Multiple perpetrator rape among girls evaluated at a hospital-based Child Advocacy Center: Seven years of reviewed cases

The aim of this study was to describe contextual events, abuse experiences, and disclosure processes of adolescents who presented to a hospital-based Child Advocacy Center for medical evaluation and evidentiary collection as indicated after experiencing multiple perpetrator rape during a single event (n = 32) and to compare these findings to a group of single perpetrator sexual assaults (n = 534). This study used a retrospective mixed-methods design with in-depth, forensic interviews and complete physical examinations of gang-raped adolescents. Patients ranged from 12 to 17 years (M = 14 years). Girls who experienced multiple perpetrator rape during a single event were more likely to have run away, to have drunk alcohol in the past month, and to have participated in binge drinking in the past 2 weeks. Acute presentation of these victims were rare but 30% had hymenal transections and 38% had sexually transmitted infections (STIs). Forensic interviews revealed alcohol was a common weapon used by offenders, and its use resulted in victims experiencing difficulty in remembering and reporting details for police investigation or physical and mental health care. Most victims were raped at parties they attended with people they thought they could trust, and they felt let down by witnesses who could have helped but did not intervene. Although relatively rare, multiple perpetrator rape during a single event is a type of severe sexual assault experience and has significant risks for deleterious health outcomes. These victims require health care by trained providers to diagnose physical findings, treat STIs, screen for trauma, and support victims.     

Sexual abuse history among adult sex offenders and non-sex offenders: A meta-analysis

ObjectiveThe sexually abused–sexual abuser hypothesis states there is a specific relationship between sexual abuse history and sexual offending, such that individuals who experience sexual abuse are significantly more likely to later engage in sexual offenses. Therefore, samples of adult sex offenders should contain a disproportionate number of individuals who have experienced sexual abuse, but not necessarily other types of abuse, compared with samples of other types of offenders.MethodsWe compared rates of sexual and other forms of abuse reported in 17 studies, involving 1,037 sex offenders and 1,762 non-sex offenders. We also examined the prevalence of different forms of abuse in 15 studies that compared adult sex offenders against adults (n = 962) and against children (n = 1,334), to determine if the sexually abused–sexual abuser association is even more specific to individuals who sexually offend against children.ResultsWe observed a higher prevalence of sexual abuse history among adult sex offenders than among non-sex offenders (Odds Ratio = 3.36, 95% confidence intervals of 2.23–4.82). The two groups did not significantly differ with regard to physical abuse history (OR = 1.50, 95% CI = 0.88–2.56). There was a significantly lower prevalence of sexual abuse history among sex offenders against adults compared to sex offenders against children (OR = 0.51, 95% CI = 0.35–0.74), whereas the opposite was found for physical abuse (OR = 1.43, 95% CI = 1.02–2.02).ConclusionThere is support for the sexually abused–sexual abuser hypothesis, in that sex offenders are more likely to have been sexually abused than non-sex offenders, but not more likely to have been physically abused. We discuss potential mechanisms for the relationship between sexual abuse history and sexual offending, including the possibility that a third factor might account for the relationship.Practice implicationsThe most obvious implications of these findings is that the prevention of sexual abuse of children, either through prevention programs directly targeting children or through treatment programs targeting individuals who are likely to sexually offend against children (e.g., known sex offenders against extra-familial boys), may eventually reduce the number of sex offenders. This implication is dependent, however, on a causal role of childhood sexual abuse, and on the effectiveness of prevention and treatment practices.     

Commercially sexually exploited youths’ health care experiences,barriers, and recommendations: A qualitative analysis

The current study sought to understand commercially sexually exploited (CSE) youths’ health care experiences, barriers to care, and recommendations for improving health care services. We conducted focus groups (N = 5) with 18 CSE youth from February 2015 through May 2016 at two group homes serving CSE youth in Southern California. We performed thematic content analysis to identify emergent themes about CSE youths’ perspectives on health care. Youth described facilitators to care, including availability of services such as screening for sexually transmitted infections, knowledge about sexual health, and a strong motivation to stay healthy. Barriers included feeling judged, concerns about confidentiality, fear, perceived low quality of services, and self-reliance. Overall, youth emphasized self-reliance and “street smarts” for survival and de-emphasized “victimhood,” which shaped their interactions with health care, and recommended that health providers develop increased understanding of CSE youth. Our findings suggest that providers and community agencies can play an essential role in raising awareness of the needs of CSE youth and meet their health needs through creating a non-judgmental environment in health care settings that validates the experiences of these youth.     

Sentinel events predicting later unwanted sex among girls: A national survey in Haiti, 2012

Sexual violence against children is a significant global public health problem, yet limited studies exist from low-resource settings. In Haiti we conducted the country's first, nationally representative survey focused on childhood violence to help inform the development of a national action plan for violence against children. The Haiti Violence Against Children Survey was a household-level, multistage, cluster survey among youth age 13–24. In this analysis we sought to determine whether sexual violence sentinel events (unwanted sexual touching or unwanted attempted sex) were predictive of later unwanted, completed, penetrative sex in Haiti. We also sought to explore characteristics of sentinel events and help-seeking behavior among Haitian children. Multivariable logistic regression was used to test associations between sentinel events and later unwanted, completed, penetrative sex. Overall, 1,457 females reported on experiences of sexual violence occurring in childhood (before age 18). A sentinel event occurred in 40.4% of females who experienced subsequent unwanted completed sex. Females experiencing a sentinel event were approximately two and a half times more likely to experience later unwanted completed sex (adjusted odds ratio = 2.40, p = .004) compared to individuals who did not experience a sentinel event. The mean lag time from first sentinel event to first unwanted completed sex was 2.3 years. Only half (54.6%) of children experiencing a sentinel event told someone about their experience of sexual violence. Among children, sentinel events occur frequently before later acts of completed unwanted sex and may represent a useful point of intervention. Reporting of sexual violence by children in Haiti is low and can be improved to better act on sentinel events.     

Is there a Complex Trauma Experience typology for Australians experiencing extreme social disadvantage and low housing stability?

Traumatic childhood experiences predict many adverse outcomes in adulthood including Complex-PTSD. Understanding complex trauma within socially disadvantaged populations has important implications for policy development and intervention implementation. This paper examined the nature of complex trauma experienced by disadvantaged individuals using a latent class analysis (LCA) approach. Data were collected through the large-scale Journeys Home Study (N = 1682), utilising a representative sample of individuals experiencing low housing stability. Data on adverse childhood experiences, adulthood interpersonal trauma and relevant covariates were collected through interviews at baseline (Wave 1). Latent class analysis (LCA) was conducted to identify distinct classes of childhood trauma history, which included physical assault, neglect, and sexual abuse. Multinomial logistic regression investigated childhood relevant factors associated with class membership such as biological relationship of primary carer at age 14 years and number of times in foster care. Of the total sample (N = 1682), 99% reported traumatic adverse childhood experiences. The most common included witnessing of violence, threat/experience of physical abuse, and sexual assault. LCA identified six distinct childhood trauma history classes including high violence and multiple traumas. Significant covariate differences between classes included: gender, biological relationship of primary carer at age 14 years, and time in foster care. Identification of six distinct childhood trauma history profiles suggests there might be unique treatment implications for individuals living in extreme social disadvantage. Further research is required to examine the relationship between these classes of experience, consequent impact on adulthood engagement, and future transitions though homelessness.     

Early-married and sexually abused girls differ in their psychiatric outcomes

Early marriage and sexual abuse are the two of the most frequent types of childhood abuse. Although early marriage is also a type of sexual abuse, it is associated with different physical, social, and mental outcomes than sexual abuse alone. The purpose of this study was to compare early-married girls and sexually abused girls who were referred for forensic evaluation in Turkey in terms of their sociodemographic characteristics, mental disorder rates, and mental symptom severity. We included 63 adolescent girls for whom a judicial report had been demanded and who were under 15 years old when they were married but were not yet 18 years old during the evaluation (15.51 ± 0.78) and 72 sexually abused adolescent girls between 14 and 18 years old (15.80 ± 1.10) in this study. Following a psychiatric evaluation, the study participants completed the Child Posttraumatic Stress Disorder Reaction Index (CPTS-RI) and the Brief Symptom Inventory (BSI). We used the Windows SPSS 16.0 software program to assess the results. At least one psychiatric disorder was determined in 44.4% of the early-married and 77.8% of the sexually abused cases (p < 0.001). A diagnosis of PTSD or ASD was observed in 11.1% of the early-married cases and in 54.2% of the sexually abused victims (p < 0.001). MDD was determined in 33.3% of the early-married cases and 56.9% of the sexually abused cases (p = 0.006). The CPTS-RI scores of the sexually abused victims were higher than those of the early-married cases (p < 0.001). All of the subscale scores of the BSI were higher in the sexually abused adolescents than in the early-married cases (p < 0.001). Although early marriage has severe physical, social and mental outcomes, it is not as severe as sexual abuse in terms of psychiatric disorder rates and the psychiatric symptom severity it causes.     

Childhood maltreatment and adolescent sexual risk behaviors: Unique,cumulative and interactive effects

Child maltreatment has been associated with sexual risk behaviors. Previous investigators have typically studied only one form of maltreatment, preventing them from exploring interrelations between forms of maltreatment and their impact on sexual risk behaviors. Thus, this study aims to examine the unique, cumulative, and interactive effects of four maltreatment forms (sexual abuse, physical abuse, neglect, and witnessing interparental violence) on sexual risk behaviors. The sample comprised 1940 sexually active adolescents (M_age = 15.6; 60.8% girls) attending Quebec (Canada) high schools. Regression results showed that all maltreatment forms were associated with having a higher number of sexual partners, casual sexual behavior, and a younger age at first consensual intercourse. Physical abuse and witnessing interparental violence were associated with inconsistent condom use, and physical abuse was associated with sexually transmitted infections. After controlling for all forms of maltreatment (unique effects), analyses showed that sexual abuse, physical abuse, neglect or witnessing interparental violence remained statistically associated depending on the sexual risk behavior. A greater number of forms of maltreatment was associated with more sexual risk behaviors (cumulative effect). When sexual abuse was not experienced, neglect was associated with a higher number of sexual partners (interactive effects). In general, associations between maltreatment and sexual risk behaviors were similar for both genders. The magnitude of the relationship between a specific form of child maltreatment and sexual risk behaviors may be inaccurately estimated when not controlling for other forms of maltreatment.     

Adverse childhood experiences (ACE) and adult attachment interview (AAI) in a non-clinical population

Adverse childhood experiences (ACE) tend to be interrelated rather than independently occurring. There is a graded effect associated with ACE exposure and pathology, with an increase when ACE exposure is four or more. This study examined a sample of active individuals (n = 129) to determine distribution patterns and relationships between ACEs, attachment classification, unresolved mourning (U), and disclosure difficulty. The results of this study demonstrated a strong relationship between increased ACEs and greater unresolved mourning. Specifically, the group differences for individuals who experienced no ACE (n = 42, 33%), those with 1–3 ACEs (n = 48, 37.8%), and those with ≥4 ACEs (n = 37, 29.1%) revealed a pattern in which increased group ACE exposure was associated with greater lack of resolution for past trauma/loss experiences, more adult traumatic events, and more difficulty disclosing past trauma. Despite ≥4 ACEs, 51.4% of highly exposed individuals were classified as secure in the Adult Attachment Interview. Resilience in this group may be related to a combination of attachment security, college education, and engagement in meaningful activities. Likewise, adversity may actually encourage the cultivation of more social support, goal efficacy, and planning behaviors; factors that augment resilience to adversity.     

The relationship between childhood adversity,attachment, and internalizing behaviors in a diversion program for child-to-mother violence

Very little research has been conducted on the role of childhood adversity in child-to-parent violence. Childhood adversity places youth at risk for internalizing behaviors (i.e. anxiety and depression) and externalizing behaviors (i.e. aggression). The purpose of this study was to explore the relationships between childhood adversity, child–mother attachment, and internalizing behaviors among a sample of 80 youth who have been arrested for domestic battery against a mother. This study reported high prevalence rates of childhood adversity (mean score of 10 out of 17 events). Multiple regression analysis indicated that insecure attachment predicted depression among females (F(6, 73) = 4.87, p < 0.001), and previous experience with child maltreatment and/or witness to parental violence predicted anxiety among females (F(6, 73) = 3.08, p < 0.01). This study is the first study to explore childhood adversity among a sample of perpetrators of child-to-mother violence and notably adds to our understanding of the multiple pathways connecting childhood adversity, child–mother attachment, and depression and anxiety among a difficult to treat youth population.     

Gender differences in the association between childhood sexual abuse and risky sexual behaviours: A systematic review and meta-analysis

This meta-analytic review examines the association between childhood sexual abuse and risky sexual behaviours with sub-group analyses by gender. Systematic searches of electronic databases including MEDLINE, PubMed, EMBASE, and PsycINFO were performed using key terms. We used a priori criteria to include high quality studies and control for heterogeneities across eligible studies. The review was registered with PROSPERO and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The final meta-analysis applied fixed-effects model to generate pooled odds ratio (OR). Subgroup analyses were conducted to identify potential methodological moderators. The meta-analysis included 8 eligible studies (N = 38,989, females = 53.1%). The overall syndemic of risky sexual behaviors at adulthood was 1.59 times more common in childhood sexual abuse victims. There was a similar association between childhood sexual abuse in general and subsequent risky sexual behaviors in both females and males. However, in cases of substantiated childhood sexual abuse, there was a greater odds of risky sexual behaviors in females (OR = 2.72) than males (OR = 1.69). The magnitude of association of childhood sexual abuse and risky sexual behaviors was similar for males and females regardless of study time, study quality score and method of childhood sexual abuse measurement. There were nonsignificant overall and subgroup differences between males and females. Childhood sexual abuse is a significant risk factor for a syndemic of risky sexual behaviors and the magnitude is similar both in females and males. More research is needed to explore possible mechanisms of association.     

The blind men and the elephant: Identification of a latent maltreatment construct for youth in foster care

Child maltreatment is a major public health concern due to its impact on developmental trajectories and consequences across mental and physical health outcomes. Operationalization of child maltreatment has been complicated, as research has used simple dichotomous counts to identification of latent class profiles. This study examines a latent measurement model assessed within foster youth inclusive of indicators of maltreatment chronicity and severity across four maltreatment types: physical, sexual, and psychological abuse, and neglect. Participants were 500 foster youth with a mean age of 12.99 years (SD = 2.95 years). Youth completed survey questions through a confidential audio computer-assisted self-interview program. A two-factor model with latent constructs of chronicity and severity of maltreatment revealed excellent fit across fit indices; however, the latent constructs were correlated 0.972. A one-factor model also demonstrated excellent model fit to the data (χ² (16, n = 500) = 28.087, p = 0.031, RMSEA (0.012–0.062) = 0.039, TLI = 0.990, CFI = 0.994, SRMR = 0.025) with a nonsignificant chi-square difference test comparing the one- and two-factor models. Invariance tests across age, gender, and placement type also were conducted with recommendations provided. Results suggest a single-factor latent model of maltreatment severity and chronicity can be attained. Thus, the maltreatment experiences reported by foster youth, though varied and complex, were captured in a model that may prove useful in later predictions of outcome behaviors. Appropriate identification of both the chronicity and severity of maltreatment inclusive of the range of maltreatment types remains a high priority for future research.     

Online sexual solicitation by adults and peers – Results from a population based German sample

Prevalence of Internet use among adolescents is high, but little is known about the online sexual activities of German adolescents. This study aimed to describe the 12-month prevalence of German adolescents’ online sexual experiences with a focus on Online Sexual Solicitation (OSS, subjectively negative online sexual experiences with a peer or any sexual online experience, positive or negative, with an adult). A sample of male and female adolescents aged 14–17 (N = 2238) was recruited using online survey panel. The sample was representative for gender and education. Subjects completed an online survey reporting their online sexual activities (i.e., sexual conversation, exchanging pictures, and cybersex) with peers (14–17 y.) and/or adults (≥18 y.). Findings illustrated that 51.3% (n = 1148) of adolescents had experienced online sexual activity, which mostly involved peers (n = 969; 84.4%). In contrast, 23.2% (n = 519) of the adolescents experienced OSS with 2.6% (n = 57) reporting subjectively negative online sexual interactions with peers and 22.2% (n = 490) reporting online sexual interactions with adults, of which 10.4% (n = 51) were perceived as negative. The findings suggest that adolescents frequently engage in sexual interactions on the Internet with only a relatively small number perceiving such contacts as exploitative. In addition, females and adolescents with incomplete family situation, foreign nationality, higher education, homo- or bisexual orientation, and those without perceived social support reported OSS significantly more often.     

Association of autistic traits in adulthood with childhood abuse,interpersonal victimization,and posttraumatic stress

Persons with autistic traits may be at elevated risk for interpersonal victimization across the life course. Children with high levels of autistic traits may be targeted for abuse, and deficits in social awareness may increase risk of interpersonal victimization. Additionally, persons with autistic traits may be at elevated risk of posttraumatic stress disorder (PTSD) symptoms subsequent to trauma. We examined retrospectively reported prevalence of childhood abuse, trauma victimization and PTSD symptoms by autistic traits among adult women in a population-based longitudinal cohort, the Nurses’ Health Study II (N = 1,077). Autistic traits were measured by the 65-item Social Responsiveness Scale. We estimated odds ratios (OR) for childhood sexual and physical/emotional abuse and PTSD symptoms by quintiles of autistic traits. We examined possible mediation of PTSD risk by abuse and trauma type. Women in the highest versus lowest quintile of autistic traits were more likely to have been sexually abused (40.1% versus 26.7%), physically/emotionally abused (23.9% versus 14.3%), mugged (17.1% versus 10.1%), pressured into sexual contact (25.4% versus 15.6%) and have high PTSD symptoms (10.7% versus 4.5%). Odds of PTSD were elevated in women in the top three quintiles of autistic traits compared with the reference group (OR range = 1.4 to 1.9). Childhood abuse exposure partly accounted for elevated risk of PTSD in women with autistic traits. We identify for the first time an association between autistic traits, childhood abuse, trauma victimization, and PTSD. Levels of autistic traits that are highly prevalent in the general population are associated with abuse, trauma and PTSD.     

Effects of childhood trauma exposure and cortisol levels on cognitive functioning among breast cancer survivors

Cognitive functioning difficultiesin breast cancer patients receiving chemotherapy are common, but not all women experience these impairments. Exposure to childhood trauma may impair cognitive functioning following chemotherapy, and these impairments may be mediated by dysregulation of hypothalamic-pituitary-adrenal (HPA) axis function and cortisol slope. This study evaluated the association between childhood trauma exposure, cortisol, and cognition in a sample of breast cancer survivors. 56 women completed measures of trauma exposure (the Traumatic Events Survey), salivary cortisol, and self-reported cognitive functioning (the Functional Assessment of Cancer Therapy – Cognitive). We examined correlations between childhood trauma exposure and cognitive functioning, then used linear regression to control for factors associated with cognition (age, education, time since chemotherapy, depression, anxiety, and insomnia), and the MacArthur approach to test whether cortisol levels mediated the relationship between trauma and cognitive functioning. 57.1% of the sample had experienced at least one traumatic event in childhood, with 19.6% of the sample witnessing a serious injury, 17.9% experiencing physical abuse, and 14.3% experiencing sexual abuse. Childhood trauma exposure and cognitive functioning were moderately associated (r = −0.29). This association remained even when controlling for other factors associated with cognition; the final model explained 47% of the variance in cognitive functioning. The association between childhood trauma and cognitive functioning was mediated by steeper cortisol slope (partial r = 0.35, p = 0.02). Childhood trauma exposure is associated with self-reported cognitive functioning among breast cancer survivors and is mediated by cortisol dysregulation. Trauma should be considered, among other factors, in programs aiming to address cognition in this population.     

Connections between online harassment and offline violence among youth in Central Thailand

Increasing evidence indicates that face-to-face (offline) youth violence and online harassment are closely interlinked, but evidence from Asian countries remains limited. This study was conducted to quantitatively assess the associations between offline violence and online harassment among youth in Central Thailand. Students and out-of-school youth (n = 1,234, age: 15–24 years) residing, studying, and/or working in a district in Central Thailand were surveyed. Participants were asked about their involvement in online harassment and in verbal, physical, sexual, and domestic types of offline violence, as perpetrators, victims, and witnesses within a 1-year period. Multivariable logistic regression was used to assess independent associations between different kinds of involvement in offline violence and online harassment. Perpetration and victimization within the past year were both reported by roughly half of the youth both online and offline. Over three quarters had witnessed violence or harassment. Perpetrating online harassment was independently associated with being a victim online (adjusted odds ratio [AOR] = 10.1; 95% CI [7.5, 13.6]), and perpetrating offline violence was independently associated with being a victim offline (AOR = 11.1; 95% CI [8.1, 15.0]). Perpetrating online harassment was independently associated with perpetrating offline violence (AOR = 2.7; 95% CI [1.9, 3.8]), and being a victim online was likewise independently associated with being a victim offline (AOR = 2.6; 95% CI [1.9, 3.6]). Online harassment and offline violence are interlinked among Thai youth, as in other countries studied so far. Interventions to reduce either might best address both together.     

Poly-victimization and psychopathology among Spanish adolescents in residential care

The aim of this study was to analyze the effect of poly-victimization on symptom severity among adolescents being cared for by the child welfare system in a southwestern European country. The sample consisted of 127 youths (62 males and 65 females) aged 12–17 years (M = 14.60, SD = 1.61) who were recruited from short- and long-term residential centers. The Juvenile Victimization Questionnaire (Finkelhor, Hamby, Ormrod, & Turner, 2005) and the Youth Self-Report (Achenbach & Rescorla, 2001) were used to assess interpersonal victimization experiences and psychopathology, respectively. Victim (n = 68), low poly-victim (n = 48), and high poly-victim (n = 18) groups had comparable rates of psychopathology severity, with the exception of rule-breaking behavior, which was more severe among those with more victimization experiences (Cramer's V = .342). Poly-victimization was shown to be a significant predictor of clinically severe rule-breaking behavior, thought problems, and anxiety/depression symptoms. Among victimization types, sexual and electronic victimization significantly predicted withdrawn/depressed and aggressive behavior, and attention problems, respectively. The results of this study highlight the importance of assessing a wide range of victimization experiences among adolescents in care, since poly-victimization seems to underlie the serious psychological problems these youth present.     

Child maltreatment and risk behaviors: The roles of callous/unemotional traits and conscientiousness

Child maltreatment poses significant risk to the development of callous/unemotional traits as well as risk behaviors such as engaging in violence, having sex with strangers, and binge drinking. In the current study, the indirect pathway from child maltreatment to risk behaviors was examined via callous/unemotional traits; whereas the conscientious personality trait was tested as a moderator of this indirect pathway. Young adults and parents (N = 361; M_age = 19.14, SD = 1.44) completed questionnaires on child maltreatment histories, callousness/unemotional traits, personality characteristics, and risk behaviors. Structural equation modeling was used to examine the hypothesized direct, indirect and conditional indirect effects. Findings showed indirect links between the child maltreatment latent factor and physical fighting, having sex with strangers, and binge drinking via callous/unemotional traits. Furthermore, the conscientiousness personality type significantly buffered the connection between callous/unemotional traits and physical fighting, supporting a conditional indirect effects. Callous/unemotional traits are important factors in the underlying mechanism between child maltreatment and risk behaviors among young adults, and conscientiousness serves as a protective factor against violence. Preventive intervention programs and clinicians may benefit from focusing in addressing callous/unemotional traits among youth who report childhood maltreatment experiences as well as targeting conscientiousness as a protective factor.     

Childhood trauma and psychosis: Beyond the association

Childhood traumas have been extensively associated with the development of psychotic disorders. However, our understanding of processes underlying this relationship remains poor. In order to address this issue, we examined which specific aspects of childhood trauma are significantly associated with a first episode of psychosis. 109 patients with first episode of psychosis and 145 controls representative from general population were recruited in three centers in France. Child experiences of care and abuses allowed obtaining information about types of childhood trauma, age at first exposure, identity of perpetrator, and social support. Odds ratio were calculated for each of these aspects, adjusted for age, sex, and education. Sexual and physical abuses (OR = 2.26 (1.19–4.32)), and separation from one or both parents (OR ranging from 1.94 to 3.17; all significant) are significantly associated with an increased risk to present a first episode of psychosis. Furthermore, separation from mother occurring before age of 4 (OR = 5.96 (1.24–28.77)), and sexual and physical abuses perpetrated by someone other than parents (OR = 4.61 (1.66–12.80)) were also associated with an increased risk of first episode of psychosis. Finally, social support was significantly associated with a decreased risk to develop psychotic disorders (OR ranging from 0.33 to 0.42; all significant). Together, these findings suggest that some but not all aspects of childhood trauma are related to a significant risk to develop a first episode of psychosis.     

Disparate plasma cortisol concentrations in sexually abused female children from Johannesburg,South Africa

A growing body of research indicates that a bidirectional response to a stressor may occur in maltreated children and may be associated with later life psychopathology. However, few studies have investigated stress reactivity in children when they first present to a sexual abuse clinic. Thus, in order to evaluate whether HPA axis dysregulation would be evident at first presentation to a sexual abuse clinic in young girls (n = 26), between the ages of 6–12 years old, blood samples were obtained immediately following examination at a forensic sexual abuse clinic and from the matched control group of children (n = 14; 10.1 ± 0.8) immediately following a bone density scan. Stratification of the sexually abused group into those children who were reportedly abused by a stranger and had no other family stressors (n = 15, 10.4 ± 1.8) and those children whose parents reported abuse of the child by a stranger and other family stressors (n = 11; 9.5 ± 1.8) revealed differences in stress reactivity. Plasma concentrations, of the children from the forensic clinic, were significantly increased in children who reported abuse by a stranger only (322.3 ± 117.4 nmol/l) and significantly decreased in children whose histories indicated sexual abuse by a stranger and other family stressors (149.6 ± 39.7 nmol/l) when compared to the control group (225.5 ± 47.5 nmol/l). In conclusion, following sexual abuse and a secondary stressor, the forensic examination, there is evidence of divergent cortisol responses in the stratified clinical group of children.     

Previous maltreatment and present mental health in a high-risk adolescent population

Childhood maltreatment is known to increase the risk of future psychiatric disorders. In the present study, we explored the impact of experienced maltreatment on the prevalence and comorbidity of psychiatric disorders in a high-risk population of adolescents in residential care units. We also studied the impact of poly-victimization. The participants of the study were adolescents in residential care units in Norway (n = 335, mean age 16.8 years, girls 58.5%). A diagnostic interview (Child and Adolescent Psychiatric Assessment Interview) was used, yielding information about previous maltreatment (witnessing violence, victim of family violence, community violence, sexual abuse) and DSM-IV diagnoses present in the last three months. Exposure to maltreatment was reported by 71%, and in this group, we found significantly more Asperger's syndrome (AS) (p = .041), conduct disorder (CD) (p = .049), major depressive disorder (MDD) (p = .001), dysthymia (p = .030), general anxiety disorder (GAD) (p < .001), and having attempted suicide (p = .006). We found significantly more comorbid disorders in the maltreated group. Poly-victimization was studied by constructing a scale comprised of witnessing violence, victim of family violence, victim of sexual abuse and household dysfunction. We found that poly-victimization was associated with significantly increased risk of MDD, GAD, AS, CD, and having attempted suicide (p < .01). The complexity of the clinical outcomes revealed in this study suggest that longer-term treatment plans and follow-up by psychiatric services might be needed to a greater extend than for the rest of the child and adolescent population, and that trauma informed care is essential for adolescents in residential youth care.