While other 9-year-old boys think about buying a better skateboard or asking for a raise in their allowance, Jeffrey has very different concerns.
He's afraid to be alone, too frightened to walk down his tree-lined street. A single fear dominates his thoughts. He worries that the two teens who sexually molested him two years ago will return to hurt him, as they threatened to do if he told on them.
The incident was far more than a curiosity-based sexual encounter. Jeffrey (not his real name) was forced to perform humiliating sexual acts with both the teen-age girl and the teen-age boy who assaulted him.
At Odds With Reality
Jeffrey doesn't fit the normal stereotype of childhood sexual abuse. Most people think of a female victim and a male offender. But that image is often at odds with reality, two San Diego-area physician-researchers say.
Sexual abuse of boys is much more common than most experts believe, according to Dr. Patricia Dunklee and Dr. Mary J. Spencer. They estimate that as many as 25% of all reported childhood sexual molestations involve boys.
The two base their findings, reported recently in the journal Pediatrics, on their own small-scale study and reviews of previous medical research reports. Their estimate is strikingly higher than those of other researchers, who have generally estimated that only 9% to 14% of reported child sexual abuse involves boys.
"It is difficult to estimate the true incidence of sexual abuse in boys, but boys, as well as girls, appear to be at significant risk. . . , " wrote Dunklee, a clinical professor of pediatrics at the UC San Diego School of Medicine and a physician at the Center for Child Protection at Children's Hospital and Health Center in San Diego, and Spencer, an associate clinical professor of pediatrics at the UCSD School of Medicine who practices in Escondido.
In their research, the two physicians found age-related patterns. "Adolescent boys who are molested are more apt to be molested by strangers," Spencer said in a telephone interview. "The little guys--ages 2, 3 and 4--are more likely to be molested by someone in the household. As the child gets more mobile--5, 6 or 7--it's more likely to be neighbors, sons of baby sitters and baby sitters (who molest)."
Estimates from the American Assn. for Protecting Children, a division of the American Humane Assn. in Denver, concur with those of Dunklee and Spencer. About 22% of the 200,000 reported cases of child sexual abuse in 1984--or 44,000--involved boys, according to Katie Bond, an association spokesperson.
Bond said reported cases probably make up only a tiny proportion of the total number that actually occur.
The San Diego study began after the two doctors realized that few researchers were focusing specifically on sexual abuse of boys. "There were so few (studies on sexual abuse of boys) that I thought we needed an update," Spencer said.
In their study, Dunklee and Spencer reviewed the medical records of 140 boys, ages 1 to 17, who were treated for sexual abuse at the Center for Child Protection at Children's Hospital and Health Center. Among the findings:
--Eighty-five percent of the victims were abused by a relative or acquaintance. Family members who abused boys younger than 13 were most likely to be the father, stepfather or the mother's boyfriend.
--Types of abuse reported by victims, whose average age was about 7, ran the gamut, but most common was attempted or actual anal-penile penetration.
--Physical evidence (such as bruises and rectal lacerations) was present in 68% of the boys, a finding that Spencer described as unexpected. "It's a message for both parents and physicians," she added.
--Multiple assaults, occurring over time periods ranging from a few days to six years, were reported by 53% of victims.
By nature, boys tend not to disclose sexual abuse, according to the San Diego researchers as well as Los Angeles-area experts. "Boys are not encouraged (by society) to be vulnerable and do not envision themselves as powerless," said Richard Embry, a social worker who counseled Jeffrey and specializes in the treatment of both sexually-abused victims and sex offenders at the Valley Child Guidance Clinic in Lancaster. "That works against boys disclosing (abuse)," he said.
While girls may "internalize" an assault and feel guilty, boys are more likely to block it out of their memory, according to Dr. Roland Summit, head physician for the Community Consultation Service in the Department of Psychiatry at Harbor-UCLA Medical Center in Torrance. "If it's too bad, they put it away as if it didn't happen," said Summit. But deep-seated rage can result, he said.