Child extrafamilial sexual abuse: predicting parent and child functioning

Objective: This study evaluated the emotional and behavioral adjustment of parents and children within 3 months and 1 year after the discovery of child extrafamilial sexual abuse.Method: Ninety-two case parents (63 mothers, 29 fathers) and 56 children were compared to a nonclinical comparison group of 136 parents (74 mothers, 62 fathers) and 75 children. Parent adjustment was assessed using self-report measures while child functioning was assessed using a combination of child-, parent- and teacher-report measures.Results: Mothers, fathers and sexually abused children experienced clinically significant effects both initially and at 12 months post-disclosure. Children’s perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symtomatology at 3 months and 1 year post-disclosure. Child age and gender also significantly contributed to the prediction of many of the child outcome measures. No abuse-related variable was related to any child self-report measure. Mothers’ satisfaction in the parenting role, perceived support and intrusive symptoms predicted their initial emotional functioning. Avoidant symptoms, child’s internalizing behavior and mothers’ initial emotional functioning were significant predictors of longer-term emotional functioning.Conclusions: Results emphasize the need to address children’s abuse-related attributions and underscore the need to expand our focus beyond the child victims to the traumatized families.     

Child extrafamilial sexual abuse: predicting parent and child functioning

Objective: This study evaluated the emotional and behavioral adjustment of parents and children within 3 months and 1 year after the discovery of child extrafamilial sexual abuse.Method: Ninety-two case parents (63 mothers, 29 fathers) and 56 children were compared to a nonclinical comparison group of 136 parents (74 mothers, 62 fathers) and 75 children. Parent adjustment was assessed using self-report measures while child functioning was assessed using a combination of child-, parent- and teacher-report measures.Results: Mothers, fathers and sexually abused children experienced clinically significant effects both initially and at 12 months post-disclosure. Children’s perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symtomatology at 3 months and 1 year post-disclosure. Child age and gender also significantly contributed to the prediction of many of the child outcome measures. No abuse-related variable was related to any child self-report measure. Mothers’ satisfaction in the parenting role, perceived support and intrusive symptoms predicted their initial emotional functioning. Avoidant symptoms, child’s internalizing behavior and mothers’ initial emotional functioning were significant predictors of longer-term emotional functioning.Conclusions: Results emphasize the need to address children’s abuse-related attributions and underscore the need to expand our focus beyond the child victims to the traumatized families.     

Incidence and impact of sexual abuse in a child outpatient sample: The role of direct inquiry

From the child psychiatry outpatient department of a university medical center, 64 charts were reviewed in two phases: 29 were randomly selected from outpatient files, and 35 were examined after clinicians were asked to directly query sexual abuse. Although the reported sexual abuse rate for randomly selected charts was quite low (6.9%), reference to sexual abuse history in charts of children who were asked about molestation was 4.5 times more frequent (31.4%; 11.5% of all boys, 50% of all girls). Children with an identified sexual abuse history reported more psychological symptoms, had made more suicide attempts in the past, and were more likely than nonabused children to receive a diagnosis of major depression.     

Early life adversities and polyvictimization in young persons with sexual behavior problems: A longitudinal study of child protective service referrals

There is scarce research on children and youth with sexual behavior problems (SBP) and their developmental antecedents and the research that does exist is mostly retrospective and correlational. While prior research focused on the central role of sexual victimization, recent research suggests that young persons with SBP are exposed to a series of adversities not limited to child sexual victimization and require multifaceted assessment and intervention using a developmental life course perspective. The current study includes an examination of the complete longitudinal sequence of child protective service (CPS) investigations involving young persons with SBP. The study is based on a sample of 957 youth referred to the CPS in Quebec, Canada. The data include their longitudinal sequence of referrals from birth to age 18. Semi-parametric analyses identified four trajectories of referrals with significant differences in terms of onset, frequency, types of life adversity, and polyvictimization. The trajectories suggest that a range of developmental profiles characterize young persons with SBP, with SBP often occurring after CPS contacts for compromising issues other than sexual victimization, especially parental neglect and serious behavior problems. Of importance, polyvictimization was relatively common for this group throughout childhood and adolescence, which highlights the multiintervention needs of this population.     

Perpetrators and context of child sexual abuse in Kenya

Child sexual abuse (CSA) interventions draw from a better understanding of the context of CSA. A survey on violence before age 18 was conducted among respondents aged 13–17 and 18–24 years. Among females (13–17), the key perpetrators of unwanted sexual touching (UST) were friends/classmates (27.0%) and among males, intimate partners (IP) (35.9%). The first incident of UST among females occurred while traveling on foot (33.0%) and among males, in the respondent's home (29.1%). Among females (13–17), the key perpetrators of unwanted attempted sex (UAS) were relatives (28.9%) and among males, friends/classmates (31.0%). Among females, UAS occurred mainly while traveling on foot (42.2%) and among males, in school (40.8%). Among females and males (18–24 years), the main perpetrators of UST were IP (32.1% and 43.9%) and the first incident occurred mainly in school (24.9% and 26.0%), respectively. The main perpetrators of UAS among females and males (18–24 years) were IP (33.3% and 40.6%, respectively). Among females, UAS occurred while traveling on foot (32.7%), and among males, in the respondent's home (38.8%); UAS occurred mostly in the evening (females 60.7%; males 41.4%) or afternoon (females 27.8%; males 37.9%). Among females (18–24 years), the main perpetrators of pressured/forced sex were IP and the first incidents occurred in the perpetrator's home. Prevention interventions need to consider perpetrators and context of CSA to increase their effectiveness. In Kenya, effective CSA prevention interventions that target intimate relationships among young people, the home and school settings are needed.     

Gendered pathways from child sexual abuse to sexual aggression victimization and perpetration in adolescence and young adulthood

This study aimed to examine the pathways from child sexual abuse to sexual assault victimization and perpetration in adolescence and early adulthood, considering risky sexual behavior and lowered sexual self-esteem as mediator variables. In a two-wave longitudinal study with 2251 college students in Germany, male and female participants provided reports of sexual aggression victimization and perpetration since age 14 (T1) and again a year later (T2), covering the last 12 months. In addition, child sexual abuse (CSA; before the age of 14), risky sexual behavior, and sexual self-esteem were assessed at T1, and risky sexual behavior and sexual-self-esteem were assessed again at T2. Experience of CSA was significantly associated with greater likelihood of sexual aggression victimization and perpetration, lower sexual self-esteem, and more risky sexual behavior in both gender groups at T1 and was directly related to victimization at T2 among male participants. In both gender groups, CSA indirectly contributed to a higher probability of sexual victimization at T2 via its impact on victimization T1. In males, the indirect path from CSA to T2 perpetration via T1 perpetration was also significant. Through its negative impact on sexual self-esteem, CSA indirectly increased the probability of sexual victimization among women and the probability of sexual aggression perpetration among men. Risky sexual behavior mediated the pathway from CSA to sexual victimization at T2 for men and women and the pathway from CSA to sexual aggression perpetration for women. The findings contribute to the understanding of gendered effects of CSA on revictimization and the victim-to-perpetrator cycle.     

Emotion regulation as a mediator of the relation between sexual abuse and behavior problems in preschoolers

Maltreated children show poor emotion regulation competencies compared to non-maltreated children. Emotion regulation has been found to mediate the association between maltreatment and behavior problems in children. The aim of the present study was to examine the relationships among child sexual abuse (CSA), emotion regulation (ER), and internalized and externalized behavior problems in preschoolers using conditional process analyses. ER competencies were assessed in 127 children aged 41–79 months (62 abused, 65 non-abused) by their parents (N = 124) and early childhood educators (N = 88) using the Emotion Regulation Checklist (Shields and Cicchetti, 1995, Shields and Cicchetti, 1997). Behavior problems were evaluated by parents using the Child Behavior Checklist (Achenbach and Rescorla, 2000, Achenbach and Rescorla, 2001). ER was found to completely mediate the relation between CSA and internalized behavior problems and partially mediate the relation between CSA and externalized behavior problems. Parents’ and educators’ evaluations of ER were also found to differ as a function of child gender. The discussion focuses on the relationships among CSA, ER, behavior problems, and child gender. The clinical implications of these findings are also examined. Promoting the optimal development of ER could prevent the emergence and exacerbation of behavior problems in these at-risk children and, in turn, foster resilience.     

Reporting possible sexual abuse: a qualitative study on children's perspectives and the context for disclosure

OBJECTIVE: The present study investigated the context in which children were able to report their child sexual abuse experiences and the children's views as to what made it difficult to talk about abuse and what helped them in the disclosing process. The aim was to study disclosures as they were occurring in their natural settings. METHOD: Data were obtained from therapeutic sessions and follow-up interviews from 20 families with 22 children. These children had said something that made their caregivers concerned about ongoing child sexual abuse. Qualitative analysis was conducted to capture the children's and caregiver's perspectives of the disclosure process. RESULTS: The children felt it was difficult to find situations containing enough privacy and prompts that they could share their experiences. They also were sensitive to others reactions, and whether their disclosures would be misinterpreted. When the children did disclose they did it in situations where the theme of child sexual abuse was in some form addressed or activated. The results indicate that disclosure is a fundamentally dialogical process that becomes less difficult if the children perceive that there is an opportunity to talk, and a purpose for speaking, and a connection has been established to what they are talking about. CONCLUSIONS: It is difficult for children to initiate a conversation about something secret, confusing and distressful, and where there are few conversational routines in a family for talking about such themes. Children also are sensitive to the needs of their caregivers and fear consequences for their family and offender. Children need a supportive structure or scaffold in order to reveal their experiences of child sexual abuse.     

Sex and sexual orientation disparities in adverse childhood experiences and early age at sexual debut in the United States: Results from a nationally representative sample

Adverse childhood experiences (ACEs) have been linked to early sexual debut, which has been found to be associated with multiple adverse health outcomes. Sexual minorities and men tend to have earlier sexual debut compared to heterosexual populations and women, respectively. However, studies examining the association between ACEs and early sexual debut among men and sexual minorities are lacking. The aim of this study was to examine the sex and sexual orientation disparities in the association between ACEs and age at sexual debut. Data were obtained from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic and linear regression models were used to obtain crude and adjusted estimates and 95% confidence intervals adjusting for age, race/ethnicity, income, education, insurance and marital status for the association between ACEs (neglect, physical/psychological abuse, sexual abuse, parental violence, and parental incarceration and psychopathology) and early sexual debut. Analyses were stratified by sex and sexual orientation. Larger effect estimates depicting the association between ACEs and sexual debut were seen for women compared to men, and among sexual minorities, particularly among men who have sex with men (MSM) and women who have sex with women (WSW), compared to heterosexuals. Sexual health education programs with a focus on delaying sexual debut among children and adolescents should also consider addressing ACEs, such as neglect, physical, psychological and sexual abuse, witnessing parental violence, and parental incarceration and psychopathology. Public health practitioners, researchers and sexual health education curriculum coordinators should consider these differences by sex and sexual orientation when designing these programs.     

Self-defining as sexually abused and adult sexual risk behavior: results from a cross-sectional survey of women attending an STD clinic

Objective

Childhood sexual abuse (CSA) is associated with increased sexual risk behavior in adulthood, and this association may be mediated by traumagenic dynamics constructs (i.e., traumatic sexualization, trust, guilt, and powerlessness). However, few studies have investigated whether such relationships hold for women who do not identify as having experienced CSA despite meeting objective criteria that CSA occurred. This study sought to determine whether individuals who met research criteria for CSA and who self-defined as sexually abused differed on traumagenic dynamics constructs and current sexual risk behavior from individuals who met research criteria for CSA and who did not self-define as sexually abused.

Methods

Participants were 481 women recruited from a publicly funded STD clinic. Participants completed a computerized survey assessing childhood sexual experiences and adult sexual risk behavior.

Results

Of the total sample, 206 (43%) met research criteria for CSA. Of the women meeting research criteria for CSA, 142 (69%) self-defined as sexually abused. Women who met research criteria for CSA reported more traumatic sexualization, more trust of a partner, more powerlessness, less sexual guilt, more episodes of unprotected sex, more sex partners, and greater likelihood of sex trading, compared to women who did not meet research criteria for CSA. Among women meeting research criteria, those who self-defined as sexually abused did not differ from those who did not self-define on any of the traumagenic dynamics constructs or on current sexual risk behavior, controlling for CSA characteristics.

Conclusions

Individuals who were sexually abused as children by behavioral research criteria are at risk for engaging in sexual risk behavior as adults, regardless of whether or not they perceive the experience to be CSA. Future research is needed to understand how non-definers perceive these childhood sexual experiences.     

Making sense of children's sexual behavior in child care: An analysis of adult responses in special investigation reports

This paper investigates how adults respond to sexual behavior among children in child care. Culturally, childhood sexuality is variously understood as natural curiosity, a sign of sexual abuse, or a symptom of a sex-offender in the making. Given these competing cultural meanings, how are sexual-like behaviors by children managed by the adults who care for them? An analysis of qualitative data from Special Investigation Reports by childcare licensing consultants in the state of Michigan is used to examine how parents, child care providers, and child care licensing consultants manage and respond to sexual behavior between children in the context of child care. How sexual behavior is responded to depends primarily on who is doing the responding – parent, childcare provider, or state licensing consultant – rather than what type of behavior is being responded to. Parents respond to a wide range of behaviors between children as if they are incidents of sexual abuse. Childcare providers respond to many of those same incidents as misbehavior. Licensing consultants understand these incidents as violation of rules of supervision, but they were also the only group to ever ask if children's sexual behavior was potentially a sign of a child having been sexually abused in another setting. Providers and parents need more education about what kinds of sexual behavior to be concerned about and what kind to understand as common. More education that sexuality that is “rare” and persistent could be a sign of sexual abuse is needed by all parties.     

Barriers and facilitators to disclosing sexual abuse in childhood and adolescence: A systematic review

Children and young people often choose not to disclose sexual abuse, thus preventing access to help and allowing perpetrators to continue undetected. A nuanced understanding of the barriers (and facilitators) to disclosure is therefore of great relevance to practitioners and researchers. The literature was systematically searched for studies related to child and adolescent disclosures of sexual abuse. Thirteen studies were reviewed and assessed for methodological quality. Results of the review illustrate the heterogeneous nature of these empirical studies. Findings demonstrate that young people face a number of different barriers such as limited support, perceived negative consequences and feelings of self-blame, shame and guilt, when choosing to disclose. Being asked or prompted, through provision of developmentally appropriate information, about sexual abuse facilitates disclosure. The review highlights the need for robust, longitudinal studies with more sophisticated methodology to replicate findings. The review identifies the need for developmentally appropriate school-based intervention programmes that facilitate children’s disclosure by reducing feelings of responsibility, self-blame, guilt and shame. In addition, prevention programmes should encourage family members, friends and frontline professionals to identify clues of sexual abuse, to explicitly ask children about the possibility of sexual abuse and also to respond supportively should disclosures occur. Facilitating disclosure in this way is key to safeguarding victims and promoting better outcomes for child and adolescent survivors of sexual abuse.     

Law enforcement officers as investigators and therapists in child sexual abuse: A training model

Law enforcement officers, often the first professionals to come in contact with a victim of child sexual abuse, can either increase or decrease the traumatic impact on the child and the family at the time of disclosure. The model for a training program for police officers in handling cases of child sexual abuse outlined in this paper is divided into three sections. The first part is directed towards theoretical issues involved in this problem, including an explanation of the history and background of sexual abuse of children by adults and of the difference in the dynamics of extra- and intrafamilial sexual abuse. The second part consists of a detailed explanation of different types of sex offenses and of standard physical examinations of sexual abuse victims. Graded slides of physical trauma geared towards wound identification are paired with relaxation exercises. The third section focuses on special considerations when interviewing sexually abused children. The difference between interviewing and interrogation, specific questioning techniques, and the use of videotape is explained. Each part of this training procedure is followed by a question and answer period and small group discussions for the purpose of encouraging disclosure and better understanding of the officers' personal reactions to cases of child sexual abuse.     

The relationship between child sexual abuse and academic achievement in a sample of adolescent psychiatric inpatients

OBJECTIVES: To examine the relationship between sexual abuse and academic achievement in an adolescent inpatient psychiatric population. Individual factors expected to influence this relationship were measured to explore the way they each interacted with sexual abuse and its relationship to academic achievement. METHOD: Eighty-one adolescent psychiatric inpatients participated in the study (aged 12--18 years: M=16.0). Participants were administered tests of academic achievement (dependent variable) and intelligence, and completed a number of self-report measures of their experience of different types of maltreatment, their perception of the parenting they received, socio-economic status, substance abuse, and psychopathology. RESULTS: Hierarchical regression analysis revealed that intelligence was the main predictor of academic achievement (uniquely explaining 26% of the variance). A number of interaction effects were also significant indicating that intelligence, substance abuse, internalizing behavior problems, externalizing behavior problems all influenced the relationship between sexual abuse and academic achievement. DISCUSSION: Examining the impact of sexual abuse is complex because it is typically an experience embedded in a range of other risk factors, such as poverty, family dysfunction, and other types of maltreatment. This study demonstrated coexistence between sexual abuse and a number of other variables, including other maltreatment types and parental overprotection, underscoring the requirement for complex models of research that more accurately reflect the experience of abused children.     

Patterns of victimization: A person-centered approach to physical and sexual violence in a representative sample of Danish youth

Professionals and policy makers have only recently begun to recognize the extent to which different types of victimization are interconnected. To enhance our knowledge of the co-occurrence of physical and sexual violence across childhood and adolescence/early adulthood, the present study investigated distinct typologies of victimization in a sample of adolescents and young adults and explored the relationship between victimization typologies and gender, age, and mental health. Data from the Danish 2013 National Health Survey (“How are you?”) were used. Latent class analysis (i.e., a person-centered approach) was used to identify typologies of physical and sexual victimization in a representative sample of 3812 adolescents and young adults aged 16–24 years. Five distinct victimization typologies emerged: a normative, non-victimization group (76%), a physical victimization in adolescence/early adulthood group (13%), a physical revictimization group (5%), a poly-victimization group (4%), and a physical victimization in childhood group (2%). Physical revictimization, poly-victimization, and physical victimization in childhood were highly associated with poor mental health status. Using a latent variable modeling approach, we identified meaningful subgroups of the victimized population. Two subgroups (i.e., physical revictimization and poly-victimization), which comprised a third of all individuals in the victimization subgroups, had a high probability of exposure to multiple traumatic events and poor mental health. These study findings underscore the need to promote interventions addressing the co-occurrence of physical and sexual victimization and the persistence of victimization over time.     

Family violence exposure and associated risk factors for child PTSD in a Mexican sample

This study was undertaken in an effort to help illuminate the deleterious effects of traumatic stress on children and families in Mexico. Rates of exposure to traumatic events, family and community violence, and posttraumatic stress disorder (PTSD) were investigated in 87 school-age children and their mothers. Binary logistic regression analysis was performed to examine potential family and ecological risk factors for the presence of child PTSD. A total of 51 children (58.6%) reported an event that met the DSM-IV A criteria, and 36 children (41.4%; 20 boys and 16 girls) met criteria for full PTSD. Traumatic exposure in this sample was considerable, particularly intense, and chronic as a result of interpersonal violence in the home and community. Results support the need for preventive systemic interventions targeting the individual level, parent–child dyadic level, and the larger cultural and community context.     

Victimization and adversity among children experiencing war-related parental absence or deployment in a nationally representative US sample

This study compares children and youth who have experienced lifetime war-related parental absence or deployment with those having no such history on a variety of victimization types, non-victimization adversity, trauma symptoms, and delinquency; and assesses whether cumulative adversity and victimization help to explain elevated emotional and behavioral problems among children of parents who have experienced war-related absence or deployment. The National Surveys of Children’s Exposure to Violence (NatSCEV) are comprised of three cross-sectional telephone surveys conducted in 2008, 2011, and 2014. Data were collected on the experiences of children aged one month to seventeen years. In each survey, interviews were conducted with youth 10–17 years old and with caregivers of children 0–9 years old. The analyses use pooled data from all three U.S. nationally-representative samples (total sample size of 13,052). Lifetime parental war-related absence or deployment was a marker for elevated childhood exposure to a wide array of victimization and adversity types. Cumulative past year exposure to multiple forms of victimization and adversity fully explained elevated trauma symptoms and delinquency in this population of children. Given the breadth of victimization and adversity risk, children with histories of parental war-related absence or deployment, as well as their families, represent important target groups for broad-based prevention and interventions to reduce exposure and ameliorate consequences when it does occur.     

Removing the child--prosecuting the offender in cases of sexual abuse: evidence from the national reporting system for child abuse and neglect

Sexual abuse has come to public attention so rapidly and is such a difficult problem to deal with that many observers are concerned that the quality of child protective intervention in these cases has been haphazard and indiscriminate. This article analyzes data on all 6,096 cases of child sexual abuse which were "officially reported" in 1978 to see what kinds of intervention were made. The data show that foster placement occurred in more cases of sexual abuse than physical abuse, and was concentrated among cases of older children who reported their own victimization. Criminal action was taken almost five times more often in cases of sexual abuse than in cases of physical abuse, and occurred more often among cases which were directly reported to police and involved offenders with prior criminal records. Black families and poorer families did not seem to be the objects of obvious discrimination in the disposition of these cases.