Research: Methodological flaws and syndrome construction

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For other reviews of research problems, see MHAMic and Ipce.

Our research reviews elsewhere have often detailed how selective sampling (criminal, legal, therapeutic, self-defined victimhood) is used to identify symptoms first and then construct a syndrome with set characteristics (pedophilia, child sexual abuse). The syndrome is then erroneously generalized to the wider population of individuals experiencing a chronophilia or sex with an adult as a minor or child. Our frequent readers will also be familiar with the concept of correlation not proving causation (due to confounding variables. For example, child sexual abuse is positively associated with misfortunes as disparate as road traffic accidents, falls from a great height, gunshot and blunt trauma, but supposedly not responsible for them.

This article puts into focus some of these methodological and conceptual flaws. For some limitations of criminal sampling in pedophilia research, see psychopathy and abnormal psychology.

Bias in research

This section provides quotes from scholars who have addressed bias relating to some aspect of MAPs, youth sexuality, trauma or intergenerational erotic encounters.

Retrospective trauma studies - an inherently flawed design

Retrospective trauma studies ignore the tendency of humans to single out formative experiences, selecting and confecting memories in order to explain later mental illness and personal struggles. The fact that over half of prospective CSA (i.e. officially reported at any time) is simply not recalled by interviewees, also hints at another source of bias - that of omission.

Using the logic of retrospective trauma studies, Down Syndrome (now known to be a genetic disorder) can be blamed, and indeed was blamed on maternal trauma:

• Widom, C. S., Raphael, K. G., & DuMont, K. A. (2004). The case for prospective longitudinal studies in child maltreatment research: commentary on Dube, Williamson, Thompson, Felitti, and Anda (2004). Child Abuse & Neglect, 28(7), 715–722.

  "Stott found that mothers of “mongol” children reported more shocks during pregnancy than mothers of children without Down’s syndrome, thus concluding that socio-emotional factors played a role in the etiology of Down’s syndrome. Since later research identified chromosomal abnormalities as the cause, it is possible that these mothers exerted extra cognitive effort in trying to recall pregnancy-related events. Another possibility is that ordinary events were redefined as traumas by mothers of affected children in an effort to explain their child’s condition."

Retrospective recall of even the most traumatic events in people who display later mental illness, does not prove causation. For example, those who report neglect, bullying or the death of a parent might go on to develop mental illness. However, it may be the case that the recalled trauma is a consequence of pre-existing problems – e.g. a bully might pick out emotionally vulnerable children - the type of children who go on to develop mental health problems. Maybe longevity is associated with better mental health, so the child of a parent who dies early might be at risk of developing psychological problems.

In Academic Textbooks

• Yates, Alayne. (1982). "Childhood Sexuality in the Psychiatric Textbook," Journal of Psychiatric Education, 6, pp. 217–226.

  "Research data, some of which was first published in 1935, does not support the assumption that masturbation and sex play in childhood is unhealthy or abnormal." (p. 218). "The trend toward acceptance of adult sexuality is evident in psychiatric texts and training programs,"

Editor: But what about children's sexuality? To address this, Yates analyzes 15 then-current psychiatric textbooks for bias in how authors erroneously or problematically rendered human sexual capacity in the earliest years of life. Yates found that:

"The word "penis" was employed nine times as frequently as "clitoris"; in fact only three books mentioned the clitoris at all. The female apparatus was accorded a less specific label, i.e.; "the genitals," even when the term "penis" had been used to designate the male." (p. 221)

"Although this may sound impressive, the average number of pages devoted to childhood masturbation throughout the entire sample was less than four-fifths of a page. While [some] opted not to discuss masturbation in childhood, others coupled it with "alarm, horror, shame, and fear," (p. 222). By contrast, a minority of 3 authors including the 2 female textbook authors and another child psychiatrist, "deemphasize pathology and state that masturbation per se is normal or acceptable but secondarily associated with guilt, anxiety, and parental intolerance." (p. 222).

"No author conveyed enthusiasm about early erotic activity. There seemed to be an underlying assumption that growth toward erotic competence would occur without validation or involvement, and that the proper adult role would be to guide children out of, rather than into sexuality." (p. 222). Yates concludes with the following: "In all, the texts within the sample convey an attitude toward childhood sexuality that ranges from neutral to negative by omitting, isolating, and minimizing the importance while continuing to associate it with pathology." (p. 223).

"The acceptance of adult sexual behavior is increasing more rapidly than the acceptance of children's age-appropriate erotic activity. Current psychiatric texts, as well as the culture, continue to view early eroticism as problematic. This negative attitude could handicap children in their developmental progress toward erotic competence" (p. 224).

For more on pre-adolescent ("children's") sexuality and what scholars have meant when using this term, see our "Youth Sexuality" page.

• Rind, Bruce. (1995). "An Analysis of Human Sexuality Textbook Coverage of the Psychological Correlates of Adult-Nonadult Sex," in The Journal of Sex Research, 32:(3), pp. 219-23.

  Abstract: Browne and Finkelhor (1986) cautioned that it is important that child abuse researchers not exaggerate or overstate the intensity or inevitability of negative consequences for children or adolescents who experience sex with adults. In recent years a number of researchers have argued that this problem has been increasing, with negative repercussions. The purpose of the current research was to analyze possible overstatement (i.e., bias) from one important source: human sexuality textbooks. To assess bias, a review of the literature on correlates of adult-child and adult-adolescent sex was first conducted to determine the criteria with which to make judgments. This review revealed that findings from clinical and legal samples, which typically indicate highly negative correlates, do not generalize beyond clinical/legal populations. Three nationally representative samples and a large number of college samples indicate that correlates are much less negative in the general population. Based on the criteria that emerged from the review, 5 coders made 14 judgments concerning biased reporting and invalid inferences for each of 14 current human sexuality textbooks. Results were that 9 textbooks presented highly biased information, 3 textbooks were moderately biased, and 2 were unbiased. Bias in reporting correlates was indicated by an overreliance on findings from clinical and legal samples, exaggerated reports of the extent and typical intensity of harm, failure to separate incestuous from nonincestuous experiences, failure to separate experiences of females from those of males, inaccurate discussions of sex differences in reactions, inappropriate generalizations, and inappropriate causal attributions. I concluded that the overreliance on using reports from clinical and legal samples resulted in many of the other biases.

• Rind, Bruce. (1998). "Biased Use of Cross-Cultural and Historical Perspectives on Male Homosexuality in Human Sexuality Textbooks," in The Journal of Sex Research, 35:(4), pp. 397-407.

  Abstract: Consistent with lay and professional views, Masters, Johnson, and Kolodny (1985), in an early edition of their human sexuality textbook, presented man-man sex as normal and acceptable but man-boy sex as pathological and unacceptable. Despite drawing these moral distinctions, they used a series of examples of socially sanctioned man-boy sex in other cultures to provide perspective on Western man-man sex, suggesting its normalcy and potential to be socially accepted. They ignored these same examples when discussing Western man-boy sex. This paper examines the biased use of cross-cultural and historical data on homosexuality in a sample of more recent human sexuality textbooks (n = 18). A brief review of male homosexuality in other times and places is presented, which shows the prevalence of man-boy sex, but the rarity of the Western man-man pattern, cross-culturally and historically. This finding further questions the practice of using man-boy examples for Western man-man, but not man-boy, sex. Seventeen of the textbooks in the current sample exhibited the same biases found in the earlier Masters et al. textbook. Only one used man-boy examples in other societies for perspective on Western man-boy sex. It is argued that these biases hinder rather than advance the objectivity that can result from the proper use of cross-cultural and historical perspective.

In the wider literature

Literature reviews have repeatedly cast doubt upon the "one size fits all" model of Child Sexual Abuse.

• Tener, Dafna (2018). Perspectives on Adolescent Sexual Relations With Older Persons: A Systematic Review of the Literature. Trauma, Violence, & Abuse. doi:10.1177/152483801877228

  "To conclude, the review highlights several major issues. First, it reveals that teens’ motivations to enter relationships with older persons are diverse and highlights their need for emotional support that is unavailable from other sources in their lives. It also reveals that these relations are perceived by the minors involved and members of the public in diverse ways, as opposed to the rigidly dichotomous perspective of the law. They may be perceived as abusive, out of the assumption that youth are unable of judicious decisions regarding sexual relations. Alternatively, they may by perceived as mutual and noncoercive relations, rejecting that implicit assumption. The literature also discusses possible negative consequences of such relations, tending to emphasize individual rather than familial, social, and cultural factors. It focuses on contextual factors affecting the perception of these relations, mainly in articles on the effect of gender and age of both the younger and older person, with mixed findings. Other possible contextual factors such as sociocultural conditions are largely absent from the literature."

• Joan A. Nelson, Ed.D. (1989). Intergenerational Sexual Contact: A Continuum Model of Participants and Experiences. JournaI of Sex Education & Therapy, Vol. 15, No.1, 1989, pp.3-12

  "So far in the professional literature only two types of children participating in intergenerational sex have been identified: powerless and precocious. Very little attention has been paid to the definition of precocious except as a negative outcome of exploitative early eroticization. The continuum model of intergenerational sexual contact, to be empirically correct, must allow for all kinds of children, including informed, consenting, and initiating participants. Such a balanced typology supersedes the unscientific belief that all children who consent and initiate do so because they are powerless. For children who do indeed consent because they are powerless, the continuum model suggests empowering them not by arbitrarily teaching them to say no to sex, but by teaching sex education in such a way that they know what sex is. Thus they will learn the difference between sex and exploitation so they will know which one it is they are refusing. Until now it has not seemed necessary to classify the children other than as victims since children's sexual feelings have been denied or relegated to the categories of sex play and curiosity. As Okami (1987) points out, however, "these are the same impulses and behaviors that in adolescents or adults are characterized as sexual desire and sexual activity!""

• Jahnke S., Schmidt, A.F., Hoyer, J. (2022). Pedohebephilia and Perceived Non-coercive Childhood Sexual Experiences: Two Non-matched Case-Control Studies. Sexual Abuse: A Journal of Research and Treatment, DOI:10.1177/10790632221098341.

  “Between a fifth and a third of the pedohebephilic participants who self-reported PNCSE-A disagreed with every item of the CTQ Sexual Abuse subscale. This noteworthy clinical observation indicates that trauma-focused questionnaires might not be sufficient to detect instances of CSAE in community samples of pedohebephilic men (and also some teleiophilic men, particularly in Study 2). We suppose that this is the case because not all of our male participants feel that the statements about CSAE with adults that imply coercion, exploitation, or unpleasantness do indeed apply to their case.” (childhood sexual abuse experiences (CSAE), perceived non-coercive childhood sexual experiences with adults (PNCSE-A))

• Laajasalo, Taina, et al. (2023) "Current issues and challenges in the definition and operationalization of child maltreatment: A scoping review." Child Abuse & Neglect 140': 106187.

“Three original studies highlighted the importance of considering victims' self-definitions (Lange, Condon, & Gardner, 2020), lay perceptions on child abuse (Calheiros, Monteiro, Patrício, & Carmona, 2016) and definitions of children themselves (Kosher & Ben-Arieh, 2020). Kosher and Ben-Arieh (2020) argue that child perspectives should be included in definitional considerations “not as a replacement for adult perspectives but to complement them”, which would help us to better understand and prevent CM [child maltreatment]."

Examples of bias

• Wang Y, Sun Y, Missmer S A, Rexrode K M, Roberts A L, Chavarro J E et al. (2023) Association of early life physical and sexual abuse with premature mortality among female nurses: prospective cohort study BMJ; 381, doi:10.1136/bmj-2022-073613

“67 726 female nurses included in the current analysis” [...] “Sexual abuse was measured using modified questions from the Sexual Experiences Survey: “Were you ever touched in a sexual way” or “forced into any sexual activity” by an adult or an older child?”

Editor: The study's design offered to participants only “none”, “forced” or “touched” as alternatives. One may only speculate if respondents who considered themselves willing or neutral regarding childhood sexual activity, they preferred to pick “touched”.

Throughout the article, the authors mentioned CSA and forced sexual activity in an interchangeable manner. They stated that CSA/forced sexual activity was associated with a greater risk of cardiovascular and respiratory diseases, suicide, etc. But they didn’t mention associations for “touched sexually”, and avoided comparative statements about these two subgroups, which both definitely considered CSA in the wider literature. But Table 3 demonstrates that the risks are higher for the "forced sexual activity in childhood and adolescence" only. "Touched sexually in childhood or adolescence" was associated with even slightly fewer risks in comparison to controls (no sexual activity), although insignificantly.

"CSA Syndrome"

Even when unrepresentatively sampled, children involved in intergenerational sexual relationships do not show a set pattern of reactions. In addition to this, certain types of reactions have been correlated with social factors.

• Bulik, C. M., Prescott, C. A., & Kendler, K. S. (2001). Features of childhood sexual abuse and the development of psychiatric and substance use disorders. British Journal of Psychiatry, 179(05), 444–449.

  "Although the univariate analyses suggested differences in patterns of predictors across diagnoses, there was no evidence that the odds ratios for any of the CSA-related variables differed significantly across diagnostic categories. Thus, not only does CSA taken as a global construct appear to have a non-specific effect on the development of psychopathology, but specific aspects of CSA do not appear to uniquely predict specific psychiatric disorders. These findings argue against the existence of a unified post-CSA syndrome with an identifiable symptom profile."

• Constantine, L.L., (1981). "The effects of early sexual experiences: A review and synthesis of research," in Constantine, L.L. & Martinson, F.M. (eds.), Children and Sex: New Findings, New Perspectives.

  MHAMIC: "The author concludes that there is no set of reactions that is a single inevitable outcome of adult-child sexual interaction. More negative outcomes are associated with violence or coercion, tense situations, sex-negative attitudes, sexual ignorance, and unsupportive or judgmental adult reactions. The amount of anxiety and guilt that the child experiences depends on two main characteristics of the interaction. These factors are of overwhelming importance in immediate and long-term effects."

• Finkelhor, David (1990). "Early and long-term effects of child sexual abuse: An update," Professional Psychology: Research and Practice, 21(5), pp. 325-330.

  "Another attempt to consider the impact of sexual abuse has been the formulation of a specific sexually-abused-child disorder (Corwin, 1988). This effort has evolved in response to the need many clinicians perceive to have a diagnostic category in which to place sexually abused children. However, this approach has not caught on because it has proved so difficult to define a set of symptoms that clearly delineates sexually abused children. As we have pointed out, some victims appear to be asymptomatic in the immediate wake of abuse. Perhaps more important, victims manifest such a large variety of symptoms that there is no single set of symptoms that can be considered characteristic. The sexualized behavior that many clinicians think is so much the hallmark of the child who has been sexually abused occurs in only 7% of all victims according to the evaluations of 369 children by Conte and Schuerman (1987). The attempts to define a single sexually abused child syndrome are unlikely to meet with future success and acceptance."

• Kendall-Tacket, K. A., Williams, L. M., & Finkelhor, D. (1993). "Impact of Sexual Abuse on Children: A Review and Synthesis of Recent Empirical Studies," Psychological Bulletin, 113(1), 164-180.

  "The findings suggest the absence of any specific syndrome in children who have been sexually abused and no single traumatizing process. [...] The range of symptoms, the lack of a single predominant symptom pattern, and the absence of symptoms in so many victims clearly suggest that diagnosis is complex. Because the effects of abuse can manifest themselves in too many ways, symptoms cannot be easily used, without other evidence, to confirm the presence of sexual abuse. Yet the absence of symptoms certainly cannot be used to rule out sexual abuse. There are too many sexually abused children who are apparently asymptomatic."

Tendency to disclose

Disclosure figures and the reasons for not disclosing shine a light on the positive and indifferent nature of the many experiences which can not be sampled via therapeutic/systemic referrals.

• Lahtinen, H., et al., (2018). "Children's disclosures of sexual abuse in a population-based sample," Child abuse and Neglect, Feb 2018; 76: 84-94.

  "The present study aimed to explore the overall CSA disclosure rate and factors associated with disclosing to adults in a large population-based sample. A representative sample of 11,364 sixth and ninth graders participated in the Finnish Child Victim Survey concerning experiences of violence, including CSA. CSA was defined as having sexual experiences with a person at least five years older at the time of the experience. Within this sample, the CSA prevalence was 2.4%. Children reporting CSA experiences also answered questions regarding disclosure, the disclosure recipient, and potential reasons for not disclosing. The results indicate that most of the children (80%) had disclosed to someone, usually a friend (48%). However, only 26% had disclosed to adults, and even fewer had reported their experiences to authorities (12%). The most common reason for non-disclosing was that the experience was not considered serious enough for reporting (41%), and half of the children having CSA experiences did not self-label their experiences as sexual abuse. Relatively few children reported lacking the courage to disclose (14%)."

Excerpt Graphic Library

These graphics below may be useful if you wish to reproduce some of our sources without being character-limited on short-form microblogging services.

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  CSA Syndrome
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  Meme addressing some sampling flaws