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# Facilitators and Barriers to Child Sexual Abuse (CSA) Disclosures: A Research Update (2000-2016)



TRAUMA, VIOLENCE, & ABUSE
2019, Vol. 20(2) 260-283
$\textcircled{1}$ The Author(s) 2017




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DOI: 10.1177/1524838017697312

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Ramona Alaggia¹, Delphine Collin-Vézina², and Rusan Lateef¹

## Abstract

Identifying and understanding factors that promote or inhibit child sexual abuse (CSA) disclosures has the potential to facilitate earlier disclosures, assist survivors to receive services without delay, and prevent further sexual victimization. Timely access to therapeutic services can mitigate risk to the mental health of survivors of all ages. This review of the research focuses on CSA disclosures with children, youth, and adults across the life course. Using Kiteley and Stogdon’s literature review framework, 33 studies since 2000 were identified and analyzed to extrapolate the most convincing findings to be considered for practice and future research. The centering question asked: What is the state of CSA disclosure research and what can be learned to apply to practice and future research? Using Braun and Clarke’s guidelines for thematic analysis, five themes emerged: (1) Disclosure is an iterative, interactive process rather than a discrete event best done within a relational context; (2) contemporary disclosure models reflect a social–ecological, person-in-environment orientation for understanding the complex interplay of individual, familial, contextual, and cultural factors involved in CSA disclosure; (3) age and gender significantly influence disclosure; (4) there is a lack of a life-course perspective; and (5) barriers to disclosure continue to outweigh facilitators. Although solid strides have been made in understanding CSA disclosures, the current state of knowledge does not fully capture a cohesive picture of disclosure processes and pathways over the life course. More research is needed on environmental, contextual, and cultural factors. Barriers continue to be identified more frequently than facilitators, although dialogical forums are emerging as important facilitators of CSA disclosure. Implications for practice in facilitating CSA disclosures are discussed with recommendations for future research.

## Keywords

sexual abuse, child abuse, cultural contexts

## Introduction

Timely access to supportive and therapeutic resources for child sexual abuse (CSA) survivors can mitigate risk to the health and mental health well-being of children, youth, and adults. Identifying and understanding factors that promote or inhibit CSA disclosures have the potential to facilitate earlier disclosures, assist survivors to receive services without delay, and potentially prevent further sexual victimization. Increased knowledge on both the factors and the processes involved in CSA disclosures is timely when research continues to show high rates of delayed disclosures (Collin-Vézina, Sablonni, Palmer, & Milne, 2015; Crisma, Bascelli, Paci, & Romito, 2004; Easton, 2013; Goodman-Brown, Edelstein, Goodman, Jones, & Gordon, 2003; Hershkowitz, Lanes, & Lamb; 2007; Jonzon & Lindblad, 2004; McElvaney, 2015; Smith et al., 2000).

Incidence studies in the United States and Canada report decreasing CSA rates (Fallon et al., 2015; Finkelhor, Shattuck, Turner, & Hamby, 2014; Trocmé et al., 2005, 2008), while at

the same time global trends from systematic reviews and meta-analyses have found concerning rates of CSA, with averages of 18–20% for females and of 8–10% for males (Pereda, Guilera, Forns, & Gómez-Benito, 2009). The highest rates found for girls is in Australia (21.5%) and for boys in Africa (19.3%), with the lowest rates for both girls (11.3%) and boys (4.1%) reported in Asia (Stoltenborgh, van IJzendoorn, Euser, & Bakermans-Kranenburg, 2011). These findings point to the incongruence between the low number of official reports of

$$^1$$ Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada

$^{2}$ Centre for Research on Children and Families, School of Social Work, McGill University, Montreal, Qubec, Canada

Corresponding Author:
Ramona Alaggia, Factor-Inwentash Chair in Children’s Mental Health, Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. West, Toronto, Ontario, Canada M4K1W1.
Email: ramona.alaggia@utoronto.ca



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CSA to authorities and the high rates reported in prevalence studies. For example, a meta-analysis conducted by Stoltenborgh, van IJzendoorn, Euser, and Bakermans-Kranenburg (2011) combining estimations of CSA in 217 studies published between 1980 and 2008 revealed rates of CSA to be more than 30 times greater in studies relying on self-reports (127 in 1,000) than in official report inquiries, such as those based on data from child protection services and the police (4 in 1,000) (Jillian, Cotter, & Perreault, 2014; Statistics Canada 2013). In other words, while 1 out of 8 people retrospectively report having experienced CSA, official incidence estimates indicate only 1 per 250 children. In a survey of Swiss child services, Maier, Mohler-Kuo, Landholt, Schnyder, and Jud (2013) further found 2.68 cases per 1,000 of CSA disclosures, while in a recent comprehensive review McElvaney (2015) details the high prevalence of delayed, partial, and nondisclosures in childhood indicating a persistent trend toward withholding CSA disclosure.

It is our view that incidence statistics are likely an underestimation of CSA disclosures, and this drives the rationale for the current review. Given the persistence of delayed disclosures with research showing a large number of survivors only disclosing in adulthood (Collin-Vézina et al., 2015; Easton, 2013; Hunter, 2011; McElvaney, 2015; Smith et al., 2000), these issues should be a concern for practitioners, policy makers, and the general public (McElvaney, 2015). The longer disclosures are delayed, the longer individuals potentially live with serious negative effects and mental health problems such as depression, anxiety, trauma disorders, and addictions, without receiving necessary treatment. This also increases the likelihood of more victims falling prey to undetected offenders. Learning more about CSA disclosure factors and processes to help advance our knowledge base may help professionals to facilitate earlier disclosures.

Previous literature reviews examining factors influencing CSA disclosure have served the field well but are no longer current. Important contributions on CSA disclosures include Paine and Hansen’s (2002) original review covering the literature largely from the premillennium era, followed by London, Bruck, Ceci, and Shuman’s (2005) subsequent review, which may not have captured publications affected by “lag to print” delays so common in peer-reviewed journals. These reviews are now dated and therefore do not take into account the plethora of research that has been accumulated over the past 15 years. Other recent reviews exist but with distinct contributions on the dialogical relational processes of disclosure (Reitsema & Grietens, 2015), CSA disclosures in adulthood (Tener & Murphy, 2015), and delayed disclosures in childhood (McElvaney, 2015). This literature review differs by focusing on CSA disclosures in children, youth, and adults from childhood and into adulthood—over the life course.

## Method

Kiteley and Stogdon’s (2014) systematic review framework was utilized to establish what has been investigated in CSA

disclosure research, through various mixed methods, to highlight the most convincing findings that should be considered for future research, practice, and program planning. This review centered on the question: What is the state of CSA disclosure research and what can be learned to apply to future research and practice? By way of clarification, the term systematic refers to a methodologically sound strategy for searching literature on studies for knowledge construction, in this case the CSA disclosure literature, rather than intervention studies. The years spanned for searching the literature were 2000–2016, building on previous reviews without a great deal of overlap. Retrieval of relevant research was done by searching international electronic databases: PsycINFO, PsycARTICLES, Educational Resources Information Center, Canadian Research Index, International Bibliography of the Social Sciences, Published International Literature on Traumatic Stress, Sociological Abstracts, Social Service Abstracts, and Applied Social Science Index and Abstracts. This review searched peer-reviewed studies. A search of the gray literature (unpublished literature such as internal agency documents, government reports, etc.) was beyond the scope of this review because unpublished studies are not subjected to a peer-review process. Keyword search terms used were child sexual abuse, childhood sexual abuse, disclosure, and telling.

A search of the 9 databases produced 322 peer-reviewed articles. Selected search terms yielded 200 English publications, 1 French study, and 1 Portuguese review. The search was further refined by excluding studies focusing on forensic investigations, as these studies constitute a specialized legal focus on interview approaches and techniques. As well, papers that focused exclusively on rates and responses to CSA disclosure were excluded, as these are substantial areas unto themselves, exceeding the aims of the review question. Review articles were also excluded. Once the exclusion criteria were applied, the search results yielded 33 articles. These studies were subjected to a thematic analysis as described by Braun and Clarke (2006). This entailed (1) multiple readings by the three authors; (2) identifying patterns across studies by coding and charting specific features; (3) examining disclosure definitions used, sample characteristics, and measures utilized; and (4) major findings were extrapolated. Reading of the articles was initially conducted by the authors to identify general trends in a first level of analyses and then subsequently to identify themes through a deeper second-level analyses. A table of studies was generated and was continuously revised as the selection of studies was refined (see Table 1).

## Key Findings

First-level analysis of the studies identified key study characteristics. Trends emerged around definitions of CSA disclosure, study designs, and sampling issues. First, in regard to definitions, the term “telling” is most frequently used in place of the term disclosure. In the absence of standardized questionnaires or disclosure instruments, telling emerges as a practical term more readily understood by study participants. Several



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Table 1. Child Sexual Abuse (CSA) Disclosure Studies: 2000-2016.

<table><thead><tr><th>Study</th><th>Purpose</th><th>Design</th><th>Sample</th><th>Findings</th><th>Summary</th></tr></thead><tbody><tr><td>Gagnier and Collin-Vezina (2016)</td><td>To explore disclosure processes for male victims of CSA</td><td>Phenomenological methodology used to interview male CSA survivors. The Long Interview Method (LIM) guided data collection and analyses.</td><td>17 men raged in age from 19 to 67—purpure sampling strategy was used</td><td>The majority of the men in the study waited until adulthood to disclose their abuse, with negative stereotypes contributing to their delayed disclosures. Negative stereotypes contributed to delayed disclosures with trying to forget. Breaking isolation was created as a motive to disclose along with the aid of various formal interventions important concreta issues such as aggressive stereotyping of males, sexuality, and victims were noted. Social media was seen as a facilitator of disclosures</td><td>All participants had disclosed and received services before participating in the study. Member checking could not be done with the participants to check themes. Small but sufficient size for a qualitative inquiry. Otherwise, high level of rigor establishing trust in the data and analysis. Rettrospective study can imply recall issues</td></tr><tr><td>Brazelton (2015)</td><td>To explore the meaning African American women make of their traumatic experiences with CSA and how the disclosure across the life course</td><td>Collective case study design with narrative tradition (storyboard) for data collection and analysis. Qualitative interviewing</td><td>17 African American women in mid-life between 40 and 63 who experienced instrumental CSA. Purpose: snowballing strategy</td><td>CSA onset was largely between the ages 5 and 9. No one ever talked to them about sex, so they have language to disclose. Burriers, fear of family burden, and trauma to trim the family in name, and fear of retribution by family members if they disclosed. Pattern of stiff and dismissed disclosures identified over the life course. All 17 participants identified spirituality as a primary source of strength through the life course</td><td>One of few studies to focus exclusively on African American women. Small but insufficient size for a qualitative inquiry. Important issues were brought forward. Rettrospective study can be used if a life-course perspective as a theoretical lens for understanding CSA in the middle to later years of life that should be considered in further investigations</td></tr><tr><td>Collin-Vezina, Sablooni, and Milne (2015)</td><td>To provide a map of factors that prevent CSA disclosures through an ecological lens from a sample of CSA adult survivors.</td><td>Qualitative design using LIM</td><td>67 male and female CSA adult survivors (78% identified as female and 24% as male). Age ranges from 19 to 69 years (m = 449). Purpose sampling strategy</td><td>Three broad categories were identified as barriers to CSA disclosure. Barriers from within-internal victim blaming, mechanisms to protect自己, and immature development at time of abuse; barriers in relation to others–violence and dysfunction in the family, power dynamics, awareness of the impact of telling, naughty behavior, banning in relation to the world, labeling, taboo of sexuality, lack of services available, and culture or time period.</td><td>Half of participants had not disclosed their CSA experiences before the age of 19. Rettrospective aspect of the study could imply recall issues. All participants had disclosed and received counseling at some before participating in the study. High level of rigor in establishing transparency of the data and analysis</td></tr><tr><td>Leclerc and Wortley (2015)</td><td>Study objectives investigated the factors that facilitate CSA disclosures</td><td>Adult male child sexual offenders were interviewed to examine predictors of CSA disclosures</td><td>369 adult males who had been convicted of the age of the victim; a generation had occurred if the victim was related to the offender; if the victim was not living with the offender at all</td><td>Disclosure increased with the age of the victim; a generation had occurred if the victim was related to the offender; if the victim was not living with the offender at all</td><td>Offender generated data through self-reports could be subject to cognitive distortions—minimization or exaggerations.</td></tr></tbody></table>

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Table 1. (continued)

<table><thead><tr><th>Study</th><th>Purpose</th><th>Design</th><th>Sample</th><th>Findings</th><th>Summary</th></tr></thead><tbody><tr><td>McBravey and Cullane (2015)</td><td>To investigate the feasibility of child assessments as data sources of informal CSA disclosure. To assess if these reports provide substantive data on disclosures</td><td>Victim disclosure. Semistructured interviews based on the QID questionnaire. File reports of children seen for assessment in a child sexual abuse unit in a children&#39;s hospital were reviewed</td><td>17 years old. Majority were White, undeciduous, almost half unemployed before their arrest. Completed 39 files (32 females and 7 males) based on a coding framework. Parents were asked to consent to have their child identified for the state. Victims assessed were 12-18岁 of age</td><td>the time of the abuse, or if the victim resisted during the offense. Male victims and victims from dysfunctional backgrounds likely to disclose information to inform them.</td><td>Perspectives of offenders on vulnerability of victims in relation to disclosure could be important information to inform them.</td></tr><tr><td>Dumont, Messerschmitt, Vila, Bohlu, and Rey-Salamon (2014)</td><td>This study aimed to explore the relationship between the perpetrator and the especially whether these reasons are infrafamilial or extrafamilial, impact CSA disclosure</td><td>File reports of children seen for assessment in a child sexual abuse unit in a children&#39;s home were reviewed</td><td>220 minor victims—78.2% female victims, 41.8% age between 14 and 18 most prevalent (age), and 48.2% were abused by a family member</td><td>Disclosure processes were more complex when it concerned sexual abuse committed by an infrafamilial perpetrator: 60% of the victims and more often to individual outside the family (78.6% of the disclosures done at school) on the contrary, extraditional disclosures take place more spontaneously and quickly; 80% of the victims reveal a few days after, most often to their mother or caretaker.</td><td>The relationship with the perpetrator has a significant impact on both timing and resolution of disclosures, indicating that disability likely to be disclosed promptly and within the family system</td></tr><tr><td>Easton, Saltzman, and Willis (2014)</td><td>Study focus was on identification of barriers to CSA disclosure with male survivors</td><td>Using qualitative content analysis, researchers conducted a secondary analysis of online survey data, the 2010 Health and Well-being Survey with self-reported CSA histories with an open-ended item on disclosure barriers</td><td>460 men with CSA histories completed an anonymous, internet-based survey. Recruited from survivors&#39; age range of 18-84 years. Two thirds of respondents reported clergy-related abuse. Majority of respondents were White</td><td>Vast majority of participants (94.6%) were sexually abused by another male. Duration of sexual abuse broke down into: 30.2% less than 6 months, 32.3% 6 months to 3 years. Ten years old were average of 3 years. Were age range of 18-84 years. Two thirds of respondents reported clergy-related abuse. Majority of respondents were White</td><td>At time of the study, this was the largest qualitative data set to have been analyzed with an explicit focus on adult male survivors&#39; perceptions of barriers to CSA disclosure. Because the sample was wide, we were able to show percentage of small minority (9.3%), disclosure differences based on race or ethnicity were not discerned. The majority of abuse present was by clery which might present a unique set of barriers to disclosure</td></tr></tbody></table>

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<table><thead><tr><th>Study</th><th>Purpose</th><th>Design</th><th>Sample</th><th>Findings</th><th>Summary</th></tr></thead><tbody><tr><td>Easton (2013)</td><td>Study purpose was to describe male CSA disclosure processes using a life span approach examining differences based on age and to explore relationship disclosure attributes and men&#x27;s mental health</td><td>Cross-sectional survey design, Eligible participants were screened and an anonymous, internet-based survey 2010. Men were used General Mental Health Distress Scale and General Assessment of Individual Needs.</td><td>Purpursive sampling of 487 men from three national organizations devoted to raising CSA among men. Age range 19-age years. Male age for women of CSA was 10.3 years</td><td>Older age and being abused by a family member were both related to delays in disclosure. Most participants who told someone during childhood did not receive emotionally supportive or protective responses and the helpfulness of providers was limited. Delays in telling the family manifested periods of time (over 20 years)</td><td>Purpursive sampling of men from awareness raising organizations may have attracted particular participants who had already participated with them and received help. Participants needed to have access to treatment in lower $BS groups and required proficiency in English which would be appropriate for the participants first told about the sexual abuse to a spouse/partner (27%) or a mental health professional (20%); 42% of helpful discussions was with a mental health provider and caused no mental distress. Clinical recommendations included more of a life-course perspective be adopted, understanding impact of unhelpful responses and the importance of expanding networks for male survivors</td></tr><tr><td>McEvaney, Greene, and Hogan (2012)</td><td>Qualitative study asked the research question: How do children tell&#x27;t Objective is to develop theory of how children tell their CSA disclosure experiences. Parents were interviewed.</td><td>Grounded theory study. Interactive study conducted. Line-by-line open and axial coding was conducted on verbatim transcripts</td><td>Sample of 126 young people. 16 and 6 boy/girl ages 8-18 years. 22 interviewed in total between the ages of 8 and 18. Mixed sample of some enduring infirmarial CSA. some extrascholar CSA, and two endured both forms</td><td>A theoretical model was developed that the CSA disclosure as one of counseling the secret; the active withholding of the secret; the experience of a &quot;pressure cooker&quot; reflecting a conflict between the toil and the wish to keep the secret and the confining itself when often occur in the context of a trusted relationship. These were derived from caregivers who developed through open and coaxing</td><td>Models but sufficient sample for an inclusive study. The sampling strategy gained access to a predominantly hidden population. Important recommendations are made with an emphasis on a life-course focus</td></tr><tr><td>Schonbacher, Maier, Mohler-Kuo, Schnyder, and Landolt (2012)</td><td>To investigate the process of CSA disclosure with adolescents from the general population who had experienced CSA, how many disclosed, who did</td><td>Data collection was through face-to-face qualitative interviews. Standardized questions and measures were administered on family inclusion, sociodemographic</td><td>Convenience sample of 26 sexually victimized adolescents. 23 girls and 3 boys. Age range 15-18 years. Online interviews and Photos were used to recruit youth from</td><td>Less than one hundred of participants immediately disclosed CSA to another person. In most cases, recipients of both immediate and delayed disclosure were more than one third of participants had never disclosed the abuse to a parent. Participants reported reluctance to disclose to parents so as to</td><td>Two thirds of the sample did not report right away. Strengthening parent-child relationships may be one of the most important ways to increase disclosure to parents. Disclosure to peers has been found a common trend in other</td></tr></tbody></table>

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<table border="1"><tr><td>Study</td><td>Purpose</td><td>Design</td><td>Sample</td><td>Findings</td><td>Summary</td></tr><tr><td>Hunter(2011)</td><td>Arm of this study was to develop a fuller understanding of CSA disclosures</td><td>data, sexual victimization, general, and mental health Sexual Assault Module of the Juvenile Victimization Questionnaire was used</td><td>community and counseling services</td><td>not to burden them. Earlier disclosures were related to extramafilial CSA, single occurrence CSA, age of victim at abuse onset, and parents of victim at abuse together. Higher levels of reported guilt and anecdotal evidence of disclosures were viewed by this sample more reliable confidants</td><td>research and bears more examination</td></tr><tr><td>Schwiffer, Leventhal, and Asnes(2011)</td><td>This study aimed to:(1) add direct inquiry about the process of a CSA disclosure;(2) determine if children will discuss process that led them to tell; and(3) describe factors identify that led them to tell about or caused them to delay CSA disclosure</td><td>Narrative inquiry methodology: Face-to-face in-depth interviews were conducted with participants were analyzed using Rosenthal and Fischer-Rosenthal&#x27;s(2004) method.</td><td>Purposive sampling was employed Sample consisted of 22 participants aged 25-70 years; 13 women and 13 pregnant patients were sexually abused at 15 years or under with someone over the age of 18.</td><td>Only 5 out of 22 participants told anyone about their fear, sexual experiences and children. Fear, shame, and self-harm are the main inhibitors to disclosure. These factors are further detailed in Appendix B. Children and an adult were further included upon using Alagita&#x27;s(2004) framework verifying behavioral indirect attempts to tell and behaviorful disclosure as categories. Thematic analysis supported that CSA disclosure should be conceptualized and viewed as complex and long-term.</td><td>Delayed disclosure was common in this qualitative study. Most participants did not make a selective disclosure until adulthood. These findings support Alagita&#x27;s(2004) discussion but highlight the importance of life stage. Moldest but sufficient sample size for a qualitative inquiry. Well-designed study with detailed analysis for transferability of findings</td></tr><tr><td></td><td></td><td>Study sought to find out if process issues of disclosure could be identified in the context of forensic interviews. Forensic interviews were asked to incorporate “telling” into an existing forensic interview protocol. Interview content related to the children&#x27;s reasons for telling or waiting was examined, and analyzed using grounded theory method of analysis</td><td>19 interviews of CSA victims ages 3-18 over a 1-year period were used in the study. Inclusion criteria included children who made a statement about CSA prior to referring for telling or waiting to tell, and those who spoke English. Participants who were interviewed at a child sexual abuse clinic, 74% were female and 51% were Caucasian</td><td>Russell&#x27;s(2004) designed for identifying forced cases into three domains: a result of internal stimuli (e.g., child had nightmares); disclosure facilitated by outside influences (e.g., the child was questioned); and disclosure identified fall into five groups (i.e., made by the perpetrator(e.g., the child was told she or he told), fears (e.g., the child was afraid something bad would happen to her or he told), lack of opportunity (e.g., the child felt the opportunity(e.g., the child felt to recognize abusive behavior as unacceptable), and) relationship with the perpetrator(e.g., the child thought the perpetrator was a friend)</td><td>As innovative study to try to assess if formal investigative interviews can facilitate discourses of CSA Data were based on a large number of interviews. Detailed analysis produced detailed findings supporting other study findings on CSA disclosure</td></tr></table>

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<table border="1"><tr><td>Study</td><td>Purpose</td><td>Design</td><td>Sample</td><td>Findings</td><td>Summary</td></tr><tr><td>Alagga (2010)</td><td>The study aimed to identify factors impeding or promoting CSA disclosures. Overarching research question What individual, interpersonal, environmental, and contextual influences impede or promote CSA disclosures.</td><td>A qualitative phenomenological design, LIM was used to interview adult CSA survivors about their disclosure experiences to provide retrospective accounts of CSA disclosure and meaning-making. This questionnaire was done through a social-ecological lens.</td><td>Purposive sampling was employed. Snowball sampling was also used to recruit more male survivors of CSA who were interviewed: 85% men and 45% women. Age range of 18-65 with a mean age of 40.1 years. Average age of abuse onset of 36% for 85% males. Oldest 36% for 85% females. Diverse socioeconomic backgrounds</td><td>Themes fell into four domains: (1) individual and developmental factors, developmental strategies as to whether they comprehended what was happening, how to be on the ability to tell and anticipating not being believed; (2) disclosure inhibited by family characteristics such as rigid gender roles with dominating fathers, gender and aggression; other forms of dysfunctional communication; and social isolation; (3) neighborhood and community context, that is, lack of interest from neighbors and teachers not pursuing troubling behavior; and (4) cultural and societal attitudes, media messages unheard as kids, gender socialization for males, and cultural attitudes influencing parent&#x27;s reactions. Purposeful disclosure is higher than reported in other studies because of the sampling attempts to purchase literature with clinical data, this article conducted an analysis to provide a culturally competent framework for CSA disclosure questioning</td><td>The study presents a comprehensive social-ecological analysis to CSA disclosure highlighting the maladapted influences of Note, 42%, use of children in the care of children, 26% had not disclosed because they had repressed the memory, or the abuse had occurred in prechool years and they had difficulty with recall. The remainder had not disclosed in a way during childhood. A retrospective approach that could be affected by recall issues</td></tr><tr><td>Fonnes and Plummer (2010)</td><td>This examination of CSA disclosure explored the ways culture affects processes of CSA disclosure and reporting, both in the United States and internationally</td><td>Using published literature with clinical data, this article conducted an analysis to provide a culturally competent framework for CSA disclosure questioning</td><td>Data consisted of published literature and culture that was triangulated with clinical case material</td><td>Cultural and societal factors affecting CSA disclosure are identified in-depth detail. Recommendations made include (1) disclosure interviewing to tailor to the child&#x27;s cultural context (2) questioning should also take into consideration the cultural context (3) questioning stands as an important factor in all cases in which children are considering or being asked to disclose, and not solely in cases in which children are from notable minority groups. Present a comprehensive intervention game. Present a comprehensive interaction game.</td><td>One of the few works that adds knowledge to culturally discursive interviewing. Unique combination of literature findings. Anecdotal accounts may provide insights. Overall impact on a CSA disclosure information</td></tr><tr><td>Unger, Barter, McConnell, Turtz, and Fairholm (2009a)</td><td>This study explored disclosure strategies with a national sample of youth focusing on</td><td>Forms were completed by youth following participation in abuse prevention</td><td>Examination of results from a national sample of 1,621 evaluation forms where young</td><td>Youth who have been abused or witnesses to abuse employ five disclosure strategies: using self-harm behaviors to signal the abuse to others; not calling</td><td>This study highlights that disclosure is an interactive ongoing process. Findings lend support to studies that have identified similarly</td></tr></table>

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<table><thead><tr><th></th></tr></thead><tbody><tr><td>Table I. (continued)</td></tr></tbody></table>

<table><thead><tr><th>Study</th><th>Purpose</th><th>Design</th><th>Sample</th><th>Findings</th><th>Summary</th></tr></thead><tbody><tr><td>(1) What are the hidden experiences of abuse among Canadian youth? (2) What impact does perceptions of abuse in programs have on youth to express their abuse experiences? (3) What disclosure barriers for youth face? (4) What are young people&#39;s defensive patterns, and (5) Who do they tell</td><td>(1) What are the hidden experiences of abuse among Canadian youth? (2) What impact does perceptions of abuse in programs have on youth to express their abuse experiences? (3) What disclosure barriers for youth face? (4) What are young people&#39;s defensive patterns, and (5) Who do they tell</td><td>Programming by the Canadian Red Cross (RespectFocus). A series of focus groups and observations of the workshops were used to help contextualize the findings. Evaluation forms were analyzed from two violence prevention programs: (1) It&#39;s too your fault, and (2) What&#39;s love got to you.</td><td>anonymously disclosed abuse experiences. Respondent&#39;s age: 13 and under (ages: 17, 14-15 (17%), 6-17 (25%), 18 and older (4%), and unknown (7%)</td><td>at all about the abuse to prevent intrusive interventions by others; seeking help from peers; seeking help from informal adults; seeking help from mandated service providers; resulting in support disclosure. An interactive process, with expectations regarding consequences to disclosure. Patterns of incrementally sharing abuse experiences are shaped by young people&#39;s interactions with peers, educators, and caregivers. Three-quarter(s) of females predisposed, significantly less maltous disclined.</td><td>interactive models of disclosure such as detailed by Aligaya (2004) and Stalter and Nelson-Gardel (2005). This mixed sample of youth who experienced different types of abuse and violence statements was participants—not limited to CSA survivors</td></tr><tr><td>Ungar, Turty, McConnell, Bartier, and Fairholm (2009b)</td><td>This study explored abuse disclosure strategies with a national sample of Canadian youth who participated in violence prevention programming. One of the goals of the study was to document not previously identified abuse and youth attitudes toward disclosure of abuse experiences</td><td>Exploratory design with a nonrepresentative samples. Qualitative analysis of 1099 evaluation forms. Comparing Red Cross RespectED violence prevention delivered between 2000 and 2003. Forms of anonymous abuse discourses by youth participants, emotional, physical, and sexual abuse. Twenty-seven interviews and focus groups were also done to understand contextual issues and engage with program facilitators in the interpretation of findings. A coding structure was developed for analysis to synthesize themes across data sources</td><td>Purposeful sample of 1,099 evaluation forms completed following Red Cross RespectED violence prevention delivered between 2000 and 2003</td><td>Findingssuggest high rates of hidden abuse, with less than one quarter of youth reporting a disclosure. 244 of the 1,099 youth who disclosed a disclosure on their evaluation form, identified specific disclosure patterns vary with boys, youth aged 14-15, victims of physical abuse, and those bound by a family member being most likely to disclose to professional or the police. Third of disclosures were directed toward professionals and the least. 5% fewer examples were shared, parents, and others. Participants were most likely to disclose sexual abuse to parents/family, professionals, and the police/council, with fewer choosing friends.</td><td>Innovative design of this study provides insight into young people&#39;s perceptions of disclosure experiences. High level of trustworthiness of the data and youth focus groups interviews, and observational data. The study results are somewhat limited in the thickness of the descriptions it can offer because most of the data are surveyed. Regional difference may not have been broaded up. Scoping of the study is broad and approach is creative</td></tr></tbody></table>

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<table><thead><tr><th>Study</th><th>Purpose</th><th>Design</th><th>Sample</th><th>Findings</th><th>Summary</th></tr></thead><tbody><tr><td>Pribee and Svedin (2008)</td><td>This study aimed to investigate disclosure rates and disclosure patterns and examine predictors of nondisclosure in a sample of male and female adolescents with self-reported experiences of sexual abuse</td><td>Participants completed 65-item questionnaire that included questions about background, consensual sex, sexual abuse experiences (noncontact, contact or penetrating abuse, including peer abuse), inclusion of CSA, own sexual abuse feelings, and experiences with pornography and sexual exploitation. The questionnaire included 6 modified items from the SC1-90 and of 25 items from the Personal Bath Instrument. The day for girls and boys were analyzed separately</td><td>The sample consisted of 4,339 high school students in Sweden (2,324 girls and 2,015 boys). The mean age of the participants was 18.15 years. This study used a subsample of 1,962 participants who answered CSA and who answered disclosure questions</td><td> whom disclosures occurred?) More females specified who they disclosed to compare to males. The data show perceptions among youth of negative consequences following disclosure</td><td>Summary</td></tr><tr><td>Sorsoli, Kia-Keating, and Grossman (2008)</td><td>Study focused on disclosure challenges for male survivors of CSA to understand three issues: (1) To</td><td>Male survivors of CSA were interviewed about their disclosure experiences. Analytic techniques included</td><td>The sample consisted of 4,339 high school students in Sweden (2,324 girls and 2,015 boys). The mean age of the participants was 18.15 years. This study used a subsample of 1,962 participants who answered CSA and who answered disclosure questions</td><td> Of these, 1,505 girls (65%) and 457 boys (23%), both CSA and 69% (boys). Girls and boys disclosed most often to a friend of their own age. Had disclosures to professionals, and even fewer had reported to the authorities. There were higher rates of disclosure to a professional with more severe abuse (contact abuse with or without penetration) for girls, but lower rates for boys. They were less likely to disclose an abuse, was a sibling of their mother, father, or a sibling. Girls were less likely to disclose if they had experienced contact sexual abuse with or without penetration, less frequent abuse, by a family member, or if they had perceived their parents as less caring and less overprotective. Boys were less likely to disclose if a family member provided them with a study member program (vs. an academic program), lived with both parents or had perceived their parents as less caring and not overprotective.</td><td>This study highlighted that sexual abuse is highly hidden from adult society, especially from professionals and the legal system. However, time lapsed to disclosure was not reported. Since friends appeared to be the main recipients of sexual abuse disclosures, practice implications of this could be to find ways to give young people better information how to support a sexually abused peer. A qualitative component to the study would have provided a broader understanding of disclosure processes. Study limitations include a significant amount of boys who did not complete the question regarding disclosures of their sexual abuse (whether it was not was measured, possibility of recital bias with rosetopic studies based on self-reports; and youth participants may not have understood all the questions</td></tr><tr><td>Sorsoli, Kia-Keating, and Grossman (2008)</td><td>Study focused on disclosure challenges for male survivors of CSA to understand three issues: (1) To</td><td>Male survivors of CSA were interviewed about their disclosure experiences. Analytic techniques included</td><td>The sample consisted of 4,339 high school students in Sweden (2,324 girls and 2,015 boys). The mean age of the participants was 18.15 years. This study used a subsample of 1,962 participants who answered CSA and who answered disclosure questions</td><td> Barriers to disclosure were found to be one in three interrelated domains: (1) personal (e.g., lack of cognitive awareness, intentional avoidance, emotional realness, and shame). (2)</td><td>Since the vast majority of men in the sample had not disclosed in childhood, they may have been predisposed to identifying barriers to disclosure more</td></tr></tbody></table>



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Table I. (continued)

<table><thead><tr><th>Study</th><th>Purpose</th><th>Design</th><th>Sample</th><th>Findings</th><th>Summary</th></tr></thead><tbody><tr><td>Hershkowitz, Lanes, and Lamb (2007)</td><td>The goal of the present study was to examine how child victims of exorfamilial sexual abuse disclosed the abuse experience</td><td>grounded theory method of analysis for coding and development of conceptually clustered murics. Participants conducted depth, semicstructured interviews, lasting between 2 and 3 hr each taking place approximately a week apart</td><td>Puerto Rican, 1 part African American, 1 African Cuban, 1 age range of 24-61 years; 9 identified themselves as heterosexual, 5 as bisexual, and 2 as bisexual</td><td>Findings<br>replications (e.g., fears about negative repercussions, isolation); and (3) sociocultural (e.g., lack of acceptance for men to experience or acknowledge victimization). Only 1 of the 16 men in this sample exhibited negative abuse experiences while he was still a child. The other men reported that they had not disclosed, although some reported attempts to tell that were indirect or incomplete. Several other men disclosed certain experiences or elements of their abuse, but concealed others. Both boys and girls of these men had disclosed their past experiences in a variety of relationships, including those with family members, partners, therapists, and infrequently friends. Had only limited discussions of their sexual abuse</td><td>readily. Retrospective accounts are subject to focal issues. Investigators made significant differences to gather a diverse sample. High level of rigor was executed in the dependability of the data and anatomy process of the interpretation of findings was conducted</td></tr><tr><td>Hershkowitz, Lanes, and Lamb (2007)</td><td>The goal of the present study was to examine how child victims of exorfamilial sexual abuse disclosed the abuse experience</td><td>Allied victims of sexual abuse and their parents were interviewed. Children were interviewed using the NCHD Protocolive Interview Procedure by expert youth investigators. Information on disclosure processes was obtained in the first formal interview, before any police investigation or child welfare intervention</td><td>Three alleged victims of CSA, 18 boys and 12 girls. Child sample was 7 to 12-year-old with an average of 9.2 years. Twenty mothers and 10 father们 were also interviewed for a third interview. A context analysis was conducted on child and parent interviews</td><td>Disclosure regimes were established (1) for 18% of children delayed disclosure for between 1 week and 2 years; (2) recipient of disclosure: 47% of children first disclosed to siblings or friends, 33% first disclosed to their parents, and 10% first disclosed to another adult; 57% of the children spared after they were prompted, 50% of the children reported feeling afraid or asthmated of their parents&#x27; responses. Parents&#x27; reactions support (37%) and unsupport (63%), which was a strong correlation between predicted and actual parent reactions and included their parents&#x27; likely reactions accurately. Disclosure processes varied depending on the children&#x27;s ages (e.g., younger children disclosed to parents), severity and frequency of abuse, parents&#x27; expected reactions, identities, and strategies used to foster secretion</td><td>Improven design to either disclosure data from young CSA. Focus is on exorfamilial CSA. Two thirds of the parents registered unsupportive responses which is high</td></tr></tbody></table>

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<table><thead><tr><th>Study</th><th>Purpose</th><th>Design</th><th>Sample</th><th>Findings</th><th>Summary</th></tr></thead><tbody><tr><td>Alagga (2005)</td><td>The objectives of the current study were to identify a broad range of factors, including family dynamics that contribute to a gender's ability to disclose CSA.</td><td>A qualitative phenomenological design—LIM was used to elicit disclosure experiences; families and barriers; and relevant circumstances. Interviews were transcribed verbally. Line-by-line open coding was conducted to capture family-level factors. Axis and self-referencing facilitated identification of themes.</td><td>Purposeful sampling was employed to recruit 20 adult survivors between the ages of 18 and 65 who were sexually abused by a female. Age of participants was 40.1 years; 60% of participants were female and 40% male. Average age of women is 6.7 years. Mixed clinical and non-clinical had received treatment for CSA at some point in their lives.</td><td>Four major themes emerged suggesting that CSA disclosure can be significantly compromised when certain family conditions exist: (1) rigidly fixed, gender roles; (2) presence of family structures; (3) presence of family communication patterns; and (4) social isolation of the family as a whole, as specific members, played a part in CSA victims feeling they had no safe to interact with them. Family systems formulations through understanding children and families at risk of disclosure barriers</td><td>Over half the participants had not disclosed the abuse during childhood, participants of the nondisclosing group, six did not disclose because they had repressed or forgotten the memory. Almost one out of every one of these individuals were intentionally moved. More data are needed on dialecticclosures to garner more information on facilites of disclosure. Retrospective approach implies recall issues. High level of trustworthiness of the data and credibility organization, and compliance through direct quotes</td></tr><tr><td>Collings, Griffiths, and Kumalo (2005)</td><td>The study purpose was to qualitatively explore dynamics that impede or promote disclosure of the range of factors including gender as a dynamic disclosure of females and males are similar and different, and in what ways gender affects CSA disclosure.</td><td>Survivors of CSA were interviewed about their disclosure experience. Implementing LIM. Assessment of participant involvement was used for queries that involved development regarding impact of gender on disclosure. Interviews were transcribed verbatim for open, audible, and codified categories and subcategories were collapsed and refining into theme areas.</td><td>Purposeful sampling of women and men along with those who did disclose during the interview were not identified among 19 females and 18 males (16-years old) who were abused by a female member or a trusted adult. Average age of abuse onset was 5.3 months, and 58% had not disclosed during childhood.</td><td>Three themes emerged for men that inhibited or precipitated disclosure for reasons related to gender: (1) fear of being viewed as homosexual; (2) fear of victimization; and (3) fear of becoming an abuser, which acted as a precipitant for disclosure. Two predominant themes related to difficulties disclosing: (1) they felt more conflicted disclosing; (2) they were more inclined to be blamed and/or not believed being blamed and/or not believed</td><td>One in a dearth of studies that conduct gender analysis. Comparative analysis draws out important practice implications. The study which implies possible recall issues. High level of trustworthiness of the data and credibility organization, and compliance through direct quotes</td></tr><tr><td>Study examined patterns of disclosure in a large representative sample of South African CSA vocabulary objectives to (1) examine how and</td><td>File reviews of all social work and medical case files for CSA victims seen at the crisis category cases of CSA reported to the North Durban</td><td>File reviews of all social work and medical case files for CSA victims seen at the crisis category cases of CSA reported to the North Durban</td><td>1,737 cases of CSA in Durban of the North Durban of Kwazulu-Natal, South Africa; January 2001 to December 2003. 1,614 girls and</td><td>Content analysis identified two broad dimensions of disclosure: (1) agency; child-inflicted disclosure versus detection by a third party and a process; (2) dimensions of disclosure: four discrete categories of defined four discrete categories of</td><td>These results fit into Alagga&#39;s (2004) discourse framework. Data analysis two enters discursive categories using both, which provided to be both exhaustive and mutually exclusive</td></tr></tbody></table>

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EFTA00156874

<table><thead><tr><th>Table I. (continued)</th></tr></thead><tbody></tbody></table>

<table><thead><tr><th>Study</th><th>Purpose</th><th>Design</th><th>Sample</th><th>Findings</th><th>Summary</th></tr></thead><tbody><tr><td>Hernkowitz, Horowitz, and Lamb (2005)</td><td>This study aimed to identify characteristics of suspected child abuse victims that are associated with disclosure and non-disclosure during formal investigations</td><td>Large database of suspected and sexual abuse investigated in Israel between 1998 and 2002 was analyzed. Interviews were also standardized NICHD investigative interview Protocol. Archival data were analyzed</td><td>The sample was comprised of 26,446 children aged 3 to 14-year-olds of alleged victims of sexual and physical abuse interviewed in Israel in the year 1998 to 2002. 40 experienced youth investigators conducted interviews</td><td>disclosure: (1) purposeful disclosure (30% of cases), (2) indirect disclosure (98% of cases), and (4) accidental detection (43% of cases). Disclosure independently predicted by victim&#x27;s age, nature of the victim-perpetrator relationship, offender&#x27;s age, frequency of relationship, and reporting latency. Mean age of patients higher than the mean age of indirect disclosures (58%). Exploit forms of disclosure were less likely when the offender was a family member. Shorer reporting latency was more likely with reported abuse</td><td>with the percentage of intergrant agreement at 99%, Government is limited to child clients receiving a crisis assessment referred through a police report</td></tr><tr><td>Jensen, Gullbrunden, MESSAGE, Reichelt, and Tjerland (2005)</td><td>This study investigated which contact children were able to report their child sexual abuse experiences; their views as to what made it difficult to talk about abused them in the disclosure process; and their parent&#x27;s perceptions of their disclosure processes</td><td>Qualitative approach to data collection and analysis was used. Thematic interviews on the children and mostly their mothers were analysed through qualitative approach. Follow-up interviews were held a year later</td><td>20 families with a total of 22 children participated. All children had told about experiences that created concerns for caregivers about CSA children&#x27;s ages CSA children&#x27;s ages (average age 75 years); 15 girls and 7 boys. Sexually abused by someone in the family or a close person to the family</td><td>None of the children told of abuse. Children exposed to repetitive abuse this a serve for to several years: 17 told their mothers first, 3 told a friend, I told their father, and I their uncle. Majority of remarks led to the suspicion of CSA being abused in the child&#x27;s dialogue about what was bothering them, resulting in a referral. The children felt it was difficult to find situations containing enough privacy and prompts that they could share their experiences. When the children did</td><td>Overall findings indicated that rates of disclosure varied systematically depending on the nature of the alleged victims, the relationship between alleged victims and suspected perpetrators, and the age of the suspected victims. Awareness that had come to the attention of official agencies, making it difficult to determine how many of abuse take place without ever triggering any kind of investigation</td></tr></tbody></table>

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<table border="1"><tr><td>Study</td><td>Purpose</td><td>Design</td><td>Sample</td><td>Findings</td><td>Summary</td></tr><tr><td>Saller and Nelson-Gardell(2005)</td><td>The purpose of this study was to understand the full process of CSA disclosure and how this included for predisposed and adolescent girls.Examined what facilitated and hindered disclosure and subsequent consequences</td><td>Secondary analysis of qualitative focus group data.Original project consisted of four focus groups without an ongoing therapy for girls who had experienced CSA.Secondary analysis consisted of written materials of each session including these conceptually and examining their interconnectedness</td><td>Sample consisted of 34 participants from four groups.Sessions analyzed were between 80 min long and documented later transcribed for content analysis</td><td>disclosure they did it in situations where the top of the table was in some form addressed or situated where someone recognized the child&#x27;s cause and probably further.They also were sensitive to others reactions, and whether their disclosures would be mistrevered. Several of the children perceive negative disclosures as major factors affecting disclosure.They were primarily concerned about negative effects for the mother.The mothers and they were also sensitive to the children&#x27;s feelings.If their children showed signs of distress and wanted to talk,the mothers would choose that subject or not pursue the topic further</td><td>Summary</td></tr><tr><td>Alagae(2004)</td><td>The study sought to examine influences that inhibit or promote children&#x27;s disclosure of CSA to address gaps in knowledge about how, under what circumstances victims of CSA disclose</td><td>The study employed LIM→ phenomenological intensive interviewing that were 2 hr long on average generated for a time.In interview guide was</td><td>Using purposive sampling 24 adult survivors of infantile abuse between ages of 18 and 65(average age 4.2).were recruited from agency and one university 57% male and 43% female</td><td>Findings reported in three major domains:(1) self-pulse;where children come to understand victimization internally;(2) conflict selection-action person to aid person to aid person to support that person;or hostile;(3) consequences phase good and bad that continued to inform their ongoing strategies of telling.The actions and reactions of victims and information the girl describes and consequences phase were further subdivided into four aspects:(1) gossiping and news networks,(2) institutional relationships,and the afterlife of friends.(3) authority within and among communities.(4) authority outside and within communities.</td><td>This study provided a contextual examination of the entire disclosure process,closer to the point in time when the abuse and disclosure of children and adolescentsgifts had survived sexual abuse also served as consultants and were encouraged to share their knowledge for the benefit of professional practitioners</td></tr><tr><td></td><td></td><td></td><td></td><td></td><td>This study expanded types of CSA disclosure to more fully understand how children and adults disclose.And under what circumstances.Asking people to recount events that occurred in childhood susceptible to minority bias when memories were forgotten</td></tr></table>



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<table><thead><tr><th>Study</th><th>Purpose</th><th>Design</th><th>Sample</th><th>Findings</th><th>Summary</th></tr></thead><tbody><tr><td>Crisima, Bascelli, Paci, and Romito (2004)</td><td>The main goals of this study were to understand impressions that patients from disclosing CSA and seeking help from their network and/or the services</td><td>In-depth telephone (anonymous) interviews were conducted after interviewers were explained and obtained. Three investigators experienced in counseling CSA counseling conducted the interviews with researchers with permission. Three researchers independently scored the interviews according to a coding framework</td><td>The sample was comprised of 36 young people who experienced sexual abuse; 35 females and 1 male aged 12–17. Some of the sample experienced sexual violence in a dating relationship</td><td>previously established categories. Three additional disclosure categories emerged: behavioral and indirect verbal attempts, discuses intentionally withdrawn, and discuses triggered by recovered memories</td><td>delayed, or repressed and later recovered, Distortion and revision of events are also potential problems in recall. High degree of trustworthiness of the disclosed quotes provided supported the categories</td></tr><tr><td>Jonson and Lindblad (2004)</td><td>Study purpose was to explore how abuse traits, openness, reactions to CSA disclosure, and social support were related. Differences based on severity of abuse time of onset of disclosure, social support, and predicting factors of positive and negative reactions were probed</td><td>Adults by someone close were interviewed using semi-structured guides together with questionnaires. Data on victimization and current social support were through the questionnaires, and data on disclosure and reactions were gathered through the interviews with participants</td><td>12 adult women between 30 and 60 years old (average age of 41 years) reporting exposure to child abuse by someone close before age of 18 and told about at least one abuse event. 90% were Swedish subjects. Purposive sampling strategy was used</td><td>The main impediments to disclose to a family member were: fear of not being believed, shame, and fear of causing trouble to the family. The main impediments to disclosure were: unaware of appropriate services, wish to keep the secret, lack of awareness of being mistreated of adults and professionals, and fear of the consequences of disclosing sexual abuse. When they did disclose to professionals, teens received very limited support; made accusations and could not offer appropriate interventions to victims</td><td>This study represented the findings of a mixed sample of survivors of child sexual abuse and intimate partner violence. The study was considered only a brief whisper about sexual abuse training is available. There may have been a selection bias as the most distressed survivors responded to the research call</td></tr><tr><td></td><td></td><td></td><td></td><td>Abuse characteristics abuse by multiple perpetrators was more common than by a single perpetrator for ages of onset if an average duration of 7 years. Severely abused women had taken to more of their social network, especially to professionals. For 23% of children before the age of 18 with an average of 2 years delay, women who had disclosed information reported more instances of physical abuse, multiple perpetrators, use of violence, and were more likely to have confronted a persecutor, and had received a negative persecution, factors</td><td>68% delayed disclosure until adulthood. At the time of the study, it was one of the studies to focus on the interplay between social support networks and disclosure of child sexual abuse. The study results are somewhat limited in that only a minority of severely abused women. Retrospective study and self-report of information obtained on abuse and disclosure characteristics. Cross-sectional</td></tr></tbody></table>

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<table border="1"><tr><td>Study</td><td>Purpose</td><td>Design</td><td>Sample</td><td>Findings</td><td>Summary</td></tr><tr><td>Kogan(2004)</td><td>The purpose of this study was to identify factors that influence made by female survivors of USE in childhood and adolescence.The predictors of both the timing of disclosure and the recipient of the disclosure were investigated</td><td>Data were gathered from a subsample of female adolescents that participated in the NSA, which consisted of structured phone interviews.USE reports in the NSA were used as a version of the Incident Classification Interview.They were then asked a series of questions about an unvaried sexual contact including event characteristics and pareratator characteristics</td><td>A subsample of 263 adolescent females between 12 and 17 years old, mean age of 15.2 years old, who reported at least one experienced sexual contact with the NSA.Participant characteristics, USE family contextual attributes were explored</td><td>S significantly predicting delay were younger age at first event and no use of violence.Disclosure outcomes of the 26 women who told in childhood during a period with ongoing abuse, 15 women were continuously abused after disclosureChildren under the age of 7 were at a higher risk for delayed discourses.Participants whose USE occurred between the ages of 5 and 13 were most likely to tell an adult.Adolescents(14-17) were more likely to tell only peers than children age 7-10 years.C children under the age of 8 had been told an adult but were not told who refused to report or discuss USE may represent a source of systematic bias would make to adolescents who are willing to disclose USE via survey.Although data may be retrospective, recall bias may have been minimized in this study and the time lag between the USE and the interview were presumably shorter than a study of adult participants recalling CSA experiences.</td><td>Summary does not allow for definite conclusions of cause and effect on the relationships found</td></tr><tr><td>Goodman-Brown, Coleklen, Goodman, Jones and Gordon(2003)</td><td>The purpose of this study was to investigate whether with disclosure of CSA and test a model for factors that influence how quickly children disclose sexual abuse</td><td>Case file reviews of data obtained from pretested files, as well as from structured interviews with the child&#x27;s careker and observations of child training graduate students and one victim advocate compares the Sexual Assault Profile</td><td>Sample consisted of 218 children referred to pretested files for all alleged CSA.All children in the sample had disclosed their abuse in some manner. Children raided in age from 2 to 16 years at the beginning of abuse.1-16 years at the end of abuse.4-16 years at the time of the abuse</td><td>64% disclosed within a month and 29% within six months.Five variables for the children who were older took longer to older children feared more negative consequences to others than their parents.freer greater negative consequences to others compared to victims of extrafamilial abuse(52%) may also account for earlier disclosures.Model suggests that older children, victims of extrafamilial abuse the greatest responsibility for the abuse, and perceiving</td><td>This study represents a higher rate of disclosures to children than it has before the study was conducted.Legal sample with higher rate of extrafamilial abuse(52%) may also account for earlier disclosures.Model suggests that older children, victims of extrafamilial abuse the greatest responsibility for the abuse, and perceiving</td></tr></table>



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<table><thead><tr><th></th></tr></thead><tbody><tr><td>Table I. (continued)</td></tr></tbody></table>

<table border="1"><tr><td>Study</td><td>Purpose</td><td>Design</td><td>Sample</td><td>Findings</td><td>Summary</td></tr><tr><td></td><td></td><td></td><td>initial police report77% female, 70% Hispanic, 17% Caucasian, 11% African American。Predominantly middle to low SE。Approximately47% inframilial abuse</td><td>negative consequences of disclosure took longer to disclose children who believed that their disclosure would bring harm to others took longer to disclose, fear of negative consequences to the self or the persecutor were unrelated to time of disclosure, and girls more than boys feared negative consequences to others。(4) Perceived responsibility: children who felt greater responsibility to disclose older children felt more responsibility for the abuse and(5) gender was not significantly correlated with time to disclosure</td><td>negative consequences to disclosing took longer to disclose.Well-designed study with high level of design. Produced a viable model of disclosure for further investigations. However, researchers were not able to interview children directly</td></tr><tr><td>Smith, Letourneau, Saunders, Kiparick, Resnick, and Best(2000)</td><td>The study focus was to gather data from a large sample of women about the length of time women who were raped before age18 delayed disclosure to, and abused that, predicted disclosure within1 month</td><td>Structured telephone interview that lasted approximately35 min were used to collect data using a computer-assisted telephone interview system.At telephone users were asked to answer each question on a computer screen.The survey consisted of several measures designed to elicit demographic information, psychiatric symptoms, substance use, and victimization history.The present report uses data from the demographic and child victimization questions</td><td>Two probability samples.Wave 1 was a random sample of2,009 respondents selected from stratified samples of defined jurisdictions.Random digit dialing using household lists and unlimited households on each computer screen.The survey consisted of several measures designed to elicit demographic information, psychiatric symptoms, substance use, and victimization history.The present report uses data from the demographic and child victimization questions</td><td>288(9%) reported experiencing at least one event that met the study&#x27;s definition of childhood rape.The average age of the first rape was10 yearsAt the 288妇女who reported a child rape,28 stated that they had never told anyone about this sexual assault until specifically qualified the lawyer for this$85 per child over1 year and up10 years post-rape.27 disclosed withina year.Monkey women who disclosed prior to their women who disclosed friends were the most common person to whom victims made disclosures, followed by mothers.Fewer than10% of victims reported making their indisclosure to social workers or law enforcement personnel.Only2% of victims reported that their studies were reported at some point</td><td>The time frame of this survey has had contextual implications.The majority of children reported that they included the large-scale child assault prevention programs in the 1980s but that assists CRA have wrong and should be discarded to responsible adults.This information may have influenced (and may currently be influencing) young women&#x27;s disclosure patterns.Wave 1, comparison of these data with the population parameters obtained from the U.S.Census Bureau indicated that the sample closely matched the demographic attributes of the population of U.S.women</td></tr></table>



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Note: SCL-90 = Symptom Check List-90; SES = socioeconomic status; LIM = long interview method; CSA = child sexual abuse; NICHD = National Institute of Child Health and Human Development; USE = unwanted sexual experiences; NSA = National Survey of Addictions; NWS = National Women’s Study; QIDS = Questionnaire informatisée sur les délinquants sexuels.

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examples of this usage were found in the research questions, interview guides, and surveys examined: “How and when do people decide to tell others about their early sexual experiences with adults?” (Hunter, 2011, p. 161); “Some men take many years to tell someone that they were sexually abused. Please describe why it may be difficult for men to tell about/discuss the sexual abuse” (Easton, Saltzman, & Willis, 2014, p. 462).

“Participants were asked a series of open-ended questions to elicit a narrative regarding their experiences of telling …” (McElvaney, Greene, & Hogan, 2012, p. 1160). “Who was the first person you told?” (Schaeffer, Leventhal, & Anes, 2011, p. 346).

There was sound consistency between studies, defining disclosure in multifaceted ways with uniform use of categories of prompted, purposeful, withheld, accidental, direct, and indirect. However, defining the period of time that would delineate a disclosure as delayed varied widely across studies, wherein some studies viewed 1 week or 1 month as a delayed disclosure (i.e., Hershkowitz et al., 2007; Kogan, 2004; Schönbucher, Maier, Moher-Kuo, Schnyder, & Lamdolt, 2012). Other studies simply reported average years of delay sometimes as long as from 20 to 46 years (Easton, 2013; Jonzon & Linblad, 2004; Smith et al., 2000).

Second, the number of qualitative studies has increased significantly over the last 15 years. This rise is in response to a previous dearth of qualitative studies. Based on Jones’s (2000) observation that disclosure factors and outcomes had been well documented through quantitative methods; in a widely read editorial, he recommended “Qualitative studies which are able to track the individual experiences of children and their perception of the influences upon them which led to their disclosure of information are needed to complement . . .” (p. 270).

Third, although a few studies strived to obtain representative samples in quantitative investigations (Hershkowitz, Horowitz, & Lamb, 2005; Kogan, 2004; Smith et al., 2000), sampling was for the most part convenience based, relying on voluntary participation in surveys and consent-based participation in file reviews (Collings, Griffiths, & Kumalo, 2005; Priebe & Svedin, 2008; Schönbucher et al., 2012; Ungar, Barter, McConnell, Tutty, & Fairholm, 2009a). Therefore, generalizability of findings is understandably limited. The qualitative studies used purposive sampling as is deemed appropriate for transferability of findings to similar populations. Some of those samples contained unique characteristics, since they were sought through counseling centers or sexual advocacy groups. These would be considered clinical samples producing results based on disclosures that may have been delayed or problematic. This might presumably produce data skewed toward barriers and bring forward less information on disclosure facilitators.

Through an in-depth, second-level analysis, this review identified five distinct themes and subthemes beyond the general trends as noted earlier.

**Theme 1:** Disclosure is viewed as an ongoing process as opposed to a discrete event—iterative and interactive in nature. A subtheme was identified regarding disclosure as

being facilitated within a dialogical and relational context is being more clearly delineated.

**Theme 2:** Contemporary disclosure models reflect a social–ecological, person-in-environment perspective to understand the complex interplay of individual, familial, contextual, and cultural factors involved in CSA disclosure. Subthemes include new categories of disclosure and a growing focus on previously missing cultural and contextual factors.

**Theme 3:** Age and gender are strong predictors for delaying disclosure or withholding disclosure with trends showing fewer disclosures by younger children and boys. One subtheme emerged that intrafamilial abuse/family-like relationship of perpetrator has a bearing on disclosure delays or withholding.

**Theme 4:** There is a lack of a cohesive life-course perspective. One subtheme includes the lack of data within the 18-to 24-year-old emerging adult population.

**Theme 5:** Significantly more information is available on barriers than on facilitators of CSA disclosure. Subthemes of shame, self-blame, and fear are uniformly identified as disclosure deterrents.

Disclosure as an ongoing process: Iterative and interactive in nature.

Disclosure is now generally accepted as a complex and lifelong process, with current trends showing that CSA disclosures are too often delayed until adulthood (Collin-Vézina et al., 2015; Easton, 2013; Hunter, 2011). Knowledge building about CSA disclosure has moved in the direction of understanding this as an iterative and interactive process rather than a discrete, one-time event. Since the new millennium, disclosure is being viewed as a dynamic, rather than static, process and described “not as a single event but rather a carefully measured process” (Alaggia, 2005, p. 455). The catalyst for this view originates from Summit (1983) who initially conceptualized CSA disclosures as process based, although this notion was not fully explored until several years later. Examinations of Summit’s (1983) groundbreaking proposition of the CSA accommodation (CSAA) model produced varying results as to whether his five stages of secrecy, helplessness, entrapment and accommodation, delayed, conflicted, and unconvincing disclosures, and retraction or recantation, hold validity (for a review, see London, Bruck, Ceci, & Shuman, 2005). However, the idea of disclosure as a process has been carried over into contemporary thinking.

Recently, McElvaney, Greene, and Hogan (2012) detailed a process model of disclosure wherein they describe an interaction of internal factors with external motivators which they liken to a “pressure cooker” effect, preceded by a period of containment of the secret. Moreover, this and other studies strongly suggest disclosures are more likely to occur within a dialogical context—activated by discussions of abuse or prevention forums providing information about sexual abuse (Hershkowitz et al., 2005; Jensen, Gulbrandsen, Mossige, Reichelt, & Tjersland, 2005; Ungar et al., 2009a). The term



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dialogical simply means to participate in dialogue. Key dialogical vehicles identified in these studies were providing sexual abuse information through prevention programs, being asked about sexual abuse, and being prompted to tell (McElvaney et al., 2012; Ungar et al., 2009a).

Contemporary models of CSA disclosure reflect a social-ecological perspective. Knowledge on CSA disclosure has been steadily advancing toward a holistic understanding of the complex interplay of individual, familial, contextual, and cultural factors (Alaggia & Kirshenbaum, 2005; Brazelton, 2015; Fontes & Plummer, 2010). Where at one time factors examined and identified were predominantly of intrapersonal factors of child victims, knowledge construction has shifted to fuller social–ecological, person-in-environment explanations (Alaggia, 2010; Collin-Vézina et al., 2015; Easton et al., 2014; Hunter, 2011; Ungar, Tutty, McConnell, Barter, & Fairholm, 2009b). Social–ecological explanations open up more opportunities to intervene in facilitating earlier disclosures. Alaggia (2010) proposes an ecological mapping of what individual, interpersonal, environmental, and contextual influences impede or promote CSA disclosures based on analysis of in-depth interview data of 40 adult survivors. Subsequently, based on a sample of 67 adult survivors, Collin-Vézina, Sablonni, Palmer, and Milne (2015) identified three broad categories, closely aligned with an ecological framework that impede CSA disclosure: (1) barriers from within, (2) barriers in relation to others, and (3) barriers in relation to the social world which can be aligned to intrapersonal, interpersonal, and contextual factors.

A summary of knowledge building using a social–ecological framework follows. Knowledge gained in the intrapersonal domain includes expanded conceptualization of disclosure by building on previous categories of accidental, purposeful, and prompted disclosure to also include behavioral and indirect attempts to tell, intentionally withheld disclosure, and triggered and recovered memories (Alaggia, 2004). Categories of indirect behavioral disclosure patterns have been further verified in follow-up research by Hunter (2011), and through an extensive file review that used Alaggia’s (2004) disclosure framework to analyze their data (Collings et al., 2005) for verification.

Interpersonal factors have also emerged in regard to certain family characteristics as disclosure barriers. Families with rigidly fixed gender roles, patriarchal attitudes, power imbalances, other forms of child abuse and domestic violence, chaotic family structure, dysfunctional communication, and social isolation have been found to suppress disclosure (Alaggia & Kirshenbaum, 2005; Collin-Vézina et al., 2015; Fontes & Plummer, 2010). In addition, relationship with perpetrator is a factor whereby research indicates that disclosure is made more difficult when the perpetrator is a family member or close to the family (Dumont, Messerschmitt, Vila, Bohu, & Rey-Salmon, 2014; Easton, 2013; Goodman-Brown et al., 2003; Hershkowitz et al., 2005; Priebe & Svedin, 2008; Schönbucher et al., 2012). This is especially a barrier when the perpetrator lives with the victim (LeClerc & Wortley, 2015).

In terms of environmental factors, one study revealed that neighborhood/community conditions can hinder disclosure when there is lack of school involvement in providing a supportive environment, such as in following up on troubling student behavior (Alaggia, 2010). Additionally, a child victim’s anticipation of a negative response to disclosure, especially that they may not be believed by others outside their family such as neighbors or other community members, has shown to deter disclosure (Collin-Vézina et al., 2015).

Cultural factors influencing CSA disclosure have been studied to a much lesser degree. Despite this, a few important studies examining critical sociocultural factors now exist for better understanding CSA disclosure within a cultural context (Brazelton, 2015; Fontes & Plummer, 2010). Among these important contributions, Brazelton’s (2015) research has delineated CSA disclosure processes as “shaped by relational, racial, socio-cultural, historical, and developmental factors” (p. 182). In a unique study using culturally focused research literature as data triangulated with clinical case material, culturally based belief systems in many cultures have been found to foster family climates that can silence children from disclosing abuse (Fontes & Plummer, 2010). Taboos about sexuality, patriarchal attitudes, and devaluation of women are among some of the cultural barriers that inhibit disclosure (Fontes & Plummer, 2010).

Clearly, disclosure conceptualizations are being integrated into a social–ecological model of individual and developmental factors, family dynamics, neighborhood, and community context as well as cultural and societal attitudes toward better understanding disclosure barriers and facilitators (Alaggia, 2010), although more data are needed on cultural and contextual factors.

## Age and gender as predictors of disclosure

Age. Age is consistently found to be an influential factor in CSA disclosure, making the life stage of the victim/survivor a critical consideration. Studies draw distinctions in age-groups falling into either under or over 18 years of age. Eighteen years of age was the common age cutoff point that investigators chose in order to distinguish child/youth populations from adult samples. Sixteen of the studies drew on samples of children and youth, while the other 15 studies sampled adults over the age of 18, and a further two studies used mixed age-groups (refer to Table 1). Among the child and youth samples, the age ranges spanned from preschool to late adolescence (3–17 years of age), with varying methodological approaches implemented across age cohorts. For younger cohorts, file reviews and secondary data analyses of CSA reports were typically undertaken. Adolescents were most often given surveys. Sometimes children and youth were interviewed as part of administering a survey or as a follow-up (Crisma et al., 2004; Hershkowitz et al., 2005; Ungar et al., 2009b). In the majority of child and adolescent samples, sexual abuse concerns were already flagged to investigative authorities. However, the work of Ungar, Barter, McConnell, Tutty, and Fairholm (2009a, 2009b) is one exception, whereby their survey elicited new disclosures.



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Adult studies typically had a mean age between 40 and 50 years. Interviews were the main data collection method with a few exceptions using survey designs (i.e., Easton, 2013; Kogan, 2004; Smith et al., 2000) and case file reviews (i.e., Collings et al., 2005; Goodman-Brown et al., 2003). Results show a clear trend toward increased likelihood of disclosure in older youth, and findings from adult samples showing a preponderance of disclosures in adulthood, with the large majority of participants of adults reporting never having had a sexual abuse complaint filed with investigative authorities as a child or an adolescent (i.e., Hunter, 2011; Gagnier & Collin-Vézina, 2016; Sorsoli, Kia-Keating, & Grossman, 2008; Ungar et al., 2009b).

With children and youth under the ages of 18 distinct patterns emerged. First, accidental detection, rather than purposeful disclosure, is more likely to occur with younger children. For example, in one large-scale study of over 1,737 file reviews, over half of the CSA-related cases were identified through accidental and eyewitness detection (61%), while less than one third were purposeful disclosures initiated by the child victim (Collings et al., 2005). A second pattern which emerged is that rates of disclosure increase with age, especially into adulthood, which is supported by persistent findings of high rates of delayed disclosure reported later in the life course by adult survivors (Collings et al., 2005; Collin-Vézina et al., 2015; Easton, 2013; Jonzon & Linblad, 2004; Kogan, 2004; Leclerc & Wortley, 2015; Sorsoli et al., 2008). While gender and relationship with the perpetrator are considerable factors in CSA disclosure, age is consistently a stronger predictor of disclosure (or nondisclosure) (Hershkowitz et al., 2005; Leclerc & Wortley, 2015). Third, younger children who disclose are more likely to do so in an interview situation or other environment that provides prompts or questions about sexual abuse (Hershkowitz et al., 2005; McElvaney, Greene, & Hogan, 2014; Schaeffer et al., 2011), but this trend can also be seen in older youth (Ungar et al., 2009a, 2009b).

Gender. A number of studies have recently focused on CSA disclosures with male victims, since males have been an understudied population (Alaggia, 2005; Easton, 2013; Easton et al., 2014; Gagnier & Collin-Vézina, 2016). Most investigations that sampled both sexes show females outweighing male participants. Although women are at double the risk of being subjected to CSA, the ratio of women to men in most disclosure studies has not been representative. This finding may be indicative of male victims more likely delaying disclosing their CSA experiences, leaving male disclosure in child and youth samples underrepresented (Hébert, Tourigny, Cyr, McDuff, & Joly, 2009; Ungar et al., 2009b).

Easton, Saltzman, and Willis (2014) have been developing gender-specific modeling of disclosure examining male disclosures. Their proposed model groups male disclosures into barrier categories as determined by individual factors, interpersonal issues, and factors that are sociopolitical in nature. These authors suggest that predominant gender norms around masculinity reinforce the tendency for male victims of CSA to blame themselves

for the abuse, resulting in no disclosure. Male participants in a subsequent study also relayed that gender norms and stereotypes contributed to them concealing the abuse because they were abused by a woman (Gagnier & Collin-Vézina, 2016). In the one study that compared male and female disclosures, investigator found that men’s fears of being viewed as homosexual; profound feelings of stigmatization or isolation because of the belief that boys are rarely victimized; and fear of becoming an abuser acted as disclosure barriers. Whereas females felt more conflicted about who was responsible for the abuse and more strongly anticipated being blamed and not believed (Alaggia, 2005).

Lack of a life-course perspective. Given that the study of CSA disclosure draws on age-groups ranging from samples of very young children to retrospective studies of adult survivors, with significant developmental considerations, this area of study lacks an intentional cohesive life-course perspective. Most data are derived from either cross-sectional or retrospective designs, with few longitudinal studies. There are a series of sound, yet disconnected, studies focusing on specific age-groups of children and adolescents, along with adult retrospective studies. Thus, the available knowledge base does not allow for a cohesive picture of CSA disclosure processes and pathways over the life course to emerge.

The life-course perspective has long been recommended as a critical lens for the study of child abuse (Browning & Laumann, 1997; Williams, 2003). For example, a life-course perspective has been utilized to understand the immediate- and long-term effects of CSA on the developing child victim (Browning & Laumann, 1997). Further, a life-course perspective is important in terms of examining age of onset of CSA to explain the differential effects of sexual victimization and developmental impacts in terms of understanding their ability to disclose—effects that need to be understood within a developmental context, especially for designing appropriate interventions for disclosure at critical transitions from early childhood through to adolescence and into adulthood. In addition, important “turning points” in life may facilitate disclosures. For example, entry into adulthood given that delayed disclosure occurs more often in adulthood. Alaggia (2004, 2005) found that being in a committed relationship or the birth of children acted as facilitators for some survivors to disclose, especially to their spouses. These significant life events, as contributing to disclosures, bear further examination.

Summary of barriers and facilitators. Research over the past 15 years continues to uncover barriers to CSA disclosure at a higher frequency than that of facilitators. As stated previously, this might be the result of sampling methods whereby participants who volunteer for disclosure research may have had more negative disclosure experiences, especially since many report delays in disclosure. The following section outlines the major trends in both barriers and facilitators (see Table 2).

Barriers. Age and gender were found to contribute to barriers as covered in Theme 3. Disclosures generally increase with age



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Table 2. Factors Influencing Child Sexual Abuse Disclosures.

<table border="1"><tr><td>Barriers</td><td>Facilitators</td></tr><tr><td>Age: The younger the child victim, the less likely they will purposefully disclose.</td><td>Age: Disclosures increase with age, especially in adulthood.</td></tr><tr><td>Gender: Males may be less likely to disclose in childhood/adolescence, fear of being seen as homosexual and as a victim, females experience more self-blame and anticipation of being blamed and/or not believed</td><td>Gender: Slight trend toward females who are older(adolescent) to disclose before adulthood</td></tr><tr><td>Relationship to perpetrator: If the perpetrator is a family member or in a family-like role, disclosure is less likely to happen</td><td>Relationship to perpetrator: If the perpetrator is not living with the victim, disclosure rates increase</td></tr><tr><td>Internal: Shame, self-blame, and fear are psychological barriers.In addition, fear of negative consequences on the family and for self-safety inhibits disclosure</td><td>Dialogical context: Opportunities to disclose through discussion, therapeutic relationship, information sessions on sexuality,and sexual abuse prevention programs</td></tr><tr><td>Family relations: Families with a patriarchal structure, rigidly fixed gender roles,dysfunctional communication,other forms of abuse(i.e.,domestic violence),and isolation inhibit disclosure</td><td>Family relations: Supportive parent-child relationship.</td></tr><tr><td>Environmental and cultural context: Lack of discussion about sexuality;passive acceptance that unwanted sexual experiences are inevitable;not wanting to bring shame to the family by admitting sexual abuse;lack of involvement from neighbors,school personnel;and stigma perpetuated by societal perceptions</td><td>Environmental and cultural context: Promotion of open discussion of sexuality;community member involvement</td></tr></table>

as children gain more developmental capacity, understanding of sexual abuse as victimization, and increased independence. Males are somewhat less likely to disclose, but this is often in interaction with other factors in the environment such as societal attitudes that promote hypermasculinity as desirable, attitudes that perpetuate negative views of boys and men who are victims, and homophobic attitudes (Alaggia, 2010; Easton et al., 2014; Gagnier & Collin-Vézina, 2016).

Victims of intrafamilial abuse when the offender is a parent, caregiver, significant family member, or someone in a family-like role are less likely to disclose immediately or at all in childhood/adolescence because of obvious power differentials and dependency needs (Collings et al., 2005; Dumont et al., 2014; Hershkowitz et al., 2005; Kogan, 2004; Leclerc & Wortley, 2015; Paine & Hansen, 2002; Schaeffer et al., 2011).

Further, the perpetrator residing with their victim(s) increases the likelihood of no disclosure (Leclerc & Wortley, 2015).

Internalized victim-blaming, mechanisms to protect oneself (such as minimizing the impact of the abuse), and developmental immaturity at the onset of abuse constituted internal barriers. Further, shame, self-blame, and fear have been identified as significant factors deterring disclosure (Collin-Vézina et al., 2015; Crisma et al., 2004; Goodman-Brown et al., 2003; Hunter, 2011; Kogan, 2004; McElvaney & Culhane, 2015; McElvaney et al., 2014). However, aspects of shame, self-blame and fear, and have not been fully explored in research. Since these are strong predictors of disclosure suppression, they bear further examination in future research to understand more fully how they operate in disclosure processes.

In terms of interpersonal and environmental factors, family dynamics can play a part in deterring disclosure. As previously mentioned, families characterized by rigidly defined gender roles, patriarchal attitudes that perpetuate power imbalances

between men and women, parents and children, presence of other forms of child abuse and/or domestic violence, chaotic family structure, dysfunctional communication, and social isolation have been found to suppress disclosure (Alaggia & Kirshenbaum, 2005; Collin-Vézina et al., 2015; Fontes & Plummer, 2010). In regard to broader environmental factors, disclosure can be hindered when involved and supportive community members are not available, or not trained in sensitive responses, or when child victims anticipate not being believed by neighbors and other people outside the family (Alaggia, 2010; Collin-Vézina et al., 2015). Further, barriers in relation to the social world were identified as stigmatization, the negative labeling of sexual abuse victims, and taboos surrounding sexuality and talking about sex as driven by cultural norms (Collin-Vézina et al., 2015; Fontes & Plummer, 2010).

Identification of cultural barriers is important recent contribution to understanding disclosure processes—and in particular to the obstacles. Findings related to cultural barriers included themes of children’s voices not being heard leading to silencing, the normalization of the sexualization and objectification of girls and women, and the perpetuation of hypermasculinity in men—all acting as barriers in terms of stigma to disclosure (Alaggia, 2005, 2010; Easton et al., 2014). Brazelton (2015) similarly found that lack of discussions about sex, young age at the onset of sexual abuse, therefore not having the language to express what was happening to them, and preserving the family good name by not talking about abuse in the family were also barriers to disclosure.

Finally, it may be the case that more barriers continue to be identified over facilitators of CSA disclosure perhaps because of the methods employed in studies—particularly those drawing on adult populations who delayed disclosure. These samples may not be representative of the overall population of CSA victims, since they may have had more negative disclosure



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experiences, consequently more readily identifying barriers. On the other hand, these findings may speak to the actual imbalance between facilitating factors and barriers for disclosure, the latter carrying more weight in the victims/survivors’ experiences, thus, explaining the high rates of disclosures delayed until adulthood.

Facilitators. Although fewer disclosure facilitators are identified in this review, very important facilitators were nonetheless uncovered—ones that should be noted for professionals in this field of practice. Internal factors that facilitate disclosures include symptoms that become unbearable, getting older with increased developmental efficacy, and realizing that an offence was committed (Collin-Vézina et al., 2015; Crisma et al., 2004; Easton, 2013; Hershkowitz et al. 2007; McElavaney, Greene, & Hogan, 2014; Schaeffer et al., 2011). Circumstantial facilitators are those where the child discloses because there has been evidence provided, eye-witnessing has occurred, and a report has been made. Environmental factors include settings that provide opportunities such as counseling, interviews, information sessions and educational forums/workshops, and prevention programs for children and youth to disclose.

To elaborate, dialogical contexts about CSA for children and youth can provide opportunities for discussion that may facilitate disclosures (Jensen et al., 2005). The research shows creating open dialogue in relationship contexts, to offset the power and influence of the perpetrator, can facilitate earlier disclosure. Among disclosure facilitators is being asked about abuse and given the opportunity to “tell” (McElavaney et al., 2014); workshops on abuse and sexual abuse, in particular, can facilitate disclosures (Ungar et al., 2009b); and using culturally sensitive probes and questions (Fontes & Plummer, 2010). In Gagnier and Collin-Vézina’s (2016) study, positive disclosure experiences were described by participants as those where they felt that they had been listened to, were safe, were believed, and were not judged by the person they disclosed to. Further, family members and friends (peers) of the child victim can act as key supports to creating an open relational context and fostering positive responses (Jensen et al., 2005; Priebe & Svedin, 2008; Schönbucher et al., 2012; Ungar et al., 2009b). In particular, as children grow older, they are more likely to disclose to a peer, as shown in a number of studies, and this is an important reality for counselors and educators to be aware of (Dumont et al., 2014; Kogan, 2004; Schönbucher et al., 2012; Ungar et al., 2009b).

## Discussion

Through examination of 33 studies published since the year 2000, this review identified five distinct themes regarding CSA disclosure: (1) Disclosure is best viewed as an iterative, interactive process rather than a discrete event done within a relational context; (2) contemporary models reflect a social–ecological, person-in-environment framework for understanding the complex interplay of individual, familial, contextual, and cultural factors involved in CSA disclosure;

(3) age and gender are significant disclosure factors; (4) there is a lack of a life-course perspective; and (5) barriers to disclosure continue to outweigh facilitators. Based on these themes, a number of conclusions are drawn from this review. First, disclosure as a process is emphasized throughout contemporary research. Advances have been made in understanding these complex processes. However, the disclosure process over time—for example, how the first detection of CSA or attempts to disclose in childhood impact later disclosures—are not well understood. This is the result of the absence of a cohesive life-course perspective in investigations, although age consistently surfaces as significantly influencing CSA disclosure. Using a life-course perspective through the use of longitudinal studies is recommended.

The use of varied methodological designs, depending on the developmental stage of the victims/survivors, influences the data generated and subsequent findings. For example, most studies on children and youth are based on file reviews of cases that have been brought to the attention of authorities, or surveys, with only a few studies using interviewing of younger children. Therefore, there is less information available on process issues with children and youth. In contrast, research on adult populations largely favors the use of qualitative interview methods for retrospective inquiry producing important process findings. In addition, investigations have not yet captured the disclosure experiences of adults in the “emerging adult” stage given that adult studies have failed to recognized that the age range of 18–24, which is now considered a developmental phase defined by neurobiological developmental uniqueness. As well, late adulthood has not been given attention as shown by the absence of participants representing this age-group in current research (70+). With a swelling geriatric population in North America, issues of historic CSA can be expected to surface and, with that, new disclosures. This trend is also anticipated due to attitudinal shifts that have presumably occurred over the last two generations about revealing such traumas and changing views about discussing sexual victimization.

Interview guides used in a number of studies intentionally probed for facilitators, producing notable findings. For example, one such finding focuses on the importance of creating a contextually supportive environment to promote disclosure across the life course. These include developing therapeutic relational contexts for disclosure by providing information about sexuality, sexual abuse, prevention programming, and by asking directly. Disclosures to professionals are positive outcomes of how therapeutic contexts work; however, for forensic purposes prompting such disclosures would be viewed as problematic in legal settings, seriously compromising testimonies for trial proceedings. This is one example that speaks to the structural barriers victims and survivors run up against time and time again. Facilitators that show evidence to promote disclosure in one domain (therapeutic) are seen to work against CSA survivors in another domain—such as legal settings when perpetrators face prosecution. Defense attorneys will use this as evidence that the disclosure was prompted, and therefore the disclosure is potentially seen as not credible. Broadcasting of



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the frequency of acquitted cases or rulings in favor of the perpetrator through media outlets, often sensationalized, become a further compounding barrier. Given the review findings, we conclude that barriers and facilitators to CSA disclosures are nuanced and clearly embedded within intrapersonal, interpersonal, environmental, contextual, and cultural domains—often interlocked in complex ways.

## Limitations

Although comprehensive in nature with its life-course coverage, this review may be limited by its qualitative, thematic focus rather than providing an evaluative, quantitative accounting of CSA disclosures. However, because of the recent focus on disclosure processes, the authors chose a suitably compatible approach—qualitative in nature. As well, a traditional checklist approach in rating the studies was not employed for interrater reliability, since two of the authors hold expertise in CSA disclosure research and are well versed with the literature. This expertise, and through closely following a systematic review framework (Kiteley & Stogdon, 2014), assures that a thorough adjudication of the research literature was completed.

## Implications for Research and Practice

These review findings have implications that can be useful in guiding future research and practice:

- Solid strides are being made in the use of a social—ecological framework to underpin investigations in the CSA disclosure investigations. Research efforts and practice considerations should continue in this vein. Investigating environmental factors and contextual and cultural forces is understudied, necessitating more research in these areas to more fully fill out understanding of CSA disclosure from a social—ecological perspective.

- There is good evidence that CSA disclosures are more likely to occur in a dialogical context—formal helping relationships but as well as other relationships such as peers and trusted adults. Providing information and education on topics of sexuality in general, and sexual abuse specifically, can help children and youth to disclose. Raising awareness and prevention programs can promote disclosures of sexual violence committed against children and youth.

- Goals of therapeutically supported disclosures (i.e., through therapy) may need to take precedence over forensic approaches, if well-being of child victims and adult survivors is to be made paramount. Legal processes may act to facilitate disclosures but can also act as barriers because of the negative outcomes experienced in the court process.

- Practitioners need to keep in mind that the legal system is lagging far behind in knowledge uptake of recent evidence on CSA disclosures so that victims and

survivors continue to be systemically and structurally disadvantaged in legal proceedings.

- Health-care practitioners (i.e., child abuse pediatricians, family practice doctors, clinical nurse specialists, and public health nurses) should be made aware of the evidence in the CSA disclosure literature to create environments for facilitating therapeutic disclosures.

- Given that age is a stable predictor of disclosure of CSA, more studies are needed that make use of a life-course perspective. More longitudinal studies are needed to better identify trends over different life stages.

- The emerging young adult as a developmental age group needs specific investigation. Neuroscience research has established that ages 18–24 is a distinct developmental phase. Late adulthood is another life stage that deserves to be researched.

- Gender needs to be more fully investigated in relation to impact on disclosure. Awareness that boys and girls have unique challenges and barriers in disclosing CSA should be paramount for practitioners.

- Intervention planning should take note that disclosures increase when perpetrators no longer reside with victims, and this finding should be heeded by policy and law makers.

- Shame, self-blame, and fear are intrapersonal factors that persistently emerge as barriers to CSA disclosures and warrant more research to understand how to redress these barriers for earlier disclosures.

## Conclusion

There are still a substantial number of children and youth who are subjected to sexual abuse, despite preventative efforts. Just as concerning is the fact that many victims continue to suffer in silence as evidenced by the high numbers of delayed disclosure. These hidden cases should not be overlooked, and these victims should not be forgotten. Despite significant progress in bringing the issue of CSA to the forefront, improving facilitation of disclosure and increasing positive influences on disclosure processes are still critical in order to protect current and future generations of children and youth from the grave effects of sexual violence. Further, the focus should not be simply on strengthening and shoring up intrapersonal resources of victims to disclose but rather to change environmental conditions to create a more supportive and safer context for CSA victims and survivors to disclose.

## Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

## Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.



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## References



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## Author Biographies

Ramona Alaggia, MSW, PhD, is an associate professor in social work and the Factor-Inwentash Chair in Children’s Mental Health at the University of Toronto. Her teaching and research focuses on gender and violence, sexual abuse disclosures, domestic violence exposure, and resilience processes.

Delphine Collin-Vézina, PhD, is an associate professor for School of Social Work, McGill University and director for Centre for Research on Children and Families. She holds the Nicolas Steinmetz and Gilles Julien Chair in Social Pediatrics in Community and the Canada Research Chair (Tier II) in Child Welfare. Her work focuses on research and clinical topics related to child maltreatment, child sexual abuse, and trauma.

Rusan Lateef, MSW, is a social worker employed in the criminal justice system with adult male offenders in Ontario, Canada. She specializes in the intersection of health and mental health, child sexual abuse disclosures, and she is a researcher on the “Make Resilience Matter” project examining childhood exposure to domestic violence with Dr. Alaggia at the Factor-Inwentash Faculty of Social Work, University of Toronto.



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