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To the Editor: In our 3 published literature reviews on the sexual abuse of boys,^1-3 we documented, and then avoided, methodological shortcomings of previous reviews. Drs Holmes and Slap,⁴ however, repeated these shortcomings, thereby compromising the value of their review.

First, in examining "sequelae," they relied too heavily on clinical samples, which are highly atypical and do not generalize, as we have shown both narratively¹ and statistically^2-3 in our reviews of the nonclinical literature. In 2 meta-analyses, one on national samples and another on college samples, we found that the sexual abuse–adjustment association for boys is small (r=0.07). By contrast, associations in clinical samples are frequently medium to large. Holmes and Slap paid inadequate attention to clinical vs nonclinical distinctions and generalizability issues.

Second, the authors failed to distinguish between willing and unwanted sexual abuse. This accounts in part for their finding adverse outcomes along with nonnegative perceptions . . . [Full Text of this Article]