Intra-familial child sexual abuse refers to child sexual abuse (CSA) that occurs within a family environment. Perpetrators may or may not be related to the child. The key consideration is whether the abuser feels like family from the child’s point of view.
Around two-thirds of all CSA reported to the police is perpetrated by a family member or someone close to the child.
Where research has recorded the gender of perpetrators of intra-familial CSA, the vast majority have been found to be male, although abuse by women does occur. In around a quarter of cases, the perpetrator is under 18.
CSA in the family is rarely an isolated occurrence and may go on for many years.
Much abuse in the family remains undisclosed. Children may fear their abuser, not want their abuser to get into trouble, feel that the abuse was ‘their fault’, and feel responsible for what will happen to their family if they tell. Disabled children and some black, Asian and minority ethnic children face additional barriers.
Abuse by a family member may be particularly traumatic because it involves high levels of betrayal, stigma and secrecy.
CSA in the family is linked to a range of negative outcomes over the whole of the life course, including poorer physical and mental health, lower income, relationship difficulties and further violence and abuse.
However, not all survivors experience long-term impacts. Much depends on the nature and duration of the abuse, the individual’s coping mechanisms, and the support they receive. Supportive responses from non-abusing carers are particularly important.
Effective support is critical to enable disclosure, and during investigation and legal proceedings. Therapeutic support for young people can have a positive impact but the availability of services remains piecemeal.
Both adult survivors and children/young people value services that listen to, believe and respect them; where professionals are trustworthy, authentic, optimistic and encouraging, show care and compassion, facilitate choice, control and safety, and provide advocacy.
It is important to provide support to the whole family, and particularly to non-abusing parents, following abuse.
The UK Government’s definition of CSA for England is:
…forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways or grooming a child in preparation for abuse (including via the internet). Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children.1
There is no single agreed definition of intra-familial CSA. However, it is generally recognised that, in addition to abuse by a relative (such as a parent, sibling or uncle), it may include abuse by someone close to the child in other ways (such as a step-parent, a close family friend or a babysitter). This understanding is in accordance with Crown Prosecution Service guidelines on the Sexual Offences Act 2003, which state:
These offences reflect the modern family unit and take account of situations where someone is living within the same household as a child and assuming a position of trust or authority over that child, as well as relationships defined by blood ties, adoption, fostering, marriage or living together as partners.2
In thinking about whether abuse is intra-familial, perhaps the most important question for professionals to consider is: ‘Did this perpetrator feel like family to the child?’
It is difficult to be certain about how much CSA happens. Estimates vary widely according to how studies define abuse and the methods used, with most based on retrospective reports by adults. Studies suggest that 15–20% of girls and 7–8% of boys experience some form of sexual abuse before the age of 16. In a UK study involving almost 2,000 young people aged 18–24, nearly 11% reported some kind of unwanted sexual experience, and 6% reported coerced sexual acts, when they were under the age of 18. It is estimated that CSA in the family environment comprises up to two-thirds of all CSA reported to the police.
The majority of known CSA is perpetrated by people known to the child, and the most serious forms of abuse are more likely to involve abusers who are family, friends or acquaintances. The vast majority of identified perpetrators of CSA, including abuse in the family, are male, although abuse by women does occur. Crime survey data indicates that 4% of sexual assaults on under-16s by adults are committed by fathers, 5% by stepfathers and 1% by mothers; other family members (gender unspecified) commit 16% of such assaults. Additionally, it is estimated that a quarter of all cases of CSA in the family environment involves a perpetrator under the age of 18.
Intra-familial CSA can involve all kinds of contact and non-contact abuse, including online-facilitated CSA. However, there is limited research into how or with what frequency abusers use technology within the family.
Abuse in the family generally starts at a younger age than extra-familial CSA, and may continue over many years.
CSA occurs in all kinds of families and across all races and ethnicities, although there are differences in the extent to which abuse gets reported and responded to. High levels of secrecy, shame and stigma within some black, Asian and minority ethnic (BAME) groups, combined with cultural assumptions by professionals can increase barriers to disclosure. BAME children are under-represented in child protection services when it comes to sexual abuse.
Research indicates that disabled children are more than three times more likely than non-disabled children to be victims of CSA. Disabled children are often more dependent on their caregivers, may have more limited means of communication and may be less likely to be perceived as potential victims. These factors, combined with a lack of specialised professional knowledge, can lead to low levels of disclosure and inadequate responses.
Although most research relates to sexual abuse perpetrated by individual family members, families can also be involved in the organised abuse of children involving multiple perpetrators or child sexual exploitation.
One of the difficulties in estimating prevalence is that so much sexual abuse remains unidentified. It is estimated that only one in eight victims of CSA in the family environment comes to the attention of statutory authorities. Disclosure by children is rare, so professionals and other responsible adults need to be able to spot the signs of possible abuse and take appropriate action.
The reasons children keep silent include fear of their abuser, not wanting their abuser to get into trouble, feeling that the abuse was ‘their fault’, and feeling responsible for what will happen to their family if they tell. Children recognise the importance of telling but believe that most children in their position would not feel able to disclose. In addition, many child victims do not recognise that they are being abused until much later, often when they are adults.
Many children do not ‘tell’ in a straightforward way; rather, their behaviour and demeanour or the characteristics or behaviour of caregivers indicates that something is wrong. Those who do tell are not always heard or believed, and, as noted above, some groups of children such as disabled children and BAME children face greater barriers to disclosure. Children abused by a female family member can face higher levels of disbelief from professionals, who may also minimise the seriousness of such abuse.
Important facilitators that enable children to tell include having access to safe adults with the skills to listen, and having the opportunity to obtain information and confidentially explore the consequences of disclosure.
The complex relationship between sexual abuse and other aspects of a person’s life means it is not usually possible to say that an outcome has been caused by their experience of CSA. Factors which may influence the impact of abuse include its severity and duration, the age at which it occurred, the relationship between victim and perpetrator and other difficulties and supports in a child’s life. There is currently no research that differentiates impact of intra-familial abuse by gender of abuser or victim.
An influential model proposed four likely impacts of CSA:
To these can be added secrecy (including the fear and isolation this creates) and confusion (because the child is involved in behaviour that feels wrong but has been instigated by trusted adults). While these impacts are not unique to intra-familial CSA, their combination and intensity in this context makes the experience particularly damaging.
CSA is strongly associated with the following adverse outcomes across the life course:
However, not every child who experiences sexual abuse suffers serious consequences. The poorest outcomes tend to be for children whose sexual abuse is combined with other adversities (such as bereavement) and/or other forms of maltreatment, and recent research suggests that it is the accumulation of victimisation across the life course that has the most negative effects.
A number of factors may contribute to an individual’s resilience to the impacts of CSA, both at the time of the abuse and later in life. These factors include high self-esteem or self-reliance, the development of positive coping strategies and the informal support a child receives from adults in their life, or through school, religious groups or social clubs.
Adult survivors and children value services that listen to, believe and respect them. There are often higher levels of satisfaction with services provided by the voluntary sector – including rape crisis centres, counselling services and independent sexual violence advisors – than with statutory services such as police, hospitals and social care.
Many children who experience CSA in the family receive no support because the abuse remains undisclosed. If a disclosure occurs, professional responses and the availability of services can vary widely. While children and young people highlight the importance of being supported in the aftermath of disclosure, their experiences suggest that services often fail to support them through difficult child protection and legal processes. Children value support from professionals who are trustworthy, authentic, optimistic and encouraging; show care and compassion; facilitate choice, control and safety; and provide advocacy.
The number of children on child protection plans because of sexual abuse has fallen dramatically over the past 20 years: it is now the lowest category of registration, far below those for neglect and emotional abuse. There are also considerable regional variations. There is no research to explain these trends, but we can be fairly certain that they have not happened because of a reduction in incidence. Indeed, over the same period, the police have recorded a large increase in the number of crimes involving CSA.
The child protection statistics may reflect changing trends in priorities, with some forms of CSA slipping down the agenda as local authorities and partner agencies have focused specifically on child sexual exploitation and prioritised other issues such as the impact of domestic violence on children. It may also reflect professional/organisational anxieties about sexual abuse in the family: the challenges of obtaining a disclosure, overcoming denial and finding ways of protecting children in a complex family context can engender feelings of professional helplessness.
Overcoming these challenges requires confident professionals, able to undertake direct work with children, and a supportive child protection system rather than one that is bureaucratic and target-centred. Recent innovations seeking to achieve such change have highlighted the importance of social workers combining empathy and collaboration with purpose and authority, good reflective supervision, access to expertise, and the use of multi-disciplinary teams including adult specialists in mental health or domestic abuse working alongside children’s practitioners.
Despite increased reporting and investigation of CSA, relatively few cases reach the Crown Prosecution Service, and even fewer get to court. One factor is the failure to follow good practice guidance on Achieving Best Evidence interviews, which are crucial in the absence of physical and other corroborative evidence.
Legal processes may also retraumatise victims. When cases do reach court, there are long delays in waiting for trial, low use of special measures to help children give best evidence and aggressive cross-examination techniques. To protect the interests of children, as well as secure convictions, a more child-friendly and responsive system is needed.
Therapeutic support for children and young people who have experienced abuse in the family may be provided by statutory, voluntary and private sector agencies. However, there is a shortage of such services, and provision varies widely between areas.
Research into the effectiveness of therapeutic support for children following CSA has reported mixed results. A systematic review concluded that cognitive behavioural therapy (CBT) may have a positive impact on depression, post-traumatic stress disorder and anxiety symptoms, although most results were not statistically significant. A similar review of psychotherapy was inconclusive, although one randomised trial in the UK found that group and individual psychotherapy for sexually abused girls was effective – particularly in relation to post-traumatic stress.
A recent randomised control trial in the UK (the largest yet conducted of an intervention for CSA) was an evaluation of the NSPCC’s ‘Letting the Future In’ programme, implemented in 20 services in England, Wales and Northern Ireland. At six-month follow-up it found evidence of reduced emotional difficulties and symptoms of severe trauma for children over the age of eight, and children themselves reported greater confidence; reduced self-blame, depression, anxiety and anger; improved sleep patterns; and better understanding of appropriate sexual behaviour.
Interventions that focus on the whole family as well as the individual child are important. Children and young people often feel responsible for the distress of their family in the aftermath of sexual abuse, and this can be reduced through providing support to non-abusing family members.
The disclosure of CSA is a major life crisis for a non-abusing parent, often with long-term effects on their mental health. This can be particularly so if they experienced abuse in childhood themselves. Children are more likely to disclose to their non-abusing parent than to anyone else, and the way a non-offending parent responds to the disclosure of their child’s abuse is crucial, with good support from parents linked to better adjustment in children. Some researchers conclude that the support needs of non-abusing carers are therefore inseparable from those of their child, and their distress should not be overlooked by professionals.
Findings from trials of trauma-focused CBT point to the importance of carer involvement and education in achieving positive outcomes for children and in reducing carers’ stress. A review of 56 systematic reviews identified strong evidence that CBT for non-abusing parents and school-age children is effective in preventing deterioration of child mental health and/or recurrence of abuse. However, even more modest parent-focused interventions (including instructional videotapes based on social learning theory) provided to a parent at the time of a sexual abuse disclosure appeared to have benefits for parents and children.
Parents value parent support groups, particularly those combining support with information about the dynamics and impacts of abuse and practical advice on how to deal with children’s feelings and behaviours. Parents who have participated in such groups report increased wellbeing and confidence, reduced stress, and greater ability to care for their child and deal with professionals. Groups help participants build vital social networks with others who share similar experiences, help to normalise children’s behaviour, and may reduce depression.