Child Abuse as Incurable Social Disease : BY SILENCE BETRAYED The Sexual Abuse of Children in America <i> by John Crewdson (Little, Brown: $17.95; 320 pp.) </i>

Abuse is a leading cause of death among children in the United States. In the form of molestation, it is seldom fatal and thus often not taken as seriously as the tiny crushed skulls and starved bodies of physical abuse and neglect. But psychological and physical injuries to young victims of sexual abuse are long-lasting, frequently stunting their growth into emotionally sound adults and begetting another generation of molesters.

The publicity surrounding several recent massive child sexual abuse cases involving middle-class alleged perpetrators and victims--the McMartin Preschool molestation case in Los Angeles and the Jordan, Minn., case, among them--destroyed any misconception that molestation just doesn’t happen to “people like us” and spawned a host of hastily written books seeking to exploit what now seems to have become nearly every parent’s nightmare--that his or her child could suffer similar abuse.

“By Silence Betrayed” is a serious attempt to outline the real dimensions of the problem of child sexual abuse and to summarize recent cases and developments in the burgeoning field. If author John Crewdson, a Pulitzer Prize-winning reporter for the Chicago Tribune, does not shed new light on the causes or propose solutions, he has at least researched and pulled together what has appeared piecemeal in newspapers and magazines in different parts of the country and enlivened his statistics and case studies with interviews and first-person accounts by children, parents, lawyers, therapists, judges, police and molesters themselves. It is an excellent overview and introduction to the subject for anyone not already familiar with the ugly problem.

It suffers, however, from too many anonymous sources and undocumented studies, and fails to explore the flip side of the sexual abuse problem--the increasing role of spurious molestation claims in child-custody battles and the ruined lives of those falsely accused.

(Crewdson may be known to some readers already as the author of a book on immigration, “The Tarnished Door: The New Immigrants and the Transformation of America.”)

Relying heavily on a 1985 Times poll, which found that 22% of Americans have been victims of child sexual abuse, Crewdson figures that there are 38 million adult victims, another 13 million children alive who will be abused, and 1 million pedophiles in this country. He also writes, incorrectly, that one man in 10 in The Times poll acknowledged sexually abusing a child; in fact, a series of questions designed to elicit such admissions yielded such disparate and apparently unreliable results among our respondents that no number was included in our published results.

In his broad overview, Crewdson discusses various types of molesters and the psychological underpinnings of their perversion, the relationship between child pornography and sexual abuse, the shortcomings of the judicial system and innovative changes afoot in some states, the botched investigations that have plagued most well-known cases--and doomed many of them--the effects of molestation on children and their families, and the failure of therapy to “cure” most of those men and women who compulsively engage in sex with children.

An entire chapter is devoted to the McMartin case, although Crewdson has not been present at the trial. While this reviewer is not familiar with the details of child abuse cases elsewhere, the McMartin portrait is essentially accurate, despite numerous, if mostly small, factual errors and the absence of information about the trial itself, which began last year. He does not appear to have interviewed either the McMartin defendants or their alleged victims and parents.

More importantly, he asserts that an unnamed lawyer for one unnamed McMartin defendant offered a guilty plea by his client to a reduced charge in exchange for her testimony against the six other defendants--which would be highly significant if true. Both prosecution and defense vehemently deny that any such offer was made or rejected, saying the only vaguely similar occurrence was a discussion with an attorney for former defendant Betty Raidor about the possibility of immunity from prosecution--a far cry from a guilty plea--should she testify against other former teachers at the Manhattan Beach nursery school.

Although Crewdson is based in Los Angeles, he also grossly underestimates the extent of the abuse problem here, writing of 50,000 reports of suspected child abuse statewide each year. In reality, the number is closer to 342,000, with more than 142,000 a year in Los Angeles County alone. About 17% involve sexual abuse.

Whenever I am asked about child abuse, people inevitably want to know: “Do these things really happen?” “How likely is it that my family will be affected?” “What can I (or we) do about it?” Crewdson answers the first and provides clues to the second, but fails to grapple with the third, offering little in the way of a blueprint for dealing with child sexual abuse on either a personal or a societal level.

Crewdson’s view of our ability to protect children from abuse is ultimately pessimistic, primarily, he writes, “because some of the same trends that appear to correlate with child abuse--the disintegration of the nuclear family, an increase in the numbers of working couples (which the bulk of McMartin parents were not, despite his assertions to the contrary) and single and divorced mothers, more second and third marriages, the emergence of a permanent underclass and an apparent increase in the number of sexually abused children--show no signs of reversing themselves.

“Even if they did, it seems unlikely that child sexual abuse can ever be eradicated, or even significantly diminished,” he concludes. “Perhaps the sexual attraction to children is so fundamental and so powerful that it can never be erased.”