Predictors of treatment outcome in sexually abused children

PROBLEM: This study evaluated the impact of child and family characteristics on treatment outcome of sexually abused children. METHOD: Forty-nine recently sexually abused 7- to 14-year-old children were randomly assigned to either abuse-focused cognitive behavioral therapy or nondirective supportive therapy, and assessed pre- and post-treatment using several standardized instruments. These included five measures of psychological symptomatology and four measures of child and family characteristics hypothesized to mediate treatment response. Correlational and multiple regression analyses were utilized to evaluate the impact of the following mediating factors on treatment outcome: Children's abuse-related attributions and perceptions; family cohesion and adaptability; parental support of the child; and parental emotional reaction to the child's abuse. RESULTS: Children's abuse-related attributions and perceptions and parental support of the child were strong predictors of treatment outcome in this population. CONCLUSIONS: Therapeutic attention to children's sexual abuse-related attributions and to enhancing parental support may be important factors in optimizing treatment outcome in 8- to 14-year-old sexually abused children.     

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.     

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.     

The child psychiatric examination of the sexually abused child

Child psychiatric examination of the sexually abused child is strongly indicated as more than two-thirds of these children have concomitant emotional problems. Special considerations which are important in approaching these children but would not be a part of the routine child psychiatric evaluation are highlighted. The approach to the child who has been sexually assaulted by someone outside the family is contrasted with the evaluation of an incestuous family.Five specific expectations of the child psychiatric examination are as follows: 1. The nature of any emotional problem must be defined and an appropriate treatment plan established. 2. An immediate proposal must be made for the care of the child which will provide protection from future abuse while minimizing emotional stress. 3. Long-term planning for the family should be initiated based on an assessment of the likelihood of future recurrence of sexual abuse. 4. The child's reality testing should be evaluated if there is a question regarding the occurrence of the sexual abuse. 5. Psychological characteristics of the child which might influence the success of long-term care proposals should be documented.     

Counseling sexually abused girls: the impact of sex of counselor

OBJECTIVE: The present study was conducted to assess the impact of sex of counselor on the therapeutic process for sexually abused girls in individual counseling. METHOD: Raters evaluated videotapes of counseling sessions recorded for 35 sexually abused girls who had been systematically assigned to brief-term psychoeducationally oriented treatment with either a male or female counselor. Clients' in-session behavior was rated using accepted therapeutic process measures, while statistically controlling for the effect of girls' pretreatment comfort level with male and female counselors. RESULTS: Overall, MANCOVA results revealed that girls' participation in counseling was not significantly related to session number, the child's age (i.e., preadolescent vs. adolescent), or the sex of counselor who provided treatment services. However, univariate results and graphic representations of girls' behavior suggest that adolescent clients, when compared with their preadolescent counterparts, seemed to be more reluctant to discuss certain child sexual abuse topics. CONCLUSIONS: The findings suggest that caution is warranted regarding categorical recommendations on the assignment of young female survivors to male counselors. Delimitations and limitations of the study and directions for future research are discussed.     

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.     

Ethical issues in research with abused children

This paper discusses sensitive ethical issues encountered in conducting research with abused children and the potential consequences of various methods of handling these dilemmas. Important ethical questions arise at three stages of the research: (1) obtaining consent for participation in the research; (2) conducting interviews with or administering tests to the subjects; and (3) providing information about test results to parents or others outside the research team. Concern with children's rights has been extended to the question of who can give consent for children to participate in research. In the case of abused children, the consent issue is complicated by the potential adversarial relationship between abusing parent and abused child. Procedures for interviewing or testing abused children must include provisions for three special situations: (1) when a child is distressed by the interviewing or testing; (2) when a child's answers or test results indicate emotional problems; and (3) when a child's answers or comments indicate that the child is being abused. Decisions concerning whether to inform parents or others about an individual child's answers must balance the parents' right to know against the child's right to privacy. All these circumstances require serious deliberation concerning the role and responsibility of the research investigator.     

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.     

Evaluation of the sustainability and clinical outcome of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) in a child protection center

This paper examines the sustainability and outcome of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) as delivered by practitioners in a community-based child protection program who had received training in the model several years earlier. Formerly described as Abuse-Focused CBT, AF-CBT is an evidence-based treatment (EBT) for child physical abuse and family aggression/conflict that was included in the National Child Traumatic Stress Network's initial EBT dissemination efforts in 2002. Seven practitioners participated in a year-long learning collaborative in AF-CBT and in similar training programs for 4 other EBTs. The agency's routine data collection system was used to document the clinical and adjustment outcomes of 52 families presenting with a physically abused child who received their services between 2 and 5 years after the AF-CBT training had ended. Measures of the use of all 5 EBTs documented their frequency, internal consistency, and intercorrelations. Controlling for the unique content of the other four EBTs, the amount of AF-CBT Abuse-specific content delivered was related to improvements on standardized parent rating scales (i.e., child externalizing behavior, anger, anxiety, social competence) and both parent and clinician ratings of the child's adjustment at discharge (i.e., child more safe, less scared/sad, more appropriate with peers). The amount of AF-CBT General content was related to a few discharge ratings (better child prognosis, helpfulness to parents). These novel data provide suggestive evidence for the sustainability and clinical benefits of AF-CBT in an existing community clinic serving physically abused children and their families, and are discussed in the context of key developments in the treatment model and dissemination literature.     

Agreement among professionals about a child's sexual abuse status: interviews with sexually anatomically correct dolls as indicators of abuse.

This study was designed to define clinicians' ratings of the comments, behaviors, and affects of abused children and compare them with the same clinicians' decisions about the child's abuse status. The authors concluded that sexually anatomically correct dolls used alone are inadequate in providing enough information for professionals to accurately assess the abuse status of young children. Also it is unclear what observations of the child by mental health professionals are best correlated with their determinations of a child's abuse status. Of concern was the finding that the mental health professionals were more likely to be in agreement with the interviewer's determination of abuse than with the actual status of the child, suggesting undue influence of the interviewer, or, alternatively, both observer and interviewer were responding to unidentified child factors.     

Symptoms and long‐term outcomes for children who have been sexually assaulted

Violent behaviors by and toward children have become an increasing concern within the American school system, with a good deal of energy devoted to developing profiles about which children are likely to exhibit these behaviors (Goldstein & Huff, 1993). Unfortunately, much less publicity has been devoted toward children who are sexually abused, despite the fact that over 300,000 children and adolescents are sexually abused annually in this country (National Center of Child Abuse and Neglect, 1996). As such, this figure reflects about a 600% increase in actual reported cases since 1980 (Burgdoff, 1980). These data suggest that a large number of school‐aged children are experiencing this kind of personal assault and professional educators are likely to encounter these children in the routine course of the educational process. This article provides a summary of the issues involved in the determination of sexual assault against a child and reviews the empirical literature describing the symptoms which may be manifested by a child who has been sexually abused. © 2001 John Wiley & Sons, Inc.     

Child abuse: A study of the child''s perspective

This study ascertained the child's response to various types of abuse and neglect. With interviews and questionnaires for the staff of a child psychiatric unit, the mothers and the children involved, we assessed the severity, frequency and duration of physical abuse, verbal abuse, physical neglect, emotional neglect or sexual abuse of children. The physically abused children accepted blame for mild but not severe mistreatment. Verbally and sexually abused children did not believe it was their fault if the mistreatment was moderately extensive but did if it was mild or severe. The relationship between extent of abuse and blame was less clear for neglect, but children usually though it was their fault. Verbal and sexual abuse appeared to have a greater impact on the children's perception of themselves and the world. Verbally abused children were more angry and more pessimistic about their future. Although physical abuse appeared to make some children feel they were unwanted at birth, how much the mother wanted her children was not related to the extent of any type of abuse. Both the type and extent of mistreatment appear to have different effects on the child's subjective experience. The use of the visual analogue scale in this study made it possible to differentiate a continuum of severity and frequency of five types of mistreatment without the need for definition.     

中小学生业余钢琴学习问题的调查与思考

中小学生钢琴学习应是一种以人为本的学习活动,应让琴童在学习过程中形成用身心去感受音乐的能力与经验,以促进其个性的完善与发展;应把钢琴学习与琴童自身的爱好结合起来,并以此为切入点发展琴童对钢琴学习的兴趣;在中小学生钢琴学习过程中,教师家长应避免功利心,对中小学生钢琴学习效果的评价应以琴童自身水平为标准;应根据琴童自身的特点与学习水平制定学习计划,并以一颗平常心对待琴童,理解容忍琴童的缺点与错误;同时,教师家长应与琴童保持平等的关系,不断了解中小学生的心理特点,选择易于被琴童接受的方式,从长远发展的高度给予琴童切实的帮助。     

Analysis of sexual abuse hotline reports

As concern about physical child abuse and neglect has increased, so too has the realization that children are also sexually exploited and abused. Yet, many protective service workers are often ill prepared to perform the difficult task of treating the abused child and his/her family. Through the analysis of sexual abuse hotline reports, the central aim of this study was to generate findings that would increase the knowledge base of protective service workers and private therapists engaged in treating sexually abused children and their families. To accomplish this task, and using seven classes of variables, analysis was performed on 205 substantiated cases of childhood sexual abuse. A number of important conclusions were discovered including: One-third of the cases had been reported to the agency previously; less than one-half (48%) of the victimized children were living with their natural fathers; natural fathers were identified as the perpetrator in 39% of the cases; and in contrast to other studies, a great number of cases (43%) involved vaginal intercourse between the victim and the perpetrator. Implications for treatment are also discussed, particularly in relation to improving resources and specialized training for workers involved in this highly sensitive area of practice.     

Variables associated with disrupted placement in a select sample of abused and neglected children

The purpose of this study was to examine the placement history of 172 abused and/or neglected children who had been placed in a residential home for maltreated children. Data were collected on the child's placement history (i.e., number of placements, time in transition, and placement rate) and also on child and family characteristics. Pearson correlation coefficients were run between child and family variables and each of the three placement history variables. In addition, t-tests were also used as a method of analysis. Results indicated that children with the following characteristics or life circumstances experienced the more disruptive experience while in foster care: children having severe behavior problems; children who were very young when first removed from their natural home; and children having drug addicted and/or alcoholic parents. Implications of these findings indicate social workers and judges need to be alert to the potential for system abuse of children in foster placement, responsible long-term planning for any child in foster care is critical, and those involved in therapeutic treatment for abused/neglected children should be attentive to the child's placement history.     

A pilot study for a structured, time-limited therapy group for sexually abused pre-adolescent children

The critical role of specific types of mastery skill development in the treatment of sexually abused children is explored, and defense mechanisms of "invulnerable children," who function adequately despite trauma and stress, are described. The authors describe their development of structured group therapy techniques designed to foster these types of mastery skills with sexually abused children aged 6 to 8. These techniques include development of intellectualization defenses through original coloring books and therapeutic board games, cathartic exploration of feelings through structured art and storytelling exercises, cognitive relabeling and self-esteem building through role-play, "chants and cheers," homework shared with mothers, and other structured group procedures designed to develop specific coping skills.     

Factors affecting placement decisions of children following short-term emergency care

Case files of 424 residents at an emergency treatment center for abused and neglected children were used to generate a beginning set of variables which, in combination, predicted whether or not children from the center would be discharged to their natural family environment. Variables with descending order of predictive significance were place from which the child was admitted, the length of time spent in treatment, the age and the race of the child, Other variables--the number of siblings, the child's sex and the presence of physical/sexual abuse--did not approach significance.