Sexual abuse prevention education for young children: A comparison of teachers and parents as instructors

The purpose of this study was to compare teachers and parents as instructors of a personal safety program. One hundred seventy-two Head Start preschoolers were randomly assigned to a personal safety program taught by their teachers, parents, both teachers and parents, or to a general safety control program. Following program participation, children taught the personal safety program by their teachers, parents, or both, demonstrated greater knowledge about sexual abuse and higher levels of personal safety skills compared with those in the control group. Gains in knowledge and skills were maintained at the 5-month follow up. Children taught by their parents showed greater improvements in recognizing inappropriate-touch requests and in their personal safety skills compared with children taught by their teachers, and children who received the program both at home and school were better able to recognize appropriate-touch requests and to demonstrate higher levels of personal safety skills compared with children taught only at school. The emotional costs associated with participating in the program were minimal, and both parents and children rated the program positively. The advantages of home-based instruction for young children are discussed and suggestions for future research are offered.     

Sexual abuse of children in the United Kingdom

Questionnaires were circulated to 1,599 family doctors, police surgeons, paediatricians, and child psychiatrists to determine the frequency and nature of child sexual abuse in the United Kingdom. At least three per 1,000 children are currently being recognized as sexually abused sometime during their childhood. The majority of cases reported involved actual or attempted intercourse, and 74% of the perpetrators were known to the child. Family disturbance was noted in 56% of the cases. The most common outcome (43%) was criminal prosecution of the perpetrator. Area Review Committees had no clear policy for the management of sexual abuse. Before it is possible to protect children and to develop therapeutic services for the family, it will be necessary to acknowledge that sexual abuse is part of the child abuse spectrum.     

Sexual interest in children,child sexual abuse,and psychological sequelae for children

This article reviews the literature on sexual victimization of minors and the role of school psychologists in assessing and intervening with sexually abused minors. Although estimates of child sexual abuse prevalence differ widely owing to disclosure biases and the definitions that researchers have used in studying it, it is clear that child sexual abuse is a serious public problem. Also troubling is the extent to which “normal” adults, especially males, exhibit sexual interest in children, suggesting that a substantial number may be at risk for victimizing minors; fortunately, a variety of inhibitory mechanisms prevent most adults from committing this crime. Although victims typically suffer from sexual abuse, surprisingly, some evidence suggests that victims of sexual abuse can exhibit neutral or even positive outcomes, a controversial finding that has numerous possible explanations. Tragically, childhood sexual abuse may lead the victim to become an abuser later in life, sometimes while still a minor. We suggest directions for future research. © 2001 John Wiley & Sons, Inc.     

Sexual abuse: somatic and emotional reactions

A chart review and telephone interview of 72 sexual abuse victims was conducted to determine if children and adolescents who are victims of sexual abuse suffer from symptoms similar to the "rape trauma syndrome," which has been reported in adults. Symptoms similar to the rape trauma syndrome were found in 48 of the 72 abused children and only 26 of the matched control group, p less than .01. Common somatic complaints in the sexual abuse patients included dysuria, vaginal discharge and chronic abdominal pain. Some of the emotional and behavioral problems noted during the follow-up period among the sexual abuse patients included sleep problems, runaway behavior, and suicide attempts. The duration of abuse and age of the victim at the time of abuse significantly affected the frequency of reported somatic symptoms, but the type of abuse and type of assailant did not significantly affect the frequency of reported somatic and emotional reactions. There was no difference in the occurrence of school problems and early pregnancy between sexually abused patients and controls. Since 67% of all sexually abused patients suffered from emotional and somatic reactions, close follow-up of these patients is indicated.     

Sexual abuse: A sociological perspective

How have contemporary social changes affected the problem of child sexual abuse? The rapid rise of this problem to public attention in the United States is in part due to the mobilization around the problem by the women's movement and the child welfare movement there. But factors shown by research to be associated with the problem—social isolation and patriarchal authority—are so widespread as to suggest that this is a problem of international proportions, as well. The rising divorce rate in the U.S. and worldwide, would appear to put more children at risk at the same time that it has also made it easier for children and their mothers to escape from the most oppressive and intolerable family situations. The sexual revolution and the erosion of external controls on sexual behavior have also in all likelihood aggravated the problem, too. Sexual abuse needs to be seen as a problem distinct from physical child abuse—characterized by the preponderance of offenders who are males. This suggests searching for the sources of the problem in male sexual socialization rather than in problems of inadequate and disaffected parenting.     

Inter-rater reliability of physical abuse determinations in young children with fractures

As there is no “gold standard” in determining whether a fracture is caused by accident or abuse, agreement among medical providers is paramount. Using abstracted medical record data from 551 children <36 months of age presenting to a pediatric emergency department, we examined the extent of agreement between specialists who evaluate children with fractures for suspected abuse. To simulate clinical scenarios, two pediatric orthopaedists and two child abuse pediatricians (CAPs) reviewed the full abstraction and imaging, whereas the two pediatric radiologists reviewed a brief history and imaging. Each physician independently rated each case using a 7-point ordinal scale designed to distinguish accidental from abusive injuries. For any discrepancy in independent ratings, the two specialists discussed the case and came to a joint rating. We analyzed 3 types of agreement: (1) within specialties using independent ratings, (2) between specialties using joint ratings, and (3) between clinicians (orthopaedists and CAPs) with more versus less experience. Agreement between pairs of raters was assessed using Cohen's weighted kappa. Orthopaedists (κ = 0.78) and CAPs (κ = 0.67) had substantial within-specialty agreement, while radiologists (κ = 0.53) had moderate agreement. Orthopaedists and CAPs had almost perfect between-specialty agreement (κ = 0.81), while agreement was much lower for orthopaedists and radiologists (κ = 0.37) and CAPs and radiologists (κ = 0.42). More-experienced clinicians had substantial between-specialty agreement (κ = 0.80) versus less-experienced clinicians who had moderate agreement (κ = 0.60). These findings suggest the level of clinical detail a physician receives and his/her experience in the field has an impact on the level of agreement when evaluating fractures in young children.     

The time-allocation decision and achievement patterns of young children

This article introduces a model of time allocation of young children. The basic ideas are that children make many important decisions for themselves, that children's levels of utility are based on present rather than future elements, and that children tend to spend more time in activities in which they are successful. Activities are classified as individual or competitive, with the hypothesis that older children will perform better than their younger peers in competitive activities. Through logical development the model leads to hypotheses concerning achievement of older and younger children. The results of indirect empirical tests of a few such hypotheses are reported.     

Sexual abuse and exploitation of children and adults with mental retardation and other handicaps

There is growing recognition that children, adolescents, and adults who are mentally retarded are particularly vulnerable to sexual abuse and exploitation and are in need of intervention services. These people are especially vulnerable due to ther often life-long dependence on caregivers, relatively powerless position in society, emotional and social insecurities, and lack of education regarding sexuality and sexual abuse. In addition the mental health functioning and emotional development of individuals who are mentally retarded are not well understood, and many professionals remain uneducated about their mental health needs. To work effectively with this population, mental health professionals and educators must be alert to what is known about the sexual abuse and exploitation of persons with mental retardation. Furthermore, they need to become educated about the rights of these persons to special legal protection from abuse and neglect and to appropriate and effective mental health interventions. The challenge for mental health professionals and educators is to protect persons who are mentally retarded from sexual abuse and exploitation, to provide appropriate psychotherapeutic interventions when abuse occurs, to respect their right to developmentally appropriate knowledge about sexuality and sexual abuse, and to allow for the fulfillment of their sexuality.     

Sexual abuse in the national incidence study of child abuse and neglect: An appraisal

The National Incidence Study of Child Abuse and Neglect was a major, government sponsored effort to collect data on reported and unreported child abuse. It used a systematic representative sample methodology and very precisely developed definitions of child abuse. This paper reviews some of the main limitations of the study in regard to findings on sexual abuse. First, there is probably less “new” data in the study on sexual abuse than on other forms of abuse, since so many of the study cases of sexual abuse were “officially reported” cases. In addition, the study limited its definition of sexual abuse only to cases where a caretaker was the perpetrator, a definition that is much more restrictive than what is used in many treatment programs. Finally, the data on perpetrators has a number of problems that stem from the study's definitions of sexual abuse. The paper makes suggestions for future incidence type studies of sexual abuse.     

Sexual abuse of children in Denver, 1979: Reviewed with implications for pediatric intervention and possible prevention

287 children involved in sexual abuse are reviewed. All were reported in Denver, Colorado, U.S.A., in 1979. Specific attention is given to the origin of the report of cases later determined to be unfounded. Sibling sexual involvement is examined, particularly with reference to the age differential. Perpetrators are categorized as fathers, stepfathers, mother's “boyfriend,” relatives or family friends. These in turn are related to the ages of the children involved. Attention is given to the frequency with which the victimized child had reported the incident(s) months to years before it was reported to an agency. In 50% of the cases the victimized children are under 12 years of age, and in 15% of the cases they are under 6 years of age. Suggestions are made regarding detection and preventive measures, particularly in the history-taking phase of the pediatrician-patient relationship and in vaginal physical findings.     

Sexual abuse of children under 12 years of age: a review of 511 cases

In a retrospective study of 511 cases of alleged sexual abuse in children 12 years of age and under, data were analyzed with respect to the victim's age, sex, and the type of sexual abuse (intra- or extrafamilial). A total of 85.5% of the victims were female and 14.5% were male with ages ranging from 2 months to 12 years. The mean age of female victims was 6.8 years and that of male victims, 7.4 years. Most victims (68%) presented with histories of single assault by a known perpetrator (78%). Characteristics of abuse were found to be associated with the victim's age, sex, and relationship to the assailant. School-age victims were more likely to be abused by an individual outside the family or by a complete stranger. Older victims were also more likely to be involved in severe forms of sexual abuse (penetration, attempted penetration or oral-genital contact), associated with acts of abduction and with reports to the police. Male victims were more likely to be assaulted by a stranger, outside the home environment, and to suffer a more severe form of sexual abuse than female victims. Finally, extrafamilial sexual abuse was distinguished from intrafamilial sexual abuse insofar as it was more often a single episode, occurring outside the home environment, involving an act of abduction and physical force, and being reported to the police.     

Occult drug exposure in young children evaluated for physical abuse: An opportunity for intervention

BackgroundAlthough screening for drug exposure is an important consideration in the evaluation of suspected child maltreatment, limited data are available on the frequency of drug exposure in children with suspected physical abuse.ObjectiveTo examine occult drug and pharmaceutical exposure in young children with suspected physical abuse.Participants and settingChildren ages 2 weeks –59 months evaluated for physical abuse by a tertiary referral center Child Protection Team.MethodsCross-sectional study of young children diagnosed with high, intermediate, or low concern for physical abuse and tested for occult drug exposure from 2013-2017. Chart review was performed to determine adherence to recommended testing and drug test results with comparison between groups.ResultsOccult drug exposures were found in 5.1% (CI 3.6–7.8) of 453 children tested: 6.0% (CI 3.6–10.0) of 232 children with high concern for physical abuse, 5.0% (CI 2.7–9.3) of 179 children with intermediate concern, and 0% of 42 children with low concern. As adherence to protocol-based screening improved during the second half of the study, so did the overall rate of detection of occult drug exposures (7.9%, CI 5.2–11.9) in 252 children with intermediate or high concern for physical abuse. Most exposures were to cocaine, although non-prescribed pharmaceutical exposures were also detected.ConclusionsUp to 7.9% of young children suspected of being physically abused also had an occult drug exposure. Given the adverse health consequences associated with exposure to a drug-endangered environment, screening for occult drug exposure should be considered in the evaluation of young children with intermediate or high concern for physical abuse.     

Child abuse and neglect re-report rates for young children with developmental delays

The study objective was to examine the likelihood and magnitude of child abuse and neglect (CAN) re-reports for young children (0–71 months) with delays in cognitive, language, and adaptive development, compared to typically developing children. The National Survey of Child and Adolescent Well-Being (NSCAW II), a nationally representative and longitudinal survey, was used to examine CAN re-reports at two follow-up waves, 18- and 36-months post baseline assessments. Logistic regression models were employed to determine the correlation between number of developmental delays and a CAN re-report at waves 2 and 3. Results indicate that children with three or more domains of delays had odds 4.73 times higher than children without developmental delays of re-report to CPS at wave 2 but not at wave 3. In this study, children with multiple developmental delays have elevated rates of CAN re-reports when compared to typically developing children. Allocation of child welfare resources should include strategies for preventing maltreatment risk among children with developmental delays.     

Therapeutic groupwork with young children and mothers who have experienced domestic abuse

There is mounting recognition that exposure to domestic abuse causes far‐reaching damage to children’s lives, development and psychological well‐being. Studies estimate 10% to 20% of children are at risk of exposure to domestic abuse – thus domestic abuse must be seen as a crucial issue for educational psychologists (EPs). This study investigates the effects of domestic abuse on a group of mothers and their young children. It also describes how an Education Psychology Service (EPS) was involved in developing, running and evaluating therapeutic groupwork to promote positive mother–child relationships and to enhance the psychological well‐being of mothers and their young children who have experienced domestic abuse.     

Sexual abuse in the developmentally disabled: Dilemmas of diagnosis

Evaluation of developmentally disabled persons for physical signs of sexual abuse presents many challenges to the practitioner. This group is especially vulnerable to all types of abuse. A group of 35 mentally retarded females from a residential treatment facility was examined by the child abuse medical team at Harbor/UCLA Medical Center after one inpatient was found to be pregnant. Patients ranged in age from 13 to 55 years (median, 26 years; mean, 31.3 +/- 13.6 years). All of the women had some degree of disability, with 24 (69%) being categorized as profoundly retarded. No patient was able to provide a history. There were 13 (37%) patients who had genital findings we believe are consistent with prior vaginal penetration. Dilemmas which arose during evaluation included the significance of healed genital lesions in this population and the implications of the findings for the residential facility. While developmentally disabled persons need an advocate in the medical and legal systems, these patients can overwhelm the practitioner. Whenever possible, a team approach is recommended to decrease the work load and frustration and provide collegial support and affirmation of findings.