ORIGINAL RESEARCH

published: 14 June 2021

doi: 10.3389/fpsyt.2021.639341

What Do Survivors of Child Sexual

Abuse Believe Will Facilitate Early
Disclosure of Sexual Abuse?
Ellen Tvedt Solberg 1*, Jorunn E. Halvorsen 2 and Signe Hjelen Stige 3
1
Department of Child and Adolescent Psychiatry, Helse Fonna, Haugesund, Norway, 2 Department of Health and Welfare
Services, Municipality of Bergen, Bergen, Norway, 3 Department of Clinical Psychology, University of Bergen, Bergen, Norway

The purpose of this study was to explore what adult survivors of child sexual abuse (CSA)
believe will facilitate early disclosure of sexual abuse. We conducted semi-structured
interviews with 12 adult survivors of CSA aged 18–57 years, and analyzed the transcripts
using reflexive thematic analysis. Our analysis resulted in three main themes: Adults
making it possible to tell; Adults daring to consider the unthinkable; and Conveying
knowledge of CSA that facilitates understanding. The findings highlighted the importance
of adults facilitating disclosure and making it possible for survivors to tell about their
experiences, but also the responsibility adults have to dare to consider the possibility
of CSA when children struggle. Another important finding was the significance of
enhancing the general population’s understanding of the complexity of CSA, including
Edited by:
why disclosure is difficult, so adults are given the tools needed to understand and know
Manasi Kumar, what to do when they suspect CSA. The findings also have important implications for
University of Nairobi, Kenya the planning and implementation of interventions to facilitate early disclosure of CSA.
Reviewed by:
Katie Edwards, Keywords: child sexual abuse, disclosure, facilitation, qualitative interview, thematic analysis
University of Nebraska-Lincoln,
United States
Hayley Walker-Williams, INTRODUCTION
North-West University, South Africa

*Correspondence: Approximately 15–18% of women and 6–7.6% of men experience CSA (Child sexual abuse) (1–3).
Ellen Tvedt Solberg On average it can take up to 18 years before victims disclose CSA (4–6), some studies showing a
[email protected] small number (8–21%) disclose after 1 month (6–8), and around 27.8% never disclose (9–11). The
health consequences have shown to be severe, both for the physical and mental health of victims
Specialty section: (4, 8, 12, 13). CSA has proven to have more serious consequences than other negative experiences
This article was submitted to during childhood (14–16), and sexual abuse by primary caretakers can lead to maladaptive normal
Public Mental Health, development (5, 17).
a section of the journal
There is a discrepancy between the number of reported cases and incident of CSA documented
Frontiers in Psychiatry
through self-reports (1, 2, 7, 18, 19). This indicates that many survivors never talk about their
Received: 08 December 2020 experiences to the public health services, and some never tell anyone about their experiences of
Accepted: 19 May 2021
CSA (9–11). How to facilitate early disclosure of CSA is therefore an important goal, both in order
Published: 14 June 2021
to secure children that experience ongoing abuse, but also because the negative outcomes caused
Citation:
by these adverse childhood experiences have been shown to increase by the number of experiences.
Solberg ET, Halvorsen JE and
Stige SH (2021) What Do Survivors of
Early disclosure may therefore help prevent sexual abuse from being repeated, and prevent more
Child Sexual Abuse Believe Will serious health issues in the future (8, 12, 20–22).
Facilitate Early Disclosure of Sexual However, facilitating disclosure is not easy due to personal and intra-personal
Abuse? Front. Psychiatry 12:639341. barriers, frequently reported by victims (7, 20, 23). Many children do not self-label
doi: 10.3389/fpsyt.2021.639341 their experiences as sexual abuse (24, 25), others feel a strong ambiguity toward the

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Solberg et al. Facilitating Early Disclosure of Sexual Abuse

perpetrator, especially if this is a primary caretaker (5, 24, 26– Research Design
28), or they experience feelings of fear, shame and guilt (29–31). The current study is a part of a larger project exploring the
Age and gender has also been found to influence this process, process and consequences of disclosing CSA. Two articles have
with some studies showing that older children disclose their previously been published from the study. One article explored
experiences more easily (4, 13), other studies report that children the process leading survivors to understand that they had been
are most likely to disclose at the age when the abuse has happened sexually abused, with the main themes The ambiguity of memory:
and that all ages therefore should be targeted for prevention “To remember the catastrophic”; The language of the body: “Let
(32). The severity of the sexual abuse and a supportive primary the body speak”; and Encountering an observant other: “The
caregiver has shown to increase the likelihood of disclosure significance of being seen and recognized” (42). Another article
(13, 25). explored survivors’ experienced barriers in their process of
Most victims disclose to their friends or parents first (7, 25). disclosing sexual abuse, with the main themes Fear of reprisals;
Some studies show that children often tell their parents, while CSA stains – Negative implications for self-representation; and
adolescents, not wanting to burden parents, more often tell their The complicating effect of ambiguity (41). In this article, we
friends (11, 29, 33, 34). Moreover, children report that they often explore adult survivors of child sexual abuse’s reflections and
test and interpret how others react to what they say and do, and perspectives on what could facilitate early disclosure of CSA.
that this influences their disclosure (35, 36). We invited the survivors to reflect upon what would facilitate
The timing and manner in which one asks about sexual processes of early disclosure of CSA using their own experiences.
abuse has also shown to be important in facilitating disclosure, Their perspective as adult survivors of CSA is unique, and could
specifically the need to provide safe contexts (20, 37). Children give important insights to the field. The use of a qualitative
and youth often underline how difficult it can be to find an research design allowed us to get close to the participants’ own
appropriate moment to talk about their experiences, and adults experiences and reflections, while at the same time reflecting on
somehow facilitating these situations could make it easier (20, how our interpretations influence the data.
35, 38). Parents on their side report difficulties talking to their
children about potential CSA not knowing what to say, and many Recruitment Procedure and Participants
still hold misconceptions about CSA such as underestimating its In order to recruit participants to our research project, we
prevalence (39, 40), thus making the facilitation children need distributed posters with information about the project to strategic
more difficult. locations. This included mental health out-patient clinics for
While there has been made considerable efforts in the adults and a support center for survivors of sexual abuse. The
research community to develop improved methods of poster carried information that we were seeking adults who
facilitating disclosure, this remains a highly complicated had experienced CSA, and that we wanted to interview them
process. It has been underlined that spreading information about the process of disclosing CSA. The poster also informed
and prevention programs can help in the process of about the project being qualitative research, and that focus of the
facilitation, and also improve how we respond in a helpful interviews would be on what they experienced made it difficult
way (8, 20, 37), but there are also findings suggesting that to disclose, what could make it easier, and what survivors of
advanced focus can be a barrier to disclosure because it CSA need to disclose. The participants were included based
creates a stigma around victims, and that keeping quiet is on the criteria of having experienced CSA before the age of
a way of maintaining control and avoiding a negative self- 18, and being older than 18 years old when included in the
representation (41). The aim of this article is therefore to add study. Interested participants first contacted the third author,
the perspectives of survivors of CSA, and what they believe who provided additional information about the project and
can facilitate early disclosure, and that this might add insights did an initial assessment of basic criteria as established by the
to ongoing efforts to facilitate in the complex process of committee of ethics (i.e., competency to consent, no suicidal risk
early disclosure. or ongoing psychotic episode). Twelve participants (nine women
and three men) between the ages of 18–57 (average 36 years)
METHODS contacted the third author, and all were included in the study. For
five of the participants their perpetrator was primary caregiver,
Study Setting for two participants it was extended family members, and five
This study was conducted in the second biggest city in Norway, participants had no family relationship to their perpetrator. All
in a societal context where the last years have seen an increased participants had already disclosed their experiences.
focus on disclosure of sexual abuse (e.g., police uncovering
networks of cyber abuse, campaigns encouraging people to report Data Collection
suspicions of sexual abuse, “me too” - campaign). Historically, The interviews were all carried out by the first and second author
sexual abuse has been denied and silenced, and there is still under supervision of the third author, who was on stand by
a taboo related to sharing experiences of sexual abuse. In this in case participants got dysregulated during the interviews and
study, for practical and ethical considerations, we have spoken to were in need of support. There were no such incidents. The
adults looking back on their experiences as children and youth, interviews were semi-structured, allowing the interviewers to
and the current findings should therefore be understood within follow the participants’ story, while at the same time maintaining
this context. a focus on the intended aim of the project; what the participants

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Solberg et al. Facilitating Early Disclosure of Sexual Abuse

believed could facilitate disclosure of CSA. The interviewers author was available during every interview, but there were no
would seek clarification by asking for examples, trying to incidents with the need to intervene. We also made sure that the
understand the participants’ experiences more correctly (see participants did not leave the interview dysregulated, and closed
Appendix). The interviews lasted between 60 and 105 min and the session by talking about easier subjects.
were transcribed verbatim by the interviewer. CSA was not Throughout the study we aimed to take care of the
measured systematically before or during the interviews, but participants in a respectful way. We considered this as important
defined by the participants themselves as something they had with a vulnerable group, and we were aware and reflected
experienced. This was done in line with a qualitative design where upon them not feeling forced to participate. The participants
the experience of the informants is highlighted. joined voluntarily on their own initiative and could at any
time withdraw from the study. No participants used this
Data Analysis option. Moreover, all the participants seemed motivated for
When analyzing the interviews, we used reflexive thematic participation, shared rich descriptions of their experiences
analysis as described by Braun and Clarke (43, 44), highlighting and perspectives during interviews, and several participants
exploration, the perspective of the participants, the researchers’ commented that their participation contributed to a feeling of
interpretations, and reflexivity (45). As technical support we taking control over their trauma, and that it gave them meaning
used NVivo 12 (46). The analytical process was carried out to share experiences and contribute to spreading knowledge
through several steps as described by Braun and Clarke (43, 44). about CSA.
First every author familiarized themselves with every transcript,
and then the analytical focus was decided; What do survivors Reflexivity
of CSA believe will facilitate early disclosure. The first author Reflexivity remained an important topic throughout the research
coded the material according to the analytical focus of this process through acknowledging our influence on the research
article, highlighting what stood out as interesting through an process, including data collection and interpretation of the data
explorative and inductive approach. Then all authors familiarized material (43, 47). Psychological trauma and the way it impacts
themselves with the codes and met to start the process of group survivors was a shared interest by all three authors, leading to
the coded material together across the interviews, constructing the initiation of this study. We also shared an interest in how and
a first, tentative theme structure. The first author then refined when mental health services can be helpful in a survivor’s process.
the final thematic structure, before consensus was reached on These interests may have made us more prone to pursue these
the three themes given in this article; Adults making it possible particular aspects of the participants’ experiences, but it has also
to tell; Adults daring to consider the unthinkable; and Conveying ensured engagement with the phenomenon being studied. The
knowledge of CSA that facilitates understanding. Through the three authors have different professional backgrounds; The first
whole process of analysis all three authors frequently consulted author recently completed her training as a clinical psychologist,
the interview transcripts to ensure that details didn’t get lost. the second author is a social worker who also just finished
Throughout the process, the perspectives of an explorative and training as a clinical psychologist, and the third author is an
inductive attitude to the material, and reflection around our associate professor and clinical psychologist. Throughout the
influence as researchers, was continuously discussed. process, we have sought to enhance our own consciousness
about the way our backgrounds influence our understanding,
Ethics utilizing the opportunities working as a researcher team provides
Our participants were all survivors of CSA and therefore part of a to clarify our own perspectives and preunderstandings. We have
vulnerable group particularly prone to physical and mental health consciously worked to enter an open and explorative attitude
issues. To maintain the focus on their emotional well-being during interviews, reading of transcripts, analyzes and writing.
throughout the study and treating the material with respect, were One example is how one participant emphasized a downside to
therefore important aspects. We have throughout the process conveying knowledge about CSA to children because this could
continued to discuss ethical dilemmas, such as considerations force them into an adult world, where we previously considered
with the use of words (“survivor” instead of “victim”), and asking this as exclusively positive.
in an open way about their experiences without inquiring too
many details. RESULTS
We did not use health status as inclusion or exclusion criteria,
but we considered every participant as part of a vulnerable Adults Making It Possible to Tell
group and took precautions accordingly. The regional committee An important theme that evolved throughout our analysis was
for ethics in medical research (Rek Vest – approval number the central role adults can play in disclosing sexual abuse. The
2017/1623/REK Vest) approved the study with the condition of participants stressed the significance of being asked directly about
the third author (psychologist with clinical specialty) being in abuse, the impact of the relationship to the one asking, the timing
proximity during interviews and that the third author also made for being asked as well as the need for a safe environment.
an initial assessment before the participants were included in Almost all the participants pointed out that being asked was
the study. The interviewers underwent training in reading signs an important facilitator to disclosure. Most of them were never
of dysregulation and in how to intervene, and had knowledge asked directly when they were younger, and were not sure if they
about trauma psychology and some clinical experience. The third would have been able to confirm if asked. However, they reflected

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Solberg et al. Facilitating Early Disclosure of Sexual Abuse

on how it could have started a process in them, had they been reflected on a dilemma adults face when suspecting someone of
asked at an earlier point. CSA; fearing both to be right and wrong.

I: [. . . ] If somebody had asked you when you were younger if It has such big consequences [to accuse someone of CSA], and
something had happened to you, “Has someone done this or that”, it’s extremely uncomfortable. If one is going to talk about these
what do you think you would have said? Well, maybe some things tings, to take these tings seriously, then of course you think about
could have started to bubble up earlier. I: If someone had asked? “what if I’m wrong?”. What have you done then, what have you
Yes, I think direct questions without going around anything. I started? (Woman, late adolescence)
think that’s the best. (Man, 50s)
Many participants shared the experience that some adults, either
Participants had, however, different perspectives on how adults in school, the community or family, were worried and suspected
should act when probing for CSA. While one participant stressed that something was happening. Some took action, but not
the importance of not to stop asking a child about sexual abuse enough. Some didn’t do anything. In retrospect, participants
even if the children initially deny, other participants underlined reflected on the importance of adults taking a more active part
the importance of not pressing too hard for disclosure, arguing and daring to ask and understand what they see.
that it may actually make things worse. One participant described
that being forced to tell felt like being pushed to jump into water And at that time I was in a choir, and I have kind of understood
from 10 meters height when not wanting to. that many of the choir leaders and teachers reacted, and. . . . I:
The participants also reflected on the significance of who Do you know what they reacted to? It was probably just the
change, I’ve heard that I had a hard look on my face, and kind
asks the child. Most participants emphasized that in order to
of, everything kind of, my eyes were completely empty and, well I
disclose, children need to feel trust in a relation, while taking
lost a lot of weight. [. . . .] I: You said your parents understood that
the time required in order to establish a feeling of safety. something was wrong, the choir leader understood something was
Significantly, most participants did not disclose to their parents wrong, at school they understood something? Yes they understood
first, independent of their perpetrators being in the family or not. something, but they did nothing. (Woman, 20s)
Some reflected that the reasons for this might have been that they
were not used to sharing intimate details in their family, but also Some of the participants recounted how they put on a happy face,
that some things are easier to discuss with someone who is not performed well in school, kept silent and tried to go unnoticed.
that close in relation. One participant explains: They highlighted how not only the children with disruptive
behavior should be noticed, but also the silent ones:
I think it can be very difficult to talk to your parents, and I
probably didn’t say anything to my doctor because my parents I have always been good at hiding you know. I: Ok. Always
were there. It could have been easier with a school nurse since been the one who is fine, or how did you hide it? Acting. I: Ok, what
they are not that close, and even easier with friends because they did you act? Someone happy or? Kind of, fake it till you make it.
are younger. Somehow keeping it away from the people you are I: And what did you fake? That nothing happened. I: So you just
closest to. (Woman, 20s) played a normal, happy 3, 4, 5, 6, 7 – year old? Yes. (Woman, 20s)

Our participants also reflected on the importance of timing and According to many participants, their difficulties and changing
space, but also the feeling that it was a person who they could behavior were interpreted as caused by other things such as
trust, and who was genuine. puberty, parents’ divorce or bullying. They underlined how adults
must dare to look beyond behavior and try to see the signs that
What I had experienced earlier with therapists, psychologists children and youth give. To be able to do this, people need to
and psychiatrists was that they sit and almost protect themselves know what to look for:
behind a big desk or talk and talk and talk and don’t dare to do
anything else. [. . . ] yes, so he [the therapist which the participant Well, later on I’ve been very angry because there were so
finally disclosed to] could be personal, talk about his own life many red flags. I: Can you talk a little about the red flags? [. . . ]
and this made us more at the same level I: Okey, so that helped In sixth grade I got a lot of bruises and I completely changed
somehow that he.. Yes he was much more trustworthy than the my personality and I started seeing a psychologist, but since my
others I had seen earlier. (Man, 50s) parents had just divorced everyone thought that was the reason
for my behavior. And then I started self-harming, not with a knife
but scratching myself. And my mom has told me later that there
Adults Daring to Consider the Unthinkable
was an extreme number of red flags and symptoms, but she just,
Most participants discussed how important it is that adults dare
it just didn’t occur to her. (Woman, late adolescence)
consider the unthinkable; that CSA happens. They stressed how
adults need to take a larger responsibility and acknowledge that
CSA happens, and not just place the responsibility of disclosure Conveying Knowledge of CSA That
on the children. The participants spoke about their experiences Facilitates Understanding
with adults misinterpreting or overlooking important signs The participants all emphasized how important it is to convey
that they expressed as children and youth. However, they also knowledge to facilitate disclosure of CSA. They described the

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Solberg et al. Facilitating Early Disclosure of Sexual Abuse

importance of openness and information, both in what to look DISCUSSION

for, but also what to do with suspicions about sexual abuse.
Due to the age range, the participants grew up in slightly In this study, through the perspective and information given
different societies and contexts regarding the view and focus on by survivors of CSA, we have gained insights into how early
CSA. The older participants talked about how the society has disclosure might be facilitated. One of the most important
changed during their lifetime, how when they were younger, findings in our interviews points to the important role adults
no one talked about sexual abuse, and people kept things to play in early disclosure of CSA. Previous research has shed light
themselves. Almost all of the participants underlined that the on the number of barriers survivors of CSA face in the process
openness in today’s society constitutes a major step toward of disclosure (20, 23, 25, 41). Telling someone about CSA is
fighting taboos around sexual abuse, and most of them see a huge therefore a complex and heavy process that can take years for
improvement from just a few years back. many victims (4, 5, 37). This line of research highlights the
It was highlighted by most participants that information importance of others contributing to making early disclosure of
conveyed to children, youth and adults is a key to facilitate CSA possible. That adults should carry much of the responsibility
disclosure. Some also pointed out how openness about feelings for uncovering CSA seems so obvious it should hardly be a
is important, especially which feelings are normal after finding in an empirical article. Yet, many who experience CSA
experiencing sexual abuse. Some talked about the importance of change behavior [e.g., get restless, and have emotional outbursts
not only learning what sexual abuse is, but also sexual education such as anger or self-harm, (16, 31, 42)], indicating to their
from an early age in order to learn what is normal and what is not: surroundings that something is not right, without adults noticing
(1, 2, 18, 19), or misinterpreting these signs (36, 42). Why, then,
My process started with learning about what sex really is, do adults around victims so often seem to either not understand
because you don’t learn about it until late elementary school. So I or overlook the signs that children and youth experiencing
didn’t understand what had happened, and when you then learn CSA provide?
what has happened, and they tell you how important it is to wait Child sexual abuse shatters our basic assumptions about the
until you are ready and stuff like that, then you get that feeling: world as meaningful and benevolent others (28). Holding on to
yeah, but I can’t wait, because it has already happened, and, it’s these assumptions are in many ways important for our survival.
kind of, to go through that process and to know that someone
People are therefore hesitant to change these beliefs because they
took something away from you without you knowing they did.
provide stability and help form attachments and trust in others.
(Woman, 20s)
The way CSA contradicts basic assumptions makes it prone to
be overlook or disregarded. These processes are strengthened by
Teaching children about the limits to what adults may do and
the way accepting that good and evil coexist can appears more
may not do, where they can touch and not, was considered
difficult and frightening than just taking in evil from a distance
important. However, one participant underlined that we have to
(48). This is also reflected in research showing that people often
be careful not to force an adult world upon children:
underestimate the prevalence of CSA, think of most perpetrators
What I am afraid of, I’ve been thinking, that I don’t want to
as strangers, and find it difficult to consider that sexual abuse
spread my fear to my kids, you know, in new areas, because they’re might happen to someone close to them (39, 40). This shows
supposed to be children and fearless. That’s what’s natural, that how people can be hesitant to even just consider sexual abuse
children grow up with adults who don’t do bad things. I: That when it happens close to them and are prone to write off claims
takes care of them and. . . yes, let’s them be themselves you know. or suspicions of wrong doings, like sexual abuse – thus why so
(Man, 50s) many survivors of CSA experience that their signs that something
was wrong were overlooked or misinterpreted by the adults in
All participants emphasized the importance of informing adults their surroundings.
about which signs to look for, because it cannot be up to children Given that we are hesitant to change our fundamental
or youth alone to disclose something as difficult as sexual abuse. assumptions about a safe world, daring to consider CSA is
Several participants also underlined the need to convey what something that takes great effort and elicits difficulties; Is it
people should do if they suspect CSA. A few of the participants worse that the suspicions are right and the consequences that this
talked about how their caretakers suspected something, but they cause, or to wrongly accuse someone of a terrible deed? Herman
didn’t know what to do or who to talk with: (17) claims that people often take the side of the perpetrator
because it’s the easier path. It’s less difficult to claim that one
It could have helped if my parents in some way knew who person, a potential victim, is lying, than taking in the horrible
to contact, how to move forward, because I think that it’s almost possibility of the victim being right, thus forcing us to change
nobody who thinks that “my kid will be exposed to sexual abuse”. our basic assumptions and accept that bad things can happen in
Well, sometimes there are parents who do it themselves, but our proximity. Studies in cognitive psychology have shown that
most people don’t think, you know. “What do I need to do if it
people often take the easiest way to think and make decisions in
happens”, right? I: So we should have almost like an instruction
manual saying “what to do if I suspect my child has been exposed to
order to avoid cognitive strain (49). When people stop thinking,
sexual abuse”? Yes, what to do and that we have a system that can stop paying attention and stop questioning things around them,
receive caretakers, schools and anybody who suspects anything. it can become a barrier to disclosure of CSA (48). Given our
Because I think my parents often have felt rejected and very, like, findings of the key role adults play if earlier disclosure of CSA is to
just let things pass, you know. (Woman, 20s) be possible, and the challenges outlined above, how to influence

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Solberg et al. Facilitating Early Disclosure of Sexual Abuse

people, especially adults in contact with children, to think the focus is then to create opportunities of joint attention and
unthinkable and act on their suspicions of CSA? communication between parents and their children.
One aspect stressed by our participants was the importance Conveying knowledge to children and youth about limits of
of conveying knowledge about CSA. If one does not know what intimacy, sex and what adults are allowed to do, is another
to look for, it is difficult to notice. Spreading information to implication stressed by our participants. They believe that giving
adults in contact with children (teachers, health professionals, children and youth a possibility and the vocabulary to understand
parents e.g.,) about common signs of CSA could help increase what happens and where the limit goes is important. If they know
awareness. An important implication of our findings is therefore that what happens is wrong, it can make it easier for them to
how giving adults the understanding of how difficult it is for disclose. It may also enhance resilience and empower children
survivors to disclose CSA, and at the same time give them the at risk to say “no” because they know that they are allowed and
tools to recognize its physical and psychological effects could entitled to say no. This is in line with findings showing that
help facilitate earlier disclosure of CSA. This is in line with children in all ages should be targeted for prevention programs
earlier research (7). This could also enhance the understanding and learn about CSA, because they are more likely to disclose at
of the responsibility adults have in the process of disclosure, the age when the abuse has happened (32).
precisely because of the barriers survivors face. It cannot be However, increased information about the long-lasting effects
the responsibility of the child alone to stop the abuse. The of CSA can also become a barrier for disclosure because it creates
increased focus in today’s society and media on CSA might a stigma around victims, and that keeping quiet is a way of
force us to consider and to a greater degree understand CSA, maintaining control and avoiding a negative self-representation
its prevalence and impact. Thus, conveying knowledge through (41). In our findings also another dilemma was raised with a
educational programs, websites, posters, etc. aimed at adults concern that an exaggerated focus on CSA may force children
could be important to facilitate early disclosure. into an adult world and putting too much of the responsibility
At the same time, daring to consider CSA does not alone to prevent and disclose abuse on the children’s shoulders. In
facilitate disclosure. Our findings show that many participants teaching children about serious topics and the importance of
experienced that relatives or other adults suspected that disclosing, it may make them more suspicious and force them
something was happening, but that they did not dare or to try to understand issues that are too complex for them. One
know what to do. Thus, another important implication of could argue that children should be allowed to be children and
our findings is the importance of teaching people how to act play carefree, and that instead there should be an increased focus
on their suspicions. It will therefore be important to make on the responsibility of adults.
information and a support system more available, especially Increasing knowledge about CSA and focusing on the
targeting adults with and working around children. Also, with responsibility of adults can thus be seen as the most important
some studies showing that many adolescents disclose to their facilitator toward disclosure. However, with a large focus on
peers (11, 29, 33, 34), this kind of information and support conveying knowledge and forcing adults to acknowledge that
should also target this group. One possible intervention could CSA happens another important dilemma arises; If adults
be creating platforms with the possibility of discussing concerns become too watchful and suspicious toward other adults, it might
and making information about what to with your suspicions scare many away from a natural closeness with children. Close
more accessible. One example of efforts in this direction is the relationships and playing adults are shaping important aspects of
Norway government’s official webpage (50), offering information the child (52). It is therefore important to maintain a balance so
and support online for survivors of violence and abuse, people as not to suspect everyone, and not scare adults into keeping a
suspecting abuse, and for perpetrators. It offers information distance from children to avoid eliciting suspicion of CSA. At the
about available treatment options and support services. However, same time, it is essential that people dare to consider that bad
the impact of this resource is uncertain, and it underlines the need doings can happen close to us. This shows the complexity and
to systematize efforts to facilitate early disclosure of CSA (42). many difficulties surrounding the disclosure of CSA also for non-
Our participants reflected on the difficulty of talking about victims, and in order to facilitate disclosure these aspects need to
something as personal and shameful as sexual abuse, and be shed light on and discussed.
underline the significance of others initiating the conversation,
and how important being asked, but also trust and timing is. Limitations
Parents, but also health professionals, often report that they In the current study we used a qualitative design with a reflexive
hesitate to ask about sexual abuse (51). Having a joint focus of thematic analytical approach to analysis. In this methodology the
attention, like a TV-program or a story targeting sexual abuse, influence of the researchers are highlighted, and this has been
has shown to help children or parents to ask or talk about sexual an ongoing focus throughout the study. There is a small sample
abuse. The joint focus serves as an indirect and less confrontative of participants (12) in this study, which by some will be seen
entry into a difficult conversation (20, 38). Based on this it can as a limitation. The focus has been on the understanding and
be assumed that todays’ focus on children’s programs and large experiences of the participants, and the aim to shed light on the
media coverage on CSA might give more opportunities for a complexities in the process.
joint focus of attention. There is also evidence to show that While our pool of participants included both genders, we
educational programs increase communication between parents ended up interviewing more women than men. Further research
and their children (20, 40). Another implication of this research should aim to recruit more men, especially given that men

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Solberg et al. Facilitating Early Disclosure of Sexual Abuse

often experience different kinds of barriers to disclosure than upon the dilemmas and complexity people face when considering
women (53). There was also a variation in the relationship to and suspecting CSA, and the importance of addressing these
the perpetrator among our participants. There might be different dilemmas and help adults to act on their suspicions. One
aspects that facilitate disclosure depending on the relationship important implication was how information, the possibility of
and closeness between victim and perpetrator that our study fails discussion and prevention programs can help in the process of
to recognize. disclosure of CSA, especially if targeting adults.
All participants were raised in x, and their thoughts and
reflections are influenced by the given society. As all knowledge
is situated, our findings and implications are influenced by the DATA AVAILABILITY STATEMENT
cultural context in which the study is conducted and us as
The original contributions presented in the study are included
researchers. As a consequence, the transferability of the findings
in the article/Supplementary Material, further inquiries can be
will be established by the readers and by future research, with
directed to the corresponding author/s.
our transparency on context and research process facilitating the
readers’ assessment of the trustworthiness and transferability of
the presented findings (54). ETHICS STATEMENT
Through the interviews the adult participants looked back
The studies involving human participants were reviewed and
to their childhood. There is often a difference in asking adults
approved by REK VEST (Norway). The patients/participants
looking back on disclosure and asking children who have recently
provided their written informed consent to participate in
been through this process. When looking back as an adult
this study.
they are at a different developmental stage, and events and
decisions are often interpreted differently. One may argue that
it is problematic to use knowledge from adults to enhance AUTHOR CONTRIBUTIONS
an understanding of facilitating disclosure among children. At
the same time, it can be easier for adults to understand the ES and JH participated in the design, data collection, analysis and
perspective of other adults when trying to understand how to writing. SS participated in the design, supervised data collection,
facilitate disclosure. But the retrospective design and age range of and participated in analysis and writing. All authors contributed
the participants is important to keep in mind when considering to the article and approved the submitted version.
the transferability of the findings.
ACKNOWLEDGMENTS
CONCLUSION
We would like to thank our participants for sharing their
The current study aimed to gain insights into how we might difficult stories with us. We also thank SMISO for helping
facilitate early disclosure of CSA by exploring the perspective with recruitment.
and reflections of adult survivors of CSA. Through in-depth
interviews with 12 survivors we found three main themes SUPPLEMENTARY MATERIAL
that highlight the importance of increased awareness and
understanding of CSA and its complexities within the general The Supplementary Material for this article can be found
population, and the responsibility adults have to bear for earlier online at: https://www.frontiersin.org/articles/10.3389/fpsyt.
disclosure of CSA to be possible. Our findings also shed light 2021.639341/full#supplementary-material

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