Child extrafamilial sexual abuse: predicting parent and child functioning

Objective: This study evaluated the emotional and behavioral adjustment of parents and children within 3 months and 1 year after the discovery of child extrafamilial sexual abuse.Method: Ninety-two case parents (63 mothers, 29 fathers) and 56 children were compared to a nonclinical comparison group of 136 parents (74 mothers, 62 fathers) and 75 children. Parent adjustment was assessed using self-report measures while child functioning was assessed using a combination of child-, parent- and teacher-report measures.Results: Mothers, fathers and sexually abused children experienced clinically significant effects both initially and at 12 months post-disclosure. Children’s perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symtomatology at 3 months and 1 year post-disclosure. Child age and gender also significantly contributed to the prediction of many of the child outcome measures. No abuse-related variable was related to any child self-report measure. Mothers’ satisfaction in the parenting role, perceived support and intrusive symptoms predicted their initial emotional functioning. Avoidant symptoms, child’s internalizing behavior and mothers’ initial emotional functioning were significant predictors of longer-term emotional functioning.Conclusions: Results emphasize the need to address children’s abuse-related attributions and underscore the need to expand our focus beyond the child victims to the traumatized families.     

Child extrafamilial sexual abuse: predicting parent and child functioning

Objective: This study evaluated the emotional and behavioral adjustment of parents and children within 3 months and 1 year after the discovery of child extrafamilial sexual abuse.Method: Ninety-two case parents (63 mothers, 29 fathers) and 56 children were compared to a nonclinical comparison group of 136 parents (74 mothers, 62 fathers) and 75 children. Parent adjustment was assessed using self-report measures while child functioning was assessed using a combination of child-, parent- and teacher-report measures.Results: Mothers, fathers and sexually abused children experienced clinically significant effects both initially and at 12 months post-disclosure. Children’s perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symtomatology at 3 months and 1 year post-disclosure. Child age and gender also significantly contributed to the prediction of many of the child outcome measures. No abuse-related variable was related to any child self-report measure. Mothers’ satisfaction in the parenting role, perceived support and intrusive symptoms predicted their initial emotional functioning. Avoidant symptoms, child’s internalizing behavior and mothers’ initial emotional functioning were significant predictors of longer-term emotional functioning.Conclusions: Results emphasize the need to address children’s abuse-related attributions and underscore the need to expand our focus beyond the child victims to the traumatized families.     

Convergence and divergence in reports of maternal support following childhood sexual abuse: Prevalence and associations with youth psychosocial adjustment

This study examined the convergence and divergence in mothers’ and children's reports of maternal support following disclosures of childhood sexual abuse (CSA). One hundred and twenty mothers and their children (ages 7–17 years) reported on two aspects of support following CSA disclosures: mothers’ belief in the child's disclosure and parent–child discussion of the abuse incident. Whereas 62% of mothers’ and children's reports on mothers’ belief of the disclosure positively converged (i.e., both reported that mothers “completely believed” the child's disclosure), 37% of mothers’ and children's reports diverged, and the remaining 1% negatively converged (i.e., both reported that the mother only believed the child “somewhat”). Positively convergent responses were associated with youths’ lower risk for tobacco and illicit drug use. Forty-four percent of mothers’ and children's reports on whether details of the CSA were discussed positively converged (i.e., both reported that details were discussed), 33% diverged, and 23% negatively converged (i.e., both reported that details were not discussed). Relative to other patterns of reporting, negatively convergent responses were associated with higher levels of trauma symptoms. Findings have implications for identifying high-risk mother–child dyads based on patterns of informant reporting following CSA.     

Children's perceived emotional behavior at disclosure and prosecutors’ evaluations

The present study investigated the perceived emotional behavior of alleged child victims when disclosing sexual abuse in a forensic interview. It also addressed whether the perceived emotional behavior influenced prosecutors’ evaluations of children's potential as witnesses and prosecutors’ recommendations to press charges. Ninety-eight videotapes of forensic interviews with alleged child sexual abuse victims (4- to 17-year-olds) were coded for behavioral indicators of emotions. Case file information and district attorney evaluations were also coded. Results indicated that children were not generally perceived as being emotional (e.g., sad) during disclosure. However, the perceived intensity of expressed emotions was greater when children disclosed the alleged abuse compared to when they discussed more neutral topics in rapport building. Greater perceived emotional withdrawal by children at disclosure was associated with more negative evaluations of child witnesses by prosecutors. Moreover, children's emotional behaviors, as noted by prosecutors, were among the predictors of prosecutors’ recommendations to file charges. Practical implications are discussed.     

A nurse practitioner-led intervention for runaway adolescents who have been sexually assaulted or sexually exploited: Effects on trauma symptoms,suicidality, and self-injury

BackgroundAdolescent victims of sexual assault and exploitation suffer significant mental health distress including PTSD, self-harm, suicidal ideation, and attempts.ObjectiveThis longitudinal observational study investigated the Runaway Intervention Program's influence on trauma responses at 3, 6, and 12 months for adolescents who have run away at least once and have been sexually assaulted or exploited.ParticipantsRunaways (n = 362) received nurse practitioner (NP) home and community visits, intensive case management, and optional empowerment groups.SettingAn urban Midwestern city's hospital-based Children's Advocacy Center.MethodsTrauma responses were measured by the UCLA PTSD-RI index, past 30 days emotional distress scale, and self-harm, suicidal ideation, and suicide attempt questions. Repeated Measures ANOVA assessed trauma response changes over time. Growth curve analyses using intervention doses determined which aspects of the intervention predicted change.ResultsFrom program entry to 3 and 6 months, mean values decreased significantly for emotional distress (−0.67, −.91) self-harm (−.30, −.55), suicidal ideation (−.45, −.57), suicide attempts (−.58, −.61), and trauma symptoms (−11.8, −16.2, all p < .001) all maintained at 12 months. In growth curve models, NP visits independently predicted declines in emotional distress (−.038), self-injury (−.020), suicidal ideation (−.025) and attempts (−.032), while empowerment groups predicted trauma symptoms (−.525) and all others except suicide attempts.ConclusionsThe program, especially NP community visits and empowerment group elements, decreased trauma responses in runaway youth with a history of sexual assault. Given high rates of PTSD and emotional distress among runaways, the Runaway Intervention Program offers promise for improving mental health outcomes.     

Barriers and facilitators to disclosing sexual abuse in childhood and adolescence: A systematic review

Children and young people often choose not to disclose sexual abuse, thus preventing access to help and allowing perpetrators to continue undetected. A nuanced understanding of the barriers (and facilitators) to disclosure is therefore of great relevance to practitioners and researchers. The literature was systematically searched for studies related to child and adolescent disclosures of sexual abuse. Thirteen studies were reviewed and assessed for methodological quality. Results of the review illustrate the heterogeneous nature of these empirical studies. Findings demonstrate that young people face a number of different barriers such as limited support, perceived negative consequences and feelings of self-blame, shame and guilt, when choosing to disclose. Being asked or prompted, through provision of developmentally appropriate information, about sexual abuse facilitates disclosure. The review highlights the need for robust, longitudinal studies with more sophisticated methodology to replicate findings. The review identifies the need for developmentally appropriate school-based intervention programmes that facilitate children’s disclosure by reducing feelings of responsibility, self-blame, guilt and shame. In addition, prevention programmes should encourage family members, friends and frontline professionals to identify clues of sexual abuse, to explicitly ask children about the possibility of sexual abuse and also to respond supportively should disclosures occur. Facilitating disclosure in this way is key to safeguarding victims and promoting better outcomes for child and adolescent survivors of sexual abuse.     

Factors affecting disclosure among Israeli children in residential care due to domestic violence

Disclosure of child abuse may enable initiating interventions to end maltreatment and mediate its negative physical and psychological consequences. The present study reviews the field of disclosure and examines factors affecting disclosure among a service population of abused children who were placed in residential care due to various forms of abuse (e.g., physical, sexual, emotional, neglect and witnessing domestic violence). The sample consisted of 286 Israeli (Hebrew and Arabic speaking) children aged 12–17 (mean = 14 ± 1). Following approval of the Ethics committee of the University and parents’ written consent, participants were administered a self-report questionnaire that included the following measures: a Socio-Demographic Questionnaire, the Childhood Trauma Questionnaire (CTQ), the Juvenile Victimization Questionnaire (JVQ), and the Disclosure of Trauma Questionnaire (DTQ). Results indicated that the three key factors enhancing the likelihood of disclosure were: moral factors, external initiatives and intolerable physical pain. The three key factors inhibiting disclosure were feelings of shame, fear of losing social support and uncertainty as to how and to whom to disclose. Results also showed that children preferred to disclose to their nuclear family members (parents and siblings) in comparison with professionals.     

Intergenerational effects of war trauma among Palestinian families mediated via psychological maltreatment

We tested the hypothesis that intergenerational effects of parents’ war trauma on offspring's attachment and mental health are mediated by psychological maltreatment. Two hundred and forty children and their parents were sampled from a war-prone area, Gaza, Palestine. The parents reported the number and type of traumatic experiences of war they had had during their lifetime before the child's birth and during a current war when the child was 10–12 years old. The children reported their war traumas, experiences of psychological maltreatment, attachment security, and symptoms of posttraumatic stress (PTSS), depression, and aggression. The direct and indirect intergenerational effects of war trauma were tested in structural equation models. The hypotheses were confirmed for father's past war exposure, and disconfirmed for mother's war exposure. The father's past war trauma had a negative association with attachment security and positive association with the child's mental health problems mediated by increased psychological maltreatment. In contrast, the mother's past war trauma had a negative association with the child's depression via decreased psychological maltreatment. The mother's current war trauma had a negative association with the child's depression and aggression via decreased psychological maltreatment. Among fathers, past war exposure should be considered as a risk factor for psychological maltreatment of children and the associated attachment insecurity and mental health problems. Among mothers, war exposure as such could be given less clinical attention than PTSS in the prevention of psychological maltreatment of children.     

Psychosocial factors influencing competency of children's statements on sexual trauma

Objectives

The objectives of this study are to assess children's competence to state their traumatic experience and to determine psychosocial factors influencing the competency of children's statements, such as emotional factors of children and parents and trauma-related variables, in Korean child sex abuse victims.

Methods

We enrolled 214 children, who visited “Sunflower Children's Center” for sexual abuse. The children were aged 8-13 years. The children's parent were surveyed using questionnaires [Beck Depression Inventory (BDI), State-Trait Anxiety Inventory(STAI)] to obtain demographic information, traumatic event profiles and self-report scale. Children completed psychological measures as follows: Children's Depression Inventory (CDI), Revised Children's Manifest Anxiety Scale (RCMAS), Traumatic Symptom Checklist for Children (TSCC). The modified-Criteria-Based Content Analysis (CBCA) was used to assess children's statements. ANOVA, independent t-test, Pearson correlation were used. All statistics were demonstrated using SPSS 12.0.

Results

Modified-CBCA scores did not differ according to children's level of depression and anxiety. Children with parents who showed supportive reactions, scored significantly higher on the modified-CBCA scores than those with unsupportive parents. Children with severely depressed parents had lower modified-CBCA scores than those with less depressed parents. Modified-CBCA scores were significantly higher in participants who experienced a single traumatic event than those who had multiple events. However, the severity of sexual abuse, relationship with the perpetrator, types of disclosure, and duration of initial disclosure did not show significant differences in capability of statement.

Conclusion

In conclusion, the competence of statements in Korean sexually child sex abuse victims is related to parental emotional states and support rather than children's factors such as psychopathology or age, and appears to be more reliable with a single traumatic experience. Therefore, promoting parental support through psychoeducation is one of the most important things to be done to help children overcome psychologic trauma but also enhance the accuracy of their statement.     

Evaluation of a school-based sexual abuse prevention program: Cognitive and emotional effects

This study evaluated a school-based child sexual abuse prevention program which consisted of separate 2-hour workshops for children, parents, and teachers. Questionnaires concerning the children's knowledge about sexual abuse prevention and level of emotional distress were developed and administered to 88 children, ages 5-12, and 60 parents before and after the program. In addition, 12 teachers completed questionnaires about the children's level of emotional distress within 2 weeks after the program. Comparison of the children's knowledge before and after the program showed significant increases in knowledge about strategies for coping with potential abuse situations. Also individual children's responses were compared with their parents' responses. After the program the parents had a more accurate appraisal of their children's knowledge, and in addition, there was a significant increase in how much parents reported that they had talked with their children about sexual abuse. In terms of possible adverse emotional effects of the program, neither teachers nor parents noticed signs of increased emotional distress. In addition, the children reported that the program made them feel safer and better able to protect themselves. The findings support the value of providing sexual abuse prevention programs to children.     

Exploratory assessments of child abuse: Children's responses to interviewer's questions across multiple interview sessions

ObjectiveThe present study extends field research on interviews with young children suspected of having been abused by examining multiple assessment interviews designed to be inquisitory and exploratory, rather than formal evidential or forensic interviews.MethodsSixty-six interviews with 24 children between the ages of 3 and 6 years who were undergoing an assessment for suspected child abuse were examined. Each child was interviewed 2, 3, or 4 times. The interviewer's questions were categorized in terms of openness (open, closed or choice), in terms of the degree of interviewer input (free recall, direct, leading, suggestive), and for topic (whether the question was abuse-specific or nonabuse-related). Children's on-task responses were coded for amount of information (number of clauses) reported in relation to each question type and topic, and off-task responses were categorized as either ignoring the question or a diverted response.ResultsChildren provided a response to most questions, independent of question type or topic and typically responded with one or two simple clauses. Some children disclosed abuse in response to open-ended questions; generally, however, failure to respond to a question was more likely for abuse-specific than for nonabuse-related questions.ConclusionThe findings are discussed in terms of the growing literature on interviewing children about suspected abuse, particularly in interviews conducted over multiple sessions.Practice implicationsAssessment of suspected child abuse may involve more than a single investigative interview. Research examining children's responses to questioning over multiple interviews (or single interviews conducted over multiple sessions) is necessary for the development of best practise guidelines for the assessment 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.     

Trauma resilience among youth in substitute care demonstrating sexual behavior problems

OBJECTIVE: The purpose of this longitudinal study was to examine the relationship between several proposed protective factors and trauma symptoms among highly vulnerable youth in the child welfare system. METHODS: Participants were 142 youth identified with a sexual behavior problem and their caregivers. Two waves of data were collected for each participant an average of 18 months apart. Foster parents reported on perceived level of support from the child welfare agency, youth involvement in club activities, and perception of youths' interpersonal and emotional competence. Youth provided self-reports of their sexual and physical abuse experiences, trauma symptoms at both time 1 and time 2, and ratings of parenting practices. RESULTS: Youth with higher rates of sexual abuse showed more negative affect and higher levels of sexual and non-sexual rumination at time 2, controlling for time 1 scores. Boys and youth who experienced better parenting practices displayed lower negative affect. Youth with higher levels of emotional and interpersonal competence showed lower levels of non-sexual rumination. Moderation analyses revealed that youth with more significant sexual abuse histories whose foster parents did not feel supported by their child welfare caseworkers had higher levels of sexually ruminative thoughts. Finally, the results revealed that only youth without sexual abuse histories experienced the benefits of club involvement in terms of lower sexual rumination scores. CONCLUSIONS: This study demonstrated that youth with significant vulnerabilities can still exhibit a degree of protection from trauma symptomatology in the presence of a wide range of personal and social variables. These findings support the efforts of stakeholders to promote strengths at the level of the individual, family, and broader social network and community.     

Identifying the characteristics of child sexual abuse cases associated with the child or child's parents withdrawing the complaint

Most child sexual abuse cases do not result in a full trial or guilty plea; rather, case attrition occurs at earlier stages of the criminal justice system. One reason for the attrition of these cases is the withdrawal of complaints, by children or their caregivers. The aim of the current study was to determine the case characteristics associated with complaint withdrawal in child sexual abuse cases by the child or his or her parents once a report has been made to authorities. All child sexual abuse incidents reported to authorities in one jurisdiction of Australia in 2011 were analyzed (N = 659). A multinomial logistic regression was used to predict the following case outcomes: (1) withdrawn by the child or his or her parents, (2) exited for other reasons (e.g., the alleged offender was not identified, the child refused to be interviewed), and (3) resulted in a charge. Five predictors significantly added to the prediction of case outcome: child age, suspect gender, suspect age, child–suspect relationship, and abuse frequency. These results should contribute to the design of interventions in order to reduce complaint withdrawals if these withdrawals are not in the child's best interests.     

Childhood emotional abuse and neglect as predictors of psychological and physical symptoms in women presenting to a primary care practice

OBJECTIVE: There were two aims to this study: first to examine whether emotional abuse and neglect are significant predictors of psychological and somatic symptoms, and lifetime trauma exposure in women presenting to a primary care practice, and second to examine the strength of these relationships after controlling for the effects of other types of childhood abuse and trauma. METHOD: Two-hundred and five women completed the Childhood Trauma Questionnaire (Bernstein et al., 1994), Trauma History Questionnaire (Green, 1996), the Symptom Checklist-revised (Derogatis, 1997), and the Revised Civilian Mississippi Scale for posttraumatic stress disorder (Norris & Perilla, 1996) when presenting to their primary care physician for a visit. Hierarchical multiple regression analyses were conducted to examine unique contributions of emotional abuse and neglect variables on symptom measures while controlling for childhood sexual and physical abuse and lifetime trauma exposure. RESULTS: A history of emotional abuse and neglect was associated with increased anxiety, depression, posttraumatic stress and physical symptoms, as well as lifetime trauma exposure. Physical and sexual abuse and lifetime trauma were also significant predictors of physical and psychological symptoms. Hierarchical multiple regressions demonstrated that emotional abuse and neglect predicted symptomatology in these women even when controlling for other types of abuse and lifetime trauma exposure. CONCLUSIONS: Long-standing behavioral consequences may arise as a result of childhood emotional abuse and neglect, specifically, poorer emotional and physical functioning, and vulnerability to further trauma exposure.     

Effects of the child–perpetrator relationship on mental health outcomes of child abuse: It's (not) all relative

The present study was conducted to better understand the influence of the child–perpetrator relationship on responses to child sexual and physical trauma for a relatively large, ethnically diverse sample of children and youth presenting for clinical evaluation and treatment at child mental health centers across the United States. This referred sample includes 2,133 youth with sexual or physical trauma as their primary treatment focus. Analyses were conducted to ascertain whether outcomes were dependent on the perpetrator's status as a caregiver vs. non-caregiver. Outcome measures included psychiatric symptom and behavior problem rating scales. For sexual trauma, victimization by a non-caregiver was associated with higher posttraumatic stress, internalizing and externalizing behavior problems, depression, and dissociation compared to youth victimized by a caregiver. For physical trauma, victimization by a non-caregiver was also associated with higher posttraumatic symptoms and internalizing behavior problems. The total number of trauma types experienced and age of physical or sexual trauma onset also predicted several outcomes for both groups, although in disparate ways. These findings are consistent with other recent studies demonstrating that perpetration of abuse by caregivers results in fewer symptoms and problems than abuse perpetrated by a non-caregiving relative. Thus, clinicians should not make a priori assumptions that children and adolescents who are traumatized by a parent/caregiver would have more severe symptoms than youth who are traumatized by a non-caregiver. Further exploration of the role of the perpetrator and other trauma characteristics associated with the perpetrator role is needed to advance our understanding of these findings and their implications for clinical practice.     

Child sexual abuse victims as witnesses: The influence of testifying on their recovery

Victims of child sexual abuse (CSA) are likely to show a wide range of adaptation difficulties. In addition, some children and their families are involved in legal proceedings following the child’s disclosure. However, little is known about the effects of legal involvement on CSA victim’s mental health and recovery. In this longitudinal study, the effects of testifying were examined in a sample of 344 children at initial assessment (67% of girls) receiving services in a Child Advocacy Centre, of which 130 children testified. The participants’ age ranged from 6 to 14 years old (M = 9.42 SD = 2.14). Children and their parents completed a series of measures to evaluate the child’s mental health (e.g. depression, anxiety, PTSD) at four points in time over a 2-year period. Multilevel analysis indicates that all the children showed significant improvement over time but the group who testified more than once shows higher levels of emotional distress 2 years after the initial assessment. This study highlights the importance of documenting the experience of CSA victims in the justice system in order to establish the adequate conditions to support child witnesses.     

The child sexual abuse accommodation syndrome

Child victims of sexual abuse face secondary trauma in the crisis of discovery. Their attempts to reconcile their private experiences with the realities of the outer world are assaulted by the disbelief, blame and rejection they experience from adults. The normal coping behavior of the child contradicts the entrenched beliefs and expectations typically held by adults, stigmatizing the child with charges of lying, manipulating or imagining from parents, courts and clinicians. Such abandonment by the very adults most crucial to the child's protection and recovery drives the child deeper into self-blame, self-hate, alienation and revictimization. In contrast, the advocacy of an empathic clinician within a supportive treatment network can provide vital credibility and endorsement for the child. Evaluation of the responses of normal children to sexual assault provides clear evidence that societal definitions of "normal" victim behavior are inappropriate and procrustean, serving adults as mythic insulators against the child's pain. Within this climate of prejudice, the sequential survival options available to the victim further alienate the child from any hope of outside credibility or acceptance. Ironically, the child's inevitable choice of the "wrong" options reinforces and perpetuates the prejudicial myths. The most typical reactions of children are classified in this paper as the child sexual abuse accommodation syndrome. The syndrome is composed of five categories, of which two define basic childhood vulnerability and three are sequentially contingent on sexual assault: (1) secrecy, (2) helplessness, (3) entrapment and accommodation, (4) delayed, unconvincing disclosure, and (5) retraction. The accommodation syndrome is proposed as a simple and logical model for use by clinicians to improve understanding and acceptance of the child's position in the complex and controversial dynamics of sexual victimization. Application of the syndrome tends to challenge entrenched myths and prejudice, providing credibility and advocacy for the child within the home, the courts, and throughout the treatment process. The paper also provides discussion of the child's coping strategies as analogs for subsequent behavioral and psychological problems, including implications for specific modalities of treatment.     

Gender differences in social reactions to abuse disclosures, post-abuse coping, and PTSD of child sexual abuse survivors

OBJECTIVE:This research examines the understudied issue of gender differences in disclosure, social reactions, post-abuse coping, and PTSD of adult survivors of child sexual abuse (CSA). METHOD:Data were collected on a cross-sectional convenience sample of 733 college students completing a confidential survey about their demographic characteristics, sexual abuse experiences, disclosure characteristics, post-abuse coping, and social reactions from others. RESULTS:Female students reported greater prevalence and severity of CSA, more distress and self-blame immediately post-assault, and greater reliance on coping strategies of withdrawal and trying to forget than male students. Women were more likely to have disclosed their abuse to others, to have received positive reactions, and to report greater PTSD symptom severity, but were no more likely to receive negative reactions upon disclosure than men. Women delaying disclosure had greater PTSD symptom severity, whereas men's symptoms did not vary by timing of disclosure. Additional regression analyses examined predictors of PTSD symptom severity and negative and positive social reactions to abuse disclosures. CONCLUSIONS:Several gender differences were observed in this sample of college students in terms of sexual abuse experiences, psychological symptoms, coping, PTSD, and some aspects of disclosure and social reactions from others.