Review of 125 children 6 years of age and under who were sexually abused

The authors present a chart review of 125 children, 6 years of age and under, who presented between early 1981 and mid 1983 to an acute care hospital because of sexual abuse. They represented one-third of the cases of alleged sexual abuse between infancy and 18 years of age referred to the hospital's multidisciplinary sexual abuse team. The ratio of females to males was 3.3:1. Sixty percent of the children were victims of intrafamilial abuse. Of the preschoolers, 72.5% were victims of intrafamilial abuse. At school age there was a reversal with 73% of 6 year olds being abused by extrafamilial offenders. The duration of the abusive relationship was greater in intrafamilial abuse. Purposeful disclosures were more frequent overall but were significantly less frequent when the perpetrator was intrafamilial or when the child was a preschooler. Two-thirds of the children had physical and/or behavioral symptoms. Parents of children who had been the victims of intrafamilial abuse were more likely to be separated or divorced. The difficulties in assessing young victims of alleged sexual abuse and the implications of the findings in this review are discussed.     

Risk factors for a New Zealand sample of sexually abusive children and adolescents

OBJECTIVE: The aim was to understand variables contributing to the occurrence of sexual offending in children and adolescents. METHOD: Twenty youngsters who had engaged in coercive sexual behavior involving other children were compared to a matched group of clinic-referred youngsters with conduct disorders. Assessments included family histories, interviews, and psychometric measures. RESULTS: There was no group difference in the frequency of experiencing sexual abuse. However, sexually abusive youngsters were more often exposed to adult caregivers with known histories of being sexually abusive. These children had been subjected to multiple distortions of adult attachment, tended to internalize distress, and failed to use available social supports. They were likely to have experienced physical and verbal abuse; children with behavior disorders were more likely to have a parent with a psychiatric illness and to have experienced parental conflict. CONCLUSION: Severely disrupted attachment, in conjunction with family experiences of inappropriate sexual expression, place children and adolescents at risk for sexual offending. Sexually abusive youngsters had less social supports and their offending occurred after a negative emotional experience, when there was opportunity in the form of younger victims. The study suggests an interaction among developmental pathways, coping skills, and immediate proximal variables for the perpetration of sexual abuse by young people.     

Sexually abused boys

Male victims of child sexual abuse have received inadequate attention in the literature. This article is a retrospective review of the reports of 189 boys evaluated during 1983-85. This population was younger than those previously reported. Comparison to an age- and race-matched group of girl victims seen during the same period revealed many similarities in patterns of disclosure and perpetrator characteristics. The acts perpetrated against the boys included a wide array of invasive acts at all ages, but sodomy was more frequently reported in the older victims. Abnormal anogenital findings were seen more often in younger children, but the findings were often nonspecific. An examiner experienced with young children and infants is essential.     

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.     

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.     

Sexual abuse of children under 12 years of age: a review of 511 cases

In a retrospective study of 511 cases of alleged sexual abuse in children 12 years of age and under, data were analyzed with respect to the victim's age, sex, and the type of sexual abuse (intra- or extrafamilial). A total of 85.5% of the victims were female and 14.5% were male with ages ranging from 2 months to 12 years. The mean age of female victims was 6.8 years and that of male victims, 7.4 years. Most victims (68%) presented with histories of single assault by a known perpetrator (78%). Characteristics of abuse were found to be associated with the victim's age, sex, and relationship to the assailant. School-age victims were more likely to be abused by an individual outside the family or by a complete stranger. Older victims were also more likely to be involved in severe forms of sexual abuse (penetration, attempted penetration or oral-genital contact), associated with acts of abduction and with reports to the police. Male victims were more likely to be assaulted by a stranger, outside the home environment, and to suffer a more severe form of sexual abuse than female victims. Finally, extrafamilial sexual abuse was distinguished from intrafamilial sexual abuse insofar as it was more often a single episode, occurring outside the home environment, involving an act of abduction and physical force, and being reported to the police.     

Sexual abuse: somatic and emotional reactions

A chart review and telephone interview of 72 sexual abuse victims was conducted to determine if children and adolescents who are victims of sexual abuse suffer from symptoms similar to the "rape trauma syndrome," which has been reported in adults. Symptoms similar to the rape trauma syndrome were found in 48 of the 72 abused children and only 26 of the matched control group, p less than .01. Common somatic complaints in the sexual abuse patients included dysuria, vaginal discharge and chronic abdominal pain. Some of the emotional and behavioral problems noted during the follow-up period among the sexual abuse patients included sleep problems, runaway behavior, and suicide attempts. The duration of abuse and age of the victim at the time of abuse significantly affected the frequency of reported somatic symptoms, but the type of abuse and type of assailant did not significantly affect the frequency of reported somatic and emotional reactions. There was no difference in the occurrence of school problems and early pregnancy between sexually abused patients and controls. Since 67% of all sexually abused patients suffered from emotional and somatic reactions, close follow-up of these patients is indicated.     

Prior incest in mothers of abused children

Previous studies have shown that most abusing parents have a history of physical abuse or neglect in their own childhoods. There is little data on the frequency of prior sexual abuse among parents who physically or sexually abuse their children. Many case reports describe the uncovering of a prior incest experience in a parent during the investigation of the child's current incest accusation, but it is unclear how frequently this occurs. One hundred mothers of abused children were asked about sexual incidents that occurred before age 18; the control group consisted of 500 normal women from the same community who were surveyed during meetings of various voluntary organizations. Age and ethnicity did not differ in the two groups. Of the mothers of abused children, 24% reported a prior incest experience, whereas only 3% of the control women reported prior incest. This eightfold difference was highly significant. The 34 mothers from families where sexual abuse was occurring were no more likely to report prior incest than were the 66 mothers from families where physical abuse occurred. The one case of genital mutilation of a child occurred in a family where both parents had been incest victims. Case studies indicate that the parent who has been an incest victim has inhibitions and fears about tenderness, traceable to the childhood incest experience, which are important in the development of either physical abuse or sexual abuse in the family.     

Behavioral problems in alleged sexual abuse victims.

This study was conducted to compare the parental assessments of problem behaviors, using the Achenbach Child Behavior Checklist, among alleged sexual abuse victims (n = 81) and an age, race, and gender matched group of nonabused comparison subjects (n = 90). Alleged sexual abuse victims demonstrated significantly higher mean total behavior problem, internalizing and externalizing scores than the comparison sample. Subscale profiles were all in the direction consistent with withdrawal, impairment in social interaction, and sexual problems. Item comparison indicated that sexual abuse victims were more likely to be assessed as having some problem behaviors that have been reported as being indicative of sexual abuse. A significant difference was not obtained on several behaviors that have been previously reported as indicative of sexual abuse. These findings support concerns that sexual abuse victims do exhibit more problem behaviors, but caution must be exercised when interpreting individual behaviors because of their frequency in a nonabused sample.     

Which sexual abuse victims receive a forensic medical examination? The impact of Children's Advocacy Centers

OBJECTIVE: This study examines the impact of Children's Advocacy Centers (CAC) and other factors, such as the child's age, alleged penetration, and injury on the use of forensic medical examinations as part of the response to reported child sexual abuse. METHODS: This analysis is part of a quasi-experimental study, the Multi-Site Evaluation of Children's Advocacy Centers, which evaluated four CACs relative to within-state non-CAC comparison communities. Case abstractors collected data on forensic medical exams in 1,220 child sexual abuse cases through review of case records. RESULTS: Suspected sexual abuse victims at CACs were two times more likely to have forensic medical examinations than those seen at comparison communities, controlling for other variables. Girls, children with reported penetration, victims who were physically injured while being abused, White victims, and younger children were more likely to have exams, controlling for other variables. Non-penetration cases at CACs were four times more likely to receive exams as compared to those in comparison communities. About half of exams were conducted the same day as the reported abuse in both CAC and comparison communities. The majority of caregivers were very satisfied with the medical professional. Receipt of a medical exam was not associated with offenders being charged. CONCLUSIONS: Results of this study suggest that CACs are an effective tool for furthering access to forensic medical examinations for child sexual abuse victims.     

Decisions and attitudes concerning child sexual abuse: does the gender of the perpetrator make a difference to child protection professionals?

Objective: An investigation was conducted into whether child protection investigators, specifically social workers and the police, are as likely to take seriously a case of child sexual abuse if it had been perpetrated by a female rather than a male. Also, to examine whether the decisions relating to female-perpetrated abuse were predicted by participants’ sex role perceptions of women and their attitudes concerning women’s sexualized behavior towards children.Method: Participants advocated decisions in response to four hypothetical case of child sexual abuse in which the perpetrator was either male or female. The female perpetrators were then rated on femininity and masculinity characteristics and attitudes concerning women’s sexualized behavior toward children were assessed.Results: Following male—rather than female—perpetrated sexual abuse, case registration and imprisonment of the perpetrator was considered more appropriate by all participant groups; male social workers also considered social services involvement and investigation as more appropriate. A substantial number of decisions concerning female perpetrated abuse were predicted by participants’ attitudes.Conclusion: While child protection professionals considered child sexual abuse perpetrated by females to be a serious issue warranting intervention, a number of advocated decisions suggested that they did not consider female-perpetrated abuse to be as serious as male-perpetrated abuse. The implication is that victims of sexual abuse perpetrated by a woman may be less likely to receive the protection afforded victims of male-perpetrated abuse. Furthermore, professionals’ practices may be inadvertently perpetuating the view that female child sexual abuse is rare or less harmful than abuse carried out by males.Spanish abstract was not available at time of publication.     

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.     

Differences between accounts provided by witnesses and alleged victims of child sexual abuse

OBJECTIVES: To determine whether child witnesses of sexual abuse were more or less informative about the alleged incidents than alleged victims when interviewed similarly. METHOD: Twenty-six alleged victims of child sexual abuse (aged 5 to 14 years; M=9.8 years) and 26 children who had witnessed but not experienced similar events were interviewed by experienced youth investigators about the alleged abuse. Children in the two groups were matched with respect to their age, relationships with the alleged perpetrator, and seriousness of the alleged offenses. All children were interviewed using the NICHD investigative interview protocol. RESULTS: Witnesses and victims provided similar amounts of information about the incidents of abuse. Interviewers used more open-ended invitations and elicited more information using open-ended prompts from witnesses than from victims, whereas they used more risky (including suggestive) prompts when interviewing victims. DISCUSSION: These results confirm that young children can be informative witnesses about events that they have either experienced or witnessed.     

The cycle of victimization: The relationship between childhood maltreatment and adolescent peer victimization

Child maltreatment has been demonstrated to have many short- and long-term harmful consequences for victims, but whether or not child abuse is associated with an increased risk of peer victimization during adolescence is unclear. This study analyzed prospective data from 831 children and parents participating in the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) to investigate the relationships between child physical and sexual abuse and adolescent victimization by peers, as well as the potential for gender to moderate these relationships. Results from ordinal logit regression models indicated that children who were physically abused prior to age 12, based on official reports, parent reports, and child reports, had a greater risk of experiencing more intimidation and physical assault by peers at age 16. Having a history of sexual abuse predicted more physical assault but not intimidation. There was no evidence that gender moderated these relationships; in all cases, the relationship between abuse and revictimization was similar for boys and girls. The findings emphasize the need to provide victims of abuse with assistance to help prevent a cycle of victimization.     

Dynamics of forensic interviews with suspected abuse victims who do not disclose abuse

OBJECTIVES: The present study was designed to explore structural differences between forensic interviews in which children made allegations and those in which children did not make allegations. METHODOLOGY: Fifty forensic interviews of 4- to 13-year-old suspected victims of abuse who did not disclose abuse during the interview were compared with the same number of forensic interviews of alleged victims who made allegations of sexual or physical abuse. Only cases in which there was substantial reason to believe that abuse had taken place were included in the study. Audiotapes of the interviews were examined with a focus on interviewer utterances and children's responses during the pre-substantive rapport-building, episodic memory training, and 'getting the allegation' phases of the interviews, which all employed the NICHD Investigative Interview Guide. FINDINGS: Forensic interviews which yielded allegations of child abuse were characterized by quite different dynamics than interviews with children who did not make allegations. When interviewing non-disclosers, interviewers made less frequent use of free recall prompts and offered fewer supportive comments than when interviewing children who made allegations of abuse. Children who did not disclose abuse were somewhat uncooperative, offered fewer details, and gave more uninformative responses, even at the very beginning of the interview, before the interviewers focused on substantive issues and before the interviewers themselves began to behave differently. CONCLUSIONS: A premature focus on substantive issues may prevent children who are not responsive in the episodic memory training phase from disclosing abuse. Identifying reluctant disclosers and making more extensive efforts to build rapport before substantive issues are broached, or interviewing such children in more than one session, may help suspected victims disclose their experiences.     

Unwanted and illegal sexual experiences in childhood and adolescence

Three hundred forty-two anonymous surveys regarding unwanted sexual experiences (USE) were filled out in three clinic sites: a pediatric sexual abuse clinic, family practice clinic, and family planning clinic. In the latter two clinics, 40% of females and 16% of males had at least one unwanted sexual experience prior to turning 18 years old. Only 91% of the sexual abuse clinic patients indicated their experience was unwanted. In addition, 27% of the subjects had wanted sexual experiences that were illegal and underreported: These experiences involved a partner at least 4 years older or younger. While feelings of victimization were most common, self-blame and naivete about the abuse were also frequently reported, especially in those who had an USE with a peer. Ambivalence, self-blame, and peer pressure were associated with a lower tendency to disclose one's USE. Although unwanted and illegal sexual experiences were less common in Hispanic females, feelings of self-blame and ambivalence regarding their USE were more frequent in comparison with White females. These findings have important investigative and therapeutic implications for professionals who encounter victims of sexual abuse.     

Posttraumatic stress avoidance symptoms as mediators in the development of alcohol use disorders after exposure to childhood sexual abuse in a Swiss community sample

This study examined the role of posttraumatic stress disorder (PTSD) symptoms of re-experience, avoidance, and hyperarousal in the relationship between different types of trauma and alcohol use disorders (AUD). We used data from 731 trauma-exposed individuals who participated in the first wave of the PsyCoLaus-study. Trauma characteristics were assessed relatively to the occurrence of lifetime PTSD symptoms and AUD. The results suggest that lifetime and childhood sexual abuse as well as overall childhood trauma were directly linked to AUD and PTSD symptoms, in particular to avoidance symptoms. From single symptom clusters PTSD avoidance was found to specifically mediate the trauma-AUD pathway. Both childhood and sexual trauma strongly contribute to the comorbidity of PTSD and AUD and avoidance-type symptoms appear to play a central role in maintaining this association. Hence, the alleviation of avoidance symptoms might be an important target for therapeutic intervention among victims of sexual abuse before specific addiction treatment is initiated.     

A review of the short-term effects of child sexual abuse

This is the first of a two-part report that critically evaluates empirical studies on the short- and long-term effects of child sexual abuse. With the exception of sexualized behavior, the majority of short-term effects noted in the literature are symptoms that characterize child clinical samples in general. Among adolescents, commonly reported sequelae include sexual dissatisfaction, promiscuity, homosexuality, and an increased risk for revictimization. Depression and suicidal ideation or behavior also appear to be more common among victims of sexual abuse compared to normal and psychiatric nonabused controls. Frequency and duration of abuse, abuse involving penetration, force, or violence, and a close relationship to the perpetrator appear to be the most harmful in terms of long-lasting effects on the child. The high prevalence of marital breakdown and psychopathology among parents of children who are sexually abused makes it difficult to determine the specific impact of sexual abuse over and above the effects of a disturbed home environment. Given the broad range of outcome among sexual abuse victims, as well as the methodological weaknesses present in many of the studies reviewed, it is not possible at this time to postulate the existence of a "post-sexual-abuse-syndrome" with a specific course or outcome.     

Oral health-related quality of life in Brazilian child abuse victims: A comparative study

This study aims to assess and compare Oral Health-Related Quality of Life (OHRQoL) in child abuse victims and non-abused children in a Southern Brazilian city. The study compared two independent samples of children aged 8–10 years: 48 child abuse victims recruited from a centre for Child and Adolescent Psychological Support (NACA) for abused children, and 144 public and private school students. Data collection consisted of administration of the Child Perceptions Questionnaire 8–10 (CPQ_8-10) to measure OHRQoL (dependent variable), clinical examination (dental caries), and collection of socioeconomic and demographic information (age, sex, skin colour, family income, and type of school). Multiple linear regression models were used to assess the association between presence of abuse and OHRQoL and subscales. After adjustment for clinical and sociodemographic variables, child abuse victims were found to exhibit higher CPQ scores on the overall scale and on the oral symptoms and functional limitations subscales. In conclusion, child abuse victims have a higher impact on OHRQoL. Based on the results, it is possible to suggest that greater care should be taken of these children, not only in providing treatment for oral disorders, but also in providing interdisciplinary care.