Childhood sexual abuse: impact on a community's mental health status.

Epidemiologists have used impact fractions (e.g., attributable fractions) to study the influence of various risk factors on the rates of physical diseases within the community. In this study, impact fractions are applied to a psychiatric epidemiologic problem in order to examine the impact of childhood sexual abuse (CSA) on the mental health status of a community. Analysis of the Los Angeles Epidemiologic Catchment Area (LAECA) data indicate that a history of CSA significantly increases an individual's odds of developing eight psychiatric disorders in adulthood. On the community level, however, it is estimated that 74% of the exposed psychiatric cases (i.e., those with a history of CSA), and 3.9% of all psychiatric cases within the population can be attributed to childhood sexual abuse. Intervention implications are discussed.     

Coping with sexual abuse: development and evaluation of a videotape intervention for nonoffending parents

OBJECTIVE: The aims of the study were: (1) to develop, apply, and evaluate a videotape intervention that targeted the development of supportive behaviors in mothers of children who were being examined because of suspected molestation; and (2) to examine the relationship between mothers' reported responses to and beliefs about the molestation and their children's perceptions of support. METHOD: Mothers (N = 87) who had children 4 to 12 years of age were recruited and randomly assigned to view either a treatment or control videotape during the time when their child was being examined. Observers who were blinded to this assignment observed and rated parent-child interactions in the waiting room prior to and again after the mothers viewed the videotape. One week after this brief intervention, 64 of the mothers and 30 of the children (8- to 12-years-old) were interviewed. RESULTS: Mothers who viewed the treatment tape were more likely to engage in supportive behaviors with their child immediately after viewing the tape, and were able to identify more supportive behaviors at the 1-week followup. In addition, mothers' reports of how they responded to the molestation (including perceived blame) was related to child perceptions of parental support. CONCLUSIONS: The findings indicate that children who have been sexually molested are sensitive to the initial reactions of their nonoffending parent to the disclosure. In addition, there is some evidence that we can design and deliver cost-effective interventions during the early disclosure period that promote more positive (or supportive) responses by the nonoffending parent.     

Hostility ratings by parents at risk for child abuse: impact of chronic and temporary schema activation

OBJECTIVE: Two studies examined whether accessibility of hostility-related schema influenced ratings of ambiguous child pictures. Based on the social information processing model of child physical abuse (CPA), it was expected that CPA risk status would serve as a proxy for chronic accessibility of hostile schema, while priming procedures were used to manipulate temporary accessibility of hostility-related schema. METHODS: Participants included 108 parents (79 low and 29 high CPA risk) in Experiment 1 and 88 parents (43 low and 45 high CPA risk) in Experiment 2. Parents were randomly assigned to either hostile or neutral priming conditions. Following the priming procedures, all parents rated pictures that depicted children who appeared ambiguous with regard to the extent to which they were being hostile/cooperative. RESULTS: In both experiments, high, compared to low, CPA risk parents rated the ambiguous child pictures as more hostile. Further, both supraliminal (Experiment 1) and subliminal (Experiment 2) exposure to hostility-related words independently increased hostility ratings. In both experiments, the influence of chronic and temporary activation of hostile schema was additive and not interactive. CONCLUSION: Findings from these experiments are consistent with the proposition that high CPA risk parents are more likely to infer hostility in response to ambiguous child cues. Further, accessibility of hostility-related schema in parents increases the likelihood of hostile inferences, which in turn may increase attributions of hostile intent and aggressive parenting behaviors.     

The impact of childhood sexual abuse in anorexia nervosa

OBJECTIVE: The aim of this study was to examine the impact of childhood sexual abuse (CSA) on clinical characteristics and premature termination of treatment in anorexia nervosa (AN). METHOD: The participants were 77 consecutive patients with AN admitted to an inpatient eating disorders unit. The patients were assessed in terms of eating disorder symptoms, general psychopathology, and CSA history at admission to hospital. RESULTS: Thirty-seven patients (48%) reported a history of CSA before the onset of the eating disorder. Individuals with a history of CSA reported significantly greater psychiatric comorbidity, including higher levels of depression and anxiety, lower self-esteem, more interpersonal problems, and more severe obsessive-compulsive symptoms. Patients with the binge-purge subtype of AN (AN-BP) were significantly more likely to report a history of CSA prior to the onset of the eating disorder as compared with patients with the restricting subtype (AN-R) of the illness (65% of the AN-BP patients vs. 37% of the AN-R patients; p<.02). Contrary to our predictions, abused patients were not significantly more likely to dropout of treatment overall. However, patients of the binge-purge subtype (AN-BP) with a history of CSA were significantly more likely to terminate treatment prematurely as compared with the other patients. CONCLUSIONS: Consistent with previous findings, the present results indicate that the prevalence of CSA is high among individuals seeking inpatient treatment for AN. A history of CSA was associated with greater psychiatric disturbance overall and a higher rate of dropout for patients of the binge-purge subtype.     

School-based sexual abuse prevention programs: a review

In response to the alarmingly high incidence and negative consequences of child sexual abuse, an increasing number of school-based prevention programs have appeared in communities across the United States. In this paper, programs which have been implemented in grades K-6 are summarized according to mode and content of presentation, audience and trainer characteristics, and program length. While many creative and entertaining prevention programs are available for children, empirical validation of these programs has lagged behind their actual development and implementation. Several research questions need to be addressed before we can confidently assert that such programs are effective in preventing the sexual exploitation of children. Evaluation efforts must be expanded in order to improve existing materials, obtain funding, and ensure public and professional support for school-based sexual abuse prevention programs.     

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

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

Factors associated with an increased impact of child sexual abuse

Data is presented identifying factors associated with the impact of sexual abuse on children. A group of 369 sexually abused children and a comparison group of 318 children recruited from the community were compared on a parent-completed behavior rating scale. Data describing the abused children were also available from a 38-item symptom checklist completed by the child's social worker. Using a score based on the symptom checklist as the measure of the impact of sexual abuse, 15 variables were in the final regression equation explaining 42% of the variance in impact. Using a score based on parent-generated data, 5 variables were in the final equation explaining 20% of the variance. The significance of the variables in identifying factors associated with an increased impact of abuse is discussed.     

The long-term impact of childhood sexual abuse in Australian women

OBJECTIVE: The aim of this study was to examine the association between childhood sexual abuse (CSA) and a range of adverse adult outcomes in a community sample of women using multivariate analysis which accounted for a number of potential confounding effects. METHOD: Retrospective study of cross-sectional data on the long-term impact of CSA, collected as part of a larger two-stage case-control study of the possible relationship between CSA and alcohol abuse. Data were appropriately weighted to adjust for the different selection probabilities of cases and controls. RESULTS: Significant associations were found between reporting CSA and experiencing domestic violence, rape, sexual problems, mental health problems, low self-esteem, and problems with intimate relationships even after taking into account a range of family background factors. Women who had experienced abuse involving intercourse were the most vulnerable to these negative outcomes. CONCLUSIONS: The findings indicate that the influence of CSA on adverse long-term effects is mediated and influenced both by the severity of the abuse experiences and by a range of family and social background factors.     

Activity centers in the home: Ideas for family day care providers and parents

The home is where young children spend most of their time. Whether it is the home of the day care provider or their own home, it is the place where much of their learning takes place during their early years. Providers and parents can arrange the home environment to maximize learning for infants, toddlers, preschoolers, and school-agers. Setting up activity centers is a good way to organize space, ensure optimum learning opportunities, and facilitate supervision.Jean Billman is Professor of Early Childhood Education at Winona State University in Minnesota. She has been a center director and now directs a laboratory preschool on campus.     

Psychological impact of childhood sexual abuse on male inmates: the importance of perception.

OBJECTIVE: The current study examined the association between childhood sexual victimization and adult psychiatric disorders among male inmates. It further assessed the association between the perception of an event (as sexual abuse or not) and psychiatric diagnoses. METHOD: A sample of 211 randomly-selected male inmates were interviewed. The Diagnostic Interview Schedule (Version III-R) was used to assess psychiatric diagnoses. An additional questionnaire assessing childhood sexual abuse and perception of childhood sexual abuse was also administered. RESULTS: Forty percent of the inmates met standard criteria for childhood sexual abuse, which far exceeded rates found in the general population. Significant differences were found between inmates who had a history of childhood sexual abuse and those who did not for a variety of psychiatric diagnoses. Forty-one percent of those who met criteria for childhood sexual abuse did not consider themselves to have been abused. Those who did not consider themselves to have been abused had higher rates of alcohol abuse/dependence, while those who considered themselves to have been abused had higher rates of posttraumatic stress and obsessive-compulsive disorder. CONCLUSIONS: This study emphasizes the importance of perception or "cognitive appraisal" of the sexual experience (as abusive or not) and the need for further study regarding the potential mediating role of cognitive appraisal. Other implications of these findings include the need for primary prevention programs designed to reduce childhood sexual abuse, and inmate rehabilitation programs with an emphasis on the connection between victimization and criminality.     

Incidence and impact of sexual abuse in a child outpatient sample: The role of direct inquiry

From the child psychiatry outpatient department of a university medical center, 64 charts were reviewed in two phases: 29 were randomly selected from outpatient files, and 35 were examined after clinicians were asked to directly query sexual abuse. Although the reported sexual abuse rate for randomly selected charts was quite low (6.9%), reference to sexual abuse history in charts of children who were asked about molestation was 4.5 times more frequent (31.4%; 11.5% of all boys, 50% of all girls). Children with an identified sexual abuse history reported more psychological symptoms, had made more suicide attempts in the past, and were more likely than nonabused children to receive a diagnosis of major depression.     

Child on child sexual abuse: psychological perspectives

OBJECTIVE: This study describes the emotional and behavioral responses of children who have been sexually victimized by juveniles (CC) 17 years of age and younger compared to child victims of adults (CA) 18 years of age and older. METHOD: A total sample of N = 194 children and adolescents participated in the study, with 26% (n = 51) comprising CC and 74% (n = 143) encompassing CA. The mother/caretaker was administered a demographic form, Achenbach's Child Behavior Checklist (CBCL), and the Family Assessment Measure (FAM-P). The child was given the Family Assessment Measure (FAM-C) and the Trauma Symptom Checklist for Children (TSCC). The clinician completed the Parental Reaction to Incest Disclosure Scale (PRIDS). RESULTS: No differences were found between the two groups for the type of sexual abuse, penetration, or the use of force. CC were younger and more likely to be males who were abused in a school setting, home, or a relative's home by a sibling or a non-related male. CC endorsed clinically significant sexual preoccupations and manifested borderline clinically significant symptomatology. CONCLUSIONS: Children victimized by other children manifested elevated levels of emotional and behavioral problems and were not significantly different from those who had been sexually abused by adults.     

Initiating day care at three years of age: effects on attachment

Using the Ainsworth-Wittig strange situation, 12 42-month-old children with approximately 6-months of day-care experience were compared with individually matched children who had not had group child-rearing experience; 8 members of each experience group were female, and 4 members were male. While the day-care children showed less distress than the home-care children in the latter parts of the laboratory situation, the 2 groups were not different with respect to most other behaviors, including those toward the mother. However, day-care experience appeared to have differential effects as a function of sex; large differences were often found between the scores of the male subgroups, whereas the differences between the female subgroups were usually small. The day-care males exhibited the most exploratory manipulation, and the home-care males showed the most approach and proximity seeking toward the mother and the strongest approach toward and avoidance of the stranger. These results did not support the idea that day-care experience impair attachment to the mother.     

Breaking the cycle of intergenerational abuse: the long-term impact of a residential care program

OBJECTIVE: The number of youth in residential care programs who have been abused is high. The relationship between childhood abuse victimization and adult intimate partner violence (IPV) is well documented. This study compared the rates of IPV 16 years after individuals had participated in a long-term residential care program with individuals accepted to the program who did not participate. The IPV rates for these two groups were also compared to national normative data. METHOD: Information on adult functional outcomes was obtained from former residential care and comparison youth via a confidential survey that was administered either by telephone or by mail. Analysis was limited to respondents who were currently married or involved in a marriage-like relationship (n=131; 92% male). RESULTS: The IPV rates for the sample were 9.3% for those who stayed in the residential program less than 18 months and 6.5% for those who stayed more than 18 months, neither of which were significantly different from the national norm of 8.4%. The IPV rate for the comparison group was 26.1%, which was significantly higher than the national norm. Regardless of length of program stay, respondents who were maltreated in childhood had a 14.5% IPV rate, which was significantly lower than the estimated 36-42% rate projected for individuals with similar backgrounds. CONCLUSION: We conclude that time spent in a treatment-oriented residential care program was associated with lower adult IPV rates. Specifically, the skills taught in a long-term, treatment-based residential program (e.g., healthy interpersonal relationships, self-government) may have a long-term beneficial impact for adolescents at high risk of adult IPV.