Online Child Sexual Exploitation and Abuse of Children and Adolescents with Disabilities: A Systematic Review
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors
I hope you find my comments/suggestions on the manuscript helpful.
Comments for author File: 
Comments.pdf
Comments on the Quality of English Language
minor editing needed
Author Response
Dear reviewer,
Thank you for your valuable feedback. All your comments were considered in this new version of the manuscript.
Page 2:
- include references to prevalence studies of sexual abuse of children with disabilities (Klebanov, Friedman-Huaser, Lusky-Weisrose, & Katz, 2023, Sexual abuse of children with disabilities: Key lessons and future directions based on a scoping review. Trauma, Violence, & Abuse)
- Done
- Here you should inform the reader about the type of disability you are studying. (or state that you are including all types of impairments)
- Done: “For this reason, the main objective of this study is to identify the prevalence, nature, and associated risk factors of OCSEA against children and adolescents with disabilities, including all types of impairments.”
- Separate into 2 sentences. Nature includes...
- Done: “Nature encompasses the characteristics and attributes of the abuse or form of OCSEA faced by children and adolescents with disabilities. Nature includes the various types of OCSEA, perpetrators, and the frequency and the consequences OCSEA.”
- Risk factors include the...
- Done: “Risk factors includes the conditions, elements, or situations that elevate the likelihood or susceptibility of children and adolescents with disabilities to undergo OCESA.”
- Risk factors may ....
- Done: “Risk factors may encompass aspects such as social isolation, communication barriers, a lack of awareness regarding sexual boundaries, and dependence on others for care and support.”
Page 3:
- not referring to OCSEA.
- Done
Page 4:
- parental monitoring and supervision are not risk factors. they are protective factors. So perhaps add "absence of" or "lack of" or "limited" before these variables.
Page 5:
- are included in Table 2.
- I see some populations where disability is not mentioned. Why?
- Revised:
- Children and adolescents with intellectual disabilities
- 15,278 children and adolescents between 11- and 17-years including disability
- Adult victim with disability of online grooming when she was a child
- Children and adolescents with Autism and Williams Syndrome
- Children and adolescents with disabilities
- Children and adolescents (boys) with physical disabilities that experienced child sexual exploitation
- Children and adolescent victims of image-based sexual abuse
- Children and adolescents with disabilities
- 20 abusers and 65 victims of OCSEA Children and adolescents with and without disabilities
- 512 youth and adolescents with disability receiving mental health services
- Children and adolescents with disabilities
- Children and adolescents with disabilities
- Children and adolescents with disabilities
- include type of disability for all studies. e.g., Moss et al, what disability did the boys have?
- Revised:
This information is included only in the studies that provided disaggregated information, not all the studies contemplated this information.
Page 6:
- only mental health challenges? Yet you say "Across the studies" which involved more than "mental health" challenges. Furthermore, this sentence should be moved to the Discussion section.
- Done, moved to discussion. “The statistical analysis from one of the studies also [15] establishes the need for targeted interventions to protect children and adolescents with mental health challenges from OCSEA.”
- did not disaggregate their sample by gender,
- without intellectual disabilities
Page 7:
- survivors of ?? (clarify what did they survive?) What type of OCSEA did they experience?
- Changed: “survivors of image-based sexual abuse”
- this paragraph seems to fit better in Perpetrators' techniques.
- Moved to Perpetrators' techniques.
- Who was providing gifts? Gifts for what?
- Changed, the perpetrator to the victim. // providing gifts to victims in exchange to OCSEA
- Please describe gender of perpetrators, not victims. Are these male perpetrators?
- Moved the following paragraph to victim gender. “The findings from a study focused on 20 perpetrators of OCSEA [4] reveal that all identified victims were male, with no instances of female victims. From this sample, heterosexual individuals accounted for 45% of victims, while 55% identified as homosexual [4].”
- Delete this sentence as you say the same thing in lines 270-273.
- Deleted
- And were there differences based on type of disability? That's the focus of your paper
- Yes, paragraph inserted.” Victims with ASD [15, 24, 25] have encountered various challenges, as evidenced by the identified online victimization experiences within OCSEA. In the context of ASD and 22q11 deletion syndrome [24], the reported occurrences encompassed cyber-threats, cyber-harassment, and grooming [23]. Victims with Williams Syndrome [15], on the other hand, faced circumstances involving providing gifts [19]. Furthermore, those with Williams Syndrome and ASD [24] shared experiences of perpetrators providing them gifts for OCSEA [19], and also encountered cyber-threats, cyber-harassment, and grooming, akin to the occurrences reported by individuals with 22q11 deletion syndrome [24] and intellectual disabilities [18].
- Perhaps start with "In terms of relationship to victim, perpetrators include...
- Done
Page 8:
- cyber-stalking
- what do you mean "first study" and why do you describe this study individually?
- “Another study”, changed.
- this finding may fit better in techniques (with and without contact abuse), it is not relevant to duration/frequency. In addition, this study involved children with intellectual disabilities. You cannot generalize to all disabilities.
- Included: “Instances of coercion were noted within the category of individuals with intellectual disabilities [25], further underscored by reported encounters with cyber-threats, cyber-harassment, and grooming experiences associated with 22q11 deletion syndrome [24]. Notably, individuals with chronic health problems [23] and those with deafness [16] reported occurrences of cyber-threats, emphasizing the diverse nature of online victimization experiences.”
- not appropriate for Results
- Deleted this part.
- too vague. Did [4] find this to be true? this statement is true for all children, not only those with disabilities
- “The awareness and active supervision provided by caregivers and parents serve as essential protective measures [24]. However, it is crucial to acknowledge that parental awareness of their children and adolescents' online relationships may be lacking in some instances and could expose children and adolescents to online risk [4], which is more important when it refers to disability as they may face challenges to understand what is happening [27].”
- Consider putting Consequences in a separate topic, as it does not fit as a Risk Factor. In addition, be clear on whether these "outcomes" could be preexisting factors.
- Title changed to: Consequences experienced by the victims of OCESA.
- These most likely are preexisting characteristics. Perhaps this section should be labeled Child and Family vulnerabilities?
- Title changed to: Vulnerabilities of the victims.
Page 9:
- These are important vulnerabilities within the children. Please provide further explanation (e.g., deaf children unable to disclose; children with intellectual disabilities unable to recognize the activity as abuse/unable to consent). But of course, no child is able to consent to sexual activities with an adult.
- Might mention that Wissink et al. (2015) found that children with intellectual disabilities did not always realize they were being abused. Wissink, I. B., Van Vugt, E., Moonen, X., Stams, G. J. J., & Hendriks, J. (2015). Sexual abuse involving children with an intellectual disability (ID): A narrative review. Research in Developmental Disabilities, 36, 20–35.
- Added: From these studies, we examined characteristics of victims and perpetrators. From these, a study about sexual abuse involving children and adolescents evidenced that those children with intellectual disabilities did not always realize they were being abused when experiencing sexual abuse [28].
- Parents of children with disabilities in one study testified that, in their opinion, they lacked the knowledge of how to talk to their children about CSA prevention, and more than 40% thought their children were too young to talk to about this topic (Guo et al., 2019). Guo, S., Chen, J., Yu, B., Jiang, Y., Song, Y., & Jin, Y. (2019). Knowledge, attitude and practice of child sexual abuse prevention among parents of children with hearing loss: A pilot study in Beijing and Hebei Province, China. Journal of Child Sexual Abuse, 28(7), 781–798.
- Added: In the same vein, parents of children and adolescents with disabilities in one study testified that, in their opinion, they lacked the knowledge of how to talk to their children and adolescents about CSA prevention, and more than 40% thought their children and adolescents were too young to talk to about this issue [29].
- Insert a sentence here--e.g., Thirteen studies met inclusion and exclusion criteria. From these studies, we examined characteristics of victims and perpetrators, etc.
- “Thirteen studies were included in this systematic review revealed information about the prevalence of OCSEA against children and adolescents with disabilities. From these studies, we examined characteristics of victims and perpetrators.”
- This paragraph is true for all children; not only those with disabilities. Perhaps you could refer to the literature on school-based/cyber-based prevention programs for youth with disabilities.
- “Also, within the broader context of online safety for children and adolescents with disabilities, future research should investigate the educational aspect of consent, as ensuring that minors possess a nuanced comprehension of consent in the digital realm constitutes a fundamental facet of safeguarding their well-being. This entails education on establishing boundaries, discerning inappropriate behaviors, and comprehending the implications of sharing personal information online. A comprehensive approach to online safety in a more simplified way so as children and adolescents could understand this issue. Furthermore, future research should investigate the understanding of consent in children and adolescents with disabilities so as they can develop skills to navigate the digital landscape with responsibly and confidently.”
Page 10:
Again, a statement true for all children. Throughout the paper, be sure to tailor your comments to your identified population. And acknowledge the many limitations (so few studies). Be more tentative in your conclusions.
Changes Included :
In conclusion, the findings underscore some of the consequences associated with OCSEA against children and adolescents with disabilities, emphasizing the need for comprehensive support and intervention measures for prevention due to their vulnerabilities. It also underscores the need to include disaggregated data in scientific research that helps tackling OCSEA against children and adolescents with disabilities, as currently there is lack of evidence related to this issue.
Additionally, this research retrieves evidence that unveil that social isolation and loneliness are some of the potential risks of victimization for children and adolescents with disabilities. Thus, aproactive approach is needed to address these critical factors. This research highlights the vulnerabilities, underscoring the importance of taking a targeted and tailored approach when addressing OCSEA to ensure the protection and well-being of this particularly vulnerable group.
This research also emphasizes the need for multifaceted interventions that address not only the explicit risks associated with online victimization but also the consequences and vulnerabilities that shape the experiences of victims with disabilities. Policymakers, educators, and support organizations should collaborate to implement targeted strategies that enhance parental awareness, provide comprehensive mental health support, and address the broader societal attitudes contributing to the vulnerability of children and adolescents, particularly those with disabilities, in online spaces.
- replace Title with Authors
- Done (page 11).
Extra: All the sentences the reviewer proposed to delete were withdrawn from the manuscript.
We have also made more changes across the manuscript.
Thank you again for your time and effort.
Author Response File: Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for Authors
I was impressed with this article and believe it will be a substantive contribution to the field.
I believe two edits are needed.
The first on line 322, the issue of "cultural contexts" is not clear and should be expanded.
Second, on line 344, the term groomers (and throughout) should be made clearer and more defined so that the reader understands the difference between sexual predator and groomers.
Author Response
Dear reviewer,
Thank you for your valuable feedback. These are the changes:
“The first on line 322, the issue of "cultural contexts" is not clear and should be expanded.”
- Changes: Within diverse contexts, as it was mentioned in one of the studies [22], it can be a challenging issue to rather identify a behavior as CSEA or not, and these differing attitudes may pose challenges to carry on an effective intervention.
“Second, on line 344, the term groomers (and throughout) should be made clearer and more defined so that the reader understands the difference between sexual predator and groomers.”
- Changes: Grooming is a prevalent tactic employed by offenders that involves inherently harming children through OCSEA, this technique was found to be utilized before being detected [4, 17].
We have also made more changes across the manuscript.
Thank you again for your time and effort.
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for Authors
This is generally a very good manuscript (MS) and it features an extremely important topic and one about which there is a dearth of date, so the authors are to be commended for promoting and critically analysing the research that has been carried out.
That said, I do have some concerns with the MS. Examples of these are illustrated and detailed in the document I am returning. In summary, these are:
1. The MS must be fully proofread. It contains some basic errors, but there are also places where the authors have not been sufficiently clear or specific. There are also grammatical errors in the MS.
2. I think the authors over claim on the basis of their work. In short, the evidence base is poor - if not very poor. They need to exercise much more caution in their Discussion and Conclusions. They could/should perhaps say less of a substantial nature regarding the abuse of child with disabilities, and more about just how poor the research base is and more precisely how this should be remedied.
3. I believe that much of the work the authors cite involves correlational type studies. If this is the case, then they should be especially careful about implying that one variable (e.g. vulnerability) leads/causes another (i.e. abuse)
Comments for author File: Comments.pdf
Comments on the Quality of English Language
See above
Author Response
Dear reviewer,
Thank you for your valuable feedback. These are the changes:
Line 10-11: “Online Child Sexual Exploitation and Abuse” – I think all of these words should be lower case - this is not a proper name.
- Change: Updated.
Line 11-13: “Despite the escalating prevalence of OCSEA, there is limited research specifically focusing on children with disabilities, as they may have more challenges in understanding what consent is.” This should be: “Despite the escalating prevalence of OCSEA, there is limited research specifically focusing on how this issue affects children with disabilities. Moreover, this issue may be especially challenging for this group of children as they may have more difficulties in understanding what consent is”.
- Change: Updated.
Line 19: “boys exhibiting higher risk”. Shouldn’t this be: “boys being more at risk”
- Change: Updated.
Line 20: “resulting in consequences such as mental health issues and social isolation” – for whom? I guess the authors mean children but this should be made explicit and not be left as implied.
- Change: “of victims”, updated.
Line 29-30: “Violence against children is a global problem which represents a pressing concern for both health and development, manifesting in various ways such as physical, sexual, or emotional violence, as well as neglect”. Should be: “Violence against children is a global problem that represents a pressing concern for both their health and their development. Such violence is manifest in various ways such as physical, sexual, or emotional violence, as well as neglect”.
- Change: Updated.
Line 109-113 – It is not clear what is being said in the following text and specifically how the search terms were chosen: “The initial phase of this study involved a rigorous process for developing appropriate search terms. This selection was tailored to the specific criteria of each designated database, ensuring alignment with their unique specifications. The procedure encompassed a deliberate choice of keywords and phrases, emphasizing precision and relevance to facilitate the retrieval of all the existing information pertinent to the research objective.”
- Change: “The initial phase of this study search terms and keywords were defined to conduct the searches in the different databases, considering the specific criteria of each database to adjust the search formulas (See Table 1). This procedure facilitated the retrieval of all the existing information pertinent to the research objective. Following the selection of search terms, the subsequent step entailed the execution of searches within each chosen database. This phase adhered closely to the distinctive parameters and search functionalities inherent to each database, recognizing the importance of optimizing the effectiveness of the retrieving process. The search terms were also translated into Spanish in the case of the databases Latindex and SciELO for more accuracy (See Appendix 1).”
Line 119-120: “Also, the search terms were also translated into Spanish in the case of the databases Latindex and SciELO for more accuracy.” – two uses of the same major word - ‘also’ - in the same sentence – this should be avoided in written work.
- Change: “The search terms were also translated into Spanish in the case of the databases Latindex and SciELO for accuracy.”
Same issue in line 59-60: “Thus, this research contributing to the advancement of knowledge in this area can contribute to overcome OCSEA”
- Change: “Thus, this research aims to identify the main factors that encompass the prevalence, nature, and associated risk factors of OCSEA”.
Table 1: This table includes mention of “adolescents”, yet all of the preceding text refers only to “children”. In the interests of consistency and clarity, the manuscript
(MS) should refer to children and adolescents throughout, with these terms defined in terms of discrete age ranges. (Different readers will employ different understandings of the terms ‘child’ and ‘adolescent’, hence the need for clarity on this issue in this MS.
- Change: Thank you for this comment. We have now provided the information about the population that was mentioned in the studies. As some of the studies do not mention the age range included, this information cannot be added.
Line 180-182: The following sentence is not grammatically correct and the point being made is not entirely clear: “It is a tool proposed for the judgment on the risk of bias within each domain can be categorized as 'Low' or 'High' RoB [14] (See Appendix 1)”
- Change: “The studies can be rated as either 'Low' or 'High' depending on the criteria established by the ROB2”
Line 193-194: “The body of evidence of the reviewed studies for prevalence estimates is scarce to understand the dimension of this global problem” - Same issue as above.
- Change: “The available evidence from the studies reviewed to estimate prevalence was limited as the review only included 13 studies.”
Line 209-212: “This statistical analysis establishes a significant positive association between age and online risk, reinforcing the need for targeted interventions to protect children and adolescents with mental health challenges from OCSEA.” – This sentence appears to make two points that do not seem to relate to one another, although this is implied. One point is about the age of children, the other is about children and adolescents in general being at risk.
- Change: New sentence – “The statistical analysis from one of the studies [15] also establishes the need for targeted interventions to protect children and adolescents with mental health challenges from OCSEA”.
Line 317-319: “Family circumstances, encompassing financial strain, dysfunction, and parental substance misuse, significantly contribute to this heightened susceptibility [19].” The preceding sentence – and others like it – imply that these vulnerabilities cause, in some way, the abuse. I assume, however, that the studies in question present only correlations. If this is the case, then such cause and effect statements should not be made. One can only say that two variables are related, associated etc.
- Change: A study suggests that family circumstances, encompassing financial strain, dysfunction, and parental substance misuse, could contribute to this heightened susceptibility [19].
More caution should be exercised in the statements made in this MS, and not least in the Conclusions. This is because the whole MS is based on only 13 studies, and even these studies were quite diverse and of varying quality i.e. the evidence base is poor.
- Change: Rewriting of the conclusions done.
In conclusion, the findings underscore* some of the* consequences associated with OCSEA *against children and adolescents with disabilities*, emphasizing the need for comprehensive support and intervention measures *for prevention due to their vulnerabilities. It also underscores* the need to include disaggregated data in scientific research that helps tackling OCSEA against *children and adolescents with disabilities, as currently there is lack of evidence related to this issue.*
Additionally, this research *retrieves evidence that unveil that social isolation and loneliness are some of the potential risks of* victimization for *children and adolescents with disabilities. Thus, a proactive approach is needed* to address these critical factors. This research highlights the vulnerabilities, underscoring the importance of taking a targeted and tailored approach when addressing OCSEA to ensure the protection and well-being of this particularly vulnerable group.
*This research also emphasizes* the need for multifaceted interventions that address not only the explicit risks associated with online victimization but also *the* consequences and vulnerabilities that shape the experiences of victims *with disabilities.* Policymakers, educators, and support organizations should collaborate to implement targeted strategies that enhance parental awareness, provide comprehensive mental health support, and address the broader societal attitudes contributing to the vulnerability of *children and adolescents**, particularly those with disabilities, in online spaces.
We have also made more changes across the manuscript.
Thank you again for your time and effort.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Comments and Suggestions for Authors
Your manuscript is much improved. However, the Discussion section requires a major revision. Be sure to present all findings in the Results (not Discussion), and to have each paragraph expand upon the first sentence. As before, I have made extensive notes/suggestions on the manuscript itself.
Comments for author File: Comments.pdf
Comments on the Quality of English Language
Author Response
Dear reviewer,
Thank you very much for your comments and for your time to give us feedback. In this new version we have revised the manuscript again to improve the language and comprehensibility of the manuscript. With your feedback along with the comments of other reviewers, we have worked hard to improve the introduction, discussion and conclusions. Please, find attached the new version of the manuscript and you can see the document with the answered comments in the following link:
https://drive.google.com/file/d/1Ajw1A5MPt-m1pWXHgfoCh6iDH_3yCjzj/view?usp=sharing
Best regards.
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for Authors
This is a review manuscript that focuses upon a very important topic - the online abuse of children and adolescents with disabilities. There is only a very modest amount of research on this topic so this review - which could serve to highlight such research - is to be welcomed. As the authors correctly point out, the literature is limited and they rightly then do not make excess claims for their manuscript. That said, I do think they could cite more statistics from the research in question to make their arguments more robust. It feels at times as if the authors just glide over the work in question.
I have made extensive and detailed comments on the copy of the manuscript I am returning. My main - and major - concern is with the quality of writing and more general presentation. There is no single massive problem but rather very many minor issues, which, when added together, represent a major problem in this manuscript. These issues include a lack of clarity and specificity, and in other places incorrect grammar. As I suggest, these issues - many of which could have been removed through a proper proofread, undermine the quality of the manuscript while at the same time making it difficult to judge its overall merit. I think I made similar comments in my earlier review.
Comments for author File: Comments.pdf
Comments on the Quality of English Language
See above. The quality of the written English needs to be improved.
Author Response
Dear reviewer,
Thank you very much for your comments and for your time to give us feedback. In this new version we have revised the manuscript again to improve the language and comprehensibility of the manuscript. With your feedback along with the comments of other reviewers, we have worked hard to improve the introduction, discussion and conclusions. Please, find attached the new version of the manuscript and you can see the document with the answered comments in the following link:
https://drive.google.com/file/d/1g_aM5RrjLmCFWXSfYymSGi8rq8Ta90sh/view?usp=sharing
Best regards.
Author Response File: Author Response.pdf
Round 3
Reviewer 1 Report
Comments and Suggestions for Authors
thank you for incorporating reviewers' suggestions
Comments on the Quality of English Language
Acceptable
