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.     

Childhood disclosure of sexual abuse: Necessary but not necessarily sufficient

Prevention programs often encourage sexually abused children to disclose without fully considering the potential for adverse consequences. This study examined the impact of disclosure on abuse cessation and later adult symptomatology. A clinical sample of 301 adult survivors completed the Impact of Event Scale (IES/IES-R), and the Beck Depression Inventory (BDI-II). Participants were divided into 3 groups: Nondisclosure (n = 221), Disclosure/Abuse Ended (n = 25), and Disclosure/Abuse Continued (n = 55). Multivariate analyses of covariance, adjusting for abuse characteristics (age of onset, penetration, and number of perpetrators) and other trauma exposure, revealed significant differences in psychiatric symptom severity among the three groups, Wilks’ λ = 0. 95, F (6, 584) = 2.69, p = 0.014, η_p² = 0.03. Specifically, those in the Disclosure/Abuse Continued group scored significantly higher on the IES/IES-R Intrusion subscale (p = 0.04) and the BDI-II (p = 0.01), as compared to the Nondisclosure group. The Disclosure/Abuse Ended group did not differ significantly from the other groups. Results suggest that disclosure may be detrimental unless adequate steps are taken to ensure abuse cessation and appropriate treatment.     

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.     

Caregiver perceptions of sexual abuse and its effect on management after a disclosure

Objective

The aim of the study was to examine caregiver management strategies for child sexual abuse (CSA) when presented with hypothetical scenarios that vary in physical invasiveness.

Methods

One hundred fifty three caregivers were given 3 scenarios of CSA with 7 management strategies presented in the 21-item Taking Action Strategies (TAS) scale. Caregivers were asked to rate strategies according to their willingness to carry out each action with rating of 5 = greater likelihood of carrying out the action specified while a rating of 1 = a lower likelihood of carrying out that action. CSA scenarios included exposure to pornography/masturbation, fondling, and penetration while management strategies including fighting the accused, blaming the child, and outreaching to the authorities. Repeated measures ANOVA was used to compare mean TAS scores for the management strategies across CSA scenarios.

Results

The difference between TAS scores across the abuse scenarios was statistically significant (p < .001). Mean TAS scores reflected greater preference for taking action if the abusive act was perceived as more physically intrusive (exposure to pornography/masturbation-TAS 3.5, fondling-TAS 3.7, penetration-TAS 3.8). Caregivers reported being less willing to handle a disclosure of CSA without outreach (TAS 2.5 and 2.0 for fighting and blaming the child, respectively) and more willing to manage a disclosure with outreach to authorities (TAS 3.8, 4.5, and 4.7 for outreaching to Child Protective Services [CPS], to the child's healthcare provider and police, respectively). A predictor of caregiver outreach to authorities identified was the caregiver having past interactions with CPS.

Conclusion

Perception of the physical invasiveness of CSA and demographic factors can impact caregiver management strategies after a disclosure.

Practice implications

Results suggest that several factors influence caregiver management of sexual abuse. These factors warrant further study, as they are potential contributors to declining trends in CSA cases observed. Other implications include the need for educational efforts targeting caregivers. These interventions should focus on dispelling myths about the perceived physical invasiveness of CSA. These perceptions should not mitigate a caregiver's decision to involve the authorities in their management after a disclosure. Lastly, despite criticisms of the child protective systems, caregivers with past encounters with CPS view these related agencies as valuable resources.     

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.     

Child sexual abuse,disclosure and PTSD: A systematic and critical review

BackgroundChild sexual abuse (CSA) is a prevalent exposure with potentially serious, negative health consequences, including post-traumatic stress disorder (PTSD) and its symptomatology.ObjectiveTo conduct a systematic and critical review in order to investigate the relationship between CSA disclosure patterns and PTSD.Participants and settingStudies included clinical, college and community-based samples of adults’ and children’s experiences of CSA.MethodsWe conducted systematic searches in five databases (Medline, Embase, PyscINFO, CINAHL, ERIC, Sociological Abstracts) from database inception to October 17, 2017 using index terms and keywords for CSA, disclosure, and PTSD. We included any English-language, primary studies involving children or adults with experiences of CSA that used quantitative research designs to explore the relationship between disclosure and PTSD. We used systematic critical review methodology in order to investigate the relationship between disclosure and PTSD symptoms and disorders. We also investigated factors that explained the relationship between disclosure and PTSD, such as individual, exposure or environmental factors.ResultsTwenty-two articles reporting 20 studies were included in this review. Studies assessing the relationship between CSA and PTSD tended to account for personal (e.g., gender) and CSA exposure variables (e.g., severity of CSA) only. While authors generally used validated measures to assess for PTSD symptoms and disorders, they tended to use author-generated or unvalidated measures to assess for disclosure process variables.ConclusionThe relationship between factors that affect disclosure, and responses to disclosure, are not well theorized in quantitative literature. Study findings suggest important avenues for future research, such as the need to assess disclosure longitudinally.     

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.     

Childhood disclosure of sexual abuse and mental health outcomes in adulthood: Assessing merits of early disclosure and discussion

BackgroundEmpirical research on the impact of early disclosure of child sexual abuse (CSA) on survivor health is limited and mixed. One recent study found that early disclosure may actually be detrimental for abuse cessation and adult symptomatology (Swingle et al., 2016). The current study re-examined the effects of early disclosure and related variables on long-term mental health for men with histories of CSA.ObjectiveThe primary aims of this study were to: a) investigate whether early disclosure and response to early disclosure were related to mental distress in adulthood, and b) examine whether having an in-depth discussion and timing of that discussion were related to mental distress in adulthood.Participants and settingData were collected from a large, non-clinical sample of male survivors (N = 487), ranging in age from 19 to 84 years, through an online, anonymous survey.MethodsHierarchical regression analyses were conducted by entering groups of variables in four steps: control variables, CSA severity, disclosure, and discussion.ResultsOverall, models explained between 24–28% of the variance in mental distress. None of the CSA severity variables reached significance. Both early disclosure (β = −0.126, p = 0.003) and response to first disclosure (β = −0.119, p = 0.006) were significant protective factors in Model 3. In the final model, having an in-depth discussion (β = −0.085, p = <0.036) and years until discussion (β = 0.102, p = 0.029) were also related to mental distress.ConclusionsResults support the merits of early disclosure and discussion on long-term mental health. Implications for future research and practice are presented.     

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.     

School and program related factors influencing disclosure among children participating in a school-based childhood physical and sexual abuse prevention program

BackgroundSchool-based child abuse prevention programs were created to provide knowledge so that children can recognize abuse, teach skills that decrease children’s risk for abuse, normalize the disclosure process, and provide a pathway for children who may be experiencing abuse to report the abuse.ObjectiveThe purpose of this study was to explore school and program factors that trainers in a school-based prevention program believed were associated with disclosure among youth from kindergarten through 12th grade.Participants and settingThis study is based on eighteen trainers and administrators who work with the Play it Safe!® school-based program in Dallas-Fort Worth area.MethodsUsing the qualitative case study method, in-depth interviews were conducted.ResultsData analysis revealed three factors that influenced disclosure: school, school personnel, and program features. The school-related factor was time allotted to the training. The school personnel-related factors were disengagement, ambiguity concerning abuse, prior history with children, and professionals’ personal history of abuse. Finally, the program-related factors were the core messages of the training, providing specific examples, and repetition of the program. To date, there is a dearth of studies that explore the role that schools and school personnel play in the disclosure process.ConclusionChild abuse has devastating effects on children’s physical, social, emotional, and psychological well-being. Understanding more about schools, personnel, and program-related factors that lead to disclosure, which are more amenable to change, is critical to ensuring the safety of children.     

Why sexual abuse? An exploration of the intergenerational hypothesis

The issue of sexual abuse in the family backgrounds of offenders and mothers of victims is explored in a clinical sample of 154 cases of intrafamilial sexual abuse. More than a third of the offenders and about half of the mothers had experienced or been exposed to sexual abuse as children. Cases were divided into those where the sexual abuser was the biological father in an intact family, those where he was a stepfather or mother's live-in partner, and those where he was a noncustodial father. In biological father cases, parents were about equally likely to have experienced sexual abuse during childhood, in the stepfather/live-in partner cases, the mother was more likely to have had such an experience, and in the noncustodial father cases, the offender was more likely to have come from a sexually abusive family.     

A meta-analysis of the prevalence of child sexual abuse disclosure in forensic settings

BackgroundIdentification, substantiation, prosecution, and treatment of child sexual abuse often rely heavily on a disclosure from the victim in the absence of corroborating evidence. For some, disclosure can be impeded by developmental or motivational barriers, thus compromising child safety and wellbeing. The literature on disclosure prevalence and mitigating influences does not yield a coherent picture. A more accurate estimate will help to inform investigation strategies to facilitate disclosure.ObjectiveThis study provides a meta-analysis of available research examining the prevalence of sexual abuse disclosure in forensic interviews with children under 18 years, and examines a range of factors that may influence the likelihood of disclosure.MethodDatabases were searched for published and unpublished studies up to May 2017. In total, 2393 abstracts were assessed for eligibility, 216 full-text articles were reviewed, and 45 samples (with 31,225 participants) provided estimates of effect sizes.ResultsThe mean prevalence of child sexual abuse disclosure in forensic settings was 64.1% (95% CI: 60.0–68.1). Between-study variability was explained by: (1) child age and gender, with higher prevalence in older children and females; (2) prior disclosure, with higher prevalence when present; and (3) study year, with higher prevalence in more recent studies.ConclusionsThis meta-analysis confirms an upward trend in child sexual abuse disclosure prevalence. However, more than a third of children do not disclose when interviewed, with those who are younger, male, and without a prior disclosure at greatest risk. Important implications for forensic interviewing protocols and future research are discussed.     

Exploring the disclosure of child sexual abuse with alleged victims and their parents

OBJECTIVE: The goal of the present study was to examine how children disclosed sexual abuse by alleged perpetrators who were not family members. METHODOLOGY: Thirty alleged victims of sexual abuse and their parents were interviewed. The children were interviewed using the NICHD Investigative Interview Protocol by six experienced youth investigators. The same principles were followed when the parents were asked to describe in detail what had happened since the abusive incidents. The statements made by the children and parents were then content analyzed. Major characteristics of the children's and parents' reported behaviors were identified by two independent raters. FINDINGS: More than half (53%) of the children delayed disclosure for between 1 week and 2 years, fewer than half first disclosed to their parents, and over 40% did not disclose spontaneously but did so only after they were prompted; 50% of the children reported feeling afraid or ashamed of their parents' responses, and their parents indeed tended to blame the children or act angrily. The disclosure process varied depending on the children's ages, the severity and frequency of abuse, the parents' expected reactions, the suspects' identities, and the strategies they had used to foster secrecy. CONCLUSIONS: The children's willingness to disclose abuse to their parents promptly and spontaneously decreased when they expected negative reactions, especially when the abuse was more serious. A strong correlation between predicted and actual parental reactions suggested that the children anticipated their parents' likely reactions very well.     

Child abuse: Betrayal and disclosure

ObjectiveThe current study tested several hypotheses about disclosure of childhood sexual, physical, and emotional abuse derived from Betrayal Trauma Theory [Freyd, J. J. (1996). Betrayal trauma: The logic of forgetting childhood abuse. Cambridge, MA: Harvard University Press]. We predicted that the duration of time from abuse to its disclosure would vary as a function of victim–perpetrator closeness.MethodsData collected from 202 undergraduate participants using a survey methodology were submitted to logistic regression analyses. The relative variance explained by other variables was also examined.ResultsCompared to survivors of emotional abuse (EA) who were in not very close (NVC) victim–perpetrator relationships, EA survivors in very close (VC) victim–perpetrator relationships were significantly more likely to wait 1 or more years to disclose, or never to disclose, than to wait a period of time less than 1 year (OR = 2.65). Further, survivors of physical abuse (PA) in VC victim–perpetrator relationships were significantly more likely to wait 1 or more years to disclose their abuse, if it was disclosed at all, than PA survivors of NVC victim–perpetrator relationships (OR = 3.99). Results for sexual abuse were not significant.ConclusionsFor EA and PA, VC victim–perpetrator relationships predicted longer durations of time from abuse to its disclosure than NVC victim–perpetrator relationships.Practice implicationsAlthough delayed disclosure may support necessary (albeit abusive) attachments with caregivers, it may also prolong the abuse and prevent receipt of support. Increased awareness that VC victim–perpetrator relationships may predict longer durations of time from abuse to its disclosure, and that these delays may serve a functional purpose, can help guide supportive and empathic responses to traumatic disclosures.     

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.