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.     

Trends in children's disclosure of abuse in Israel: a national study

OBJECTIVE: To identify characteristics of suspected child abuse victims that are associated with disclosure and nondisclosure during formal investigations. METHODOLOGY: The database included all suspected cases of physical and sexual abuse investigated in the state of Israel between 1998 and 2002. All investigative interviews were conducted using a single standardized protocol, the National Institute of Child Health and Human Development (NICHD) Investigative Interview Protocol. FINDINGS: Overall, 65% of the 26,446 children made allegations when interviewed, but rates of disclosure were greater in the case of sexual (71%) than physical (61%) abuse. Children of all ages were less likely to disclose/allege abuse when a parent was the suspected perpetrator. Rates of disclosure/allegation increased as children grew older, with 50% of the 3- to 6-year-olds, 67% of the 7- to 10-year-olds, and 74% of the 11- to 14-year-olds disclosing abuse when questioned. CONCLUSIONS: Although most interviews of suspected victims yielded allegations, such rates of disclosure varied systematically depending on the nature of the alleged offences, the relationship between alleged victims and suspected perpetrators, and the age of the suspected victims. The findings obtained in this large and unselected data set confirm patterns previously reported in smaller and quite selective samples, most of them obtained in the United States.     

Child peer sexual abuse: preliminary data on outcomes and disclosure experiences

OBJECTIVE: This study compared experiences of children sexually abused by peers to those of children abused by adolescents/adults. Variables examined included perceived negativity of the abuse, self-reported outcomes, overall psychological functioning, and disclosure. METHOD: An archival data set containing retrospective reports of childhood sexual experiences was culled for instances of sexual abuse by child peers and adolescents/adults. An equivalent nonabused comparison group was identified. The Self-Report Outcome Checklist (SROC; Gilbert, 1994b), the MMPI-Hugo Short Form (Hugo, 1971) and a disclosure survey were also retrieved from these data. RESULTS: Compared to abuse by peers, abuse perpetrated by adolescents/adults was more intrusive and intrafamilial. Both groups rated their experiences as equally negative, and reported equally pervasive outcomes. Those abused by adolescents/adults reported significantly higher scores on the Psychopathic Deviate, Psychasthenia, and Schizophrenia scales compared to nonabused controls; similar findings did not emerge for those abused by child peers. Less than a fourth in either abuse group reported disclosing their experience to a parent. Among those who did not disclose, participants abused by child peers anticipated less support from both parents and more anger from their mothers. CONCLUSIONS: The findings suggest that child peer sexual abuse may be associated with adverse outcomes.     

Consistency in children's reports of sexual and physical abuse

OBJECTIVE: The goal of the present study was to investigate the consistency of children's reports of sexual and physical abuse. METHOD: A group of 222 children, ages 3-16 years, participated. As part of legal investigations, the children were interviewed twice about their alleged experiences of abuse. The consistency of children's reports of sexual and physical abuse was examined in the two interviews, in relation to age, type of abuse, gender, memory, suggestibility, and cognitive capabilities. RESULTS: Older children were more consistent than younger children in their reports of sexual and physical abuse. Children were more consistent when reporting sexual abuse than physical abuse. Girls were more consistent than boys in sexual abuse reports. Consistency in sexual abuse reports was predicted by measures of memory, whereas consistency in physical abuse reports was not. Cognitive abilities did not predict consistency in sexual abuse or physical abuse reports. CONCLUSIONS: Implications for understanding children's allegations of abuse are discussed.     

Adolescents who experienced sexual abuse: fears, needs and impediments to disclosure

OBJECTIVE: Understanding the impediments that prevented sexually abused adolescents from disclosure to their family or to professionals, and analyzing the responses they received when they did disclose. METHODS: In depth anonymous interviews were conducted in Italy through a toll-free telephone line with 36 young people who experienced sexual abuse in adolescence. A qualitative analysis was carried out of the adolescents' feelings, fears and needs, and of the help received, if any. RESULTS: The main impediments to disclose to a family member were fear of not being believed, shame, and fear of causing trouble to the family. The main impediments for not seeking services were ignorance of the existence/functioning of protective agencies, wish to keep the secret, lack of awareness of being abused, mistrust of adults and professionals, and fear of the consequences of disclosure. When they did disclose to professionals, the teens received very limited support. CONCLUSION: Adolescents need to receive proper information about the risk of being sexually abused and about the help they can receive from their social network and protective agencies. There is a crucial need for appropriate training of professionals.     

Child sexual abuse prevention: Evaluation of a teacher training model

Teachers are potentially helpful resource persons for large numbers of sexually abused children who may have difficulty disclosing abuse, particularly to family members. In the present study, the effectiveness of a 6-hour teacher training workshop on child sexual abuse prevention was evaluated. Responses of 26 female elementary teachers who participated in the workshop were compared to responses of 19 control teachers on several pre-, post-, and follow-up measures. Relative to controls, trained teachers demonstrated significant increases from pre- to post-testing in knowledge about child sexual abuse and pro-prevention opinions. On a post-only vignettes measure, trained teachers were better able than control teachers to identify behavioral indicators of abuse and suggest appropriate interventions for hypothetical sexually abused children. Over a 6-week follow-up period, trained teachers read more about child abuse than control teachers but did not differ on other behavioral dimensions such as reporting suspected abuse cases. Further research will examine the effects of additional teacher training over an extended follow-up period.     

The effect of multipart prompts on children's testimonies in sexual abuse investigations

ObjectiveThe current study aimed to explore the frequency and effects of multipart prompts on the testimonies of children who were alleged victims of sexual abuse and were interviewed using the National Institute of Child Health and Human Development (NICHD) Investigative Protocol. The effects of the multipart prompts were studied by considering the type of prompt given to the children and examining the richness of the children's testimonies (e.g., the number of words and the number of forensic details) and the ways the children contended with these prompts (e.g., which demand they answered, whether they signaled misunderstanding).Method71 Israeli children aged 4–9 years were interviewed after a complaint of single incident of sexual abuse by a perpetrator who was not a family member. All of the interviews that met the specified criteria and were conducted within a specified period were included in this study. Two raters identified simple versus multipart prompts and analyzed the children's responses.ResultsThe results clearly showed that multipart prompts were used in most interviews, regardless of the child's age. An average of 5.58 multipart prompts per interview was given. The effects of the multipart prompts were destructive and harmed the length and the richness of the children's testimonies. Children of all ages failed to signal their lack of understanding of multipart prompts, and 24% of their responses were unintelligible. When the children did produce a relevant and substantive answer, they primarily responded to the last demand in the multipart prompt and rarely provided an answer to both demands.ConclusionsThe study clearly indicates that even well-trained investigative interviewers present inappropriate multipart prompts to children. The findings contribute to the existing knowledge about the adverse effect that multipart prompts have on children's narratives, indicating that children of all ages provided poorer testimonies in response to multipart prompts. The systematic knowledge accumulated in both laboratory and field studies indicates that it is necessary to eliminate the use of multipart prompts by updating existing practical guidelines and training courses.     

One thousand fifty-nine children with a chief complaint of sexual abuse

Sexual assault victims (1,059) under the age of 17 were evaluated over a period of 44 months in a teaching, metropolitan county emergency room. The cases were recorded and reviewed by use of a protocol. The children ranged in age from 3 months to 16 years of age. Most were female (89%). The average age for all children was 8.3 years. There was no mean age difference between male and female victims 12 and under. Victims were 1.58 times as likely to be black, 0.22 times as likely to be Latin, and 0.96 times as likely to be white than the general population. Perpetrators were strangers in 13.8% of cases and close family (incest) in 28.1% of cases. A major finding is that 58.1% of the perpetrators were known to the child but were not family members. These episodes were severe with penetration occurring in 754 (71%) of the assaults. Cultures were positive in 1.5% of all cases. The medical and social response to these children's needs is noted to be inadequate.     

The contribution of children's advocacy centers to felony prosecutions of child sexual abuse

ObjectiveTo describe trends of felony sexual abuse prosecutions between 1992 and 2002 for two districts of a large urban city that differed primarily in their use of children's advocacy centers (CACs) for sexual abuse evaluations in children.MethodsAggregate data for two districts of a large urban city were provided from 1992 to 2002 from the district attorney's office, child protective services (CPS) agency, and all CACs serving both districts. Summary statistics were calculated over time and compared between both districts for ecologic trends using negative binomial regression.ResultsOver the time period of the study, substantiated reports of child sexual abuse declined: District 1 experienced a 59% decrease in the incidence of reports, while District 2 experienced a 49% decrease in the incidence of reports. Despite this decrease, felony prosecutions of child sexual abuse increased in District 1 (from 56.6 to 93.0 prosecutions/100,000 children, rate ratio 1.64, 95% CI 1.38–1.95), but did not significantly increase in District 2 (from 58.0 to 54.9 prosecutions/100,000 children, rate ratio 0.94, 95% CI 0.73–1.23); by 2002, the rate of felony prosecutions in District 1 was 69% greater (95% CI 37–109%) than the rate in District 2. In 1992, CACs in District 1 evaluated approximately 400 children, increasing to 1,187 children by 2002. The number of children evaluated by CACs in District 2 increased modestly from nearly 800 in 1992 to 1,000 in 2002.ConclusionFelony prosecutions of child sexual abuse doubled in a district where the use of CACs nearly tripled, while no increase in felony prosecutions of child sexual abuse was found in a neighboring district, where the use of CACs remained fairly constant over time.Practice implicationsThough many limitations exist when bringing together ecological data from different agencies, the strength of the association we observed between increased CAC use and increased felony prosecutions, and the stepwise fashion in which it occurred should support future research to confirm our findings and to delineate which attributes of CAC performance might impact the likelihood of prosecution of child sexual abuse.     

Physical and sexual abuse among school children: Prevalence and prevention

Prevalence of physical and sexual abuse, with emphasis on data provided by the 1986 National Incidence Study sponsored by the U.S. Department of Health and Human Services, is discussed within certain data collection constraints. Incidence results are reported by subcategory of abuse, child's sex, child's age, child's race/ethnicity, family income, and family size. Effects of physical and sexual abuse and characteristics of abusers are presented to establish the context in which primary, secondary, and tertiary prevention programs are developed and delivered. Research on abuse prevention programs is discussed, with attention drawn to problems associated with the lack of a research base for school-based abuse prevention programs.     

Symptomatology in adolescents following initial disclosure of sexual abuse: The roles of crisis support, appraisals and coping

ObjectiveThe present study examined possible explanations for symptom development and variability in sexually abused adolescents. A theoretical model of sexual abuse, in which appraisal, coping and crisis support play prominent roles, was tested in a clinical group of 100 sexually abused adolescents.MethodParticipants, aged 12–18 years, completed questionnaires regarding severity of abuse, negative appraisals, crisis support, coping strategies, and trauma-related stress symptoms.ResultsSince severity of abuse had no influence on the association between appraisals and symptoms it was eliminated from our model. Structural equation modeling analyses showed a significant interrelationship between the examined concepts. Adolescents who appraised the abuse as more threatening showed more internalizing and externalizing trauma symptoms. Moreover, more negative appraisals were associated with more avoidance as well as with more active coping strategies. Direct crisis support was associated with less negative appraisals and with the use of more active coping strategies.ConclusionsThe study showed that especially the buffering role of crisis support and the role of negative appraisals explained symptom development and variety in sexually abused adolescents.Practice implicationsAdaptation to sexual abuse includes the ways in which adolescents perceive the event as threatening and harmful, how they cope with the abusive experience, and how they receive direct support from their family. Clinicians, therefore, need to expand the focus of their assessments beyond age- and trauma-specific symptoms, to age- and trauma-specific appraisals, coping, and social support. The assessment of these factors should take place as soon as possible after the disclosure of the abuse. Individualized treatment plans and clinical interventions need to be based on these personal and environmental variables, rather than reliance on the influence of abuse-related characteristics, such as the severity or type of abuse.     

Proximate effects of a child sexual abuse prevention program in elementary school children

OBJECTIVE: The effects of the sexual child abuse prevention program ESPACE were evaluated by means of a Solomon-type design with first and third grade children. ESPACE is an adaptation of the American Child Assault Prevention Program (CAP). Possible side effects of the program were also examined. METHOD: A total of 133 children (64 first-graders and 69 third-graders) participated in the study. Children completed a knowledge questionnaire and a video vignette measure designed to evaluate preventive skills towards abusive and potentially abusive situations. A follow-up measure (2 months) was administered to verify whether knowledge and skills were maintained. RESULTS: Results indicated that children participating in the prevention program showed greater preventive knowledge and skills relative to children not participating. Follow-up data showed that knowledge gains were maintained while the preventive skill gains may attenuate. However, while global skill scores decreased between post-test and follow-up, children still showed greater preventive skills at follow-up than before the program. In terms of unanticipated side effects, results revealed that almost half of the parents noted positive reactions following children's participation in the ESPACE program. Furthermore, the majority of parents did not identify negative reactions in their children following their participation in the workshop. CONCLUSION: The findings suggest that the Quebec adaptation of the CAP program was effective in training children in abuse prevention concepts and skills.     

Characteristics predicting children's responses to sexual encounters with other children

The replies to a survey of more than 1,000 undergraduates concerning childhood sexual encounters are reported. Linear structural equation modeling is employed to analyze which characteristics of the sexual encounters with other children were associated with more positive or negative responses by subjects. Approximately 42% of the subjects reported a childhood sexual encounter with another child. Most encounters involved sexual kissing or exposing of genitalia, and they generally occurred with a friend. High levels of coercion from the other child to gain the subject's cooperation, homosexual encounters, and encounters with those other than friends predicted a more negative response. The type of sexual activity was not associated with response. Subjects who experienced a high level of coercion from another child reacted to their sexual encounter similarly to other subjects who had a sexual encounter with an adult, while those who experienced low levels of coercion rated their encounter with a child more positively.     

The family environment of sexual abuse: a comparison of natal and stepfather abuse

Data from 17 states, drawn from the 1983 National Study on Child Neglect and Reporting, were used to compare families in which a daughter had been sexually abused by a natal father or stepfather. While broad comparisons are made in terms of age and race of victims, as well as household composition, the primary focus is on familial stress factors. Given the lower incidence of natal father abuse and the assumption that natal fathers have stronger emotional links to their children and greater commitment to the father role, we predicted that when they did engage in sexual abuse, it would be in a family environment characterized by relatively high levels of personal, social, and economic stress. This was confirmed to the extent that natal father abuser families showed significantly higher levels of drug and/or alcohol abuse, marital problems, and insufficient income than did stepfather abuser families.     

"A burden in your heart": lessons of disclosure from female preadolescent and adolescent survivors of sexual abuse

OBJECTIVES: To enhance understanding of the sexual abuse disclosure process from the perspective of preteen and teenage survivors. To reconsider prominent models of the disclosure process in light of our findings. METHODS: We conducted a secondary analysis of data from four focus groups in which 34 preadolescent and adolescent female survivors of sexual abuse had been asked about their treatment experiences. Girls often recounted disclosing their victimization to others. Using the disclosure segment as our unit of analysis, we isolated 106 for study. During analysis, we wrote narrative summaries of each segment's significance, grouped these conceptually, and examined their interconnectedness. When synthesized, individual experiences of disclosing contributed to understanding the overall disclosure process. RESULTS: Three phases were identified: Self, where children come to understand victimization internally; Confidant Selection-Reaction, where they select a time, place, and person to tell and then weather that person's reaction (supportive or hostile); and Consequences (good and bad) that continued to inform their on-going strategies of telling. The actions and reactions of adults were significant and informed the girls' decisions. CONCLUSIONS: We advocate integrating existing theories and research into a model which views the disclosure process from the child's perspective and includes pre-disclosure and a post-initial public disclosure stages. The model conceptualizes disclosure as an iterative process in which children interact with adults and incorporate responses into their on-going decisions about telling (recant, deny, affirm, etc.). The combined model should recognize the concerns and position of adults as well as the perspective and logic of youth.     

Gendered experiences of sexual abuse of teenagers and children in Mexico

The prevalence of sexual abuse during childhood and adolescence in a national representative sample of Mexican youngsters is examined from a gender perspective using data from the 2007 National Survey on Exclusion, Intolerance and Violence in Public Institutions of High School Level Education. Of those surveyed, 1.76% were forced into their first experience of intercourse, and 6.43% had their genitalia touched or their first sexual interaction imposed against their will. In this sample, 6.82% had experienced sexual abuse before the age of 18. Child sexual abuse was most commonly perpetrated by family members and neighbors. Only 20% reported being abused by an unknown person. Males and females had different victimization experiences. Forty percent disclosed information about the abuse to another person, and 7% reported their experiences to law enforcement agencies. Males and females stated different reasons for not disclosing. These findings are discussed within the context of the social construction of the male and female body and sexuality in the Mexican context.