Interviewing young sexual abuse victims with anatomically correct dolls

Two groups of children were interviewed with a structured format to elicit their responses to sexually anatomically correct dolls. Significant differences were found between the responses of children who had not been referred for suspected sexual abuse and those who had. Nonreferred children (n = 25) revealed very few behaviors indicative of abuse whereas referred children (n = 25) demonstrated significantly more sexually related behaviors when presented with the dolls. Of the age groups studied (2-6 years), 3 year olds were the most responsive to the dolls, while older children tended either to reveal their experiences or to become very nonresponsive. The authors argue for the use of structured interview techniques with use of the anatomical dolls and the collection of normative comparison data relative to the evaluation of suspected sexual abuse.     

Use of anatomical dolls among professionals in sexual abuse evaluations

A total of 295 child protection workers, law enforcement officers, mental health practitioners, and physicians were surveyed to ascertain their uses of the anatomical dolls in child sexual abuse evaluations and their interpretations of young children's interactions with the dolls. The dolls enjoy fairly wide use among all four professional groups although most professionals employing the dolls have had little specific training in their use. Law enforcement officers were significantly less likely than the other professionals to view children's demonstrations of sexual acts with the dolls as convincing evidence of sexual abuse. There was no behavior (e.g., undressing the dolls, touching the dolls' genitals) which all professional groups unanimously agreed would be normal play behavior by young children ages 2-5, who had not been sexually abused. Results highlight the need for training resources and normative research.     

Investigative interviews of alleged sexual abuse victims with and without anatomical dolls

Verbal and nonverbal responses by alleged victims of child sexual abuse were coded for length, amount of information, and the manner in which they were elicited by the interviewer. In 16 of the interviews, anatomical dolls were employed for the purposes of demonstration, whereas they were not used in another eight cases matched with respect to other characteristics of the children and the alleged events. Children interviewed with dolls provided an equivalent number of details and spoke as many words in the substantive portion of the interview as did children interviewed without dolls, and interviewers in the two groups used similar probes to elicit information. However, the average responses by the children were significantly longer and more detailed when dolls were not used. Children gave longer and more detailed responses to open-ended invitations when dolls were not used. Caution is necessary when interpreting these findings.     

An assessment of the behavior of sexually abused and nonsexually abused children with anatomically correct dolls

The behaviors of two groups of children were observed and recorded in their play with anatomically correct dolls. One group had been determined to have been sexually abused and the other group had not been determined to have been sexually abused. The findings show that significantly more children who had been sexually abused demonstrated sexual behavior(s) with the anatomically correct dolls than did the group of children who had not been sexually abused. These findings suggest that anatomically correct dolls are a useful instrument in sexual abuse investigations.     

The variability of practice in interviews used by professionals to investigate child sexual abuse.

OBJECTIVE: The study aimed to examine: (1) the variability of interview practice among professionals who interview children to investigate suspected sexual abuse; (2) the relationship between interview practice and respondent characteristics; (3) the characteristics of interviewers who used the anatomically correct dolls in the course of their interviews. METHOD: Sixty investigatory interviewers completed questionnaires focusing on professional background, training, and interview practice. RESULTS: Interview practice varied considerably and some practices were at odds with the recommendations of the literature. Most of this variability was not accounted for by the respondent variables examined. Where there was evidence for an association, the interviewers' professional background, number of interviews conducted in the previous year, and whether or not they used the anatomically correct dolls appeared to influence practice, whereas general training and specific training in child sexual abuse had no significant effect. Only a minority (36%) used the anatomically correct dolls and none of the interviewer characteristics evaluated differentiated them from non doll-users. CONCLUSIONS: In this sample interview practices varied considerably and did not appear to be influenced by the interviewer's specific or general training. Further research is needed to focus on the comparative effectiveness of different interview techniques and the comparative effectiveness of different training programs in influencing interviewing practice.     

Working with childhood sexual abuse: a survey of mental health professionals

OBJECTIVE: This study aimed to establish the views of a group of mental health professionals from various disciplines working in mental health service in a British hospital about the needs of clients who had experienced childhood sexual abuse. METHOD: Staff members were asked to complete an anonymous survey which asked questions relating to knowledge of sexual abuse and its effects, and the needs of clients and staff in working with this client group. A total of 54 people responded to the survey, 42 were female, 11 male. Most (72%) reported having over 10 years experience working in mental health, working in both in-patient and out-patient settings. RESULTS: While respondents were reasonably knowledgeable about childhood sexual abuse, they were not very comfortable, competent or supported in their work with this client group. There were no differences in responses according to the age or gender of respondents, but less experienced staff were more likely to feel supported. Those that had received training and/or supervision felt significantly more capable in working with this client group. CONCLUSIONS: The study offers some support for the development of specialist training, consultancy and supervision programs for mental health staff in the area of child sexual abuse.     

Assessing the accuracy of a child's account of sexual abuse: a case study

OBJECTIVE: The objective of the case study reported in this paper was to examine the accuracy of one child's account of a sexually abusive incident. The availability of an audio recording of the last in a series of abusive incidents enabled us to assess accuracy in greater detail than has hitherto been possible in forensic contexts. METHODS: Information given by the victim during an investigative interview was compared with an audio-taped record of the incident. Content analyses of the interview involved quantitative and qualitative analyses of the victim's account, and a qualitative analysis of the eliciting utterances. A CBCA analysis was performed on the victim's account to assess its purported credibility. RESULTS: Over 50% of the informative details reported by the victim were corroborated by the audio-recorded account (of which 98% were central, i.e., allegation related and 64% were confirmed by more than one source (audio-recording, suspect, witness). A total of 10 CBCA criteria were present in the victim's free-narrative account of the last abusive incident. CONCLUSIONS: Our findings confirm that children can indeed provide remarkably detailed and accurate accounts of their experiences.     

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.     

The development of communicative and narrative skills among preschoolers: lessons from forensic interviews about child abuse

This study examined age differences in 299 preschoolers' responses to investigative interviewers' questions exploring the suspected occurrence of child abuse. Analyses focused on the children's tendencies to respond (a) at all, (b) appropriately to the issue raised by the investigator, and (c) informatively, providing previously undisclosed information. Linear developmental trends characterized all types of responding. When the types of prompts were considered, 3- to 4-year-olds responded slightly more informatively to specific (directive) recall prompts than to open-ended prompts whereas children aged 5 and older were more responsive to open-ended recall prompts. The findings suggest that even 3-year-olds can provide information about experienced events when recall processes are activated, although the ability to provide narrative responses to open-ended recall prompts only becomes reliable later in development.     

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.     

Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men's Health Study

OBJECTIVE: The prevalence and characteristics of childhood sexual abuse (CSA) among men who have sex with men (MSM), and links with sexual risk are explored. A model linking CSA and sexual risk among MSM is proposed. METHOD: A telephone probability sample of urban MSM (n = 2881) was recruited and interviewed between November 1996 and February 1998. The interview covered numerous health issues, including history of sexual victimization. RESULTS: One-fifth reported CSA, primarily by non-family perpetrators. Initial CSA experiences are characterized by high levels of force (43% involved physical force/weapons), and penetrative sex (78%; 46% reported attempted or actual anal intercourse). Such men are more likely than nevercoerced men to engage in high risk sex (unprotected anal intercourse with a non-primary partner or with a serodiscordant male). In multivariate analyses, the effect of childhood sexual coercion on sexual risk is mediated by substance use, patterns of sexual contacts, and partner violence, but not by adult sexual revictimization or by depression. CONCLUSIONS: Findings are interpreted within the context of social learning theory and prior research on sexual risk-taking. The high risk for CSA among MSM, which can predispose such men to patterns of HIV sexual risk, warrants new approaches in HIV prevention.     

Psychologists' beliefs about the prevalence of childhood sexual abuse: the influence of sexual abuse history, gender, and theoretical orientation.

OBJECTIVE: This study examined the influence of sexual abuse history, gender, theoretical orientation, and age on beliefs about the prevalence of childhood sexual abuse among clinical and counseling psychologists. METHOD: A mail survey design was used in this study. Participants were randomly selected from the American Psychological Association membership database. There were 615 psychologists who completed self-report measures on beliefs about the prevalence of childhood sexual abuse and demographic characteristics. RESULTS: Overall, clinicians' scores on the prevalence of childhood sexual abuse were moderate. There were significant gender differences on beliefs, suggesting that women were more likely believe that childhood sexual abuse is a common occurrence compared to men. Multiple regression analysis indicated that clinician characteristics (history of sexual abuse, gender, and theoretical orientation) were significantly related to beliefs about the prevalence of childhood sexual abuse. However, these characteristics only accounted for a small amount of the overall variance predicting beliefs. CONCLUSIONS: These results suggest that clinicians do not hold extreme beliefs regarding the prevalence of childhood sexual abuse. Moreover, certain clinician characteristics are associated with their beliefs, which in turn, may impact their clinical judgment and treatment decisions. Furthermore, much of the variance was unaccounted for in the model indicating that psychologists' beliefs are complex and are not unduly influenced by their personal characteristics. Implications for clinical practice and future research are discussed.     

Childhood physical and sexual abuse as risk factors for heavy drinking among African-American women: a prospective study

OBJECTIVE: This study examines the associations among characteristics of child sexual abuse. childhood physical abuse, lack of parental care, and heavy drinking in a relatively young, urban population of African-American women all of whom have documented histories of child sexual abuse. METHODOLOGY: The sample consists of 113 African American child victims who were brought to a city hospital emergency room for treatment and collection of forensic evidence in the 1970s and re-interviewed as adults in the 1990s. RESULTS: The results of this research suggest that multiple incidents of child sexual abuse, more than the characteristics of such abuse is an important predictor of adult heavy alcohol use and binge drinking. These results remain even after controlling for the effects of parental drinking behavior. CONCLUSION: Although the victim of multiple child sexual assaults is more likely to suffer force and penetration, these analyses suggest that it is the multiple victimization and not the force or penetration that drives the relationship between child sexual assault and drinking behaviors.     

The impact of child sexual abuse and stigma on methods of coping with sexual assault among undergraduate women.

OBJECTIVE: The aim of the current study was to determine whether a prior history of child sexual abuse increased the likelihood of using disengagement methods of coping with a sexual assault that had occurred within the past year. Once this was established, a mediational model was tested in which it was hypothesized that specific traumagenic dynamics and changed world views would mediate the association between child and/or adolescent sexual abuse and increased use of disengagement coping methods in response to a recent sexual assault. METHOD: One thousand and fifty women undergraduates from a New England state university completed a survey for research credit. Respondents were asked detailed questions regarding experiences of sexual assault within the past year, histories of child and/or adolescent sexual abuse, traumagenic dynamics, and world assumptions. Analyses were based on 106 participants who had experienced a sexual assault within the past year. RESULTS: Sexually assaulted young women with a history of child sexual abuse used more disengagement methods of coping to deal with the adult sexual assault than women without this history. In addition, the relationship between prior sexual abuse and the use of disengagement coping strategies was mediated by feelings of stigma, but not by feelings of betrayal and powerlessness or beliefs in the meaningfulness and benevolence of the world. CONCLUSIONS: This is the first study to find that sexually revictimized young women may be particularly at-risk of relying on disengagement methods of coping with sexual assault. Furthermore, this association is mediated by feelings of shame or stigma. Directions for further research and clinical implications are discussed.     

The rates of child sexual abuse and its psychological consequences as revealed by a study among Palestinian university students.

OBJECTIVES: The study aimed to achieve the following two objectives: First, it sought to examine the rates of sexual abuse in Palestinian society at three ages (12 years or less, 12-16 years, and 16 + years) by three perpetrators (a family member, a relative, and a stranger). Second, the study sought to assess some psychological implications of sexual victimization. METHOD: A cross-sectional survey was conducted among 652 Palestinian undergraduate students from the Palestinian Authority. A revised version of Finkelhor's scale was utilized to measure sexual abuse, and a revised and culturally adjusted version of Derogatis and Melisaratos' Brief Symptoms Inventory was used to measure nine psychological symptoms. RESULTS: The rates of sexual abuse among Palestinian students fall within the range of the problem in many other societies. Similar rates of abuse were found among female and male students. Moreover, sexually abused participants expressed significantly higher levels of psychoticism, hostility, anxiety, somatization, phobic anxiety, paranoid ideation, depression, obsessive-compulsiveness, and psychological distress compared with their nonabused counterparts. Sexual abuse by different perpetrators at different ages significantly explained between 20.7% and 35.8% of the variance in these psychological symptoms. CONCLUSIONS: The results provide strong support for the argument that sexual abuse exists in Palestinian society, as well as for the hypothesis that sexual abuse has a strong psychological impact on victims. Furthermore, the results highlight the need for further research into different aspects and dimensions of the problem in Arab societies.