Clinical and Nonclinical Findings Differ
Disturbed Target Population for Clinicians
Problems in Separating Symptoms From Value Judgments of Harm
Constantine's (1981) Model of Outcomes
The nonclinical research on boys' sexual contacts with adults supports several basic conclusions.
First, a wide range of responses to such experiences occurs, with reactions that range from very negative to very positive and psychological correlates that range from severe emotional and behavioral problems to a lack of any symptoms. The research findings do not support the view that sexual contacts between boys and adults are typically experienced as negative or that they are invariably harmful. In contrast, results from both college-based samples and general population samples indicate that the majority of such experiences are evaluated by males as neutral or positive. Results from standardized measures of adjustment are consistent with
self-reports, with most researchers finding either no differences in overall adjustment or a few differences out of a large number of scales. Again, the real difficulties of many male victims of sexual abuse should not be denied or minimized by these findings; rather, they are emphasized as a counterpoint to the assumption that all such contacts must be experienced as abusive or negative and typically produce long-lasting harm.
Second, a number of moderator variables are consistently and logically related to these reactions and correlates. Force or coercion in particular is closely linked to perceptions of the experience as negative and to the presence of psychological and behavioral problems. Other moderators (e.g., relationship to the adult) appear to be important as well. In short, these moderator variables can potentially account for the full range of reactions and correlates of boys' sexual experiences with adults, indicating that sexual contact per se is not intrinsically harmful.
Third, the experiences of boys in general are not the
same as those of girls. Both college studies (e.g., Finkelhor, 1979) and
national population studies (Baker and Duncan, 1984; Laumann et al., 1994)
demonstrate that the majority of boys see their experiences as positive or
neutral, but the majority of girls see their experiences as negative.
Fourth, the findings in nonclinical studies contrast sharply with those of clinical researchers, who report a broad range of emotional, behavioral, and sexual problems (e.g., Mendel, 1995; Urquiza and Capra, 1990). Reasons for this contrast need to be explored.
Clinical and Nonclinical Findings Differ
Clearly, by whatever measures of effects are used, the nonclinical research findings reviewed here differ consistently from clinically based studies
of the correlates of early sexual experiences. Reviews of clinical literature on experiences of both boys (e.g., Urquiza and Capra, 1990) and girls (e.g., Brownc and Finkelhor, 1986) document an enormous range of problems associated with early sexual contacts with adults. In addition, male and female experiences in clinical studies appear much more similar in terms of outcome, although externalizing symptoms (behavior problems, sexual aggression) and concerns about sexual identity appear more common among males, and intcrnalizing symptoms (depression, lowered self-esteem) among females (e.g., Urquiza and Capra, 1990).
Contrary findings do exist in the clinical literature. Some researchers report few or no emotional or behavioral problems for some males, both as children (e.g., Lukianowicz, 1972; Baurmann, 1983) and as adults (e.g., Bender and Grugett, 1952). Clinical research also has identified a minority of subjects who do not appear to be symptomatic (e.g., Friedrich el al., 1986; see Finkelhor, 1990, for a discussion). Despite these exceptions, clinical research clearly documents a wide array of problems associated with early sexual contact with adults.
We do not propose that the differences between findings from the nonclinical and clinical literatures mean that one set of literature is somehow right and the other wrong. Rather, the different sets of literature focus on different groups of individuals, with a target population for clinicians that by definition is disturbed in some way. There are also potential confounds and biases in the clinical literature that may maximize findings of harm, including confounding variables; iatrogenic harm; and, in some cases, a failure to distinguish actual harm from value judgemcnts.
Disturbed Target Population for Clinicians
The wide range of outcomes reported in this review contradicts other literature reviews (e.g., Mendel, 1995) that emphasize the extent of harm found among boys. Previous reviews, however, rely almost exclusively on clinical and legal samples. To the extent that clinical studies tap into the population of persons most disturbed and affected by their sexual experiences, negative outcomes are unsurprising.
First, adult individuals who are functioning well and do
not feel disturbed by their experiences are unlikely to come to clinical
Thus, clinical studies are biased towards those individuals most negatively affected by their experiences (Okami, 1991).
Another potential problem is that clinicians may tend to attribute problems to sexual experiences, when othcr risk factors such as physical abuse or family disruption
are present, because of the recent focus on child sexual abuse in the therapeutic community and in society at large (Higgins and McCabc, 1994).
Because all research (clinical or otherwise) on the effects of early sexual experiences is by nature correlational, the possibility of confounding variables must be considered. One important confound is physical abuse.
In some clinical studies (Burgess et at., 1987; Dimock, 1988; Harper, 1993) a third or more of all subjects reported physical abuse. In addition, other family problems, such as substance abuse, occurred. Such experiences make it difficult to determine to what extent observed problems are due to sexual experiences themselves. Recent research shows the importance of examining multiple types of abuse or mistreatment (Higgins and McCabc, 1994; Ney et al., 1994).
For example, Ney et al. (1994) examined experiences of sexual abuse, physical abuse, emotional abuse, and neglect, and found that a combination of physical and emotional abuse and neglect was associated with the worst outcomes. Clearly, other abuse and neglect variables and family dysfunction must be controlled before specific effects of sexual contacts can be identified.
The possibility that some symptoms for some individuals are the result of the intervention itself (e.g., iatrogenic harm), rather than the sexual experience, must also be examined. Interventions may be carried out by authorities in such a way that they exacerbate problems created by the sexual experience or even produce problems not previously present (Baurmann, 1983; Okami, 1990).
Some research provides anecdotal accounts of individuals stating they were disturbed by reactions of authority figures but not the sexual contact itself (e.g., Bernard, 1981; Brunold, 1964).
Other researchers have cautioned against the risks of overreaction by parents, police, and othcrs when the young person shows little concern or distress over the sexual experience (e.g., Ingram, 1981).
Unfortunately, little direct research has been carried out.
A related issue is the effects of family and other social reactions following disclosure of adult-nonadult sexual contacts. Researchers have noted the pressures of social condemnation and blame on adolescents and children.
Burgess el al. ( 1984) reported that prior to exposure to sexual contacts the children and adolescents in their study had "vague symptoms" and "unspecified complaints"; following exposure, 49 of 66 subjects developed new symptoms. Rather than attributing the new symptoms to the sexual experience, as Burgess el at. did, a plausible alternative explanation is that much of the new symptomatology was due to pressure and/or ridicule from friends and family and the stresses of intervention by legal authorities (Rind and Bauserman, 1993).
Elwell and Ephross (1987) also found that the more neighbors and family became involved, the worse the symptoms in the children were. Social condemnation of adult-nonadult sexual contacts and of homosexual behavior creates additional pressures for boys with sexual contacts with adults in general and with older males in particular, and these socially induced concerns have been noted by clinicians (e.g., Rogers and Terry, 1986).
Appropriate emotional support by the family is now widely acknowledged as an important factor in successful coping with abuse experiences. Actions of police, therapists, family, friends, and others in the social network must all be considered when attempting to explain the problems observed in children and adolescents.
Problems in Separating Symptoms From Value Judgments of Harm
Some symptoms discussed in the clinical literature may represent a failure to distinguish harm from value judgments (Kilpatrick, 1987).
Two major examples exist in the current literature: sexualized
behavior in children or adolescents, and sexual orientation.
Sexualized behavior as a "symptom" must, however, be examined critically. Constantine (1981) argued that "whether and to what extent 'precocious sexually' is problematic will depend on the social and familial values with which the child lives" (p. 239).
In short, sexual interaction with peers may in no way be harmful (unless they involve elements of coercion or unwillingness), but parents and others who feel such behavior is inappropriate may interpret it as a symptom or problem. Measures of sexualized behavior and other problems, such as the Child Behavior Checklist or CBCL (Achenback and Edelbrock, 1983), are vulnerable to such value judgments.
On the CBCL, parents respond to such questions as whether the child "plays with own sex parts too much" or "asks about sex too much". Responses to such items, however, seem likely to be influenced more by parental values than by some objective standard of just how much masturbation or inquiry about sex is problematic.
Clinicians may also display a confirmation bias in their own judgements; if sexual abuse is suspected in a child or adolescent, the clinician may carefully look for sexual interest and behaviors and then interpret these behaviors as a reaction to the sexual contact.
In one study, "sexual advances toward other children" was listed as a sex problem (Friedrich et al., 1988). Vague, broad definitions like this could result in almost any form of childhood sex play being labeled pathological or a symptom if the clinician so chooses. Although some information on the frequency of various sexual behaviors in childhood is available, there is no standard of what might be "normal" in the sense of healthy or within the expected range of behaviors (Okami, 1992).
Cross-cultural research on child and adolescent sexual behavior reveals tremendous variation in terms of what sexual behaviors are viewed as normal or appropriate for children and adolescents (cf. Currier, 1981; Ford and Beach, 1951).
Recent definitions of "child perpetrators" already seem to go beyond coercive behaviors and potentially label any type of childhood sex playas an indicator of abuse (Okami, 1992).
The issue becomes even more difficult to resolve with adolescents. Interest in sex and overt sexual activity are a normal part of adolescence in that they form part of the experience of most adolescents (Gullotta et al., 1993). To label any manifestation of adolescent sexuality a "problem" cannot be accepted as valid.
Even if specific sexual behaviors displayed by children or adolescents are a problem, the issue of causality arises. It is possible that adolescents and children who are more sexually active than average are also more likely to come into contact with adults who are predisposed to engage in sexual behaviors with them.
A second example of confusion between "harm" and "abuse" occurs when sexual orientation is discussed as an outcome. Some researchers note a higher prevalence of homosexual or bisexual orientation among those with early sexual contacts with adults (e.g., Johnson and Shrier, 1985), and state or imply a causal connection.
This assumption is problematic for two reasons.
First, such an approach imputes pathology to orientations other than exclusive heterosexuality. The implication that homosexual or bisexual interest in males are a symptom of sexual abuse may further imply that, as with any other symptoms, they are a problem to be treated and cured. If sexual orientations other than exclusive heterosexuality are not inherently pathological, such implications are inappropriate.
Second, even if a connection between early sexual experiences of boys with adult males and later sexual orientation does exist, there is an equally plausible alternative
explanation: A developing homosexual or bisexual orientation may lead to the sexual contacts. The male child or adolescent with the homosexual or bisexual orientation may either deliberately seek sexual contacts with older males or more readily accept sexual advances.
Research on the development of sexual orientation indicates that homosexual interests or feelings of "being different" typically occur before actual homosexual activity (Savin-Williams, 1995). Alternatively, such youth may simply seek out more contact in general with male adults and consequently be more likely to encounter an adult who makes sexual advances.
In short, harm to individuals must be distinguished from violations of social norms or moral codes (Kilpatrick, 1987). A behavior may be a violation of legal or social norms, but not necessarily cause harm to the individuals involved. This issue is often overlooked when sexual issues are involved, but it must be recognized and dealt with in order to obtain valid information about the effects of adult-nonadult sexual contacts.
Taken together, the above issue leads to the conclusion that generalizing from the findings of clinical studies to nonclinical populations is invalid. This lack of generalizability to nonclinical populations is now acknowledged by many clinical researchers ( e.g., Friedrich et at., 1988).
In a recent meta-analysis, Jumper (1995) found that studies based on student samples consistently reported smaller effects sizes of abuse on psychological symptoms than did studies based on clinical sources. Although most of the studies in Jumper's meta-analysis included primarily or exclusively female subjects, the current review suggests similar outcomes for clinical versus nonclinical male samples.
Constantine's (1981) Model of Outcomes
Results of both nonclinical and clinical studies fit the model of outcomes proposed by Constantine (1981). Constantine argued that outcomes of early sexual experiences are shaped by two dimensions, consent and sexual knowledge. "Consent" here refers to the freedom to participate perceived by the individual, not informed consent in the sense of a given level of knowledge or awareness of possible consequences. Nonclinical research clearly shows that boys (at least those in adolescence or around puberty) may perceive their sexual experiences with older persons as voluntary (e.g., Money and Weinrich, 1983; Sandfort, 1984; Tindall, 1978), and the importance of perceived consent versus force or coercion is clear from the study results discussed above.
As for sexual knowledge, Constantine (1981) proposed that an adolescent or child involved in a voluntary sexual contact who was also sexually knowledgeable, but had not absorbed "conventional moral negatives,"
would experience the best outcome. The positive outcome would largely be due to a lack of negative feelings such as guilt or shame regarding the sexual contact. However, a child or adolescent who was relatively sexually ignorant but had absorbed negative beliefs regarding sexuality (e.g., "sex is dirty") would have a worse outcome because of confusion, guilt, and shame. Guilt and shame might even intensify the negative outcome of nonconsensual contacts because of the adolescent or child's awareness of the taboo nature of the sexual activity. Constantine noted that unfortunately this condition "describes the typical American child, who is told that sex is dirty, but not what it is" (p. 240).
Constantine's model is consistent with the observation that social condemnation and pressure are associated with more negative outcomes. In the absence of social taboos and moral condemnation, negative feelings such as guilt and shame and doubts or conflicts about masculinity should not arise for children and adolescents who experience such contacts.
The cross-cultural and historical literature provides examples of societies where sexual contacts between boys and adults, rather than being condemned and pathologized, instead were approved of encouraged, or even regarded as necessary for healthy development. In ancient Greece, sexual relations between men and adolescent boys from about 12 to 17 were widely accepted and were seen as facilitating the boys' educational development (Cantarella, 1992).
Up until the mid-19th century, sexual relations between men and boys were also accepted and widely practiced in premodern Japan (Saikaku, 1990; Watanabe and Iwata, 1989). The samurai warriors engaged in sexual relations with boys in a way that paralleled the form practiced by thc ancient Greeks in terms of function and ages of the boys involved (Schalow, 1989).
In less structured forms, sexual relations between men and boys were common and widely practiced in numerous Islamic societies in Africa and the Middle East (Burton, 1935), and were an acceptable alternative to heterosexual relations during many periods of dynastic China (Hinsch, 1990).
Numerous pre-industrial societies have had institutionalized age-stratified sexual relations between boys and older males, including groups in Melanesia, Australia, Africa, and South America (Herdt, 1987).
Other cultures have accepted heterosexual contacts between women and boys. For exam- ple' on the island of Mangaia in Polynesia, female adults instructed boys in sexual techniques and in intercourse when they reached puberty (Mar- shall, 1971). Similar practices between women and pubertal boys occurred in other parts of Polynesia, such as in the Marquesas Islands (Suggs, 1966), the Hawaiian Islands (Diamond, 1990), and Tahiti (D. L. Olivcr, 1974).
These historical and cross-cultural examples imply that shame, guilt, and doubts about one's sexuality are not inherent in sexual contacts between boys and adults, but depend on cultural views of these behaviors.
The present review indicates several important directions for future research.
First, given the range of reaction found, researchers should allow individuals to indicate their personal reactions and own evaluation of their experience(s). This point may seem obvious, but Okami (1990) noted that some recent research has in fact structurally disallowed the possibility of subjects reporting positive outcomes. Constantine (1981) also noted that much of the research simply asked "how bad was it" rather than asking about the full range of possible responses. Asking about a full range of possible outcomes does not mean that claims of harm are to be minimized or denied; rather, it a1lows those who do not feel that they were harmed, or who feel that they may have benefitted, to indicate this perception. Measures of perceived consent, sexual knowledge, and sexual values would also be useful in predicting reactions and correlates (cf. Constantine, 1981).
Participants should also [,secondly,] be grouped compared on the basis of their self-evaluations of their experiences-that is, positive, neutral, and negative responders should all be compared to each other and to control groups. This separation would a1low researchers to examine consistency between self-evaluations and observed problems, and how characteristics of the experiences are associated with different responses. It would also eliminate the risk that effects on positive responders are exaggerated, and those on negative responders are minimized, by combining these groups indiscriminately.
Finally, researchers should use standardized measures of adjustment and control groeps as standard practice, but should also measure potential confounding variables (e.g., family disruption, physical abuse, and socioeconomic status). Such measures can be instrumental in examining cause and effect. Without controlling for background factors such as physical abuse that may lead to problems in and of themselves, researchers may mistakenly assume that observed problems are due to the sexual experiences of their subjects (Higgins and McCabe, 1994). It is important that researchers not assume cause and effect, but instead carefully test this assumption.
The nonclinical research literature supports the conclusions that boys experience a wide variety of reactions and outcomes following sexual contacts with adults; outcomes reported in nonclinical research are readily explained by moderator variables such as the presence of force or coercion; the experiences of males and females in nonclinical samples are different, and it is inappropriate to generalize from females to males or vice versa; and generalization from clinical to nonclinical samples is invalid.
These conclusions may contradict those of other reviewers, but are in fact based on the findings of the nonclinical research literature neglected in previous reviews. To claim that boys' sexual experiences with adults may be associated with neutral or positive outcomes should under no circumstances be misinterpreted as an effort to deny the difficulties encountered by those males truly abused or to minimize the problems they experience. Rather, it should be recognized as an effort to obtain a more complete and accurate understanding of the sexual experiences of boys with adults in the general population.
Labeling all such experiences as "abuse" without any further distinction obscures the range of responses that actually occur (Kilpatrick, 1987; Okami, 1990) and may distort perceptions by exaggerating effects on those who regard their experience as positive while simultaneously under-estimating effects on those with negative experiences.
Inaccurate generalizations about abuse and its effects do a disservice to all those who have such early sexual experiences - both those with nonnegative experiences and those with negative experiences.