Childhood sexual abuse between ages 9 to 15 and having a childhood diagnosis of ADHD might be linked to later involvement in sex work, according to preliminary research published in the Journal of Child & Adolescent Trauma. The findings suggest that targeted interventions addressing these risk factors and promoting education and access to medication may help support young women at risk of engaging in sex work.
Sex work is a complex and stigmatized issue. Sex workers face numerous health inequities and adverse outcomes, including high rates of sexual trauma and victimization. Conducting rigorous longitudinal research with sex workers is challenging due to the criminalization and stigma associated with their occupation. As a result, most studies on this topic are cross-sectional and limited to specific subgroups of sex workers.
“The criminalization of sex work in the United States, as well as its associated stigmatization, contributes to the difficulty of conducting rigorous longitudinal research with this population, as sex workers may be hesitant to speak openly about their experiences or consent to being tracked for follow-up for fear of incarceration,” the authors of the new study explained.
To explore the risk factors associated with later engagement in sex work among young women, the researchers analyzed data from an ongoing prospective study that initially involved 228 participants. The original study was not designed specifically to investigate sex work, but it included a measure that assessed whether the participants had engaged in sex for payment.
These participants were girls with ADHD, diagnosed during childhood, and a comparison group of girls without ADHD. The data collection started when the participants were between 6 to 12 years old, and they were followed through different stages of life into adulthood.
Data were collected at multiple points in time using various methods, including parent-reported questionnaires, diagnostic assessments, and self-reports from the participants. They specifically looked at childhood sexual abuse data collected during childhood and adolescence and ADHD diagnostic status and symptoms across development.
In addition to CSA and ADHD, the researchers included other risk factors and covariates that were identified from existing literature and found to be significantly different between those who engaged in sex work and those who did not. These factors included age of the biological mother at birth, family structure, age of pubertal development, educational attainment, and age of first sexual intercourse, among others.
Among the 228 participants, seven women disclosed involvement in sex work by early adulthood. All seven of these sex workers had received a childhood diagnosis of ADHD-C (combined presentation of ADHD). In ADHD-C, individuals exhibit both symptoms of inattention and hyperactivity/impulsivity. These symptoms can manifest in various ways, such as being easily distracted, having difficulty sustaining attention, being forgetful, being unable to sit still, and acting impulsively without thinking about the consequences.
The researchers also found that CSA predicted involvement in sex work when considered by itself, but this effect was reduced and became non-significant when adjusting for other key risk factors. However, when examining the developmental timing, CSA occurring between ages 9 to 15 independently and significantly predicted engagement in sex work in adulthood, even after adjusting for other risk factors.
Furthermore, the study showed that a childhood diagnosis of ADHD-C significantly predicted later involvement in sex work. The use of ADHD-related medication and higher educational attainment were found to be protective factors against sex work.
But the study has a few important limitations. The number of participants engaged in sex work was very small, so the findings cannot be considered as representative of all sex workers or women with ADHD. More research with larger groups is needed to confirm the results. Due to the small sample size, the study could not explore the specific mechanisms that might explain the relationship between CSA and sex work, such as risky sexual behaviors.
“Limitations notwithstanding, we suggest that the developmental timing of CSA is crucial to consider with respect to sex work and other behavioral outcomes,” the researchers concluded. “Early impulsivity, as exemplified by a childhood diagnosis of ADHD-C, may be an additional factor of relevance, although replication studies are necessary to confirm this link. Given the health risks of engaging in sex work and cascading developmental outcomes associated with ADHD, further prospective research in this area is critically needed.”
The study, “An Exploratory Investigation of Childhood Sexual Abuse and Other Theory‑Driven Predictors of Sex Work Among Women with and without Childhood ADHD“, was authored by Ashley Halkett, Sinclaire M. O’Grady, and Stephen P. Hinshaw.