Monday, November 16, 2015

"Spotlight" reminds us that preventing child sexual abuse starts at home

I had the extraordinary pleasure of viewing the new film, Spotlight, this weekend. The critical acclaim of this masterpiece has been loud and unanimous, but more importantly, well-deserved. The film recounts the efforts of the investigative team, Spotlight, at The Boston Globe back in 2001 as they scrupulously uncovered systemic protection of Catholic priests who had repeatedly molested and raped children in their parishes with this article. This isn't a film blog, so I will simply leave you with a strong recommendation to see the film and get straight to the science. 

Children exposed to sexual abuse sustain psychological injuries that persist throughout their lives. In fact, I became a clinical psychologist because my first experience in clinical psychology research was in treating adults who continued to suffer from Post-traumatic Stress Disorder (PTSD) from severe sexual abuse as children. For the most part, a child who is sexually abused will have more physical illnesses, be less educated, have poorer and fewer close relationships, more problems with depression and anxiety, and more likely to attempt suicide than their peers for the rest of their lives. In fact, the World Health Organization (WHO) ranks child sexual abuse as equivalent to other well-known health concerns such as lead exposure and urban air pollution. 

This occurs for a lot of reasons, some of which we understand and some of which we don't yet. As a scientist, I am often more interested in the how and why of psychological phenomenon, but in the case of childhood sexual abuse, the negative consequences are so horrifying that our attentions should be solely focused on intervention and treatment. In the service of that goal, I have identified an article published this year that begins to explain how child sexual abuse prevention can start in the home. 

The main argument of this article is aimed at intervention researchers and emphasizes that child sexual abuse prevention should occur through parenting programs which still need to be developed. And further, these programs should target the parents of young children (ages 3-5). The rationale and evidence for this argument is what I want to share with you and your loved ones.

Currently, there are a number of preventive efforts in place that serve to protect children from sexual abuse. They are: 

1)Punishing offenders with incarceration, required public registration as a sex offender, and restrictions to where they can live and work. 
2)Advocacy and media campaigns that combat the "bystander effect" which basically encourage members of the community to take a "if i don't help, who will?" approach to protecting members of their community and neighborhood. 
3) Treating sexual offenders to prevent future victimizations
4) Treating victims to prevent future victimization

While each of these preventive strategies has been effective in some ways, they argue that more can be done to educate children and families to protect themselves. For example, we know that parenting intervention programs can reduce other types of abuse to children, such as physical abuse, but also that these parenting intervention programs can increase different parenting skills and practices that will help to prevent a child's risk for being sexually abused. 

The most important parenting predictors of positive child outcomes are warmth and control. Parents who are high in both warmth and control have children that grow up to be healthy, happy, and accomplished. This is obviously an over-generalization of what we know in developmental psychology, but either way, a child almost always benefits from their parent exhibiting mutual increases in warmth and control in their daily lives. The good news is that warmth and control can be taught, and child and adolescent psychologists know how to teach it! 

How to use Warmth and Control as a parent to prevent sexual abuse: 

Warmth: Sounds simple, but talk to your young child about sex and everything else. Parents who provide a safe environment for their children to talk about sexual behavior are more likely to delay the onset of having sex and end up more effectively using contraceptives. The authors of the article argue that these benefits could also be extended to helping children understand what type of touching is and is not ok. The truth is that children, especially young children, often do not know they are being victimized. They often believe they are just doing what they are told, or are playing a game. As a parent, your job is to learn as much as possible about the world they live in from their perspective and from there you will learn about their experiences, both good and bad. Also, kids know when something is "taboo" but often misread the signals as they are "in trouble." In fact, the children and adults I have treated who have a history of sexual abuse failed to tell an adult because they were worried they would get in trouble. Create a safe and supportive place for them to talk to you. This starts early. The peak age for sexual abuse exposure is in the early teen years (ages 12-14) but the number jumps from 3% among 0-2 year olds to 14% among 3-5 year olds. If you start the conversation early, you are the most likely to be effective in teaching your child what is and is not ok. 

Control: The highest risk populations for child sexual abuse are single parent families, families who live in poverty, children with disabilities, and families with domestic violence. The common denominator here is parent supervision. Basically, children who spend time with more adults who are not their parents are at highest risk. So, watch your kids, and when you can't watch your kids make sure they are with adults that you know and trust. Not to make you paranoid, but perpetrators are actually less likely to be strangers than your child's friends, their friends' older siblings, and babysitters. 

A scandal like this, and a film like Spotlight can often turn into a dramatized smear campaign against the Catholic Church and everything it stands for. However, perhaps most brilliant and much appreciated about the film was the attempt at an honest portrayal of an entire community that was guilty of negligence. We are all vulnerable to valuing belonging to a group over protecting individuals. From an evolutionary standpoint, that serves us well more often than it hurts us. We live in complex social systems made up of families, and neighborhoods, and cities, and states, and nations, and cultures. When it come to sexual abuse of a child, what we have to remember is that it is not enough to simply separate the perpetrator from the victim. It is not enough to remove the perpetrator from other potential victims. In the anticipation of Spotlight's release, The Boston Globe released an article highlighting the reformed Catholic Church on all issues related to child molestation and handling of church officials suspected of this behavior. Archbishop Michael Jackels in Iowa said it well, "The story told by the movie bears repeating until all of us get all of it right."

Mendelson, T., & Letourneau, E. J. (2015). Parent-Focused Prevention of Child Sexual Abuse. Prevention Science, 1-9.

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