Behavioral/emotional indicators of sexual abuse in child psychiatric inpatients: A controlled comparison with physical abuse

Several behavioral and emotional indicators of child sexual abuse were compared for both sexually (n = 29) and physically abused (n = 52) children from a sample of 103 hospitalized psychiatric patients. The measures included (1) scores from a factor-analyzed sexual abuse symptom checklist covering home/community behavior that was rated by parents during a clinical interview and (2) frequency counts of psychological symptoms exhibited by the children during a 3-week period of hospitalization. Results of a 2 (sexual abuse status) X 2 (physical abuse status) X 2 (gender) Multivariate Analysis of Variance indicated that sexually abused children exhibited greater sexual behavior, fear/mistrust/anxiety, and withdrawal at home, and greater sexual behavior, fear/anxiety, and sadness in the hospital than nonabused children. In contrast, there were no significant differences between physically abused and nonabused children, and no significant interactions. Few significant correlations were found between symptoms exhibited at home and in the hospital.     

The relationship between child sexual abuse and academic achievement in a sample of adolescent psychiatric inpatients

OBJECTIVES: To examine the relationship between sexual abuse and academic achievement in an adolescent inpatient psychiatric population. Individual factors expected to influence this relationship were measured to explore the way they each interacted with sexual abuse and its relationship to academic achievement. METHOD: Eighty-one adolescent psychiatric inpatients participated in the study (aged 12--18 years: M=16.0). Participants were administered tests of academic achievement (dependent variable) and intelligence, and completed a number of self-report measures of their experience of different types of maltreatment, their perception of the parenting they received, socio-economic status, substance abuse, and psychopathology. RESULTS: Hierarchical regression analysis revealed that intelligence was the main predictor of academic achievement (uniquely explaining 26% of the variance). A number of interaction effects were also significant indicating that intelligence, substance abuse, internalizing behavior problems, externalizing behavior problems all influenced the relationship between sexual abuse and academic achievement. DISCUSSION: Examining the impact of sexual abuse is complex because it is typically an experience embedded in a range of other risk factors, such as poverty, family dysfunction, and other types of maltreatment. This study demonstrated coexistence between sexual abuse and a number of other variables, including other maltreatment types and parental overprotection, underscoring the requirement for complex models of research that more accurately reflect the experience of abused children.     

The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings

OBJECTIVE: To determine the demographic and psychosocial correlates of physical and sexual abuse among children with autism. METHODS: Data collected from 1997 to 2000 through the national evaluation of the Comprehensive Community Mental Health Services for Children and their Families Program on 156 children with autism were used. Data included a baseline assessment of child and family psychosocial experiences and presenting problems associated with referral into system-of-care service, demographic information, and a clinical record review to obtain psychiatric diagnosis. Binary and multinomial logistic regression was used to determine the association of different characteristics of children who were abused compared with those who were not abused. RESULTS: Caregivers reported that 18.5% of children with autism had been physically abused and 16.6% had been sexually abused. Physically abused children more likely had engaged in sexual acting out or abusive behavior, had made a suicide attempt, or had conduct-related or academic problems. Sexually abused children more likely had engaged in sexual acting out or abusive behavior, suicidal or other self-injurious behavior, had run away from home, or had a psychiatric hospitalization. In adjusted multivariate models, the relationship between sexual abuse and sexual acting out, running away from home and suicidal attempts persisted. CONCLUSION: Based on the prevalence of abuse and its association with various behaviors, clinicians should be as attuned to the psychosocial histories of children with autism as they are for other children, and consider the potential of abuse when these behaviors are observed.     

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.     

Child victims of sexual abuse: Teachers' evaluation of emotion regulation and social adaptation in school

This study assessed the social adaptation of sexually abused children and tested whether children's emotion regulation competencies mediated the association between child sexual abuse (CSA) and two outcomes of the social domain (i.e. withdrawal and social difficulties). A group of 283 child victims of sexual abuse and a comparison group composed of 60 nonabused children was recruited. Teachers completed questionnaires assessing the children's emotion regulation competencies, withdrawal, and social difficulties exhibited in the school context. Results showed that sexually abused children displayed poorer emotion regulation skills and higher levels of both withdrawal and social difficulties relative to nonabused children. CSA was associated with social difficulties and withdrawn behavior through the mediation of emotion regulation competencies. Teachers and school psychologists should be assisted in identifying children at risk of social difficulties and emotional dysregulation and schools be encouraged to adopt a trauma‐informed approach.     

A clinical-demographic study of sexually abused children

Forty-five children who had been sexually abused were psychologically evaluated. Parents or guardians of the children completed symptom checklists. Results indicated that the majority of children (71%) were abused 4 or fewer times. In addition, genital manipulation and/or fondling was the most common form of abuse. In 82% of the cases, there were no marital separations or family breakups of any kind within six months before or six months after the abuse. Many children (69%) displayed psychological symptoms. The most frequent were nightmares, bedwetting, clinging behavior, inappropriate sexual behavior, anxiety and sadness. Results of this study are largely inconsistent with popular notions about the nature of child sexual abuse. The major methodological shortcoming of the investigation was the lack of a systematic control group.     

Which sexual abuse victims receive a forensic medical examination? The impact of Children's Advocacy Centers

OBJECTIVE: This study examines the impact of Children's Advocacy Centers (CAC) and other factors, such as the child's age, alleged penetration, and injury on the use of forensic medical examinations as part of the response to reported child sexual abuse. METHODS: This analysis is part of a quasi-experimental study, the Multi-Site Evaluation of Children's Advocacy Centers, which evaluated four CACs relative to within-state non-CAC comparison communities. Case abstractors collected data on forensic medical exams in 1,220 child sexual abuse cases through review of case records. RESULTS: Suspected sexual abuse victims at CACs were two times more likely to have forensic medical examinations than those seen at comparison communities, controlling for other variables. Girls, children with reported penetration, victims who were physically injured while being abused, White victims, and younger children were more likely to have exams, controlling for other variables. Non-penetration cases at CACs were four times more likely to receive exams as compared to those in comparison communities. About half of exams were conducted the same day as the reported abuse in both CAC and comparison communities. The majority of caregivers were very satisfied with the medical professional. Receipt of a medical exam was not associated with offenders being charged. CONCLUSIONS: Results of this study suggest that CACs are an effective tool for furthering access to forensic medical examinations for child sexual abuse victims.     

Sexual abuse in young children: its clinical presentation and characteristic patterns

A retrospective record survey was performed using all child clients aged less than 7 years seen at a community mental health center during the period 1982-1984. The total number of 202 children fell into three groups: sexually abused (n = 37), physically abused (n = 35), and nonabused clinical children (n = 130). These groups were compared in order to learn more about sexual abuse in young children. Family background of both abused groups were similar to each other but differed from the nonabused group in having more factors related to family stress than the nonabused group. Clinical presentations of all the children overlapped a great deal symptomatically; however, the sexually abused children had a statistically significant higher frequency of inappropriate sexual behavior than the other two groups. Several characteristics of the abusive patterns suffered by the two abuse groups differed at or near statistical significance: sexually abused children were more often victimized in single acts by nonrelated child perpetrators than were physically abused children.     

Further abuse of sexually abused children

OBJECTIVE: To determine the incidence of re-abuse in children known to have been sexually abused and to find factors that increase the risk of re-abuse. METHOD: The study group consisted of 183 children with substantiated sexual abuse who presented to two children's hospitals' Child Protection Units in Sydney, Australia during 1988 through 1990. At intake, when the children were aged between 5 years and 15 years, data about the child, the family, and the nature of the index sexual abuse were collected. Six years after presentation for the abuse, records of the Department of Community Services were checked to see if any of the young people had been the subject of substantiated notifications for abuse/neglect before and after intake to the study. Predictors of notifications for abuse/neglect after presentation for the index sexual abuse were identified. RESULTS: Of the sexually abused young people, nearly one in three were the subject of subsequent substantiated notifications to the Department of Community Services for some form of child abuse and neglect or behavior which placed them at risk of harm. Later notifications for abuse/neglect were predicted by notifications for emotional abuse before the index sexual abuse (adjusted RR = 4.88, CI: 1.43 to 16.65), severity of the index sexual abuse (p = .03), and the number of changes in the child's primary caregivers before intake (p = .03). Approximately one in six of the sexually abused young people were notified for sexual abuse after intake to the study. One in 10 also had prior notifications for sexual abuse. Sexual abuse notifications after study intake were predicted by caregiver changes before intake (p = .01) and whether or not there were notifications for emotional abuse before the index sexual abuse (adjusted RR = 3.40, CI: 1.05 to 11.02). CONCLUSIONS: Revictimization of children appears to be a marker of ongoing family dysfunction. Intervention in child sexual abuse needs to consider a range of risk factors associated with re-abuse and, in particular, should focus on family functioning if further abuse is to be prevented.     

Testing the sexually abused-sexual abuser hypothesis: A prospective longitudinal birth cohort study

The sexually abused-sexual abuser hypothesis posits that persons, especially males, who are sexually abused as children are at particular risk of sexually abusing others later in life. We tested this hypothesis by prospectively examining associations between maltreatment and offending in a birth cohort of 38,282 males with a maltreatment history and/or at least one finalized offense. We examined these associations within the context of the wider birth population. Proportionally few boys were the subject of official notifications for sexual abuse (14.8% of maltreated boys, and 1.4% of the birth population); proportionally very few of these sexually abused boys (3%) went on to become sexual offenders; and, contrary to findings typically reported in retrospective clinical studies, proportionally few sexual offenders (4%) had a confirmed history of sexual abuse. Poly-victimization (exposure to multiple types of maltreatment) was significantly associated with sexual offending, violent offending, and general (nonsexual, nonviolent) offending. We found no specific association between sexual abuse and sexual offending, and nor did we find any association between sexual abuse and sexual offending specifically within the poly-victimized group. The total number of sexual abuse notifications did make a small unique contribution to the variance in sexual offending compared to other offending. Implications concerning maltreated boys and male sexual offenders are discussed.     

Sexual abuse characteristics associated with survivor psychopathology

OBJECTIVE: This study was designed to examine predictors of psychopathology in non-clinically referred, sexually abused (SA) children, ages 6-16 years, 30-60 days following abuse disclosure and termination. METHOD: Eighty SA children were administered a structured diagnostic interview and a variety of rating-scale instruments. Several forms of psychopathology were assessed, including posttraumatic stress, global functioning, anxiety, depression, and externalizing behavior. Abuse interviews also were used to guide the collection of demographic (victim age, gender) and abuse-related information (e.g., frequency of abuse). RESULTS: Abuse-related factors and demographic variables accounted for greater than half of the variance predicting global functioning, and accurately predicted posttraumatic stress disorder (PTSD) status for 86% of the participants. Also, analyses yielded significant predictors of parent-reported attention problems and sexual behavior. Of additional importance, none of the abuse-related and demographic variables predicted scores on measures of general anxiety, depression, and externalizing behavior. CONCLUSIONS: Specific demographic and sexual abuse information may, to some extent, be used to identify children who are at increased risk for short-term post-abuse psychopathology. Although the present findings suggest that such information may not be useful in the prediction of general anxiety, depression, and externalizing behavior, demographic and abuse-related variables importantly appear to account for significant variance in the prediction of global functioning, posttraumatic stress, attentiveness, and sexual behavior. Additional research is needed to improve mental health professionals' ability to identify SA children who are at high risk for psychopathology.     

Linking childhood sexual abuse and abusive parenting: the mediating role of maternal anger

OBJECTIVE: This study had two primary objectives: First, to examine the association between childhood sexual abuse (CSA) and later parenting characteristics, particularly physical abuse potential, and second, to explore maternal anger as a mediator of the relationship between CSA and adult physical abuse potential. METHOD: Utilized a community sample of low SES participants that included 138 mothers classified as having experienced CSA, and a comparison group of 152 non-sexually abused mothers. Parenting variables examined included the mothers' physical abuse potential, nurturance toward their children, unrealistic developmental expectations of children, as well as frequencies of spanking and general punishment. Data was collected via interview and other self-report measures. RESULTS: Even after controlling for mothers' childhood experience of Physical abuse, CSA significantly predicted adult risk of physically abusing one's own children. Further, maternal anger was confirmed as a mediator of the relationship between having been sexually abused as a child and the potential for physically abusing one's own children. CONCLUSIONS: CSA may be a risk factor for subsequent physically abusive parenting, while anger appears to play a significant role in mediating this relationship. Findings are discussed in the context of current knowledge concerning the impact of child sexual abuse and the processes contributing to abusive parenting.     

Examining the validity and reliability of childhood abuse scales: putting the courage to heal to the test

Objective: The main purpose of the current study was to examine the validity and reliability of The Courage To Heal Workbook checklist (Davis, 1990) in part, through examining the internal consistency and studying whether the CTHC distinguished between the participants reporting sexual abuse histories and those who did not.Method: Two hundred and seventy-nine college students were surveyed utilizing the symptom checklist from the Courage to Heal Workbook, Trauma Symptom Checklist-40 (TSC-40), Abusive Behavior Inventory (ABI), and questions related to participants’ beliefs that they had been abused as a child.Results: Results indicated that the Courage to Heal Checklist (CTHC) has robust reliability (alpha = .97) and can significantly discriminate between reported abuse survivors and nonsurvivors. Fifty-five percent of those participants reporting sexual abuse, 47% of those reporting physical abuse, and 34% of those reporting emotional abuse indicated a period of time during which they did not remember the abuse.Conclusion: Results indicate that the CTHC reliably differentiated between participants reporting past sexual abuse and those who did not. Mounting evidence continues to support that adult symptom profiles are able to indicate that some form of trauma is likely to have occurred in the past; however, differentiating between types of abuse based on symptom profiles may be impossible.Spanish abstract was not available at time of publication.     

Cumulative childhood trauma and psychological maladjustment of sexually abused children in Korea: Mediating effects of emotion regulation

The purpose of the present study was to identify the mediating effects of emotion regulation on the association between cumulative childhood trauma and behavior problems in sexually abused children in Korea, using structural equation modeling (SEM). Data were collected on 171 children (ages 6–13 years) referred to a public counseling center for sexual abuse in Seoul, Korea. Cumulative childhood traumas were defined on the basis of number of traumas (physical abuse, witnessing domestic violence, neglect, traumatic separation from parent, and sexual abuse) and the severity and duration of traumas. Children were evaluated by their parents on emotion regulation using the Emotion Regulation Checklist and internalizing and externalizing behavior problems using the Korean-Child Behavior Checklist. SEM analyses confirmed the complete mediation model, in which emotion dysregulation fully mediates the relationship between cumulative childhood traumas and internalizing/externalizing behavior problems. These findings indicate that emotion regulation is an important mechanism that can explain the negative effects of cumulative childhood traumas and that there is a need to focus on emotion regulation in sexually abused children exposed to cumulative trauma.     

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.     

Preventing sexually abused young people from becoming abusers,and treating the victimization experiences of young people who offend sexually

OBJECTIVE: This study was designed to determine whether it is possible to prevent those sexually abused boys who are at risk of abusing other children from doing so, and to assess whether factors associated with an experience of sexual abuse in young people who are offending can be dealt with as a key aspect of therapeutic work alongside treatment of offending behavior. METHOD: The author examined cross-sectional and longitudinal research which demonstrates the impact on sexually abused children of living in a climate of violence, suffering physical abuse, exposure to abuse of maternal figures, and suffering disruption and poor quality of care and supervision. These factors are confirmed in prospective research. RESULTS: The application of these findings to therapeutic programs for boys who are sexually abused is described, including the assessment of care needs as well as the specific therapeutic work with the young person, and work to modify the family context. The specific treatment of victimization experiences in young people who have committed sexual offenses is also examined, with recommendations for modification of treatment approaches suggested. CONCLUSION: It is vital in therapeutic work with boy victims of sexual abuse that the issue of their abusive potential be considered, even if a relatively small proportion of such boys will go on to abuse others. Given that boys who do sexually abuse are likely to have grown up in a climate of violence and poor care, methods of dealing with such victimization experiences need to be developed alongside offending focused treatments.     

Why children tell: a model of children's disclosure of sexual abuse

OBJECTIVE: The present study investigated variables associated with delay of disclosure of child sexual abuse and tested a model of time to disclosure. METHOD: Data were obtained for 218 alleged child sexual abuse victims whose cases had been referred to District Attorneys' Offices. Five variables were posited to influence the delay between an abusive event and children's disclosure of that event to a reporting adult: child's age, gender, type of abuse experienced (intrafamilial or extrafamilial), perceived responsibility for the abuse, and fear of negative consequences of disclosure. These variables were used to create a model of factors influencing children's disclosure of sexual abuse. RESULTS: Results indicated that age, type of abuse, fear of negative consequences, and perceived responsibility all contributed to predicting time to disclosure. There was significant support for the model, suggesting that children who were older, came from incestuous families, felt greater responsibility for the abuse, and feared negative consequences of disclosure took longer to disclose. CONCLUSIONS: Children's cognitive appraisal of others' tolerance of disclosure of child sexual abuse, and their own perceptions of responsibility for the abuse, are crucial to the decision to disclose. When evaluating children for possible sexual abuse, developmental, cognitive, and socio-emotional factors need to be taken into consideration.     

When is the personal professional in public child welfare practice? The influence of intimate partner and child abuse histories on workers in domestic violence cases

OBJECTIVE: The objective of this article is to examine children's services workers' (CSWs') personal histories of abuse and their influence on professional responses to allegations of domestic violence. METHOD: Using an anonymous questionnaire, data were collected from CSWs in two large urban counties in Southern California who participated in a domestic violence training program (n=303). It was hypothesized that CSWs' responses to domestic violence cases would be affected by personal histories of abuse and the degree to which the CSWs identified with battered women. RESULTS: Approximately one-half of the respondents reported experiencing physical and/or sexual violence by an intimate partner. One-third of respondents reported physical abuse, and 22%, sexual abuse during childhood. The experience of childhood sexual abuse, especially for female CSWs, was associated with increased support for removal of children whose mother is being abused. Those CSWs with a history of partner violence who identified with battered women were less likely to approve of removing children from the battered mother than were CSWs without partner abuse history or identification with battered women. CONCLUSIONS: Our findings provide support for expanded training efforts that recognize the ongoing impact of victimization on CSWs' professional functioning.     

Assessment for self-blame and trauma symptoms during the medical evaluation of suspected sexual abuse

The purpose of this study was to describe behavioural and emotional symptoms and to examine the effect of abuse-related factors, family responses to disclosure, and child self-blame on these symptoms in children presenting for medical evaluations after disclosure of sexual abuse. A retrospective review was conducted of 501 children ages 8–17. Trauma symptoms were determined by two sets of qualitative measures. Abstracted data included gender, ethnicity, and age; severity of abuse and abuser relationship to child; child responses regarding difficulty with sleep, school, appetite/weight, sadness, or self-harm, parent belief in abuse disclosure, and abuse-specific self-blame; responses to the Trauma Symptom Checklist in Children-Alternate; and the parent's degree of belief in the child's sexual abuse disclosure. Overall, 83% of the children had at least one trauma symptom; 60% had difficulty sleeping and one-third had thoughts of self-harm. Child age and abuse severity were associated with 3 of 12 trauma symptoms, and abuse-specific self-blame was associated with 10 trauma symptoms, after controlling for other variables. The children of parents who did not completely believe the initial disclosure of abuse were twice as likely to endorse self-blame as children of parents who completely believed the initial disclosure. Screening for behavioural and emotional problems during the medical assessment of suspected sexual abuse should include assessment of self-blame and family responses to the child's disclosures. In addition, parents should be informed of the importance of believing their child during the initial disclosure of abuse and of the impact this has on the child's emotional response to the abuse.     

Sexual behavior problems in sexually abused children: a preliminary typology

OBJECTIVE: The goal was to develop an empirically derived typology for sexually abused children exhibiting sexual behavior problems to assist practitioners in differential assessment, treatment, and case planning. METHOD: Data were systematically gathered from the clinical records of 100 sexually abused children, aged 3 years to 7 years, enrolled in two treatment programs. Twelve indexes were created corresponding to major areas of child and family history, functioning, and treatment response. After initial sorting into subgroups based on the presence or absence of interpersonal sexual behavior problems, further subdivision was based on hierarchical cluster analysis. RESULTS: Five distinctive sexual behavior profiles emerged: (1) developmentally expected; and developmentally problematic (2) interpersonal, unplanned, (3) self-focused, (4) interpersonal, planned (noncoercive), and (5) interpersonal, planned (coercive). Elements of the child's sexual abuse experience, opportunities to learn/practice problematic sexual behavior, and familial variables best differentiated between the types. CONCLUSIONS: The five types differed not only in child sexual behavior but in most areas of child and family functioning, including treatment outcome. The findings offer support for the development of an empirically-based typology for children with sexual behavior problems utilizing a range of variables which go beyond typical classification systems based on offender and victim characteristics.