Friday, April 22, 2016

Where's The Data on Child Sexual Abuse?

Abuse scandals are running rampant in the media right now. From Penn State, the Catholic Church to elite boarding schools and colleges, pedophilia cases in high-profile institutions have made it in a big way to the media spotlight (and not just at the Oscars). A few weeks ago my children's school revealed a former teacher had molested students over three decades ago and that they were conducting their own investigation. I was not surprised. Who would be?

Not that long ago I used to think I could spot a child molester. If not pick him out of a crowd of strangers, surely as a psychologist I'd know if an acquaintance, someone I knew, preyed on kids. There would be clear red flags. Uh, not exactly. That naive assumption was blown to bits about over a decade ago. My neighbor, a seemingly well-adjusted family guy, did not scream deviant but normal dad. The police picked him up half-way across the country going to meet a thirteen-year old girl he'd chatted up online, an actual teen and not some decoy pretending to be one. Unfortunately I know that case too, from too close for comfort (not to imply any distance is comfortable, bad wording but I am trying to be discreet).  

A classic child molester? Does he exist? 

I bet most incidences don't involve overtly creepy men. None of the perps I’ve known over the years are at all like the Andrew McCarthy character on that new show, The Family. None are awkward loners that you'd never leave alone with your kid. I'm not sure if the Andrew McCarthy character, likely the classic stereotype of a pervert, reflects reality. I'm not even sure in fact there is a profile of a child molester only because there is so little published information. So little research. Most of it seems to be collected as crime data. 

A 2005 report by the US Department of Education (more on it in a minute) suggests it's the well-regarded, popular teachers that take advantage of kids in elementary school and early adolescence. Despite the fact that Pamela Smart became a household figure and might be the only nationally known educator-pedophile, men far outweigh the female offenders (96% v. 4%).

It's frustrating, how much we do not know about this. More to the point, it's frustrating how much we don't know given what we do know (the long-term consequences of abuse, the cycle of abuse, repeat offenders, that early childhood abuse sets kids up for being adult victims and perps, etc.). If we knew more, if we had lots of researchers and research dollars on it as a society we would be better able to recognize it, treat it and prevent it. 

Granted, sexual victimization is challenging to study for a number of reasons. The stigma, shame, and secrecy alone, prevents victims and perpetrators (some both) from stepping forward let alone answering questions about it. Growing awareness might engender more opportunities for study, for that I am hopeful. In ten years I don't want to have to find this same sorry state of knowledge. 

At the very least get the known perps into those overworked fMRI machines. Seriously, I'd be happy about a brain region study. I welcome anything suggesting somebody out there is on it. NIH, where is the mission, the will? Where is the call for more research into understanding and preventing it? I want to learn we are closer to preventing it. Please. 

Of course I always wonder about the evidence out there. Here, I'm thinking about the statistics, the prevalence, the traits of predators and victims, etc. I'd wanted to provide some data. The problem is, there is not a heck of a lot of good current estimates. The CDCs must have data on it, right? They have some figures posted (unpublished except on their site) from a large on-going study out of southern California adults but it's impossible to separate out the childhood sexual abuse from the other categories of neglect and abuse. The other government sites are equally unsuccessful in providing clear answers. 

A 2005 study by the Crimes Against Children Research Center at the University of New Hampshire, found 8.2% of youths reported being sexually victimized and 3.2%, sexual assaulted. There seemed to be a small flurry of interest in compiling this kind of data in the 80s and 90s but not so much of late. Maybe those who would have studied it have been too busy with cyber bullying, sex trafficking or college sexual assault. That's a wild guess, but they have received their share of attention.  

A 2004 report commissioned by the US Department of Education (because it was mandated by No Child Left Behind) estimated 10% of children are subjected to unwanted sexual advances from adults (ranging from offensive comments to rape) at some point during their schooling and that doesn't include college nor I should mention, time outside of school. You can read the report, Educator Sexual Abuse. 

The backstory on this "official" report, namely the shoddy lip service from the US Department of Ed, speaks to just how little public will exists to study this topic. Read the article at Education Week and you'll discover just how worried the people in charge of our nation's youth are about child victimization:

Ms. Shakeshaft said her initial understanding from the department was that she was to conduct a review of the existing research to set the stage for a broad national study. 

She said that after she turned in a draft of the report last May, she received feedback from the department that led her to believe that the literature review was no longer intended to lay the groundwork for a future study. In a letter stating that the Education Department "has not made plans to conduct further work on a national study on sexual abuse in schools," Ms. Shakeshaft was asked to change the original subtitle of her report, which was "A Synthesis of Existing Literature in Connection With the Design of a National Analysis."

The report is simply Educator Sexual Abuse now that the National Analysis has been indefinitely postponed (or buried so well I can't find it). Let's hope Dr. Shakeshaft shakes things up further. And yes, Professor Shakeshaft has a Ph.D. although Education Week refers to her as Ms. and she has no title at all on the report. 

If you do want to know the warning signs of educator sexual misconduct, the term coined by Dr. Skakeshaft, (e.g., the patterns, the perps, the vics, the how, when and where it happens) you will have to read her paper not in a scientific journal, not on the CDC website, not at the American Academy of Pediatrics, not the New York Times, Fox, Babble, HuffPo or WebMD. Nope, this information appears only at The Kappan, a sorority periodical. What a shame. So here it is, consider this a public service announcement: Know The Warning Signs of Educator Sexual Misconduct.

BTW, April is National Child Abuse Prevention Month according to the US Department of Health and Human Services. 

*Note, this report isn't published in Pediatrics. Unlike so much research including government reports that feature many names and institutions, this paper only has one author, Charol Shakeshaft, at the time a researcher at Hofstra (now at VCU). What a statement of the relative status of this topic. Yeah, they commissioned a report. Done. Check that box. Bury it. 

UPDATE: I've gotten emails with links to cases. Feel free to post them here in the comments. I'll will add them here too later. Thanks for sharing.

Thursday, April 07, 2016

The Perfect Parenting Storm?

I’ve often called the autism-vaccine debacle The Perfect Storm of Parenting. Not solely for dramatic effect but because it's true. Just look at this remarkable, combustible brew of ingredients:
  • Botched media coverage with ongoing misinformation to this day,
  • Botched (and fraudulent, now retracted) research, 
  • Botched public health response, 
  • The rise of new media, questionable experts and the blogosphere,
  •  An epic showdown (falsely) pitting autism, a serious, rising neurocognitive disorder (this is the century of the brain!) against a host of serious childhood diseases.
Plus substantial long-term consequences. 

Lowered vaccination rates and heightened vaccine hesitancy treated us to a number of measles outbreaks and an even greater aversion to Disneyland and large groups of children accompanied by sweaty adults wielding jumbo turkey legs. We spent years and millions of research dollars on the debunked theory. Parents suffered plenty of distrust, worry, stress, inconvenience, and frustration (no, there is no data on this last, sadly). Still, the thoroughly debunked theory lives on, in fact, flourishes in some communities but thankfully, not on screen at the Tribeca Film Festival this year. (Good grief, Mr. DeNiro, I thought you were smarter!). One more thing, the controversy has inspired its own research paradigm. Yes researchers are using beliefs about the link between autism and vaccines to study judgments about public health information and experts. 

This is what I believed. Had believed. I truly thought I’d lived through The Perfect Storm and that nothing cold ever come even remotely close to it in this generation of parenting if not this lifetime. Now I’m not so sure there won’t be another perfect storm.  In time the autism-vaccine crisis could be just a perfect storm. True, a raging monster, but far from the only memorable one. I do still think it will go down in the history books. Our kids (and grandkids) will study it. Laugh at it. Take great joy in the stupidity of their parents.

No one particular event has changed my perspective. I’ve always fretted about misinformation and botched research. I’ve not had a personal crisis or any stunning revelations. Maybe it is the function of time and perspective and more misinformation or flawed advice. In the past several years alone there have been a number of opportunities to see the cracks and flaws in in the latest, greatest recommendations and interventions, ones with the potential to do damage for years, for a lifetime potentially.

Take the peanut allergy recommendations. 

Over 15 years I’ve witnessed drastic changes in food allergy recommendations. From no official recommendations during my first pregnancy, to discussion of banning peanuts and other allergens in pregnancy, breastfeeding and early childhood or “early avoidance” (second pregnancy), to an official early avoidance policy (third pregnancy), to a little loosening of early avoidance policy (a few years later) to correlational research suggesting early avoidance might backfire to last year’s first official trial showing early avoidance promotes more peanut allergies (or if you prefer: early exposure prevents them). It’s only a matter of time before the AAP catches up with the research and advocates early exposure at least when it comes to peanuts (fingers crossed).

Here stringent recommendations - broad extreme recommendations from peanuts to other food allergens from pregnancy, breastfeeding, to the first seven years of life for families with a history of allergies - were put in place without much evidence, in fact without any direct evidence. Not only did these steps not reduce peanut allergies, unfortunately if the latest studies are correct, this policy has caused peanut allergies. So not only did the old recs not work, they caused harm, potentially fatal harm. For families encumbered with food allergies, early avoidance was a perfect storm. For some, The Perfect Storm. 

It might be a slow accumulation of perfect storms for we parents. I dunno. 

Many of you know I wonder about other recommendations, especially the extreme breastfeeding guidelines and the recent “no alcohol is safe” one. Certainly they carry psychological risks for women and mothers being subjected to anxiety, frustration and other hardships associated with complying with perhaps overly harsh guidelines. But there is one other potential consequence of these stringent recommendations. Namely, the risk that people stop believing the purported risks. 

As a psychologist, I often think about the  possibility some parents will tune out or not give much thought to future expert recommendations. This psychological phenomenon has been studied for decades. Some researchers have shown that a single false alarm, even if it is a near miss so to speak, has the potential to negatively impact perception and judgment of future events. Especially for events that carry high emotion. Uh huh. In some ways the first Perfect Storm has set us up to ignore or discount the second one. Which is okay, I suppose, if it is a false alarm. But if it isn’t, if the threat is real, then those who have become jaded might miss it. Or not believe it is real. 

So I wonder what other issue could implode into the parenting media causing such long-term controversy, anxiety and lasting fall out? Ideas welcome.