Child sexual abuse and its relationship with health risk behaviors among rural children and adolescents in Hunan, China

Objective

The current study was designed to explore the prevalence of child sexual abuse (CSA) and its association with health risk behaviors (i.e., smoking, alcohol use, binge drinking, suicidal ideation, and suicide attempt) among rural children and adolescents in China.

Methods

A sample of 683 rural children and adolescents (8 to 18 years of age) completed an anonymous questionnaire which assessed experiences of CSA and 5 health risk behaviors. Data on several potential confounding factors were also collected.

Results

A total of 123 (18%) respondents reported experiencing at least 1 kind of CSA before 16 years of age, with more boys reporting CSA than girls (21.5% vs. 14.2%). In addition, attending non-boarding schools, lower levels of self-esteem, and higher levels of perceived peer pressure for engagement in health risk behaviors were associated with higher rates of CSA. Multivariate logistic regression analyses revealed that CSA experience was significantly associated with cigarette smoking (aOR = 2.14), binge drinking (aOR = 2.68), suicidal ideation (aOR = 1.69), and suicide attempt (aOR = 2.69) after controlling for several demographic and psychological factors.

Conclusion

More attention should be paid to the issues of CSA among rural children and adolescents in China. Effective CSA prevention intervention needs to address the vulnerabilities of the population, increase children's and parents’ awareness of CSA and ability of self-protection.     

Identifying and predicting problem behavior trajectories among pre-school children investigated for child abuse and neglect

Objective

Young children involved with child welfare services are at high risk for behavior problems. This study aims to identify externalizing behavior paths that preschoolers in this high-risk population follow over a 6 year period, and the predictors of membership in normative and problematic pathways.

Methods

Using data from the National Study of Child and Adolescent Well-being (NSCAW), the sample included 246 4-year-olds who remained home after investigation. Latent class growth analysis (LCGA) was used to estimate the number, size, and shape of subgroups of preschoolers following distinct behavioral pathways. Early predictors of membership in the resulting groups were then examined.

Results

Four groups of preschool children following distinct behavior trajectories over 6 years were identified. Weighted results show that more than half (61%) of the children followed a low/normal problem behavior trajectory while just over one tenth (12%) were on a persistent high trajectory, remaining in the clinical range throughout the study. Improving (23%) and worsening (4%) problem behavior groups were also identified. Internalizing problems, attention problems, child ethnicity, and maltreatment type reported at age 4 predicted membership in the trajectory groups.

Conclusions

Internalizing behavior problems and maltreatment type may distinguish preschool children who are more likely to experience worsening or persistent problematic externalizing behaviors from those likely to follow a normal behavior trajectory.

Practice implications

Identifying early indicators of externalizing behavior problems and addressing them with evidence-based interventions to reduce negative behaviors may avert long-term negative outcomes.     

Malicious use of nonpharmaceuticals in children

Objective

The objective of this study was to describe malicious nonpharmaceutical exposures in children reported to US poison centers.

Methods

We performed a retrospective study of all nonpharmaceutical exposures involving children 7 years old reported to the US National Poison Data System (NPDS) from 2000 to 2008 for which the reason for exposure was coded as “malicious”. The American Association of Poison Control Centers definition and categorization of nonpharmaceuticals was used. Data collected for each case included age, gender, month and year of the exposure, the exposed substance or substances, intent, and poison center outcome designation. Fatality abstracts (summaries of the facts reported to the poison center) were reviewed.

Results

Out of approximately 21.4 million exposures reported to NPDS during the study period, 4,053 cases involving 4,232 nonpharmaceuticals were identified. The mean number of cases per year was 450 (range 409-546) with no linear annual trend (p = 0.28). The median age was 3 years (1.5, 5) with boys constituting 57%. 4.5% of the cases resulted in moderate or worse outcomes in which the outcome was known. The most commonly reported major categories were household cleaning substances (23%), cosmetics/personal care products (13%), pesticides (8%), other/unknown nondrug substances (6%), foreign bodies/toys/miscellaneous (5%), alcohols (5%), hydrocarbons (4%), lacrimators (4%), chemicals (4%), and deodorizers (3%). Four children died and 18 others had lifethreatening injuries. Among these 22 children, cleaning substances (7) were the most common major category followed by chemicals (4), alcohols (3), fumes/gases/vapors (2) and six other categories with 1 each. In the only case where the presence or absence of associated physical injuries was described, the child had multiple injuries consistent with physical abuse.

Conclusion

Malicious administration of nonpharmaceuticals is an important component of child maltreatment with cases being reported consistently to poison centers.

Practical implications

Clinicians should consider the possibility of child abuse when presented with these exposures.     

Pediatric health assessments of young children in child welfare by placement type

Objectives

To describe health-related problems across placement types (unrelated foster, kin foster, in-home with birth parent); to examine the association of placement and demographic/child welfare variables (child gender, age, race/ethnicity; caregiver language; type of maltreatment, and length of time receiving services from child welfare) with health-related problems.

Methods

This study utilized a retrospective medical chart review of children less than 6 years old (n = 449) seen at an outpatient child welfare pediatric clinic. Logistic regression modeling was used to estimate odds of having a weight, medical, or provisional developmental delay problem by placement and demographic/child welfare characteristics.

Results

Almost 13% of children in the sample were obese (≥95% age-gender specific percentile) and more than a quarter were overweight/obese (≥85%) while only 7% were underweight (≤5%). Most children (78%) had a physical health diagnosis and 25% were provisionally identified with a developmental delay. No differences between weight diagnoses, type of medical diagnoses, and provisional developmental delay by placement type were found, although children with 3 or more medical diagnoses were more likely to be with kin (p < .05). Children 2 years old or older were more likely to be overweight/obese than children under 2 years old (p < .05) and Hispanic children were more likely to be overweight/obese than non-Hispanic children (p < .01). Length of stay in child welfare was positively related with a medical diagnosis or provisional developmental delay (p < .01).

Conclusions

Results argue for careful assessment of weight, medical, and developmental problems in children active to child welfare, whether residing in their home of origin, with kin, or with unrelated foster parents. The increasing problem of obesity among young children in child welfare warrants further investigation and intervention.

Practice implications

The comprehensive health examination and enhanced health maintenance schedule for children in foster care should be extended to children who remain at home with child welfare services as child welfare involvement rather than placement is related to health-related problems.     

Implicit attitudes toward children may be unrelated to child abuse risk

Objective

To explore whether adults possess implicit attitudes toward children and whether those attitudes are especially negative among respondents who are high in child physical abuse (CPA) risk.

Methods

The present study used an implicit evaluative priming procedure. In this procedure, participants were instructed to make decisions about the evaluative implications of target words. These words were preceded by photographs of child faces or adult faces displaying positive, neutral, or negative expressions. Reaction times for the evaluative decisions were used as an index of the extent to which photos invoked negative or positive evaluative reactions.

Results

Results from 2 studies, the first conducted on a student sample (N = 90) and the second on a parent sample (N = 95), demonstrated that evaluative congruence between the facial expressions displayed in photographs and the target words facilitated responses. Furthermore, the results suggested that regardless of CPA risk, child faces, relative to adult faces, facilitated responses to negative target words, suggesting an out-group bias. This implicit out-group bias was not moderated by respondents’ CPA risk status.

Conclusions

Faces of children, relative to faces of adults, appear to activate negative information structures that facilitate evaluative decisions of negative stimuli, suggesting an out-group bias. Given that out-group biases typically lead to less favorable treatment of out-group members, additional research is needed to examine the pervasiveness of negative evaluative biases towards children and the potential implications of such biases on children's lives. Further, research examining whether high CPA risk parents and low CPA risk parents differ in how they manage initial negative evaluative reactions is needed.     

Psychosocial factors influencing competency of children's statements on sexual trauma

Objectives

The objectives of this study are to assess children's competence to state their traumatic experience and to determine psychosocial factors influencing the competency of children's statements, such as emotional factors of children and parents and trauma-related variables, in Korean child sex abuse victims.

Methods

We enrolled 214 children, who visited “Sunflower Children's Center” for sexual abuse. The children were aged 8-13 years. The children's parent were surveyed using questionnaires [Beck Depression Inventory (BDI), State-Trait Anxiety Inventory(STAI)] to obtain demographic information, traumatic event profiles and self-report scale. Children completed psychological measures as follows: Children's Depression Inventory (CDI), Revised Children's Manifest Anxiety Scale (RCMAS), Traumatic Symptom Checklist for Children (TSCC). The modified-Criteria-Based Content Analysis (CBCA) was used to assess children's statements. ANOVA, independent t-test, Pearson correlation were used. All statistics were demonstrated using SPSS 12.0.

Results

Modified-CBCA scores did not differ according to children's level of depression and anxiety. Children with parents who showed supportive reactions, scored significantly higher on the modified-CBCA scores than those with unsupportive parents. Children with severely depressed parents had lower modified-CBCA scores than those with less depressed parents. Modified-CBCA scores were significantly higher in participants who experienced a single traumatic event than those who had multiple events. However, the severity of sexual abuse, relationship with the perpetrator, types of disclosure, and duration of initial disclosure did not show significant differences in capability of statement.

Conclusion

In conclusion, the competence of statements in Korean sexually child sex abuse victims is related to parental emotional states and support rather than children's factors such as psychopathology or age, and appears to be more reliable with a single traumatic experience. Therefore, promoting parental support through psychoeducation is one of the most important things to be done to help children overcome psychologic trauma but also enhance the accuracy of their statement.     

Academic achievement despite child maltreatment: a longitudinal study

Purpose

Although researchers have concluded that child maltreatment has a negative effect on children's learning and academic achievement, not all children are negatively affected by maltreatment, and some children seem to succeed academically despite being maltreated. Drawing on risk and resilience theory, we examined a broad range of potential risk, promotive, and protective factors within children and their environments along with characteristics of the maltreatment to account for variability in test scores.

Methods

A national longitudinal probability sample of 702 maltreated school-aged children, ages 6-10, and their caregivers was used to predict reading and math scores among maltreated children over three years.

Results

We found that chronic maltreatment, poorer daily living skills, and lower intelligence explained a substantial proportion of the variance in maltreated children's math scores (39%), whereas type of maltreatment, poorer daily living skills and lower intelligence explained a substantial proportion of the variance in reading scores (54%) over time. Contrary to our prediction, having a behavior problem seemed to protect chronically maltreated children from poorer performance in math over time.

Conclusions

To increase academic achievement among maltreated children, it is imperative that we prevent chronic maltreatment and help children increase their competency on daily living skills.     

Maternal experiences of childhood abuse and intimate partner violence: Psychopathology and functional impairment in clinical children and adolescents

Objectives

The current study examined the independent effects of mothers’ childhood abuse (CA) and intimate partner violence (IPV) on psychopathology and functional impairment in children; and the potential moderating and mediating role of individual and family factors in these relationships. Additionally, this study explored the potential cumulative effects of both maternal CA and IPV on children's outcomes.

Method

The sample included 547 Spanish children and adolescents aged between 8 and 17 years, and their parents, who had accessed mental health services. The assessment was based on structured interviews with the children and their parents. Statistical analyses were carried out through hierarchical multiple, negative-binomial and logistic regressions, and Structural Equation Models.

Results

Children whose mothers experienced CA and those whose mothers suffered physical IPV showed increased DSM-IV disruptive disorders and externalizing behavior problems, respectively. Children who directly observed physical IPV and also suffered physical punishment by parents showed increased internalizing problems. IPV had effects, either direct or indirect by physical punishment, on children's externalizing problems. Cumulative effect analyses indicated that the prevalence of disruptive disorders was highest in children whose mothers had suffered both CA and IPV.

Conclusion

Spanish children whose mothers have suffered CA, IPV or both, are at high risk of serious conduct problems, whereas children exposed to IPV and who were also physically abused are at greater risk of internalizing problems. Physical punishment of children contributes in part to explain externalizing problems of IPV-exposed children. These findings indicate potential targets of assessment and intervention for families seeking help in mental health services.     

Identifying children at high risk for a child maltreatment report

Objective

To help professionals identify factors that place families at risk for future child maltreatment, to facilitate necessary services and to potentially help prevent abuse and neglect.

Method

The data are from a prospective, longitudinal study of 332 low-income families recruited from urban pediatric primary care clinics, followed for over 10 years, until the children were approximately 12 years old. Children with prior child protective services involvement (CPS) were excluded. The initial assessment included sociodemographic, child, parent and family level variables. Child maltreatment was assessed via CPS reports. Risk ratios (RRs) and their 95% confidence intervals (CIs) were estimated using Cox regression models.

Results

Of the 224 children without a prior CPS report and with complete data who were followed for an average of 10 years, 97 (43%) later had a CPS report. In a multivariate survival analysis, 5 risk factors predicted CPS reports: child's low performance on a standardized developmental assessment (RR = 1.23, 95% CI = 1.01-1.49, p = .04), maternal education ≤ high school (RR = 1.55, CI = 1.01-2.38, p = .04), maternal drug use (RR = 1.71, CI = 1.01-2.90, p < .05), maternal depressive symptoms (RR per one standard deviation higher score = 1.28, CI = 1.09-1.51, p < .01), and more children in the family (RR per additional child = 1.26, CI = 1.07-1.47, p < .01).

Conclusions

Five risk factors were associated with an increased risk for later maltreatment. Child health care and other professionals can identify these risk factors and facilitate necessary services to strengthen families, support parents and potentially help prevent child maltreatment.     

Student victimization by peers in elementary schools: individual, teacher-class, and school-level predictors

Objectives

This study examined individual and contextual factors that explain students’ victimization by peers among 4th- through 6th-grade Jewish and Arab students.

Method

A total of 120 homeroom teachers and 3,375 students from 47 schools participated. The study explored how students’ reports of violence are influenced by individual factors (gender, age, perception of school climate, victimization by teachers, and fear) teacher-class factors (school climate, homeroom teachers’ characteristics such as self-efficacy, and education) and cultural affiliation as a school level factor.

Results

The results showed that levels of victimization vary significantly between classes and between schools. However, the vast majority of variation in students’ victimization lay at the individual level. Factors such as fear, physical and emotional victimization by teachers, and gender affected levels of students’ victimization by peers.

Conclusions

Students victimized by peers are more likely to be victimized by their teachers and to miss school because of their fear of violence. Further research should be conducted to investigate additional teacher, class and school factors that can predict levels of students’ victimization.

Practice implication

Based on the study's results, efforts to deal with school violence should be targeted to students and school staff. It is essential to design and implement a “whole school” approach that includes participation of the entire school community. Furthermore, intensive individual treatment should be given to victimized students to improve their sense of safety and protection on school property. In addition, the findings emphasized the need to design and implement school intervention programs in a sensitive way that takes into consideration children's developmental stages and other factors that affect their levels of victimization. The results showed that younger children do not take advantage of the many positive effects that can be achieved from positive school policy and good relationships with staff. It might be that more efforts should be made to raise victimized students’ awareness by emphasizing that schools have rules that are there to protect them.     

The relationship between time spent living with kin and adolescent functioning in youth with a history of out-of-home placement

Objective

Many children in the US who are court-ordered to live in out-of-home care are placed with kinship caregivers. Few studies have examined the impact of living with kin on child well-being. This study examined the relationship between length of time living with kin and indices of adolescent well-being in a cohort of children who were initially court-ordered into out-of-home care.

Methods

Prospective cohort design with 148 youth, ages 7-12, who entered out-of-home care between May, 1990, and October, 1991. Seventy-five percent of those interviewed at T1 (6 months following placement) were interviewed at T2 (5 years later).

Results

Bivariate analyses did not demonstrate significant relationships between length of time living with kin and the outcome variables. In multivariate analyses, longer length of time living with kin was related to: (1) greater involvement in risk behaviors including: delinquency (β = .22, p < .05), sexual risk behaviors (β = .31, p < .05), substance use (β = .26, p < .05), and total risk behaviors (β = .27, p < .05), and (2) poorer life-course outcomes including: Tickets/Arrests (OR = 1.4, p < .05) and lower grades (β = −.24, p < .05). Time living with kin was not related to total competence, or self-destructive, internalizing, externalizing, or total behavior problems. There were trends (p < .10) for time living with kin to predict greater trauma symptomatology (β = .17) and suspensions (OR = 1.1).

Conclusions

There were no significant bivariate findings. The multivariate findings suggested a pattern of poorer functioning for youth who spent more time living with kin. No differences were found in current symptomatology.

Practice implications

Although findings from a single study should not dictate changes in practice or policy, the current study's findings do suggest that the field needs to conduct more methodologically sophisticated research on the impact of kinship care.     

Maternal mental illness and the safety and stability of maltreated children

Objective

Children of mothers with mental illness are at risk for multiple untoward outcomes, including child maltreatment and foster care placement. The purpose of this analysis was to determine the association between maternal mental illness and children's long term safety and stability.

Methods

A multi-sector administrative dataset from the Department of Social Services (DSS) and Department of Mental Health (DMH) was analyzed. The sample was 4,895 low income families (mother and child dyads) first reported to child welfare in 1993 or 1994. Families were followed until March of 2009. Dates of new report and foster care placement were obtained from DSS data. ICD-09 or ICD-10 diagnostic codes were obtained from Department of Mental Health data. Schizophrenic disorders, episodic mood disorders, anxiety disorders and personality disorders were examined.

Results

New reports were more likely for children of mothers with mental illness, regardless of diagnosis. While overall 67% of children had a new report over the course of their childhood, rates ranged from 80 to 90% for children of mothers with mental illness and occurred within a shorter time frame than for other children. In the multivariate models, mood (HR = 1.41, p < .001) and anxiety disorders (HR = 1.32, p < .05) placed children at greater risk for new reports. The proportion of children with foster placements was more than double for children of mothers with mental illness than for other children. In the multivariate model, anxiety disorders were strongly associated with the risk of placement (HR = 1.75, p < .001).

Conclusions and Practice implications

Important differences in safety and stability were found between children of mothers with and without mental illnesses, as well as some variability across diagnoses. Since these mothers had already received services our findings suggest that access is not enough. The services they are receiving or have received may be an ineffective approach to helping them parent safely.     

The validity and utility of the California Family Risk Assessment under practice conditions in the field: A prospective study

Objective

Analysis of the validity and implementation of a child maltreatment actuarial risk assessment model, the California Family Risk Assessment (CFRA).

Questions addressed

(1) Is there evidence of the validity of the CFRA under field operating conditions? (2) Do actuarial risk assessment results influence child welfare workers’ service delivery decisions? (3) How frequently are CFRA risk scores overridden by child welfare workers? (4) Is there any difference in the predictive validity of CFRA risk assessments and clinical risk assessments by child welfare workers?

Method

The study analyzes 7,685 child abuse/neglect reports originating in 5 California counties followed prospectively for 2 years to identify further substantiated child abuse/neglect. Measures of model calibration and discrimination were used to assess CFRA validity and compare its accuracy with the accuracy of clinical predictions made by child welfare workers. The extent of use of an override feature of the CFRA and child welfare worker reliance on CFRA risk scores for making service decisions were analyzed.

Results

Imperfect but better-than-chance predictive validity was found for the CFRA on a range of measures in a large temporal validation sample (n = 6,543). For 114 cases where both CFRA risk assessments and child welfare worker clinical risk assessments were available, the CFRA exhibited evidence of imperfect but better-than-chance predictive validity, while child welfare worker risk assessments were found to be invalid. Child welfare workers overrode CFRA risk assessments in only 114 (1.5%) of 7,685 cases and provided in-home services in statistically significantly larger proportions of higher- versus lower-risk cases, consistent with heavy reliance on the CFRA.

Conclusions/practice implications

Until research identifies actuarial models exhibiting superior predictive validity when applied in every-day practice, the CFRA is, and will be a valuable tool for assessing risk in order to make in-home service-provision decisions.     

The relation between abuse and violent delinquency: the conversion of shame to blame in juvenile offenders

Objective

While the relationship between abusive parenting and violent delinquency has been well established, the cognitive and emotional processes by which this occurs remain relatively unidentified. The objective of this work is to apply a conceptual model linking abusive parenting to the conversion of shame into blaming others and therefore to violent delinquency.

Methods

A retrospective study of 112 adolescents (90 male; 22 female; ages 12-19 years; M = 15.6; SD = 1.4) who were incarcerated in a juvenile detention facility pending criminal charges, completed measures of exposure to abusive and nonabusive discipline, expressed and converted shame, and violent delinquency.

Results

Findings tend to confirm the conceptual model. Subjects who converted shame (i.e., low expressed shame, high blaming others) tended to have more exposure to abusive parenting and showed more violent delinquent behavior than their peers who showed expressed shame. Subjects who showed expressed shame (i.e., high expressed shame, low blaming others) showed less violent delinquency than those who showed converted shame.

Conclusions

Abusive parenting impacts delinquency directly and indirectly through the effects of shame that is converted. Abusive parenting leads to the conversion of shame to blaming others, which in turn leads to violent delinquent behavior.

Practice implications

For juvenile offenders, the conversion of shame into blaming others appears to contribute to pathological outcomes in relation to trauma. Translation of this work into clinical practice is recommended.     

Predictors of placement for children who initially remained in their homes after an investigation for abuse or neglect

Objective

To examine the frequency and predictors of out-of-home placement in a 30-month follow-up for a nationally representative sample of children investigated for a report of maltreatment who remained in their homes following the index child welfare report.

Methods

Data came from the National Survey of Child and Adolescent Well-being (NSCAW), a 3-year longitudinal study of 5,501 youth 0-14 years old referred to child welfare agencies for potential maltreatment between 10/1999 and 12/2000. These analyses focused on the children who had not been placed out-of-home at the baseline interview and examined child, family and case characteristics as predictors of subsequent out-of-home placement. Weighted logistic regression models were used to determine which baseline characteristics were related to out-of-home placement in the follow-up.

Results

For the total study sample, predictors of placement in the 30-month follow-up period included elevated Conflict Tactics Scale scores, prior history of child welfare involvement, high family risk scores and caseworkers’ assessment of likelihood of re-report without receipt of services. Higher family income was protective. For children without any prior child welfare history (incident cases), younger children, low family income and a high family risk score were strongly related to subsequent placement but receipt of services and case workers’ assessments were not.

Conclusions/practice implications

Family risk variables are strongly related to out-of-home placement in a 30-month follow-up, but receipt of child welfare services is not related to further placements. Considering family risk factors and income, 25% of the children who lived in poor families, with high family risk scores, were subsequently placed out-of-home, even among children in families who received child welfare services. Given that relevant evidence-based interventions are available for these families, more widespread tests of their use should be explored to understand whether their use could make a substantial difference in the lives of vulnerable children.     

Should child protection services respond differently to maltreatment, risk of maltreatment, and risk of harm?

Objective

To examine evidence available in large-scale North American datasets on child abuse and neglect that can assist in understanding the complexities of child protection case classifications.

Methods

A review of child abuse and neglect data from large North American epidemiological studies including the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS), the National Child Abuse and Neglect Data System (NCANDS), and the National Incidence Studies of Reported Child Abuse and Neglect (NIS).

Results

The authors of this paper argue that recent evidence from large North American epidemiological studies examining the incidence of child abuse and neglect demonstrate that children and families identified as being at risk of maltreatment present with as many household and caregiver concerns as investigations that are substantiated.

Conclusions

In order to continue to develop appropriate services and policies for vulnerable children the authors urge continue definitional clarity for research in child maltreatment that considers the exemplars or indicators of categories, in tandem with parental and child characteristics which can provide one source of evidence-basis to meaningful child protection case classifications. Continued monitoring, refined by the dilemmas faced in practice, are critical for a continued public health investment in children's well-being, predicated upon upholding children's rights.     

Children's disclosures of sexual abuse: learning from direct inquiry

Objectives

Published protocols for forensic interviewing for child sexual abuse do not include specific questions about what prompted children to tell about sexual abuse or what made them wait to tell. We, therefore, aimed to: (1) add direct inquiry about the process of a child's disclosure to a forensic interview protocol; (2) determine if children will, in fact, discuss the process that led them to tell about sexual abuse; and (3) describe the factors that children identify as either having led them to tell about sexual abuse or caused them to delay a disclosure.

Methods

Forensic interviewers were asked to incorporate questions about telling into an existing forensic interview protocol. Over a 1-year period, 191 consecutive forensic interviews of child sexual abuse victims aged 3-18 years old in which children spoke about the reasons they told about abuse or waited to tell about abuse were reviewed. Interview content related to the children's reasons for telling or for waiting to tell about abuse was extracted and analyzed using a qualitative methodology in order to capture themes directly from the children's words.

Results

Forensic interviewers asked children about how they came to tell about sexual abuse and if children waited to tell about abuse, and the children gave specific answers to these questions. The reasons children identified for why they chose to tell were classified into three domains: (1) disclosure as a result of internal stimuli (e.g., the child had nightmares), (2) disclosure facilitated by outside influences (e.g., the child was questioned), and (3) disclosure due to direct evidence of abuse (e.g., the child's abuse was witnessed). The barriers to disclosure identified by the children were categorized into five groups: (1) threats made by the perpetrator (e.g., the child was told (s)he would get in trouble if (s)he told), (2) fears (e.g., the child was afraid something bad would happen if (s)he told), (3) lack of opportunity (e.g., the child felt the opportunity to disclose never presented), (4) lack of understanding (e.g., the child failed to recognize abusive behavior as unacceptable), and (5) relationship with the perpetrator (e.g., the child thought the perpetrator was a friend).

Conclusions

Specific reasons that individual children identify for why they told and why they waited to tell about sexual abuse can be obtained by direct inquiry during forensic interviews for suspected child sexual abuse.

Practice implications

When asked, children identified the first person they told and offered varied and specific reasons for why they told and why they waited to tell about sexual abuse. Understanding why children disclose their abuse and why they wait to disclose will assist both professionals and families. Investigators and those who care for sexually abused children will gain insight into the specific barrier that the sexually abused child overcame to disclose. Prosecutors will be able to use this information to explain to juries why the child may have delayed his or her disclosure. Parents who struggle to understand why their child disclosed to someone else or waited to disclose will have a better understanding of their child's decisions.