P3A165: What Made You Tell? factors Impacting Child Sexual Abuse Disclosure

Background: Child sexual abuse is a global public health concern prevailing across generations, socioeconomics classes, and cultures. Consequently, within the past 40 years, awareness and education of child sexual abuse have expanded. Children frequently delay disclosures and may experience physical and behavioral symptoms until disclosure occurs. Research on child sexual abuse and disclosure indicates a lower number of official reports to authorities compared to the high rates of actual incidences of child sexual abuse. Despite the increasing literature on this topic, there is minimal information available identifying what factors specifically facilitate timely disclosure. The aim of this study was to identify external/internal factors that prompted the child’s disclosure of sexual abuse.

Methods: This retrospective qualitative descriptive study was conducted at a single-site state-designated Regional Diagnostic Center for child abuse and neglect. Patient information and medical records were protected in accordance with state law and the study received expedited approval from the Institutional Research Board in 2019.
Based on historical trends, a convenience sample of 201 subject’s records were assessed. Content analysis reported aggregate characteristics of subjects (age, gender, race/ethnicity), perpetrators (age, relationship), time to disclosure, and duration of abuse. Thematic analysis examined the semi-structured interview responses to the open-ended question “what made you tell” and isolated trends associated with internal/external factors prompting the child’s disclosure of sexual abuse.

Results: Of the 201 subject responses, 110 indicated more than one factor prompted disclosure while 92 responses indicated a singular factor; consequently, 376 unique theme entries were identified.
Children aged 12 were the most frequent age at time of disclosure, accounting for 16.2% of entries. Among subjects < 8 years old, internal and external factors were equally identified as the reason for disclosure. While children aged 9-14 years identified internal factors for prompting disclosure, children aged 15-17 most frequently identified external factors (see table 1).
Internal factors were more frequently identified as the prompt for disclosure when the duration of abuse occurred between 6-10 years and when abuse occurred for less than one year. External factors most frequently prompted disclosure among subjects abused between 1-5 years and when abuse duration was 10 years or more (see table 2).
Although 55% of children were abused by a familial perpetrator and 45% of children were abused by a non-familial perpetrator, both indicated internal factors prompted their disclosure.

Conclusion: When stratified by age, the study shows that the factor of focus shifts from internal as a pre-teen to external when older; consequently, targeted intervention and education specific to each age group would provide opportunity for encouraging prompt disclosure in alignment with the age-specific factors. Similar to prior findings, our study indicates that perpetrators of child sexual abuse were more likely to be a family member than an unrelated individual.