A clinical-demographic study of sexually abused children

Forty-five children who had been sexually abused were psychologically evaluated. Parents or guardians of the children completed symptom checklists. Results indicated that the majority of children (71%) were abused 4 or fewer times. In addition, genital manipulation and/or fondling was the most common form of abuse. In 82% of the cases, there were no marital separations or family breakups of any kind within six months before or six months after the abuse. Many children (69%) displayed psychological symptoms. The most frequent were nightmares, bedwetting, clinging behavior, inappropriate sexual behavior, anxiety and sadness. Results of this study are largely inconsistent with popular notions about the nature of child sexual abuse. The major methodological shortcoming of the investigation was the lack of a systematic control group.     

Families with abused children: A follow-up study of post-crisis support

Treatment provisions planned and executed were studied in a follow-up of 14 abused or neglected children three years after discharge from the Children's Department of Ullevaal Hospital. A majority of the families were shown to have received either no help or inappropriate help. Half of the children were evaluated as being so emotionally impaired that serious future adjustment problems could be anticipated. Inappropriate treatment related to lack of understanding, workers' own feelings and normative standards. Overidentification with parents and a general belief in their ability to develop caring skills were observed as was the tendency to overlook or minimize the child's experiences and the risk to which he was exposed. Anxiety, insecurity and lack of skill in establishing appropriate relationships prevented workers obtaining adequate bases for evaluation and for effectuation of treatment. Workers' professional situations were unfavorable in specified ways. Appropriate treatment was based on differentiated psychosocial evaluation, a high involvement level by the worker and continuity. The professional situation was also favorable. Workers combined traditional therapeutic approaches with conscious use of professional authority. They intervened actively for protective purposes but were empathetic with both child and parents.     

Reducing out-of-home placements of abused children: two controlled field studies

This study presents the outcome data on the effectiveness of social learning treatments in reducing out-of-home placements of abused children. Noteworthy are that true experimental designs used in both studies and their being conducted in a natural field setting, child protection services agencies. The results indicate that this model of family intervention is an effective alternative to out-of-home placements with this population for approximately 50% of typical child protection services caseloads. The cost benefits of social learning treatments are discussed along with potentially useful clinical and research directions.     

Self-esteem of abused children

Thirty-seven children admitted to hospital with a diagnosis of abuse at an average of 5.5 years previously were compared with 37 non-abused children matched for age, sex, ethnic group, school and social class. The mean age of the children with 8.9 years (range 4.6-14.0 years). Self-esteem in the children was assessed by means of a structured interview with the child and the Piers-Harris Self-Concept Scale. The abused children saw themselves as having significantly fewer friends than the comparison children and they played with friends less often. They were less ambitious than the non-abused children with regard to the sort of occupation they would like as adults and were significantly lower in self-concept on the Piers-Harris Self-Concept Scale. These results show that, as well as providing treatment for abusive parents, a long-term program which aims at improving interpersonal relationship skills and self-esteem is required for abused children.     

Treating sexually abused children: 1 year follow-up of a randomized controlled trial

OBJECTIVE: To measure the durability of improvement in response to two alternative treatments for sexually abused children. METHOD: Eighty-two sexually abused children ages 8-15 years old and their primary caretakers were randomly assigned to trauma-focused cognitive-behavioral therapy (TF-CBT) or non-directive supportive therapy (NST) delivered over 12 sessions; this study examines symptomatology during 12 months posttreatment. DATA ANALYSIS: Intent-to-treat and treatment completer repeated measures analyses were conducted. RESULTS: Intent-to-treat indicated significant group x time effects in favor of TF-CBT on measures of depression, anxiety, and sexual problems. Among treatment completers, the TF-CBT group evidenced significantly greater improvement in anxiety, depression, sexual problems and dissociation at the 6-month follow-up and in PTSD and dissociation at the 12-month follow-up. CONCLUSION: This study provides additional support for the durability of TF-CBT effectiveness.     

A pilot study for a structured, time-limited therapy group for sexually abused pre-adolescent children

The critical role of specific types of mastery skill development in the treatment of sexually abused children is explored, and defense mechanisms of "invulnerable children," who function adequately despite trauma and stress, are described. The authors describe their development of structured group therapy techniques designed to foster these types of mastery skills with sexually abused children aged 6 to 8. These techniques include development of intellectualization defenses through original coloring books and therapeutic board games, cathartic exploration of feelings through structured art and storytelling exercises, cognitive relabeling and self-esteem building through role-play, "chants and cheers," homework shared with mothers, and other structured group procedures designed to develop specific coping skills.     

Typology for parents of abused children

This paper reports an effort to classify the parents of abused children with some existing and some new empirically/clinically consistent typologies, which are derived from the parents' psychopathological personality profiles. Such a classification scheme is informative and helpful for both treatment planning and permanency planning for abusive parents and abused children, whether or not the children have been separated from their parents. Several previously reported typologies for abusive parents are reviewed and then elaborated in light of the additional data and insights gained from an ongoing study of 50 abusive parents who were separated from their children due to severe child abuse. Such typological analyses based upon principal personality characteristics and dynamics promise to help in formulating both secondary and even primary child abuse prevention procedures and programs. The parent typologies which represent the more favorable prognoses, as determined by their therapist's estimate of their response to ongoing treatment, are those classified as rigid-compulsive, or experiencing identity/role crisis, or displaced abuse/violence. Parents whose child abusive behavior is a function of extremely maladaptive resolutions of major life issues fall into the hostile-aggressive, passive-dependent, and severe mental illness typologies, where the prognoses are considerably more guarded. The relatively high incidence of hostile-aggressive fathers coupled with passive-dependent mothers as abusive parents to children in a residential program for severely abused children also helps explain some of the children's psychopathology.     

Further abuse of sexually abused children

OBJECTIVE: To determine the incidence of re-abuse in children known to have been sexually abused and to find factors that increase the risk of re-abuse. METHOD: The study group consisted of 183 children with substantiated sexual abuse who presented to two children's hospitals' Child Protection Units in Sydney, Australia during 1988 through 1990. At intake, when the children were aged between 5 years and 15 years, data about the child, the family, and the nature of the index sexual abuse were collected. Six years after presentation for the abuse, records of the Department of Community Services were checked to see if any of the young people had been the subject of substantiated notifications for abuse/neglect before and after intake to the study. Predictors of notifications for abuse/neglect after presentation for the index sexual abuse were identified. RESULTS: Of the sexually abused young people, nearly one in three were the subject of subsequent substantiated notifications to the Department of Community Services for some form of child abuse and neglect or behavior which placed them at risk of harm. Later notifications for abuse/neglect were predicted by notifications for emotional abuse before the index sexual abuse (adjusted RR = 4.88, CI: 1.43 to 16.65), severity of the index sexual abuse (p = .03), and the number of changes in the child's primary caregivers before intake (p = .03). Approximately one in six of the sexually abused young people were notified for sexual abuse after intake to the study. One in 10 also had prior notifications for sexual abuse. Sexual abuse notifications after study intake were predicted by caregiver changes before intake (p = .01) and whether or not there were notifications for emotional abuse before the index sexual abuse (adjusted RR = 3.40, CI: 1.05 to 11.02). CONCLUSIONS: Revictimization of children appears to be a marker of ongoing family dysfunction. Intervention in child sexual abuse needs to consider a range of risk factors associated with re-abuse and, in particular, should focus on family functioning if further abuse is to be prevented.     

Post-traumatic stress in sexually abused, physically abused, and nonabused children

This investigation compared the rates of post-traumatic stress disorder symptoms across sexually abused, physically abused, and nonabused psychiatrically hospitalized children matched for age, sex, and socioeconomic status. Among the sexually abused children, 20.7% met diagnostic criteria for post-traumatic stress disorder compared with 6.9% of the physically abused and 10.3% of the nonabused children. Although these overall rates were not significantly different across groups, they were significantly high to reinforce the need for further study of post-traumatic stress in childhood. Further, significant symptom rate differences across groups were found with respect to specific post-traumatic stress symptoms. Specifically, sexually abused children exhibited significantly higher rates of inappropriate sexual behaviors than either the physically abused or nonabused children. In addition, both the sexually abused and physically abused groups showed a tendency to exhibit more avoidant/dissociative symptoms as compared to the nonabused children. Results are discussed in terms of their clinical and research implications.     

Helping behaviors: An observational study of preschool children

The present study examined the stability and circumstances of helping behaviors in the preschool classroom. Frequencies of helping/nonhelping behaviors, including the type and circumstance of helping behavior, were observed for 51 children during free play by two judges. The frequency of helping behaviors was not correlated with age or sex and was not stable over four 10-min observation periods. Helping behaviors may depend on the details of evoking situations. The majority of all helping acts are performed during nonimaginary play. Each child performed at least one real helping act: the majority of children performed at least one self-initiated helping act. Most helping acts occur in response to a request from a teacher. Results were interpreted to support that most preschool children are capable of engaging in helping acts; however, in the preschool classroom, teachers elicit most helping behaviors.     

Educational and psychological problems of abused children

The findings of this study tend to confirm the hypothesis that abused children are found to be significantly different from nonabused children in academic achievement, placement in classes for the emotionally disturbed and for the educable mentally retarded. The data also confirm the hypothesis that abused and neglected children are placed in special facilities more frequently than children who have not been adjudged as abused. Further, abused and neglected children were reported to exhibit behaviors indicative of psychological problems. Within each of the dimensions investigated, abused and neglected children were found to have significant problems.In light of the significant differences found in this study, we find substantial support for the projects being supported by the National Center for Child Abuse and Neglect designed to involve the schools in the United States in the battle against children abuse and neglect. Especially important is the project of the Education Commission of the States designed to create an awareness among school systems, professional teacher organizations, and state and local legislative governing bodies of their potential in the battle against child abuse and neglect.In light of the loss of human potential as well as the increased costs involved in providing special classes for the abused and neglected child, allocation of resources to involve schools and school personnel as a part of the multidisciplinary team concerned with child abuse and neglect seems well justified. Additionally, the allocation of fiscal resources for research designed to secure data regarding the sequelae of child abuse is also amply justified.     

A meta-analytic investigation of therapy modality outcomes for sexually abused children and adolescents: an exploratory study

OBJECTIVE: The purpose of the current study was to investigate the independent effects of different treatment elements on a number of secondary problems related to childhood and adolescent sexual abuse, as well as investigate a number of different moderators of treatment effectiveness. METHOD: Twenty-eight studies that provided treatment outcome results for children and adolescents who had been sexually abused were included in the meta-analysis. Different aspects of psychological treatment, such as specific treatment modalities (individual, cognitive-behavioral, etc.) or secondary problems (behavior problems, psychological distress, etc.) were investigated. RESULTS: The overall mean weighted effect size for the meta-analysis was d=.72 (SE=.02). The results indicate that psychological treatment after childhood or adolescent sexual abuse tended to result in better outcomes than no treatment. There was significant heterogeneity in the effectiveness of the various psychological treatment elements. Play therapy seemed to be the most effective treatment for social functioning, whereas cognitive-behavioral, abuse-specific, and supportive therapy in either group or individual formats was most effective for behavior problems. Cognitive-behavioral, family, and individual therapy seemed to be the most effective for psychological distress, and abuse-specific, cognitive-behavioral, and group therapy appeared to be the most effective for low self-concept. CONCLUSIONS: The choice of therapy modality should depend on the child's main presenting secondary problem. Further research should be conducted investigating other possible moderators and secondary problem outcomes.     

Prior incest in mothers of abused children

Previous studies have shown that most abusing parents have a history of physical abuse or neglect in their own childhoods. There is little data on the frequency of prior sexual abuse among parents who physically or sexually abuse their children. Many case reports describe the uncovering of a prior incest experience in a parent during the investigation of the child's current incest accusation, but it is unclear how frequently this occurs. One hundred mothers of abused children were asked about sexual incidents that occurred before age 18; the control group consisted of 500 normal women from the same community who were surveyed during meetings of various voluntary organizations. Age and ethnicity did not differ in the two groups. Of the mothers of abused children, 24% reported a prior incest experience, whereas only 3% of the control women reported prior incest. This eightfold difference was highly significant. The 34 mothers from families where sexual abuse was occurring were no more likely to report prior incest than were the 66 mothers from families where physical abuse occurred. The one case of genital mutilation of a child occurred in a family where both parents had been incest victims. Case studies indicate that the parent who has been an incest victim has inhibitions and fears about tenderness, traceable to the childhood incest experience, which are important in the development of either physical abuse or sexual abuse in the family.     

Peer group interaction of physically abused children

The aim of this research study was to test the assumption that physically abused children differ significantly from their non-abused peers along dimensions which characterize abusing adults and other social deviants. Nineteen 5-10 year-old physically abused children and 38 non-abused peers were assessed by video-taped behavioral observations during free-flowing social interaction in a playroom. The dimensions tapped were: aggression, warmth, fear, pleasure, concentration, imagination and social participation. The dimension social participation was split into three variables: total social participation, negative participation and positive participation. The data from these nine dimensions was subject to a Pearson's correlation. Given the high correlation amongst these variables the data was subject to a principal components analysis with varimax rotation. From this analysis two components emerged which explained 76.9% of the total variance. These components were designated "social interaction" (component 1) and "hostility" (component 2) and were then subject to analyses of variance. A significant difference was found between the two groups on the "social interaction" component. The implications of these findings were explored and treatment possibilities examined.     

Determinants of placement for sexually abused children

While conducting a prospective study of 100 sexually abused children, we found a much higher rate of out-of-home placement than has been previously described for child maltreatment. This study was designed to determine which factors were most influential in predicting the placement experiences of this cohort. The children, ages 6-17 years, were recently substantiated victims of intrafamilial sexual abuse whose parents or guardians permitted study involvement. We examined child and family demographics, abuse characteristics, and family response as possible determinants of immediate and later placement. At the initial assessment, within a few weeks of the disclosure, 50% of the children had already been removed. A follow-up assessment of 83 children two years later revealed that 73% had been removed from the abusing home. In a multivariate regression model, only maternal support of the child emerged as a significant predictor of immediate placement and placement over time. The offender's status as a resident in the child's home was an important predictor of immediate placement but was not significant as a predictor of all placements at any time. As maternal support is an important predictor of the need for placement, workers are encouraged to seek ways of enhancing maternal support as a means of reducing placement.     

A group for sexually abused young children: unravelling the web

This paper describes clinical material from a group for young sexually abused children. The group work combines both an educational and dynamic approach drawn from previous models. The group was clearly structured and ran over nine weeks in conjunction with a parallel caregivers' group who were informed each week of the main themes. The caregivers were also involved in evaluating the effectiveness of the therapy by completing questionnaires which recorded symptomatology. A statistical analysis based on the questionnaires showed a significant reduction in problems reported by the caregivers before and after the group therapy. The authors recommend that such therapeutic work be combined with formal evaluation in the future to assess the effectiveness of different approaches with a view to clarifying which aspects are responsible for promoting positive change.