.ac.uk/7190/1/dcsf-rr023.pdf Serious case reviews are carried out when abuse and neglect are known or suspected factors when a child dies (or is seriously injured or harmed), and there are lessons to be learnt about inter-agency working to protect children (HM Government 2006a). The review should establish what improvements can be made to the way in which professionals and agencies work together to safeguard children and identify how these will be acted upon. At least every two years, an overview analysis of serious case reviews in England is commissioned to draw out themes and trends, so that lessons learnt from these cases as a whole can inform both policy and practice. This is the third such overview analysis. The 161 reviews studied were notified during the period April 2003 - March 2005

The science of prevention: A conceptual framework and some directions for a national research program - 

The concept of prevention as it is used in public health has been taken seriously in the mental health field only in the last few decades (G. Caplan, 1964; Sarason, Levine, Goldenberg, Cherlin, & Bennett, 1966). In the last decade particularly, interest in general human development has converged increasingly with examination of causes and remedies for psychological disorder. A new research discipline, which we term prevention science, is presently being forged at the interfaces of psychopathology, criminology, psychiatric epidemiology, human development, and education. The purpose of this article is to provide a description and working definition of prevention science and to offer general principles that outline its conceptual framework. The final section of the article offers some suggestions about future directions for a national program of prevention research. Definition of Prevention Science The goal of prevention science is to prevent or moderate major human dysfunctions. An important corollary of this goal is to eliminate or mitigate the causes of disorder. Preventive efforts occur, by definition, before illness is fully manifested, so prevention research is focused primarily on the systematic study of potential precursors of dysfunction or health, called risk factors and protective factors, respectively. Risk factors are variables associated with a high probability of onset, greater severity, and longer duration of major mental health problems. Protective factors, in contrast, refer to conditions that improve people's resistance to risk factors and disorder. Current etiological models emphasize complex interactions among genetic, biomedical, and psychosocial risk and protective factors. Prevention science research explicitly addresses the complex biomedical and social processes believed to influence the incidence and prevalence of mental illness. Preventive interventions aim to counteract risk factors and reinforce protective factors in order to disrupt processes that contribute to human dysfunction. Ideally, there is a complementary interplay of science and practice. Basic research on risk and protective factors should inform the design of preventive interventions. Field trials of these interventions, in turn, should yield insights about the causes of disorder and the developmental processes that contribute to risk or recovery.  

In terms of how gender compares to other risk factors, the majority of studies report do not specify a particular gender which could be inferred that it the risk factors that are found can be applied to all genders. Sexual abuse can happen to any child but there may be certain circumstances that can increase a child’s vulnerability. Most research also focus solely on females as it has been shown that there is a general view that girls are likely target, however research does show that it is just as likely to happen to males.   

Some abusers target children who are neglected by their parents or children who don’t have many friends as they are more likely to be willing to accept to the attentions of an adult (Elliot et al, 1995).  Girls from stepfather families were five times more likely to experience victimisation. Another risk factor was if a girl had ever lived at some point without her mother, or even if her mother had substantially lower education than her father, or if her mother was particularly punitive about sexual matter, and low caregiver warmth (Finkelhor, 1980; Butler, 2013). A disrupted home life can make children particularly vulnerable to sexual abuse. Domestic violence can push children out of the home and make them susceptible to people who seem kind and show them affection (Goodyear-Brown 2012). 

Finkelhor, Hotaling, Lewis and Smith (1990) found that girls showed markedly higher risk under all family circumstances except that of living with two natural parents and particularly when living alone with father or with two non-natural parents. Boys, in contrast, were primarily at risk when they lived with their mothers alone or with two non-natural parents. This suggests  that almost any long-term disruption of the natural parent situation is risky for girls but not so for boys. Moreover, the transition from a single mother alone to a single mother with stepfather increases the risk for girls but not for boys. 

Overall, it seems that in general family can affect the likelihood of any child being at risk to sexual abuse this could be because children in such families probably receive poorer supervision when out of the home and, those who may have particularly strong needs for positive attention and affection, may be more vulnerable to the ploys of non-family perpetrators who offer attention and affection as a lure (Finkelhor, Hotaling, Lewis and Smith, 1990).

Finkelhor (1980) found the key risk factors in childhood sexual abuse were that more girls from lower-income groups experienced victimization. Also those from socially isolated backgrounds were more likely to experience victimisation. Also having been classified by their school as needing special education was a risk factor. Girls with behavioural health problems and learning challenges are at heightened risk for sexual assault (Butler, 2013). 

Finkelhor, Hotaling, Lewis and Smith (1990) reported that women who described the sex education they received as inadequate were at higher risk for abuse. Adequate sex education may well protect children because it gives specific sexual abuse prevention information, like the kind advocated by prevention education programs, or it may be that inadequately educated children have unfulfilled curiosity about sex, a vulnerability which potential perpetrators can more easily manipulate. However, it is also possible that the causal order is reversed here. A child who has been abused could readily conclude that she had not received adequate sex education to help her avoid becoming a victim. 

Reid and Piquero (2014) For both males and females, maternal substance use and earlier age of first sex were associated with early age commercial sexual exploitation. For males, experiencing rape and substance use dependency were risks. Psychotic symptoms and lower educational attainment were also associated. Finally substance use dependency was linked to late age onset for female youth.

Ethnicity of the individual can contribute towards as a risk factor for sexual exploitation as found by Euser, Alink, Tharner, IJzendoorn and Bakermans‐Kranenburg (2016); Reid and Piquero (2014) who found that African American male youth were at heightened risk, whereas female youth were at risk regardless of all races/ethnicities. 

Dagon (2012) and Pemberton (2011) both use three distinct models for abuser-victim relationships.

Inappropriate relationships where an older abuser has a measure of power over their victim. This could be physical, emotional or financial and in many cases the victim will believe that they have a sincere or loving relationship with their abuser.

The boyfriend model. Cases often involve the abuser and victim entering into an almost conventional relationship with the exchange of gifts and other dating activities. This model can lead the abuser to manipulate the victim. This is a common model for abuse by peers.

Organised exploitation and trafficking. Children are abused by more than one adult as part of a network that may involve the movement of victims into and across the country as well as the exchanging of images of abuse.

Risk factors that have been identified in research can contribute towards these models to explain different ways a child can be exploited when they have been exposed.

From the research discussed it be seen that overall, most risk factors can be applied to all genders however, there is still the assumption that females are more likely to be affected as some risk factors state that females are more at risk when comparing to males. Though there are some studies that have looked into the risk factors of male sexual exploitation they still imply that females are more vulnerable and at risk. This links to the proportions and attitudes in gender differences where it is assumed that the victim will be a girl and the perpetrator will be a male. There needs to be more awareness that boys can also be the victim too so it can be known if there are gender differences in risk factors.     

Dagon, D. (2012) Preventing sexual exploitation. Children and Young People Now, 6-19 March: 36.

Pemberton, C. (2011) Disturbing signs. Community Care, 1870: 16-17.

Goodyear-Brown, P. (ed.) (2012) Handbook of child sexual abuse: identification, assessment and treatment. Hoboken, New Jersey: Wiley.

Elliot, M., Browne, K. and Kilcoyne, J. (1995). Child sexual abuse prevention: what offenders tell us. Child Abuse and Neglect, 19(5): 579- 594.

Finkelhor, D. (1980). Risk factors in the sexual victimization of children. Child Abuse & Neglect, 4(4), 265-273. 

Finkelhor, D., Hotaling, G., Lewis, I., & Smith, C. (1990). Sexual abuse in a national survey of adult men and women: Prevalence, characteristics, and risk factors. Child Abuse & Neglect, 14(1), 19-28.

Butler, A. (2013). Child sexual assault: Risk factors for girls. Child Abuse & Neglect, 37(9), 643-652.

Reid, J., & Piquero, A. (2014). Age-Graded Risks for Commercial Sexual Exploitation of Male and Female Youth. Journal Of Interpersonal Violence, 29(9), 1747-1777.

Euser, S., Alink, L. R., Tharner, A., IJzendoorn, M. H., & Bakermans‐Kranenburg, M. J. (2016). The prevalence of child sexual abuse in out‐of‐home care: Increased risk for children with a mild intellectual disability. Journal of Applied Research in Intellectual Disabilities, 29(1), 83-92. 

Finkelhor, D., & Asdigian, N. L. (1996). Risk factors for youth victimization: Beyond a lifestyles/routine activities theory approach. Violence and victims, 11(1), 3. http://www.unh.edu/ccrc/pdf/CV13.pdf

Theories indicate that some individuals more likely to come into contact with potential offenders due to the activities they take part in and their lifestyle. These individuals are then at a greater risk of youth sexual victimization. For example, living in a high crime area or being out at night will both put an individual at an increased risk. This explains why individuals in high crime, low ses, or poverty areas are at a greater risk for sexual assault. Therefore, focus should be on these particular at risk groups to educate children of the dangers and to also put extra supports in place for children in reporting and coping with sexual victimization.

East, P. L., & Hokoda, A. (2015). Risk and protective factors for sexual and dating violence victimization: A longitudinal, prospective study of Latino and African American adolescents. Journal of youth and adolescence, 44(6), 1288-1300.
 

Hirschi’s social control theory (Hirschi 2008) contends that extensive social controls, such as diligent parental supervision and involved parenting, prevent youth from engaging in risky behaviors and consorting with violent- prone peers. Such protective mechanisms redirect youth away from potential perpetrators and divert them from engaging in behaviors that make them vulnerable to assault. Others have suggested that parents’ attitudinal conventionality also represents a social control, wherein parents’ conservative attitudes set a standard of what constitutes allowable and tolerated behavior in their children (Jessor 1998). Indeed, attentive parental monitoring has been linked with adolescents’ lesser likelihood of dating violence victimization (Brooks-Russell et al. 2013; Chapple 2003; Foshee et al. 2004), and the presence of two adult parental figures in the home, presumably an index of parental monitoring and supervision, has also been associated with young adult women’s reduced likelihood of sexual (East et al. 2010) and dating violence victimization (Gover 2004; Halpern et al. 2009).

Given evidence that these social controls protect youth from dating and sexual violence, it would seem important to determine whether these factors, if present early in life, can protect youth from experiencing victimization later in life. Previous research on protective factors have tested both main protective effects as well as buffering effects (Loukas et al. 2007). Main protective effects, as their name implies, are factors associated with a lower likelihood of an adverse event (Masten and Garmezy 1985). In contrast, buffering effects involve protective factors that are associated with a lower likelihood of an adverse event in the presence of a risk factor (Roosa 2000). In this case, protective factors interact with risk factors to buffer or offset their impact and thus moderate risk effects. The current study sought to identify both main protective factors (or parenting factors associated with a lower likelihood of youth victimization), as well as interactive-buffering effects (or parenting factors that in interaction with risk factors are associated with a lower likelihood of youth victimization).

Turchik, J. A., Hebenstreit, C. L., & Judson, S. S. (2016). An examination of the gender inclusiveness of current theories of sexual violence in adulthood: recognizing male victims, female perpetrators, and same-sex violence. Trauma, Violence, & Abuse, 17(2), 133-148.http://journals.sagepub.com/doi/pdf/10.1177/1524838014566721

Generally looking at adult sexual violence, but theories could be applied to child situation as talking about perpetrators as adults.

Outlined three main theories:

Feminist theory.

Brownmiller’s (1975) Against Our Will: Men, Women, and Rape states that rape is ‘‘a conscious process of intimidation by which all men keep all women in a state of fear’’ in order to maintain the patriarchal status quo, which clashed with the early 20th century belief that sexual violence was due to an uncontrollable male sexual drive (Donat & D’Emilio, 1992). Brownmiller and other feminists posit that this subordination of women through rape and other forms of violence maintains a cultural system in which men are able to control power in social, political, and economic realms. Although there is no singular feminist theory of sexual violence, some commonalities exist across many of the feminist perspectives (Ellis, 1989; Ward et al., 2006). Ellis (1989) articulated some of the following assumptions: (1) rape is primarily associated with power and not primarily motivated by sexual desire; (2) rape should be associated with gender disparities in social status and power; (3) exposure to violence against women (i.e., pornography and prostitution) increases male tendency to rape; (4) sexual egalitarianism should be associated with decreases in incidents of rape; and (5) men who rape should hold less egalitarian and more rape-supportive views compared to men who do not rape.

Suggesting that only happens to females (and perpetrators only male), which is not true. But looking in the cases of females, where it happens most, suggests that prevention could lie in the educating of males, or education of all people at a young age to get rid of these belief systems. Also teaching children both male and female about rape and sexual exploitation to educate them of the dangers and that it isn't right and they should speak out against it.

Routine activity theory.

 Routine activity theory was put forth to guide the prediction of criminal acts by positing that a direct- contact criminal opportunity requires the following three elements that must converge in time and space: (1) a motivated offender, (2) a suitable target or victim (e.g., vulnerable, fits offender’s preferences), and (3) the lack of a capable guardian (Felson & Cohen, 1980). The theory therefore assumes that criminal victimization is not randomly distributed in the population. Routine activity theory is not specific to sexual violence but is meant to predict both perpetration and vulnerability to victimization for all types of crime, involving contact with a person or personal property (e.g., murder, burglary, and rape). An extended version of the routine activity theory includes a variable from the general theory of crime (Gottfredson & Hirschi, 1990) which states that low levels of self-control lead to increased risk to commit criminal offenses as well as increasing one’s vulnerability and exposure to crime (Schreck, 1999).

Social learning and related theories. 

Social learning theory has roots in the work of Bandura (1979), with the overarching premise that cognitive, behavioral, and environmental determinants reciprocally interact with one another to produce a multitude of behaviors, both prosocial and deviant, through the mechanism of observations and imitation. Social learning theory has been applied to the understanding of deviant and criminal behavior (Cullen, Wright, & Blevins, 2006), including sexual violence. Through this lens, individuals who witness sexual violence committed by role models or caregivers form favorable attitudes toward sexual violence through childhood socialization and anticipate pleasurable consequences that lead to an increased propensity to imitate and commit sexual violence (e.g., Akers & Sellers, 2009). A closely related hypothesis is the intergenerational transmission of violence hypothesis (Curtis, 1963; Widom, 1989), which posits that witnessing or experiencing aversive interpersonal behavior in one’s family of origin is functionally reinforcing and increases risk of offending. In other words, ‘‘violence breeds violence.’’

Many theories based on social learning theory, such as Riggs, Murphy, and O’Leary’s (1989) background-situational model and a number of theories of social cognition have been applied to understanding interpersonal violence (see Gannon et al., 2008; Shorey, Cornelius, & Bell, 2008). The background–situational model draws upon the intergenerational transmission of violence hypothesis as well as conflict theory and postulates that a number of background factors (i.e., inter- parental aggression, child abuse, and prior aggression) and situational factors (i.e., alcohol use and relationship distress) influence the acceptance and subsequent use of aggressive tactics in intimate relationships (Riggs, Murphy, & O’Leary, 1989). A number of theories of social cognitions (see Gannon et al., 2008 for review) view dysfunctional schemas developed in childhood and adolescence as providing support for deviant behavior. For example, Mann and Beech’s (2003) schema model of sexual assault incorporates developmental experiences into a model of factors leading to dysfunctional schemas that influence proclivity to commit sexual violence

https://www.sciencedirect.com/science/article/pii/S135917891200122X 

Risk factors of online grooming

Low self-esteem, susceptibility to persuasion, behavior difficulties, emotional suffering and immaturity are all characteristics associated with victims of offline sexual abuse (Dombrowski et al., 2004; Olson, Daggs, Ellevold, & Rogers, 2007; Stanley, 2001).

Similar vulnerabilities have been found in research relating to online grooming where young people with low self-esteem, emotional disturbances and psychological disorders are more at risk (European Online Grooming Project et al., 2012; Soo & Bodanovskaya, 2012).

Mental health problems (such as depression), troubled minds, and delinquent tendencies may make a young person more vulnerable to online grooming (De Graaf & Vanwesenbeeck, 2006; Mitchell, Ybarra, & Finkelhor, 2007; Mitchell et al., 2001; Wolak et al., 2004, 2008), although it is again worth noting potential discrepancies depending on the use of the term grooming or sexual solicitations within the study. Furthermore, Livingstone et al. (2011a, 2011b) found that across Europe, young people with psychological problems encounter more risks online and have a higher chance of being upset by the experience.

Evidence suggests that depression is positively related to chat room use and accessing the internet for longer than 1 h per day at home (Sun et al., 2005) and more than 2 h of any screen time (e.g., TV, computers) a day is related to psychological difficulties regardless of the level of physical activity (Page, Cooper, Griew, & Jago, 2010). It is, therefore, possible that using the internet for long periods of time or using chat rooms could increase vulnerability towards online grooming due to the impact these activities may have on a young person's mental health. Research surrounding an individual's self-perception and mental health contributing to online grooming vulnerability has begun, but further research is necessary to provide more information on causal links.

It is generally supported by research that there is an association between disability and vulnerability to child sexual abuse offline (Brunnberg, Boström, & Berglund, 2012; Sinanan, 2011; Yancey & Hansen, 2010). Online, while young people with a disability are slightly less likely to use the internet as regularly as their non-disabled peers (Livingstone & Bober, 2005), the internet can provide solace and support for those with disabilities, particularly if they feel marginalized or excluded from peer groups in the real world. However, while the online environment may offer opportunities for social engagement, young people with disabilities sometimes experience further marginalization online (Söderström, 2009). And like other young people, they are exposed to the risk of online grooming but may be less able to recognize or cope with it.

Family (more or less the same as the other research we have found)