A Meta-Analysis : The Effects of Child Sexual Abuse Towards Children

Recently, cases of sexual abuse against children became a phenomena and it is a traumatic events that give a deep impact towards the victim. Therefore, the purpose of this study was to conduct a metaanalysis on a published researched about effects of child sexual abuse towards children. There were 20 journal articles collected from Science Direct, SpringerLink, Willey Online Library and Web of Science databases with the keywords „child sexual abused‟ „behavior‟, „emotional‟, „social‟ and „academic‟ being used. The year of papers selected were from 2010 until 2017. The researcher differentiated and analyzed the effect of child sexual abuse toward four themes: internalizing and externalizing behavior, emotional regulation, suicidal behavior and academic achievement and performance. The findings from this study shown that child with previous experiences as victims in child abuse display internalizing and externalizing behavior and poor on academic achievement and performance. The findings also shown that the sexually abused children especially girls has low emotional regulation and the victims also had suicidal ideation and suicidal attempt. The implication from this study was to provide the insight for future researchers on the effects of child sexual abuse in behavior, emotional, social and academic aspects. Since this study only focused on the effect of sexual abuse towards children, it was suggested that for future researches, the effects of sexual abuse towards different range of age such as adult with history of sexual abused should be further investigated and more effects apart from behavioral, emotional, social and academic should be considered.


Introduction
Recently, cases of child sexual abuse became a phenomena and widespread throughout the world with prevalence rates ranging between 8-31% for females and 3-17% for males (Barth, Bermetz, Heim, Trelle, & Tonia, 2013).This is seriously an alarming high prevalence rates.The Federal Child Abuse Prevention and Treatment Act defines child abuse and neglect as "any recent act or caretaker which result in death, serious physical or emotional harm, sexual abuse or exploitation, an act or failure to act which presents an imminent risk of serious harm".Child abuse can be differentiated by three types which were physical abuse, psychological abuse and sexual abuse that will be the focus of this study.Sexual abuse is defined as "the abuse of a child or adolescent who has not achieved sexual maturation by an adult for fulfillment of sexual desires and needs by use of force, threat, deception or other kinds of manipulation" (İşeri, 2008).Therefore, child sexual abuse (CSA) cannot be ignored due to its potential to contribute numerous effects towards the victims whether in male or female.
There were many studies about the effects of child sexual abuse towards the victims with different types of variables such as the study from (Fergusson, McLeod, & Horwood, 2013) stated that depression, anxiety, low self-esteem, suicide attempts, as well as alcohol and drug dependence is the risk factor of childhood sexual abuse.The children who exposed with sexual abuse are likely to show posttraumatic stress disorder (PTSD) symptoms (Hé bert, Langevin, & Daigneault, 2016).Based on past study, experiencing abuse such as physical, emotion and sexual abuse give a negative impact on the development of emotion regulation (Langevin, Cossette, & Hé bert, 2016;Langevin, Hé bert, & Cossette, 2015).For the meta-analysis or systematic review studies about this effects of child sexual abuse, they were rarely founded.But, there was this one study that doing a research regarding this topic by (Kendall-Tackett, Williams, & Finkelhor, 1993).In their systematic review, Kendall-Tackett and colleagues examined 45 studies and calculated that 64-79% of children who disclosed with sexual abuse display psychological symptom such as low self-esteem, anxiety, fear, suicidal ideation and attempts, somatic complaints, aggressive behavior, running away from home, and substance abuse.The child sexual abuse also gives an impact towards children academic achievement and academic performance (Boden et al., 2007).
Although there were many studies about the effects of child sexual abuse, not many researcher done the meta-analysis studies and even it was exists the studies were far from recent years.Therefore, the author decided to study the effects on child sexual abuse towards children and came out with a table of meta-analysis at the end of this study.In addition, the author also aim to update the literature regarding this topic.

Method
There were three stages of methodology in this study which were literature search, selection process and lastly was data selection.All of this process will be explained more below.

Literature Search
The search strategy for this study were selection of publication from several databases using computer.The articles journal about the effects of child sexual abuse towards children were acquired through searching from Web of Science, Wiley Online Library, Science Direct, SpringerLink and Taylor and Francis Online.The articles published date from year 2010 until 2017 and only limited to English language will be selected.All publications were searched using the keywords "child sexual abuse", "behavior", "social", "emotion" and "academic".The screening process examined titles, abstracts, and full-text of potential articles and was conducted by the author to ensure all eligible articles were included.There were about 150 articles were screened during the search in the databases.

Selection Process
For the selection process, the articles were included if they met the eligibility criteria: 1) The sample of the study is the children aged from 4 to 18 years old; 2) The year of publications were 2010 onwards; 3) The articles have these variables which are child sexual abuse, behavior, emotion, social and academic achievement; 4) The articles were in English language only.The author investigated publications independently and any discrepancies the authors will discuss with co-author and solved it together.The author also categorized all the publication and organized them into different folders for each variables to avoid confusion.In the end of selection process, total of 20 articles were selected.

Data Extraction
For data extraction, relevant information from the included studies was independently extracted.When there was a disagreement regarding whether a study should be included for analysis, the primary author made the final decision.The following information was extracted from each eligible study: author"s name, year of publication and the findings of each study.The authors read thoroughly the full text articles to identify the findings for each publications.In the end of the process, the author came out with the table of meta-analysis regarding the issues to be discussed.

Result
Below is the table of meta-analysis for effects of child sexual abuse towards the children.Next, the process of literature search, selection process and data extraction, the author came out with this table which were divided according to the four themes which were social, behavior, emotion and academic.There were total of 20 publications selected by the author.There were specification founded for each theme which were social are suicide attempt and suicide ideation, emotion is emotional regulation, behavior are internalizing and externalizing behavior and academic is academic achievement and performance.The overall results will be discussed on discussion section.The young victims expose to violence and sexual abuse have negative effect on academic achievement.

Discussion
Child sexual abuse is a traumatic phenomenon that have been a widespread in the world.These events have highly adverse impact towards everyone especially the victims.The results from the meta-analysis have shown that the researcher has come out with four themes which are social, emotion, behavior and academic achievement.There are total of six studies for social, four studies for emotion and five studies for both behavior and academic achievement.For each theme, the author found the similarities and differences for each study that will be discussed later.In this section also, the author will discussed the limitation and the strength of this study.
The first theme was social and the author found that every studies selected were related with suicide.Based on the analysis, it was discovered that social effects of child sexual abuse towards children was suicide which were consists of suicide ideation and suicide attempt.It can be justified based on this study from (Sigfusdottir et al., 2013) stated that the exposures to family conflict/violence and sexual abuse lead to depressed mood and anger as well as suicidal ideations and suicide attempts.Suicidal behaviour was more frequently in victims exposed to abuse involving contact and penetration and also experienced sexual abuse more than one (Soylu & Alpaslan, 2013).Based on the author perspectives, the victims or children who have been sexually abused are tend to attempt suicide or have suicide ideation because they feel they have lost everything in their life.Moreover, on such a young age, this event could give a very huge damage and impact to their well-being.
The second theme is emotion and the studies selected were specifically focused on emotion regulation.Emotion regulation has been defined as ""the extrinsic and intrinsic processes responsible for monitoring, evaluating, and modifying emotional re-actions, especially their intensive and temporal features, to accomplish one"s goals.""(pp.27-28).The study founded that sexually abused children had lower emotion regulation competencies compare to non-abused children (Sé guin-Lemire et al., 2017).The sexually abused children with more serious and long duration of trauma were found to have more serious impact to their emotional regulation ability (Choi & Oh, 2014).The author realized that emotion regulation is very important to every human being.The sexually abused children have impact on their emotion regulation due to trauma of the sexual abuse event.So that, it makes their emotion cannot differentiate and react according to the certain situation.
The third theme is behaviour and the studies selected were focusing on internalizing and externalizing behaviour which was known as psychiatric symptoms.Based on the theoretical framework of Developmental of Psychopathology, the externalizing and internalizing behaviour can be defined as undercontrolled and overcontrolled, of behaviour, emotion and thoughts respectively (Achenbach & Edelbrock, 1978;Achenbach, Howell, Quay, & Conners, 1991).Based on analysis, those with a history of sexual abuse had significantly greater externalizing and internalizing problems over time compared those without sexual abuse histories (Lewis et al., 2016).The study also revealed that there were not any sex differences in the severity of internalizing, externalizing and trauma symptoms (Maikovich-Fong & Jaffee, 2010).The example of externalizing behaviour are delinquency and bullying while internalizing is isolation from others.The victims showed these behaviour because of sense of guilt and feel ashamed with others such as peers.The traumatic event happen to the victims caused them to express their feelings by doing such behaviors.The forth theme is academic which can be differentiated by academic achievement and academic performance.Academic achievement is the accomplishment at the end of the course while academic performance is the observed behaviour in achieving specific task (Yusuf, 2002).Based on the study selected, there are impact of child sexually abused on the academic performance (Mugabe, 2016).The young victims expose to violence and sexual abuse have negative effect on academic achievement (Huang & Mossige, 2012).The students also the victims has poor academic achievement and academic performance due to after effects of sexual abuse towards them.Every students need a healthy mental and physical for focusing in their studying but if that particular students is one of the sexual abused victims, their emotion and cognitive are surely disturbed and as a result affect their academic achievement as well as performance.
There were several limitations by conducting this study.First was the number of publications is small which was only 20 publications.It was not strong enough to summarize and represent these four themes which were emotion, social, behaviour and academic.Second, the publication only focusing on children and adolescent so that, it cannot be generalized to other range of age.Third, this study only focusing on themes and not measured the effects size which can be more detailed and complete for this study.Despite that, there was one strength of this study which was this study successfully come out with a complete table of meta-analysis regarding the effects of child sexual abuse towards children.It gives a huge contribution to the literature about this topic.

Conclusion
Based on this study, the author successfully came out with a table of meta-analysis regarding the effects of child sexual abuse towards children.There were total of 20 publications selected from various databases.At the end of this studies, there were four outcomes or themes which were social (suicide attempt and suicide ideation), emotion (emotional regulation), behavior (internalizing and externalizing behavior) and academic (academic achievement and performance).These four themes were discovered after thoroughly analysis and summarization from the author after several period of time for completion this study.
There were several implication that can be taken from this study and first, this study will give insight for future research in conducting their studies regarding this topic by referring this study.This study also gave implication to the researcher who was interested to study about the prevention of child sexual abuse because before the prevention they should aware the effects of the child sexual abuse.Lastly, in education setting this study will give insight to the educator about the child sexual abuse and its relation with academic achievement and academic performance.
For future research, the author suggesting to make another meta-analysis but focusing different range of age such as adult who have been experiencing child sexual abuse.In addition, the author also suggest for further research of different effects of child sexual abuse such as PTSD, self-esteem and internet addiction.

Table 1 .
Table of Meta-Analysis: The Effects of Child Sexual Abuse towards Children