The influence of childhood sexual abuse,physical abuse,family environment,and gender on the psychological adjustment of adolescents

OBJECTIVE: The primary aim of the current study was to examine the contributions of sexual abuse, physical abuse, family cohesion, and conflict in predicting the psychological functioning of adolescents. Additional analyses were conducted to determine whether adolescent victims of child sexual abuse and physical abuse perceive their family environments as more conflictual and less cohesive than nonabused adolescents. METHOD: Participants were 131 male and female adolescents, ages 16 years to 18 years, receiving services at a residential vocational training program. Participants completed well established psychological assessment tools to assess abuse history, family environment characteristics, and current adjustment. RESULTS: Physically abused adolescent females perceived their family environments as more conflictual and less cohesive than females without physical abuse, and sexually abused females perceived their family environments as more conflictual and less cohesive than females without sexual abuse. Physically abused adolescent males reported more conflict than males without physical abuse, but did not differ with regard to cohesion. Adolescent males with and without a sexual abuse history did not differ on the family dimensions. Multiple regression analyses revealed that both conflict and cohesion, in addition to a history of sexual and physical abuse, predicted depression and distress. Separate analyses by gender revealed these variables differentially impact adjustment in male and female adolescents. Results of a power analysis indicated sufficient power to detect these differences. CONCLUSIONS: Findings indicate that in addition to child sexual abuse and physical abuse, family conflict and cohesion are risk factors for the development of psychological distress and depression in adolescence. Implications for treatment and directions for future research are discussed.     

Differences in child sexual abuse cases involving child versus adolescent complainants

While adolescents report the highest rates of sexual abuse victimization, few studies have investigated how child sexual abuse (CSA) cases involving adolescent complainants may differ from cases involving child complainants. The current study draws on 3,430 allegations of CSA in Canada to compare abuse characteristics and judicial outcomes in cases involving adolescent complainants to cases involving child complainants. Adolescent complainants were more likely than child complainants to be abused by a stranger or a person with a community connection to the complainant, while children were more likely than adolescents to be abused by a parent or other relative. Furthermore, compared to child complainants, adolescent complainants were more frequently involved in the most intrusive offenses and their cases were more likely to involve violence. Both groups were most likely to disclose the abuse to a parent, though a greater proportion of children disclosed the abuse to a parent. There were no differences in the delay to disclosure. Accused were equally likely to plead “guilty” and to be convicted in cases involving child and adolescent complainants. However, offenders convicted of the most intrusive offenses received longer probation sentences when the complainant was a child than when the complainant was an adolescent. These findings have implications for ensuring appropriate support and services to adolescent victims of CSA.     

Child sexual abuse consequences in community samples of Latino and European American adolescents

ObjectiveResearch investigating the impact of child sexual abuse (CSA) in community samples of adolescents has been limited. This study aims to identify sexual abuse among ethnically diverse high school adolescents of both genders and evaluate their psycho-emotional consequences.MethodThrough the use of self-report instruments, a sample of 223 Latino and European American 16–19-year-old high school students were identified as either victims of CSA or as nonabused. The emotional impact of sexual abuse was also investigated among these ethnically diverse adolescent males and females.ResultsInitial findings revealed that those adolescents who gave inconsistent responses to CSA assessments questions were much more similar in patterns of psychological distress to CSA victims compared to nonabused teenagers. Prevalence analyses revealed that females (45%) were nearly two times more likely to report CSA than males (24%). Latinos (44%) were significantly more likely to experience CSA compared to European Americans (27%), and Latinas (54%) had the highest prevalence overall. Other findings indicated substantial differences in type of perpetrator. While female victims of CSA identified male perpetrators in 91.9% of cases, male victims of CSA identified female perpetrators in 52.9% of cases. Consistent with past research, sexually abused adolescents reported significantly greater psychological distress than their nonabused peers, regardless of gender or ethnic group. Gender differences emerged with females reporting greater psychological symptoms, but these differences were substantially reduced when CSA was controlled. European Americans reported greater anxious arousal symptoms compared to Latinos.ConclusionsOur findings suggest that the prevalence of CSA among adolescents is higher than existing research has noted for both males and females and particularly higher for Latinos compared to European Americans. Perpetration by females upon males may also be higher than research has noted. Our findings also revealed many ethnic and gender similarities and fewer differences in the psychological impact and circumstances of sexual abuse in this diverse sample of adolescents.Practice implicationsThe high prevalence of CSA among adolescent males and particularly Latinas emphasize the need to intervene on a community level and with parents for both prevention and intervention regarding issues of sexual victimization. The numbers of female perpetrators, especially when boys are the targets of abuse, may be higher than previously imagined and thus must be assessed tactfully and thoroughly. This study found that adolescents who reported CSA inconsistently had similar symptoms as those with confirmed CSA and therefore warrant greater attention and more persistent intervention. When treating victims of CSA, the Trauma Symptom Inventory (TSI) is effective in identifying specific areas of emotional distress to treat in sexually abused ethnically diverse male and female adolescents. Culturally relevant prevention efforts are needed for ethnically diverse children of both genders.     

Democratic reform paves the way for new reproductive health strategy and advocacy. Mongolia

Ms. Munkhuu, senior adviser to the Reproductive Health Advocacy Project in Mongolia, reports the implementation as well as the impact of its National Adolescent Health Program. She relates the program's beginnings with the adoption of the National Program in Reproductive Health in 1997, which made adolescent reproductive health issues a public concern. Through the program, formal health education was incorporated in the secondary school curriculum. Other developments of the program were the training of trainers, publication of a quarterly newspaper called the Uerkhel--Love for adolescents, creation of educational radio and television programs on adolescent sexuality, and the establishment of a hot line service. In conclusion, Ms. Munkhuu emphasizes the need to make the program more effective and responsive by improving the country's information system and by increasing reproductive health awareness among policy-makers and the general public. Advocacy training should also be actively pursued.     

Characteristics of child sexual abuse treatment programs

Within the professional community, a vast number of sexual abuse treatment programs have emerged to meet the needs of victims and their families. Significant variations among these programs can be observed due to differences in philosophy, system context, client focus, problem definition, and the treatment strategy adopted. Unfortunately, little comparative information is available regarding the operation of different programs and, more importantly, their relative treatment effectiveness. This article presents the findings from a nationwide survey of 553 sexual abuse treatment programs. The survey focused on program context, client, and service characteristics. Overall it was found that most programs are affiliated with a larger public or private agency, focus on treating victims, and rely on a combination of individual, family, dyad, and group therapy approaches.     

Child sexual abuse and incest: community-based intervention

OBJECTIVE: The primary aim of this article is to determine the effectiveness of community intervention in the case of child sexual abuse. The article describes and analyses an actual case in a small urban community in Israel. METHOD: After several incidents of child sexual abuse, much of it incestuous, were brought to light in the community, they were discussed openly, contained, and punished. A community campaign, in which community activists as well as all the service providers were involved, was organized by community social workers. Individual, group, and community interventions were used. RESULTS: The continuation of the abuse has been checked, and, so far, there is no evidence to suggest its resurgence. Community apathy to child sexual abuse seems to have been halted and reversed. The involvement of community residents, particularly the activists, has increased, and this appears to be the major factor in changed community norms toward child sexual abuse. CONCLUSION: Implications of the individual, group, and community interventions are discussed. An integrated program of intervention practices is advocated to contain and prevent the incidence of child sexual abuse and incest.     

The maltreatment of adolescents

Official reports of maltreatment involving adolescent victims were compared to those involving younger children in a representative sample of protective services' reports drawn from New York State in 1985. Specific case characteristics, including age, gender, ethnicity of the victim, and source of report, are described and their relation to case substantiation is examined. Analyses revealed that adolescents represent a substantial proportion of all victims of official child maltreatment reports. The impact of age on substantiation varied as a function of the type of maltreatment, where for adolescents sexual abuse reports were more likely to be substantiated, while neglect and physical abuse reports were less likely to be substantiated. Reports involving adolescents were significantly more likely to involve a female victim. Significant gender differences in substantiation rate were found only for sexual abuse reports involving adolescents. White children were also found to be under-represented in this sample, while blacks were over-represented relative to their numbers in the population. The impact of minority status on substantiation was significant for neglect and physical abuse reports involving children. The majority of adolescent reports came from mandated sources, which had a significantly higher substantiation rate than reports from non-mandated sources.     

Reaching adolescents: a role for radio

The radio is a powerful means to reach adolescents and to address their concerns, particularly those that are not being addressed by their families or by the school curriculum. Proving this point is a radio program, "Sandhikhan" (Bengali for adolescence), which aired on national radio covering adolescent health issues, particularly reproductive health. The program's impact was the subject of a WBVHA survey among adolescent radio listeners in West Bengal. About 79% (369 individual listeners) of the respondents rated the radio program very good, with only a negligible 1% describing it as unnecessary. Only 21% of respondents listened to the program alone, with the majority listening in the company of friends, mothers, sisters, brothers, fathers, and other relatives. This suggested a wider group of listeners in addition to the program's primary target audience. Clearly, findings pointed to the effectiveness of teaching adolescent health on the air and the role that was played by WBVHA in developing healthy attitudes and habits among its young audience. The findings of the survey will provide the basis for producing educational materials on reproductive health for students as well as teachers.     

Child perpetrators--children who molest other children: preliminary findings

While the seriousness of sexual abuse by adolescents is finally beginning to receive adequate attention from the professional community, the existence of child perpetrators is largely dismissed and denied. Forty-seven boys between the ages of 4 and 13 are described who have molested children younger than themselves. Coercion was involved in all of the cases included in this study. These children had been treated in a program especially designed for child perpetrators at Children's Institute International in Los Angeles. Prior to their own sexually abusive behaviors, 49% of these boys had been sexually abused and 19% physically abused. The children all knew the people who victimized them. These male child perpetrators all knew the children they molested. In 47% of the cases the sexual abuse was of a sibling. The average number of victims of these children was 2.1 with a range of 1 to 7. The mean age at the time of perpetration was 8 years, 9 months. The mean age of the victims of these children was 6 years, 9 months. There was a history of sexual and physical abuse in the majority of the families of these children, as well as a history of substance abuse. This population is compared to adolescent perpetrators.     

Adolescent abuse and the development of personal sense of control

The link between adolescent abuse, the adolescent's psychological functioning, and locus of control orientation is explored. Maltreated adolescents experience such problems as low self-esteem, antisocial behavior, and suicidal tendencies. It is argued that the adolescent's locus of control orientation, deriving from his/her experiences in the home, may determine the extent to which the adolescent exhibits problematic behavior and personal maladjustment. Although locus of control in abused adolescents has not been investigated, studies show that individuals who experience the same types of problems evidenced by abused adolescents are more likely to have perceptions of external control. The nature of the relationship between locus of control and abuse may depend upon the duration of the abuse (i.e., long- versus short-term abuse). For example, adolescents who have experienced abusive behavior throughout childhood are expected to be more externally oriented than those adolescents who have been abused for a shorter time. Thus, long-term abused adolescents will be more likely to have perceptions of external control than nonabused adolescents, with short-term abused adolescents falling in the middle. The distinction between short- and long-term abuse in the context of locus of control may be important to consider when designing treatment programs for abused adolescents.     

Child abuse by adolescent caregivers

The purpose of this analysis was to estimate the frequency and severity of child abuse committed by adolescents who were in nonparental caregiving roles. The sample was composed of cases in which either physical or sexual abuse was substantiated through child welfare investigation. The main comparisons were between adolescent and adult caregivers. While caregiver age did not appear to have a consistent effect on the occurrence of physical abuse, notable differences between adolescents and adults were found in the area of sexual abuse. Not only were adolescents observed to commit substantially more sexual abuse than older caregiver cohorts, but the sexual abuse they committed was more likely to involve intercourse and physical assault. These findings have implications for future research and practice.     

Childhood sexual abuse and revictimization in adolescence.

OBJECTIVE: The aim of this study was to examine the link between childhood experiences of sexual abuse and subsequent revictimization in adolescence. METHOD: A sample of 281 female adolescents between 17-20 years of age, who participated in a prevalence survey of unwanted sexual contacts, completed the Sexual Experiences Survey as a measure of unwanted sexual contacts in adolescence and indicated whether or not they had experienced childhood sexual abuse. RESULTS: Childhood experiences of sexual abuse were reported by 8.9% of the respondents, a further 8.5% indicated they were not sure if they had been sexually abused as children. Both abused women and women uncertain about their victimization status were significantly more likely to report unwanted sexual contacts as adolescents than women who did not state abuse. The link between childhood abuse and subsequent victimization was mediated by a higher level of sexual activity among the abuse victims. CONCLUSIONS: The results support existing evidence on the impact of childhood sexual abuse on sexual relationships in subsequent developmental stages and underline the need to consider childhood sexual abuse as a risk factor of adolescent sexual victimization.     

Perceptions of caregivers and adolescents of the use of telemedicine for the child sexual abuse examination

BackgroundChildhood sexual abuse is a common cause of morbidity and mortality. All victims should receive a timely comprehensive medical exam. Currently there is a critical shortage of child abuse pediatricians who can complete the comprehensive child sexual abuse examination. Telemedicine has emerged as an innovative way to provide subspecialty care to this population. Despite the growing popularity of telemedicine, no literature exists describing patient and caregiver perceptions of telemedicine for this sensitive exam.ObjectiveTo explore caregiver and adolescent perspectives of the use of telemedicine for the child sexual abuse examination and discover factors that drive satisfaction with the technology.Participants and SettingCaregivers and adolescents who presented for a child sexual abuse medical evaluation at our county’s child advocacy center.MethodsWe completed semi structured interviews of 17 caregivers and 10 adolescents. Guided by the Technology Acceptance Model interviews assessed perceptions about: general feelings with the exam, prior use of technology, feelings about telemedicine, and role of the medical team. Interviews were audio-recorded, transcribed, coded and analyzed using content analysis with constant comparative coding. Recruitment ended when thematic saturation was reached.ResultsThere was an overwhelming positive response to telemedicine. Participants reported having a good experience with telemedicine regardless of severity of sexual abuse or prior experience with technology. Behaviors that helped patients and caregivers feel comfortable included a clear explanation from the medical team and professionalism demonstrated by those using the telemedicine system.ConclusionTelemedicine was widely accepted by adolescents and caregivers when used for the child sexual abuse examination.     

Adaptation and psychometric properties of the ISPCAN Child Abuse Screening Tool for use in trials (ICAST-Trial) among South African adolescents and their primary caregivers

Child abuse prevention research has been hampered by a lack of validated multi-dimensional non-proprietary instruments, sensitive enough to measure change in abuse victimization or behavior. This study aimed to adapt the ICAST child abuse self-report measure (parent and child) for use in intervention studies and to investigate the psychometric properties of this substantially modified tool in a South African sample. First, cross-cultural and sensitivity adaptation of the original ICAST tools resulted in two preliminary measures (ICAST-Trial adolescents: 27 items, ICAST-Trial caregivers: 19 items). Second, ICAST-Trial data from a cluster randomized trial of a parenting intervention for families with adolescents (N = 1104, 552 caregiver-adolescent dyads) was analyzed. Confirmatory factor analysis established the hypothesized 6-factor (adolescents) and 4-factor (caregivers) structure. Removal of two items for adolescents and five for caregivers resulted in adequate model fit. Concurrent criterion validity analysis confirmed hypothesized relationships between child abuse and adolescent and caregiver mental health, adolescent behavior, discipline techniques and caregiver childhood abuse history. The resulting ICAST-Trial measures have 25 (adolescent) and 14 (caregiver) items respectively and measure physical, emotional and contact sexual abuse, neglect (both versions), and witnessing intimate partner violence and sexual harassment (adolescent version). The study established that both tools are sensitive to measuring change over time in response to a parenting intervention. The ICAST-Trial should have utility for evaluating the effectiveness of child abuse prevention efforts in similar socioeconomic contexts. Further research is needed to replicate these findings and examine cultural appropriateness, barriers for disclosure, and willingness to engage in child abuse research.     

Sponsored and contest modes of social reproduction in selective community college programs

Theoretical constructs derived from the work of Turner (1960) and Hopper (1971) are discussed to clarify how community colleges may contribute to the social reproduction—the perpetuation and legitimation—of inequalities in wealth, power, and status. Data collected on two selective-entry community-college-allied-health-career programs are presented to illustrate the utility of examining the structural effects and ideological bases of educational programs in terms of contest and sponsored modes of social reproduction. Findings indicate that ethnic group inequalities are reinforced in both programs, but in different ways. In one program, nonwhites are discriminated against at the admission stage; but when they are admitted, white and nonwhite students receive equivalent sponsorship toward completing the degree. In the other program, nonwhites are not only less likely to be admitted, but among those admitted, nonwhites are more likely to drop out or be eased out before completing the contest. The ideologies of implementation and legitimation drawn upon by key gate-keepers to explain each program appear to correspond to the systems of social reproduction evidenced in the respective program's structural effects.An earlier version of this paper presented at the Annual Meeting of the American Educational Research Association, Montreal, April 11–15, 1983.     

Reproductive health through community involvement with special attention to adolescents and clinical contraception. RAS/98/P63

This article outlines the objectives, strategies and main activities of Save the Children Fund/Bangladesh to increase reproductive health (RH) through community involvement with special attention to adolescents and clinical contraception. It is noted that the ways to increase the range of reproductive information and care available to adolescents are being explored, with a view to improving their sexual and RH knowledge and practices, and to increasing clinical contraception use. The following strategies are being implemented: 1) strengthen the capacity of local partners, which include the districts of Khulna, Moulavibazar, Cox's Bazar and Panchagarh; 2) conduct participatory workshops with adolescent groups; 3) promote advocacy for adolescents regarding their needs; 4) develop a platform for adolescent and adolescent-friendly clinics; and 5) promote community-based programs in RH and family planning, especially contraception. A summary of the main program activities of the project is given.     

Impact of family abuse on running away, deviance, and street victimization among homeless rural and urban youth

PROBLEM: Various demographic and familial risk factors have been linked to runaway behavior. To date, there has not been a systematic investigation of the impact of size of community on runaway behavior. This study will compare runaways from smaller cities and rural areas to their urban counterparts. METHODS: A convenience sample of 602 adolescents was interviewed between 1995 and August of 1996 in Missouri, Iowa, Nebraska, and Kansas, USA. Multiple regression was used to examine the association between gender, neglect, sexual abuse, physical abuse, geographic and family structure change, and community size of first runaway to predict age at first runaway, deviant subsistence strategies, and street victimization. RESULTS: Findings indicate that adolescents exposed to neglect (beta=-.20) and sexual abuse (beta=-.16) ran away sooner and were more likely to be victimized on the street. Rural adolescents who experienced higher levels of physical abuse relied more heavily on deviant subsistence strategies (beta=.15) and remained in abusive homes longer (beta=.15) than their similarly situated urban counterparts. CONCLUSIONS: Rural youth who have been subjected to elevated levels of familial abuse are at greater risk of deviant subsistence strategies, which increase the likelihood of street victimization.     

Psychological functioning and family discord among African-American adolescent females with and without a history of childhood sexual abuse

OBJECTIVES: The aim was to examine the rate of childhood sexual abuse along with the factors (age of abuse onset, type of perpetrator, and duration of the abuse), as well as the relationship of these factors to psychological functioning among females with a history of childhood abuse. Second, to determine whether levels of psychological functioning and family discord differ among females with and without a history of childhood sexual abuse. METHOD: A cross-sectional design was used. Two hundred and forty-nine adolescent females were recruited from a community-based health program. Two trained female interviewers administered an anonymous survey that assessed childhood sexual abuse, psychological functioning, and family environment. RESULTS: Fifty-seven (22.9%) of those surveyed reported childhood sexual abuse, of which 44.3% were intrafamilial and 55.7% were interfamilial. Age at onset ranged from 3 years to 17 years; 62.5% reported that the sexual abuse occurred 1 to 4 times; 27.9% reported a duration ranging from 1 year to 13 years; and 9.6% reported a duration of 1 month to 7 months. Multiple regression analysis revealed that a greater duration predicted higher levels of depression and lower levels of self-esteem among females with a history of sexual abuse. Females with a history of childhood sexual abuse scored significantly lower on measures of self-esteem and mastery, and significantly higher on measures of physical and emotional abuse. CONCLUSIONS: Results indicate that adolescent females with a history of childhood sexual abuse suffer an array of negative sequelae that include psychological and family distress.     

Depression,anxiety and PTSD in sexually abused adolescents: Association with self-efficacy,coping and family support

Sexual abuse has the potential to generate serious emotional consequences for its victims, but there is high variability in the symptoms reported by different victims. Therefore, it is necessary to ascertain the factors associated with the symptoms presented by sexual abuse victims. The aim of the study was to use a single model to evaluate the relationship between sexual abuse characteristics (frequency, violence, relation with the aggressor and physical commitment), cognitive and behavioral factors (self-efficacy, active coping and perceived family support) and internalizing symptoms (anxiety, depression and posttraumatic stress) in a group of sexually abused adolescents. The participants included 106 female adolescent victims of sexual abuse (M = 14.25 years, SD = 1.74). The results of a path analysis indicated that sexual abuse characteristics were unrelated to symptomatology. Only a negative relationship was observed between the victim’s relationship with the aggressor and PTSD symptomatology. The violence of the sexual abuse was negatively related to self-efficacy, and self-efficacy was positively related to active coping and negatively related to symptomatology. Finally, the perception of family support was positively related to self-efficacy and negatively related to symptomatology. These results suggest the need to consider the studied factors in the process of psychotherapy with victims of sexual abuse.     

Changes in the prevalence of child maltreatment in Vietnam over 10 years

ObjectivesIn the context of the shortage of studies on child maltreatment changes over time in limited resource settings, this paper explored the changes in the prevalence of multiple types of child maltreatment over a period of 10 years in Vietnam and tested the moderating role of some demographic characteristics in these changes.MethodsWe used data from two prevalence studies conducted in 2004 and in 2014 using similar methodologies. Both studies used self-report questionnaires which were completed by randomly selected students aged 12–17 years from different provinces in Vietnam. We also compared Hanoi subgroups to examine the trend using the most equivalent samples.ResultsWhile the prevalence estimates of sexual abuse and neglect were unchanged over 10 years, the prevalence of physical abuse and emotional abuse declined. The decrease in the prevalence of physical abuse was larger for younger adolescents and boys than for their counterparts. For sexual abuse, older adolescents reported an increase in the prevalence of sexual abuse. In the Hanoi sample comparison, only the prevalence of emotional abuse declined and this reduction was smaller for younger adolescents than for the older group.ConclusionDespite the reduction of emotional and physical abuse in the whole sample and emotional abuse in the Hanoi sample, all types of child maltreatment were still highly prevalent in Vietnam. We argue that interventions on all types of child maltreatment should be further implemented. Similar studies could be conducted to evaluate the effect of child protection policies on the prevalence of child maltreatment.