Research: Association or Causation

The 9 criteria outlined by Austin Bradford Hill in The Environment and Disease: Association or Causation? are used to determine whether causation can be assumed in medicine. This page will review the research on adult-child sex to see if these criteria have been met. Unfortunately, much research fails to disentangle adult-child sex from clearly abusive activity, so some quotations examine the contruct of 'child sexual abuse' as a whole.

• Strength: the demonstration of a strong association between the causative agent and the outcome
  • See Prevalence of Harm and Negative Outcomes
• Consistency: consistency of the findings across research sites and methodologies
• Specificity: the demonstration of specificity of the causative agent in terms of the outcomes it produces
• Temporality: the demonstration of the appropriate temporal sequence, so that the causative agent occurs prior to the outcome
• Biological gradient: the demonstration of a biological gradient, in which more of the causative agent leads to a poorer outcome
  • Forouzan, Elham, and Gijseghem, Hubert Van (2005). "Psychosocial Adjustment and Psychopathology of Men Sexually Abused During Childhood," International Journal of Offender Therapy and Comparative Criminology, 49(6), 626-651

    "Certain studies conducted with clinical participants have revealed that frequency and duration of sexual contacts had a significant effect on the development of the participant (Freeman-Longo, 1986; Friedrich, Urquiza, & Beilke, 1986; Gerber, 1990; Mendel, 1995), whereas studies carried out with nonclinical participants reported no clear link between frequency and duration of contacts and the development or later aggravation of disorders of whatever nature among participants (Finkelhor, 1979; O’Neill, 1990; Sarbo, 1984; Urquiza & Capra, 1990)."

  • Rind, B., Tromovitch, P. & Bauserman, R. (1998). "A meta-analytic examination of assumed properties of child sexual abuse (CSA) using college samples," Psychological Bulletin, 124(1), 22-53

    "Multiple regression analyses showed that the intensity of the relationship between CSA and adjustment varied reliably as a function of gender, level of consent, and the interaction of these two factors. It is noteworthy that neither the level of contact nor the interaction between gender and level of contact was related to intensity. These latter results failed to provide support for the common belief that contact sex is more harmful than noncontact sex or that contact sex for girls is especially harmful. These conclusions, however, should be viewed cautiously because of the overlapping nature of the two levels of the contact variable (i.e., contact only versus contact and noncontact sex). This same caveat applies to consent because its two levels (unwanted versus willing and unwanted) were overlapping as well. [...] In separate moderator analyses, we examined how aspects of the CSA experience moderated self-reported reactions and effects, as well as symptoms. Although these results should be viewed cautiously because they were usually based on a small number of samples, we found that only force and incest moderated outcomes. The largest relation occurred between force and self-reported reactions or effects, but force was unrelated to symptoms. Incest moderated both symptoms and self-reported reactions and effects. Penetration, duration, and frequency did not moderate outcomes. The near-zero correlation between penetration and outcome is consistent with the multiple regression analysis finding that contact sex did not moderate adjustment. [...] This finding is consistent with Laumann et al.'s (1994) failure to find an association between their composite variable (consisting of penetration, number of older partners-abusers, relatedness of partner-abuser, frequency of contacts, age when having contacts, duration of contacts) and adjustment for SA respondents in their study of a U.S. national sample. "

  • Finkelhor, D. (1979). Sexually victimized children. New York: Free Press.

    "Unlike force, sexual activity and duration both are ambiguous in their implications. A longer relationship and one involving intercourse indicate greater intensity. Intensity may be more harmful, but it could also be an indicator in some cases of a positive, or at least. an ambivalent, bond. In contrast, presence of force would almost always signal something negative about the relationship. It is a concise symptom of a whole negative context - the reluctance of the child, the pressure exerted by the partner, the difference in power and control. The primary recollection of the child is of the coercion. That there was sex involved is perhaps less important than the fact that there was aggression." (pp. 104-105; as cited in Rind, 2001)

• Plausibility: the demonstration of a biologic rationale, such that it makes sense that the causative agent causes the outcome
• Coherence: coherence of the findings, such that the causation argument is in agreement with what we already know
• Experimental evidence
• Analogy: evidence from analogous conditions