Child Abuse & Neglect 99 (2020) 104230

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Child Abuse & Neglect

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Prevalence of child maltreatment in Ecuador using the ICAST-R

T
Micaela Jiménez-Borjaa, Verónica Jiménez-Borjab, Teresita Borja-Alvareza,*,
C.arlos José Jiménez-Mosquerac, José Murgueitiod
a
Department of Psychology, Universidad San Francisco de Quito, Ecuador
b
Department of Communication and Arts, Universidad San Francisco de Quito, Ecuador
c
Department of Mathematics, Universidad San Francisco de Quito, Ecuador
d
Universidad San Francisco de Quito, Ecuador

A R T IC LE I N F O ABS TRA CT

Keywords: Objectives: While the link between childhood experiences of physical, emotional, and sexual
Child maltreatment abuse and mental health problems has been largely studied, there is limited information re-
Sexual abuse garding the prevalence of child maltreatment in developing countries, particularly in South
Gender differences America. The present study is an effort to investigate the prevalence of child maltreatment in
Prevalence
Ecuador using the ISPCAN Child Abuse Screening Tool Retrospective version (ICAST-R).
Ecuador
Method: A student sample (males = 1579; females = 1554) from the seven largest universities in
Latin America
ICAST Quito, Ecuador, completed the ICAST-R.
Results: Our findings indicate that 69.6 % of participants experienced child maltreatment.
Physical abuse was reported by 47.6 % of respondents; this commonly involved being beaten by
parents. Emotional maltreatment was reported by 53 % of the participants; mostly through in-
sults by same-sex peers and parents. Sexual abuse was reported by 15.5 % of the participants. The
most prevalent forms of sexual abuse included being coerced into touching another person’s
genitals, having their genitals touched by others, or having someone expose their genitals to
them. Sexual abuse was more prevalent amongst females (males = 12.9 %; females = 18.1 %,
OR = 1.49; CI = 1.22–1.81), and physical abuse was more prevalent amongst males
(males = 50.5 %; females = 44.6 %, OR = 0.79; CI = 0.69-0.91).
Conclusions: Our study shows evidence of a high prevalence of child maltreatment in Ecuador.
We also identify significant gender differences in the type of abuse experienced, and in the
context in which this abuse takes place. These results are important given the negative con-
sequences of child maltreatment. More research applying ICAST to different populations is re-
commended to further validate the present findings and facilitate international comparisons.

1. Introduction

Since the United Nation General Assembly adopted the Convention on the Rights of the Child in 1989, countries endorsing the
treaty have found it necessary to adjust their legislations and international agreements so that these may fulfill their commitment to
defend the rights of children. This commitment includes efforts to prevent and combat child maltreatment and sexual abuse (Doeck,
2009). Despite these efforts, millions of children in the world still suffer from different forms of violence (Pinheiro, 2006; World
Health Organization WHO, 2014). Taking into account that child maltreatment is related to a variety of health, interpersonal,

⁎
Corresponding author at: Universidad San Francisco de Quito, Diego de Robles y Pampite, Cumbayá, 170901, Quito, Ecuador.
E-mail address: tborja@usfq.edu.ec (T. Borja-Alvarez).

https://doi.org/10.1016/j.chiabu.2019.104230
Received 16 January 2019; Received in revised form 3 October 2019; Accepted 10 October 2019
0145-2134/ © 2019 Elsevier Ltd. All rights reserved.
M. Jiménez-Borja, et al. Child Abuse & Neglect 99 (2020) 104230

psychological, sexual and behavioral problems, the prevalence of child physical, emotional and sexual abuse is alarming (Chen et al.,
2010; Corwin & Keeshin, 2011; Cutajar et al., 2010; Ferguson, 2013; Gershoff, 2002; Maniglio, 2009, 2013). Internationally, these
negative consequences are considered to be a significant public health problem and economic burden. As such, the issue of child
maltreatment continues to constitute a mental health priority (Fang, Brown, Florence, & Mercy, 2012; UNICEF, 2012).
Doeck (2009) points out the need to collect and share updated information regarding the prevalence of child abuse worldwide in
order to understand global trends and variations, to raise awareness about the prevalence of child maltreatment, to measure the
effectiveness of maltreatment prevention programs, and to shine light on factors contributing to cross-country variations. However,
the lack of consensus amongst researchers on the operational definition of child maltreatment and sexual abuse, along with the use of
diverse measures across studies, make cross-country comparisons particularly difficult. To overcome this problem, the International
Society for the Prevention of Child Abuse and Neglect (ISPCAN) endeavored to develop improved psychometric assessment tools
(Dunne et al., 2009; Rao & Lux, 2012; Runyan, Dunne, & Zolotor, 2009, 2009b; Zolotor et al., 2009). These efforts resulted in three
ISPCAN Child Abuse Screening Tools (ICAST) available in several languages: Retrospective (ICAST-R), Parent (ICAST-P) and Child
(ICAST-C). Studies on the psychometric properties of the ICAST questionnaires have shown moderate to high internal consistency
scores (Chandraratne, Fernando, & Gunawardena, 2018; Dunne et al., 2009; Meinck et al., 2018; Rao & Lux, 2012; Runyan, Dunne,
Zolotor et al., 2009, 2009b; Silveira & Grassi-Oliveira, 2016; Zolotor et al., 2009). The effort and commitment of researchers to using
these standardized and validated tools have provided a means of slowly accruing data on the extent of child maltreatment worldwide.
Up to the date of publication, the ICAST-R, applied in the present study, was also used to collect data in South Korea, Turkey and Sri
Lanka (Chandraratne et al., 2018; Lee & Kim, 2011; Simsek, Guney, & Bysal, 2017). Additionally, the ICAST-C has been used in
Georgia, Croatia, Saudi Arabia, Taiwan, Turkey and India (Ajduković, Rimac, Rajter, & Sušac, 2012; Al-Eissa et al., 2015; Feng,
Chang, Chang, Fetzer, & Wang, 2015; Kumar, Kumar, Singh, & Kar, 2017; National Study on Violence Against Children in Georgia,
2008; Sofuoğlu, Sariyer, & Ataman, 2016); and the ICAST-P has been applied in Georgia and Turkey (National Study on Violence
Against Children in Georgia, 2008; Sofuoğlu et al., 2016).
It should be noted that the three ICAST versions provide data stemming from different sources: the ICAST-C gathers data directly
from children; the ICAST-R gathers data from young adults who report their experience retrospectively; and the ICAST-P gathers data
from parents/caregivers. It is thus important to be cautious when comparing our findings with those of other studies that have
applied one of these three ICAST versions in other countries. Comparisons amongst these studies are also difficult because published
articles do not present results in the same manner. For example, some authors report data regarding the overall prevalence of
maltreatment (i.e., Feng et al., 2015; Simsek et al., 2017); others report the prevalence of specific types of maltreatment (i.e., Al-Eissa
et al., 2015; Kumar et al., 2017; National Study on Violence Against Children in Georgia, 2008), and some authors report the
prevalence of maltreatment according to the gender (i.e., Lee & Kim, 2011; Sofuoğlu, Sarıyer, & Ataman, 2016) or the age of the
participants (i.e., Ajduković et al., 2012). So far, the findings of these studies point to a broad variability in the prevalence of child
maltreatment (e.g., 91 % in Taiwan; 51 % in Turkey) and of gender-specific types of maltreatment experienced by boys and girls in
each country. In some countries, the findings show that boys are more likely to experience physical maltreatment (i.e. India, Taiwan,
Georgia, Turkey, Korea) and sexual abuse (i.e., India, Taiwan, Georgia), while in other countries, studies suggest that girls are more
likely to experience physical (i.e., Saudi Arabia), emotional (i.e., Taiwan, Saudi Arabia) or sexual abuse (i.e., Korea).
The present study is the first effort to apply the ICAST-R to study the prevalence of child maltreatment in a Latin American
country. Indeed, research studying the situation of children in Latin America is scarce (Guedes, Bott, Garcia-Moreno, & Colombini,
2016; Stoltenborgh, Bakermans-Kranenburg, Alink, & van IJzendoorn, 2015). Additionally, the few studies that have been published
about the region do not use comparable definitions of what constitutes child maltreatment or methodologies to research the issue
(Santamaria Galeano & Tapia Varas, 2018; Wirtz, Alvarez, Guedes, Brumana, Modvar, & Glass, 2016). It is thus important to be
cautious when comparing findings across the region or of coming to any general conclusion regarding the prevalence of child
maltreatment experienced by Latin American children. Stoltenborgh et al. (2015) meta-analysis based on studies using self-report
questionnaires conducted in Central America countries (k = 8; Costa Rica, Nicaragua, México) suggest that 13 % of children have
experienced sexual abuse and 54.8 % have experienced physical abuse at some point in their life. Hillis, Mercy, Amobi, and Kress
(2016) systematic review of studies in the region (k = 9) that used population-based self-report surveys, suggests that at least 34 % of
Latin American children have experienced physical, emotional or sexual abuse in the past twelve months. From these estimates, it
seems that violence against children continues to occur at high rates despite the fact that every Latin American country is a signatory
of the United Nation Convention on the Rights of the Child (United Nations Treaty Collection, 2019) and that most have implemented
laws against sexual abuse and physical punishment, including mandatory reporting of child abuse (Wirtz et al., 2016).
Ecuador is a developing country with around 17 million inhabitants of which a majority is mestizo and catholic (Instituto
Nacional de Estadística y Censos INEC, 2011). Children and adolescents (under 18 years) represent one third of the population.
Ecuadorian laws protect children from all types of maltreatment and ensure free access to public health services and to pre-school,
primary, and secondary public education (Consejo Nacional para la Igualdad y la Intergeneracionalidad, 2014). Ecuador’s most
significant achievement during the past few decades in its quest to ensure the full enforceability of the rights of children has un-
doubtedly been the development of its National Decentralized System of Comprehensive Protection for Children and Adolescence
(Jiménez-Borja, Jiménez-Borja & Borja-Alvarez, 2019 in pressJiménez-Borja et al., 2019Jiménez-Borja, Jiménez-Borja & Borja-Al-
varez, 2019 in press). This has resulted in significant strides in the country’s ability to prevent maltreatment and to protect the rights
of children. For example, there has been an exponential increase in the number of child maltreatment and sexual abuse complaints
reported to police (Observatorio Social del Ecuador, 2018). While recent studies suggest that the situation of children in the country
has improved dramatically in the past decade, the prevalence of child maltreatment within families, communities and the school
system remains high (Jiménez-Borja et al., 2019; Observatorio Social del Ecuador, 2016, 2018). Moreover, like most Latin America

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countries, Ecuador suffers from deep-set structural socio-economic, regional, ethnic, and gender inequality. These persistent in-
equalities pose one the greatest challenges to guaranteeing equal access to essential child protection services for marginalized
communities and territories.
The most recent national comprehensive reports on the living conditions of children in Ecuador—based on government popu-
lation surveys and non-government interviews, focus groups and self-report questionnaires —suggest that between 2000 and 2015
there was an increase of the use of physical punishment by caretakers (35 % vs. 38 %) and by teachers (20 % vs. 26 %) (Observatorio
Social del Ecuador, 2016, 2018). The Social Observatory of Ecuador suggests that this may be related to the fact that Ecuadorian
legislation does not clearly and expressly ban the use of corporal punishment against children and adolescents (Observatorio Social
del Ecuador, 2018). Furthermore, these reports indicate significant ethnic inequalities in the prevalence of child maltreatment, with
indigenous (42 %) and Afro-Ecuadorian (47 %) children being more at risk of maltreatment by their caretakers than mestizo (29 %)
children. These national reports also suggest that gender is related to children’s vulnerability to different types of abuse. For example,
males (36 %) are more likely to experience physical punishment than are females (30 %). Additionally, while not reported as child
sexual abuse in the studies, estimates of teen pregnancies indicate that 2 % of girls between the ages of 10 and 14, and 12 % of girls
between the ages of 15 and 17, have been pregnant at least once. The most recent 2010 national census survey (Instituto Nacional de
Estadística y Censos, 2011), which included questions regarding violence against women, indicates that 60 % of Ecuadorian females
have experienced some type of intra-family violence (sexual 25 %, physical 38 %, and emotional 54 %), and that 10 % of women have
experienced some form of sexual abuse before turning 15 years old. Of these, the most vulnerable victims are indigenous and low-
income women. A 2004 national survey (Encuesta Demográfica y de Salud Materna e Infantil, 2004) found that 30 % of girls in
Ecuador have experienced some form of physical and/or emotional maltreatment –perpetrators were mostly parents and siblings. A
recent study (Viteri, 2017), researching the problem of child maltreatment within indigenous communities in rural areas of Ecuador,
found that 80 % of girls reported some form of sexual abuse. This study employed interviews because of the high rate of illiteracy
amongst these communities. Additional interviews with community leaders also showed a general sense of helplessness regarding the
prevalence of sexual abuse. Indeed, indigenous people are some of the most overlooked and neglected communities in the country.
National services developed in recent years to improve the situation of children still remain largely unavailable to them (Observatorio
Social del Ecuador, 2016, 2018). Altogether, these findings suggest that although laws to protect children are in place, child mal-
treatment remains a serious social problem in Ecuador. To summarize, it seems that between 30–47% of Ecuadorian children are at
risk for physical maltreatment, and that at least 10 % of Ecuadorian girls are at risk for sexual abuse. However, the scope of the
problem remains unclear since there is limited research on the subject. One major problem of cross-study comparisons in the country
is that the few national studies that exist have employed significantly different definitions of what constitutes child maltreatment. As
an example, while some of the studies on the subject define sexual abuse in terms of “forced sexual penetration” (Encuesta
Demográfica y de Salud Materna e Infantil, 2004), other studies define it as “forced sexual relations” (Instituto Nacional de Estadística
y Censos, 2011). Moreover, the methodologies employed have been heterogeneous (surveys, self-reports, focus groups, interviews).
Comparing the findings of these studies thus becomes problematic. As such, it is of uttermost importance to continue accruing data
using standardized and valid measures, such as the ICAST, that can facilitate cross-study comparisons.
The present study uses the ICAST-R to examine the prevalence of child maltreatment in students from various universities in
Ecuador and is thus an important contribution to both national and international research on child maltreatment. The primary
purpose of this research is to explore the prevalence of physical, emotional and sexual child abuse in Ecuador. We are also interested
in examining gender-specific differences along with the particular contexts in which various types of maltreatment occur.
Additionally, we examine participants’ perception of their maltreatment experiences and their sexual abuse disclosure process.

2. Method

2.1. Participants and procedures

A sample of 3133 (males = 1579; females = 1554) university students (mostly 18 to 24-years-old) in Quito, the capital of
Ecuador, responded the ICAST-R. The age range of participants was between 18–35 years old, with most of them between the ages of
18–24 years (79.4 %). Most participants were non-working full-time students (66.2 %) who had lived most of their life in a large city
(63.5 %). The data for this study was collected in 2015. Quito has 14 universities and a student population of about 159,000 (Instituto
Nacional de Estadística y Censos INEC, 2017). Seven of the largest universities participated in the present study (four private and
three public –containing 86 % of the total university population). The sample size for each university was calculated using an error
rate of 5 %, a design effect of two, and a final population correction for each university. University authorities for each institution
were contacted for permission to collect the data from students on their respective campuses. A convenience sample of university
professors was contacted, and permission was requested to allow a research assistant to come to their classrooms and distribute the
ICAST-R. Only classrooms arranged with individual desks were included in this study. Students were first given consent forms and the
ICAST-R questionnaire was distributed only to those students who agreed to participate. The response rate for this study was high (98
%). Students who did not consent were requested to stay silent and remain in their own individual chairs. After completion of the
questionnaire, participants were asked to place the questionnaire in a slotted box located in the front of the classroom. The research
assistant responded to questions and remained in the classroom until all students finished.

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2.2. Measurement

The Ecuadorian Spanish adaptation of the ICAST-R (Dunne et al., 2009) was used to retrospectively measure experiences of
physical, emotional and sexual abuse during childhood. With ISPCAN permission, the original Spanish version of the ICAST-R was
reviewed for translation and Ecuadorian language adaptations. Three fully bilingual Spanish/English Ecuadorian speakers with post-
graduate education compared the original ICAST-R English and Spanish versions and some changes were made. A team of five
Spanish-speaking senior undergraduate psychology students then reviewed this modified version. The final version of the Spanish
ICAST-R included grammatical modifications (“Amiga de la familia mayor” was changed to “Mujer mayor amiga de la familia”) and
changes that would improve the English to Spanish translation (instead of “extraña” we used “desconocido/a”). Words were added to
facilitate understanding (“estrujó o sacudió” was added to the simple “estrujó”) or were added because they were missing in the
original ICAST Spanish version (“látigo” and “senos”).

2.3. Data analysis

The statistical software R (R Core Team, 2018) was used for data analysis. To examine the internal consistency of the Spanish
version of the ICAST-R, Cronbach alpha scores were calculated based on the presence or absence of the specific types of abuse.
Descriptive analyses were conducted to examine the prevalence of physical, emotional and sexual abuse. To examine the differences
between males and females regarding the probability of maltreatment experiences, logit models were adjusted, and their odd ratios
(OR) —with their corresponding lower (2.5 %) and upper (95 %) coefficient intervals (CI)—were calculated as a measure of the effect
size for the difference. Contingency tables were calculated and their corresponding Chi-square statistics were computed. The cor-
responding standardized residuals (SR) were calculated to measure the strength of the differences between categories within con-
tingency tables. In the case of contingency tables, the criterion to mention a difference was a SR superior to 2 in absolute value
(Agresti, 2019). The corresponding Phi coefficients were also calculated to determine the effect size of the difference. The criterion to
mention a difference was Phi superior to 0.2 (Kelley & Preacher, 2012). The Bonferroni-Holm procedure with an alpha value of 0.05
was computed to control for type I error when several tests of non-a priori hypotheses were performed (Holm, 1979).

3. Results

3.1. Internal consistency of the Spanish ICAST-R

The ICAST-R Ecuadorian Spanish adaptation obtained Cronbach alpha scores of 0.62 for physical maltreatment, 0.54 for emo-
tional abuse, and 0.69 for sexual abuse subscales. These scores resemble those obtained by Dunne et al. (2009).

3.2. Physical maltreatment in Ecuador

Table 1 shows that child physical maltreatment was reported by 47.6 % of the participants. The most common type of physical
abuse (Table 2) experienced by children was being beaten with an object (31.1 %). Most respondents experienced this kind of
maltreatment once or twice (73.2 %) between the ages of 14 and 17 years (41.5 %). Another form of physical maltreatment com-
monly experienced by participants was being hit or punched (26.3 %). Most respondents experienced this type of maltreatment once
or twice (56.8 %) between the ages of 5 and 9 years (42.4 %). Table 3 shows that parents are the most common perpetrators of
physical abuse. Some respondents reported that, as a consequence of abuse, they either visited a doctor or went to a hospital
(males = 12.5 %; females = 6.8 %), had to stay at home (males = 9.3 %; females = 8.1), missed school (males = 7.4 %; fe-
males = 5.5 %), or had a permanent injury (males = 3.4 %; females = 4.0 %). Around half of the participants (males = 53.1 %;
females = 46.9 %) justified these experiences of physical maltreatment as a reasonable disciplinarian method, and the majority of
respondents (males = 61.5 %; females = 69.4 %) believed that they were much less physically maltreated compared to other chil-
dren.

3.3. Gender differences in physical abuse

Table 1 shows that males (50.5 %) are more likely to experience physical abuse than females (44.6 %) (OR = 0.79;

Table 1
Odd Ratios and Percentage of Respondents Who Experienced Physical, Emotional and Sexual Abuse.
Type of Maltreatment All % M% F% OR(F/M) CI (95%)
2.5% 97.5%

Physical *** 47.6 (N=3133) 50.5 44.6 0.79 0.69 0.91

Emotional 53.0 (N = 3115) 53.1 52.9 1.0 0.86 1.14
Sexual Abuse*** 15.5 (N = 3091) 12.9 18.1 1.49 1.22 1.81
At least one type 69.6 (N = 3074) 68.9 70.4 1.08 0.92 1.24

*** p < 0.001.

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M. Jiménez-Borja, et al. Child Abuse & Neglect 99 (2020) 104230

Table 2
Odd Ratios and Percentage of Different Types of Maltreatment.
Type of Maltreatment All% M% F% OR CI (95%) (F/M) 2.5% 97.5% N/ NR

Hit/punched ** 26.3 (N=3133) 28.6 24.0 0.79 0.67 0.93 R

Kicked *** 11.5 (N=3131) 15.1 7.8 0.48 0.38 0.60 R
Beaten with object 31.1 (N=3030) 30.8 31.3 1.02 0.88 1.19 NR
Shaken 12.2 (N=3125) 10.7 13.6 1.31 1.06 1.63 NR
Stabbed or cut *** 3.6 (N=3124) 5.7 1.6 0.27 0.17 0.42 R
Insulted 45.2 (N=3115) 44.0 46.4 1.10 0.96 1.27 NR
Told not loved *** 9.4 (N=3103) 6.4 12.5 2.10 1.63 2.71 R
Told wish not born*** 6.1 (N=3100) 3.8 8.4 2.35 1.72 3.24 R
Threatened hurt/killed *** 17.0 (N=3099) 21.5 12.5 0.52 0.43 0.63 R
Threatened abandoned 6.2 (N=3092) 5.2 7.3 1.44 1.08 1.94 NR
Exposed genitals 9.1 (N=3091) 8.3 10.7 1.33 1.04 1.69 NR
Posed naked 0.5 (N=3090) 0.7 0.3 0.46 0.15 1.28 NR
Touch others’ genitals *** 9.1 (N=3090) 5.8 12.5 2.33 1.80 3.04 R
Touched own private parts 5.2 (N=3089) 4.6 5.9 1.30 0.95 1.79 NR
Sexual intercourse 2.8 (N=3087) 2.8 3.0 1.08 0.70 1.65 NR

Note. Column R/NR indicates if the Bonferroni-Holm procedure with α = 0.05 rejects (R) or not (NR) the hypothesis that the Odds Ratios do not
differ for males and females.
*** p < 0.001.
** p < 0.01.

CI = 0.69–0.91). Table 2 shows that males are more likely to be hit/punched (males = 28.6 %; females = 24 %; OR = 0.79;
CI = 0.67–0.93), kicked (M = 15.1 %; 7.8 %; OR = 0.48; CI = 0.38–0.60) or stabbed/cut (males = 5.7 %; females = 1.6 %;
OR = 0.27; CI = 0.17–0.42) than females. Males (12.5 %) reported having gone to a doctor/hospital as a consequence of their
physical maltreatment more often than females (6.8 %) (p < 0.001; Phi = 0.31). More males (53.1 %) than females (46.9 %)
believed that the physical maltreatment received during their childhood was a reasonable and justifiable disciplinarian method
(χ2 = 12.3, df = 3, p < 0.01, Phi = 0.3, SR = 3.31). More females (69.4 %) than males (61.5 %) believed that they had experienced
much less physical maltreatment than other children (χ2 = 27.04, df = 4, p < 0.001, Phi = 0.45, SR = 4.5). Table 3 shows that,
when asked to designate the perpetrator of physical abuse, females named their mothers (63.8 %) more often than their fathers (44.1
%) while males named both their fathers (49.6 %) and their mothers (45.6 %).

3.4. Emotional maltreatment in Ecuador

Table 1 shows that emotional maltreatment was reported by 53 % of the participants. Table 2 indicates that the most common
type of emotional abuse experienced by participants were insults (45.2 %). Most respondents experienced this kind of maltreatment
once or twice (40.2 %) between the ages of 14 and 17 years (45.1 %). Table 3 shows that both same-sex schoolmates and parents are
the most common perpetrators of emotional maltreatment. Around one third of the participants (males = 39.9 %; females = 31.8 %)
justified emotional maltreatment as a reasonable disciplinary method. The majority of respondents (males = 63.5 %; females = 67.5
%) believed that they had experienced “much less” insults/threats than other children.

3.4.1. Gender differences in emotional maltreatment

Table 1 shows that overall there are no gender differences in the prevalence of child emotional maltreatment; however, as can be
seen in Table 2, males and females experienced different forms of emotional abuse. Girls were more likely than boys to be told that
they were not loved (F = 12.5 %; M = 6.4 %; OR = 2.10; CI = 1.63–2.71) or that they were not wished to be born (F = 8.4 %;
M = 3.8 %; OR = 2.35; CI = 1.72–3.24). Males were more likely than females to have received death threats or threats of injury
(males = 21.5 %; females = 12.5 %; OR = 0.52; CI = 0.43–0.63). In terms of participants’ perception of emotional maltreatment,
our findings indicate that males (39.9 %) more often than females (31.8 %) believed that the emotional maltreatment was a rea-
sonable and justifiable disciplinarian method (χ2 = 23, df = 3, p < 0.001, Phi = 0.41, SR = 4.6). More females (67.5 %) than males
(63.5 %) reported that they had experienced “much less” emotional maltreatment compared to other children (χ2 = 15.4, df = 4,
p < 0.01, Phi = 0.34, SR = 2.3). Table 3 shows that while males mentioned schoolboys (43.3 %) as the most frequent emotional
maltreatment perpetrators, females mentioned their mothers (31.5 %), schoolgirls (31.9 %) and their fathers (23.5 %).

3.5. Sexual abuse in Ecuador

Table 1 shows that child sexual abuse was reported by 15.5 % of participants. The most common types of sexual abuse reported by
participants (Table 2) included: having been coerced into touching another person’s genitals (9.1 %), having had someone expose
their genitals to them (9.1 %); or having had their own genitals touched by another person (5.2 %). Most respondents experienced
these kinds of maltreatment once or twice (touching other = 58 %; exposed = 65.3 %; being touched = 53.4 %) between the ages of
5 and 9 years (touching other = 48.2 %; exposed = 46.6 %; being touched = 43.2 %). Sexual abuse which included intercourse was
reported by 2.8 % of participants and had most frequently occurred once or twice (53.4 %) when they were between 5 and 9 years old

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Table 3
Context of Maltreatment: Most Common Perpetrators.
Type of Abuse Sex of the Child Context/ Perpetrators

Family Members School Community

Parents Siblings Teachers Peers

Physical Male Father (49.6%) Older brother (9.4%) Male professor (9.9%) Boy from school (20.2%) Young male stranger (9.0%)
n = 798 Mother (45.6%) Same age sister or younger (4.0%) Female professor (7.6%) Boy from neighborhood (7.9%) Older male stranger 7.3%)
Other relatives (4.0%) Same age brother or younger (7.5%)
Female Mother (63.8) Older brother (7.3%) Female professor (6.1%) Girl from school (4.2%) Boyfriend or ex-boyfriend (8.4%)
n = 694 Father (44.1%) Same age sister or younger (6.1%) Male professor (1.7%)
Other relatives (4.5%)
Emotional Male Father (19.8%) Older brother (7.1%) Male professor (12.0%) Boy from school (43.4%) Older male stranger (13.4%)

6
n = 835 Mother (19.5%) Same age brother or younger (5.1%) Female professor (8.5%) Boy from neighborhood (16.6%) Young male stranger (16.2%)
Male relatives (7.9%) Girl from school (9.0%)
Female Mother (31.5%) Older sister (11.0%) Female professor (13.8%) Girl from school (31.9%) Boyfriend or ex-boyfriend (7.1%)
n = 817 Father (23.5%) Same age sister or younger (10.0%) Male professor (4.0%) Boy from school (15.9%) Girl from neighborhood (5.9%)
Female relatives (12.7%) Older brother (9.3%)
Same age brother or younger (8.8%)
Sexual Male Male relatives (10.3%) Female cousin (15.3%) Male cousin (7.4%) Female professor (3.0%) Girl from neighborhood (20.7%) Girlfriend or ex-girlfriend (25.6%)
n = 203 Female relatives (8.9%) Girl from school (16.7%) Young female stranger (12.8%)
Female family friend (6.9%) Boy from school (7.4%) Older female stranger (8.4%)
Boy from neighborhood (7.4%) Older female from neighborhood (7.9%)
Female Male relatives (29.6%) Male cousin (14.1%) Boy from neighborhood (9.0%) Male stranger (19.9%)
n = 277 Male family friend (9.7%) Older brother (5.1%) Boy from school (4.7%) Male from neighborhood (11.9%)
Female relatives (5.7%) Boyfriend or ex-boyfriend (7.9%)
Father (4.7%)
Child Abuse & Neglect 99 (2020) 104230
M. Jiménez-Borja, et al. Child Abuse & Neglect 99 (2020) 104230

Table 4
Percentage of Participants Who Disclose Their Sexual Abuse Experiences and Context.
Children Who Disclose * M% F% Phi
n = 42 n = 90
32.1 45.0 0.27

Most Common Confidants

Mother *** 14.0 39.6 0.59
Female friend(s) 32.6 40.7
Male friend(s) * 39.5 20.9 0.41
Time Passed Before First Told
Within one day 13.9 11.2
After a few days 3.9 5.6
After a few weeks 8.3 2.2
After a few months 11.1 13.5
After a year or two 5.6 12.4
Three or more years later 47.2 55.1

*** p < 0.001.

* p < 0.05.

(40.9 %). Table 4 shows that the majority of participants had never disclosed their sexual abuse experiences (males = 67.9 %;
females = 55 %), and that close to half of those who did, did so three or more years later (males = 47.2 %; females = 55.1 %).
Table 5 shows that most children were believed and supported (males = 61.5 %; females = 78.7 %) after they disclosed the sexual
abuse experience.

3.5.1. Gender differences in sexual abuse

Table 1 shows that girls (18.1 %) are more at risk than boys (12.9 %) of experiencing sexual abuse (OR = 1.49; CI = 1.22–1.81),
and are more vulnerable to certain kinds of sexual abuse experiences (Table 2) such as being coerced into touching another person’s
genitals (males = 5.8 %; females = 12.5 %; OR = 2.33; CI = 1.80–3.04). Table 3 indicates that most of the sexual abuse experienced
by girls was perpetrated by males whereas most of the sexual abuse towards boys came from females. Table 4 shows that more girls
(45 %) than boys (32.1 %) disclosed their sexual abuse experiences (p < 0.05, Phi = 0.27). Additionally, more girls (39.6 %) than
boys (14 %) disclosed these experiences to their mothers (p < 0.001, Phi = 0.59). While both boys and girls confided in their female
friends (males = 32.6 %; females = 40.7 %), more boys than girls confided in their male friends (males = 39.5 %; females = 20.9 %,
p < 0.05, Phi = 0.41). Table 5 shows that more girls (78.7 %) than boys (61.5 %) who disclosed their sexual abuse experiences
received support or were believed (χ2 = 9.0, df = 3, p < 0.05, Phi = 0.26, SD = 2.01).

4. Discussion

The present study is a first effort to accrue data about child maltreatment using the ICAST-R in Ecuador. This is also the first study
to apply the ICAST in a South American country. We first sought to compare our findings with international global reports. However,
comparisons of this kind must be interpreted with caution since global comprehensive estimates are based on studies that use a
variety of definitions for maltreatment and heterogeneous methodologies for data collection. With this in mind, we compared our
findings with global estimates (K = 244) of child maltreatment (Stoltenborgh et al., 2015). Our Ecuadorian sample reported: a)
higher rates of physical (47.6 % vs. 22.6 %) and emotional (53 % vs. 36.3 %) maltreatment; b) similar rates of sexual abuse in girls
(18 %); and c) higher rates of sexual abuse in boys (12.9 % vs. 7.8 %). When comparing our findings with estimates of child
maltreatment in Central American countries (k = 8; Stoltenborgh´s et al., 2015), we found lower rates of physical maltreatment (47.6
% vs. 54.8 %), higher rates of sexual abuse in females (18 % vs. 13 %), and similar rates of sexual abuse in males (12 % vs. 13 %).
When comparing our findings with national reports estimating the prevalence of the use of physical punishment on Ecuadorian
children (Observatorio Social del Ecuador, 2016, 2018), we found higher rates of physical maltreatment (47.6 % vs. 38 %). We also
found higher rates of child sexual abuse in our female participants (18 % vs. 10 %) than those reported in the 2011 national census
survey (Instituto Nacional de Estadística y Censos INEC, 2011)—this report was based on girls under the age of fifteen whereas our

Table 5
Reaction of the Confidant to Children’s Disclosure of Sexual Abuse Experiences.
M% F% SR
n = 42 n = 90

Believed me and supported me 61.5 78.7 2.01*

Believed me, but did not care 25.6 13.5 1.67
Blamed me for causing it 0.0 4.5 1.34
Did not believe me at all 12.8 3.4 2.03*

* χ2 = 9.0, df = 3, Phi = 0.26; p < 0.05.

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M. Jiménez-Borja, et al. Child Abuse & Neglect 99 (2020) 104230

study was based on cases of girls under the age of eighteen.

Using a standardized tool such as the ICAST should eventually offer the possibility of cross-country comparisons. However, at the
moment this kind of comparison would not yield significant conclusions. To begin with, there are only three additional studies which
have employed the ICAST-R in different countries (i.e. South Korea, Sri Lanka and Turkey). These studies all have limited samples and
require further validation regarding the prevalence of child maltreatment. Lee and Kim’s (2011) study in South Korea used a sample
of 539 participants between the ages of 18 and 24 from university, work and clinical settings. Chandraratne et al. (2018), on the other
hand, employed a sample of 200 participants from Sri Lanka between the ages of 18 and 20. Finally, Simsek et al. (2017) study in
Turkey employed a sample of 173 first year medical students between the ages of 18 and 24. While the present study employed a
larger sample size of 3133 participants, this sample is limited to university students in the country´s capital, and thus does not take
into account significant regional, socio-economic and ethnic differences. As such, at this point, any comparison would be of limited
value. Additionally, as argued previously, comparisons with studies using other versions of the ICAST should also be approached with
caution since each ICAST calls for the use of different samples.
Our study analyzes gender specific patterns of maltreatment within our sample. The results suggest that boys are more at risk than
girls for physical maltreatment and girls are more at risk than boys for sexual abuse. While we did not find gender differences in
overall emotional maltreatment, we did find gender-specific types of emotional abuse (e.g., females are more likely to be told that
they are not loved or that they are not wished to be born; males are more likely to be threatened with being hurt or killed). When
examining the context of child maltreatment, our findings point to parents as primary perpetrators of physical and emotional
maltreatment.
The most common sexual abuse perpetrators are relatives or people acquainted with the child. In the case of girls, the most
common perpetrators were males—a finding that is consistent with previous studies in Ecuador (Consejo Nacional para la Igualdad de
Género, 2014). In patriarchal societies—like Ecuador—males are associated with sexual assertiveness and aggression while females
are associated with more passive, receptive roles during sexual encounters. Indeed, gender stereotypes sexualizing girls’ bodies and
reasserting ideas about a passive female sexuality susceptible to coercion are pervasive in Ecuador’s media, educational system, and
societal discourse (Consejo de Regulación y Desarrollo de la Información y Comunicación, 2017; Freire & Castillo, 2016). More
concerning, female sexuality and attractiveness tends to be associated with childlike features and behaviors. These stereotypes can
reinforce and perpetuate sexual abuse against girls by adult males (OHCHR Commissioned Report, 2013).
On the other hand, most sexually abused male participants mentioned females as perpetrators of sexual abuse. This is particularly
interesting because studies focusing on female perpetrators of child sexual abuse are scarce and little is known regarding this kind of
perpetrator in comparison to male child sex offenders (Tozdan, Briken, & Dekker, 2019). Most likely this is because gender role
stereotypes do not tend to associate females with child sexual abuse. The belief that females do not actively seek sexual experiences
but are rather receptors of these desires, along with the idea that men are not only active seekers of sexual experiences but remain in
control during these encounters may make it difficult to understand and name these sexual abuse experiences as abuse. Indeed, these
stereotypes tend to reinforce the belief that it is always men who can and should take the initiative during a sexual encounter and
reinforce the belief that sexual activities, such as penetration, are representative of sexual control and power (Frey, 2006). Indeed,
Frey (2006) points out that there are still no clear operational definitions of what constitutes abuse when it comes to female per-
petrators. Frey’s (2006) review of studies that have investigated young females’ sexual abuse of boys, led the author to conclude that
in order to understand this issue, it is necessary to focus on power and developmental differences (e.g., consider a 13-year-old female
with a 10-year-old boy) rather than on aggression or penetration. This may be a useful path forward for studies analyzing female
perpetrators of sexual abuse in Ecuador.
The result of these stereotypes regarding female perpetrators of sexual abuse has been that the general public, professionals, the
justice system and even researchers downplay or ignore the possibility that females may be potential sexual abuse perpetrators
(Bumby & Bumby, 2004; Frey, 2006; Gannon, Rose, & Cortoni, 2010; McLeod, 2015; Tozdan et al., 2019). Indeed, there are no studies
conducted into female perpetrators of sexual abuse in Ecuador and very few international studies on the subject. As such, these events
may go under-reported in study findings and their impact may be minimized or neglected due to gender assumptions and stereotypes
held by researchers (Bumby & Bumby, 2004; Bunting, 2007; Clements, Dawson, & das Nair, 2014; Frey, 2006; Gannon et al., 2010;
Mellor & Deering, 2010; Tozdan et al., 2019). Rather than an anomaly, female perpetrators of child sexual abuse may constitute a
common phenomenon within larger patterns of abuse. Both Tozdan et al. (2019) and Frey’s (2006) studies reviewing the subject of
female perpetrators of sexual abuse, found few differences between male and female perpetrators.
Altogether, our findings suggest that boys and girls differ in their risk for specific types of child maltreatment. As has been largely
discussed by researchers in the field of child maltreatment (Iruka, Durden, & Kennel, 2015; National Academies of Sciences,
Engineering, & Medicine, 2016; National Research Council U.S., 1993), gender-specific patterns of child abuse are likely related to
differences in child protection programs, cultural differences related to how children’s rights are understood and differential social
importance given to boys and girls, along with differences in parenting beliefs and practices, and in the childcare roles assigned to
parents and community leaders. Indeed, accruing data that studies the gender-specific vulnerabilities of children in Ecuador may
provide policy makers and project developers with valuable and necessary information to create gender-appropriate prevention,
education and intervention programs.
We found that many participants consider that their physical and emotional maltreatment experiences were reasonable and
justifiable disciplinarian methods. This suggests the need for more studies that focus on child’s perceptions of maltreatment in order
to understand the impact of these experiences. Indeed, research has shown that the relationship between child maltreatment and
mental health is mediated by the child’s perceptions of maltreatment, which in turn depends on the duration and intensity of abuse as
well as on the cultural normalization of harsh discipline (Liu & Wang, 2018; Xing, Wang, Zhang, He, & Zhang, 2011). Our

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participants’ perception of maltreatment as justifiable disciplinarian methods makes evident a significant cultural barrier to breaking
the cycle of intergenerational violence (Thornberry et al., 2013). Additionally, these results suggest an important cultural component
in the normalization of child maltreatment in Ecuadorian culture. While the child rights movement has made considerable strides in
the past few decades and the country`s current Constitution (2008) and legislation now recognizes children as full citizens (Código de
la Niñez y Adolescencia, 2003; Consejo Nacional de la Niñez y Adolescencia, 2004), cultural norms have changed at a much slower
pace. Indeed, children are still largely understood as “belonging” to their parents and physical punishment continues to be a nor-
malized form of disciplining and teaching children (Observatorio Social del Ecuador, 2016). Many parents believe that physical
punishment is not a form of violence as long as it is managed and employed as a means of teaching the child a lesson. Additionally,
there are gender differences in the ways in which parents use physical punishment, with harsher forms used against boys than against
girls. This may help explain the high prevalence of physical maltreatment in our study, along with the gender specific vulnerability of
boys to this kind of maltreatment. As such, future preventive educational programs may need to focus on changing perceptions
regarding the rights and status of children within society as well as de-normalizing the employment of harsh disciplinarian methods
on children.
Our results suggest that many children never disclose their sexual abuse experiences. This is consistent with other studies (e.g.,
Goodman-Brown, Edelstein, Goodman, Jones, & Gordon, 2003; Scrandis & Watt, 2014). As Clancy (2009) claims, children probably
do not disclose because they may not understand the experience, may believe that they are responsible for the abuse, or may fear the
consequences of their disclosure. Also, we found that boys are less likely than girls to disclose. As discussed previously, females
perpetrated most sexual abuse against boys. Since this finding challenges patriarchal assumptions about gender roles and ideas about
what constitutes abuse, it may not only be difficult to study the problem, but it may also make it hard for victims to process and
disclose the abuse to others. Indeed, the non-consensual aspect and the confusing feelings that emerge in many boys’ sexual ex-
periences with young females have been highlighted in the few studies that have focused on this topic (e.g., Ott, Ghani, McKenzie,
Rosenberger, & Bell, 2012; Wellings et al., 2001). Additionally, boys are constantly taught not to show weakness or vulnerability. As
such, they may find it more challenging to share these experiences. Our study found that mothers are the most common confidants of
sexually abused girls whereas peers are the most common confidants of sexually abused boys. After disclosing their experiences, most
sexually abused children are believed and receive support; however, boys are less likely than girls to be believed and supported. This
finding is significant given that the negative impact of sexual abuse is greatly reduced when the child receives support after the
disclosure process (Clancy, 2009).
Given that disclosure of maltreatment experiences can be challenging, retrospective self-reports, such as the ICAST-R, can be
important and helpful means of studying child maltreatment. Particularly, given that most child maltreatment experiences go un-
reported and data derived from parents’ reports or the judicial system do not deliver the full picture (Stoltenborgh et al., 2015).
Additionally, retrospective tools can provide reliable information about what respondents consider to have been significant life
events (Hardt & Rutter, 2004; Stoltenborgh et al., 2015). Thus, gathering retrospective information directly from those who have
experienced these forms of maltreatment is particularly valuable. However, the ICAST-R does pose limitations to research that should
be taken into account. To begin with, the ICAST-R does not assess retrospective experiences of neglect or of witnessing intra-family
violence (Dunne et al., 2009). Thus, including these types of maltreatment in future versions of the ICAST-R is recommended. This is
particularly important when considering that child neglect and intra-family violence is a crucial social issue in Ecuador (Encuesta
Demográfica y de Salud Materna e Infantil ENDEMAIN: Informe final, 2004). Moreover, it should be noted that in the course of this
study, the language of the ICAST-R Spanish version was refined for better consistency and adapted to employ Ecuadorian termi-
nology. While this study researches the internal consistency of our ICAST-R Spanish version, further efforts to investigate its test-
retest reliability and its predictive validity are necessary. This would help contribute to the growing body of studies aiming to adapt
and study the psychometric properties of the three ICAST tools (Chandraratne et al., 2018; Meinck et al., 2018; Silveira & Grassi-
Oliveira, 2016)
It is important to note that since our participants were recruited from universities in Quito —the country’s capital— the external
validity of the present study is limited. As such, further research is necessary in order to continue validating the present findings.
Relying solely on retrospective data is just one way to study the problem of child maltreatment. Further studies using and/or adapting
the child and parent versions of the ICAST, would provide additional data and enhance the research as a whole while maintaining a
common and comparable methodological tool. Moreover, a more intersectional (Hill-Collins & Bilge, 2016) approach to gender
specific types of child abuse should take into consideration the country’s deep-set socio-economic, regional, and ethnic differences. As
such, additional research exploring the prevalence of child maltreatment amongst different populations in Ecuador is necessary.
Specifically, since child maltreatment is a particularly serious problem in rural areas and amongst indigenous communities, more
studies working with these populations are necessary (Instituto Nacional de Estadística y Censos INEC, 2011; Observatorio Social del
Ecuador, 2016, 2018; Viteri, 2017). It should be noted that applying the Spanish version of the ICAST-R in these populations may
pose a significant challenge given lower levels of literacy rates, and the fact that some communities either do not speak Spanish or
speak it as a second language. Adapting the ICAST-R to these situations may be an important future endeavor in order to accrue more
robust national and international data on the subject. Additionally, a more expansive study applying all three ICAST versions is
recommendable since it would also provide important additional data on diverse samples.

5. Conclusions

Although Ecuador has updated its legal framework and child protection system in order to better prevent child maltreatment and
protect at risk children our findings show that children are still highly vulnerable to physical, emotional and sexual abuse (69.6 %).

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We also found gender-specific differences in the types of maltreatment experienced by boys and girls (boys are more likely to
experience physical maltreatment whereas girls are more likely to experience sexual abuse), as well as in the gender of perpetrators of
sexual abuse (adult males are the most frequent perpetrators of sexual abuse against girls while females are the most frequent
perpetrators of sexual abuse against boys). These findings suggest the need for further research examining gender differences in the
types of and context of maltreatment. Indeed, this may yield more nuanced and specific data into child maltreatment in general. This
may also serve to stress the importance of developing gender-specific interventions and prevention programs that respond to the
particular vulnerabilities of boys and girls within each country. Also, our study emphasizes the importance of continuing to accrue
data on child maltreatment using standardized, valid and consistent instruments such as the ICAST in order to allow for further
national and international comparisons.

Acknowledgment

A Grant from the Universidad San Francisco de Quito, Ecuador, financially supported this study.

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