A clinical-demographic study of sexually abused children

Forty-five children who had been sexually abused were psychologically evaluated. Parents or guardians of the children completed symptom checklists. Results indicated that the majority of children (71%) were abused 4 or fewer times. In addition, genital manipulation and/or fondling was the most common form of abuse. In 82% of the cases, there were no marital separations or family breakups of any kind within six months before or six months after the abuse. Many children (69%) displayed psychological symptoms. The most frequent were nightmares, bedwetting, clinging behavior, inappropriate sexual behavior, anxiety and sadness. Results of this study are largely inconsistent with popular notions about the nature of child sexual abuse. The major methodological shortcoming of the investigation was the lack of a systematic control group.     

Further abuse of sexually abused children

OBJECTIVE: To determine the incidence of re-abuse in children known to have been sexually abused and to find factors that increase the risk of re-abuse. METHOD: The study group consisted of 183 children with substantiated sexual abuse who presented to two children's hospitals' Child Protection Units in Sydney, Australia during 1988 through 1990. At intake, when the children were aged between 5 years and 15 years, data about the child, the family, and the nature of the index sexual abuse were collected. Six years after presentation for the abuse, records of the Department of Community Services were checked to see if any of the young people had been the subject of substantiated notifications for abuse/neglect before and after intake to the study. Predictors of notifications for abuse/neglect after presentation for the index sexual abuse were identified. RESULTS: Of the sexually abused young people, nearly one in three were the subject of subsequent substantiated notifications to the Department of Community Services for some form of child abuse and neglect or behavior which placed them at risk of harm. Later notifications for abuse/neglect were predicted by notifications for emotional abuse before the index sexual abuse (adjusted RR = 4.88, CI: 1.43 to 16.65), severity of the index sexual abuse (p = .03), and the number of changes in the child's primary caregivers before intake (p = .03). Approximately one in six of the sexually abused young people were notified for sexual abuse after intake to the study. One in 10 also had prior notifications for sexual abuse. Sexual abuse notifications after study intake were predicted by caregiver changes before intake (p = .01) and whether or not there were notifications for emotional abuse before the index sexual abuse (adjusted RR = 3.40, CI: 1.05 to 11.02). CONCLUSIONS: Revictimization of children appears to be a marker of ongoing family dysfunction. Intervention in child sexual abuse needs to consider a range of risk factors associated with re-abuse and, in particular, should focus on family functioning if further abuse is to be prevented.     

A comparison of Hispanic and African-American sexually abused girls and their families.

OBJECTIVE: To study the differential effects of sexual abuse on Hispanic (HN) and African-American (AA) girls. METHOD: Sexually abused girls and their caretakers (N = 159), of which 52% (n = 82) were AA (mean age 9.8 years, SD = 3.4, R = 6-17) and 48% (n = 77) were HN (mean age 10.1 years, SD = 3.8, R = 6-18), were included in the study. The mother/caretaker was administered a demographic form, the Achenbach's Child Behavior Checklist (CBCL), and the Family Assessment Measure (FAM-P). The child completed the FAM-C and the Trauma Symptom Checklist for Children (TSCC). The clinician completed the Parental Reaction to Incest Disclosure Scale (PRIDS). RESULTS: HN girls were found to have a greater number of sexually abusive episodes and waited longer to disclose their abuse while AA girls were more likely to have experienced vaginal penetration. The perpetrators of HN girls were older and more likely to be fathers or stepfathers. The mothers/ caretakers of HN girls perceived their children as having significantly more aggressive behavior, anxiety/depression, somatic complaints, internalizing and externalizing behaviors, and had a higher total score on the CBCL than did AA girls. The HN girls were more likely to see their family as dysfunctional with confusion regarding family values and rules. HN mothers/caretakers perceived their families as more conflicted regarding adaptability and family controls. CONCLUSIONS: HN girls experienced more emotional and behavioral problems, and both HN girls and their mothers/caretakers perceived their families as more disturbed and dysfunctional.     

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.     

Educational and psychological problems of abused children

The findings of this study tend to confirm the hypothesis that abused children are found to be significantly different from nonabused children in academic achievement, placement in classes for the emotionally disturbed and for the educable mentally retarded. The data also confirm the hypothesis that abused and neglected children are placed in special facilities more frequently than children who have not been adjudged as abused. Further, abused and neglected children were reported to exhibit behaviors indicative of psychological problems. Within each of the dimensions investigated, abused and neglected children were found to have significant problems.In light of the significant differences found in this study, we find substantial support for the projects being supported by the National Center for Child Abuse and Neglect designed to involve the schools in the United States in the battle against children abuse and neglect. Especially important is the project of the Education Commission of the States designed to create an awareness among school systems, professional teacher organizations, and state and local legislative governing bodies of their potential in the battle against child abuse and neglect.In light of the loss of human potential as well as the increased costs involved in providing special classes for the abused and neglected child, allocation of resources to involve schools and school personnel as a part of the multidisciplinary team concerned with child abuse and neglect seems well justified. Additionally, the allocation of fiscal resources for research designed to secure data regarding the sequelae of child abuse is also amply justified.     

Early indicators of pathological dissociation in sexually abused children.

Although reported cases of adult multiple personality disorder (MPD) are increasing, confirmation of MPD and related dissociative disorders in children remains rare. Since MPD can cause severe impairment and psychological distress, and is thought to originate in childhood, early recognition of pathological dissociation and predictors of MPD is critical. Sexual abuse in childhood has similarly been under-reported until recently, and is highly associated with the development of dissociative disorders. This paper reviews factors in the professional neglect of these syndromes as well as recent diagnostic developments in childhood dissociative disorders. The identification of subtle dissociative symptomatology in children is illustrated and two case examples are presented.     

Post-traumatic stress in sexually abused, physically abused, and nonabused children

This investigation compared the rates of post-traumatic stress disorder symptoms across sexually abused, physically abused, and nonabused psychiatrically hospitalized children matched for age, sex, and socioeconomic status. Among the sexually abused children, 20.7% met diagnostic criteria for post-traumatic stress disorder compared with 6.9% of the physically abused and 10.3% of the nonabused children. Although these overall rates were not significantly different across groups, they were significantly high to reinforce the need for further study of post-traumatic stress in childhood. Further, significant symptom rate differences across groups were found with respect to specific post-traumatic stress symptoms. Specifically, sexually abused children exhibited significantly higher rates of inappropriate sexual behaviors than either the physically abused or nonabused children. In addition, both the sexually abused and physically abused groups showed a tendency to exhibit more avoidant/dissociative symptoms as compared to the nonabused children. Results are discussed in terms of their clinical and research implications.     

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.     

Thyroid hormone levels and psychological symptoms in sexually abused adolescent girls

OBJECTIVE: To explore the relationships between psychological symptoms and thyroid hormone levels in adolescent girls who had experienced the traumatic stress of sexual abuse. METHOD: The study design was cross-sectional/correlational. Subjects (N=22; age range=12-18 years) had their blood drawn, and they completed 2 psychological tests (depression and general distress/posttraumatic stress disorder [PTSD]). A pediatrician completed a sexual abuse questionnaire after reviewing law enforcement and Child Protective Services reports and conducting forensic interviews and medical examinations. RESULTS: Girls' average free T4, total T4, free T3, total T3, and TSH levels were within age-specific laboratory reference range limits, as were most individual concentrations. The strongest correlations (p<.05) were between free T3 and PTSD total score (-.50), PTSD-avoidance/numbing (-.49), and general distress (-.48); and between total T3 and depression (-.46), general distress (-.45), and PTSD-arousal (-.44). CONCLUSIONS: Our findings support one of the two contemporary models of the relationships between thyroid hormones (i.e., free and total T3) and psychological symptoms (i.e., depression, general distress, and PTSD)--one of shutting down (vs. activation) in the face of trauma.     

Group treatments for women sexually abused as children: a review of the literature and recommendations for future outcome research

OBJECTIVE: Adults with a history of sexual abuse often suffer many long-term consequences. It is important that therapists be able to provide effective treatment to address the host of issues that are presented in therapy by adult survivors of childhood sexual abuse (CSA). In order to provide the best possible treatment, therapists should know which treatments are most effective. METHOD: This paper provides a critique of the outcome research of 13 studies (six uncontrolled and seven controlled) on the treatment of adults who suffered childhood sexual abuse and discusses specific methodological strategies that can enhance the quality of such research in the future. RESULTS: Although many of the studies contain methodological limitations, the results generally indicate that group treatment helps reduce symptomatology in the short-term and at follow-up. CONCLUSION: Although outcome research has not been published on specific individual or conjoint treatment approaches for adult survivors of CSA, several outcome studies have found group treatment to be effective in the recovery of female CSA survivors.     

A group for sexually abused young children: unravelling the web

This paper describes clinical material from a group for young sexually abused children. The group work combines both an educational and dynamic approach drawn from previous models. The group was clearly structured and ran over nine weeks in conjunction with a parallel caregivers' group who were informed each week of the main themes. The caregivers were also involved in evaluating the effectiveness of the therapy by completing questionnaires which recorded symptomatology. A statistical analysis based on the questionnaires showed a significant reduction in problems reported by the caregivers before and after the group therapy. The authors recommend that such therapeutic work be combined with formal evaluation in the future to assess the effectiveness of different approaches with a view to clarifying which aspects are responsible for promoting positive change.     

Cumulative childhood trauma and psychological maladjustment of sexually abused children in Korea: Mediating effects of emotion regulation

The purpose of the present study was to identify the mediating effects of emotion regulation on the association between cumulative childhood trauma and behavior problems in sexually abused children in Korea, using structural equation modeling (SEM). Data were collected on 171 children (ages 6–13 years) referred to a public counseling center for sexual abuse in Seoul, Korea. Cumulative childhood traumas were defined on the basis of number of traumas (physical abuse, witnessing domestic violence, neglect, traumatic separation from parent, and sexual abuse) and the severity and duration of traumas. Children were evaluated by their parents on emotion regulation using the Emotion Regulation Checklist and internalizing and externalizing behavior problems using the Korean-Child Behavior Checklist. SEM analyses confirmed the complete mediation model, in which emotion dysregulation fully mediates the relationship between cumulative childhood traumas and internalizing/externalizing behavior problems. These findings indicate that emotion regulation is an important mechanism that can explain the negative effects of cumulative childhood traumas and that there is a need to focus on emotion regulation in sexually abused children exposed to cumulative trauma.     

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 effects of psychotherapy on behavior problems of sexually abused deaf children.

This study assessed the effectiveness of a broad based psychotherapeutic intervention with a sample of 72 children sexually abused at a residential school for the deaf. An untreated comparison group emerged when about half of their parents refused the offer for psychotherapy provided by the school. Treated and untreated children were randomly assigned to two assessment groups: those who participated in a pretreatment assessment and those who did not. Houseparents at the residential school used the Child Behavior Checklist (CBC) to rate the pretreatment assessment children before treatment and all 72 children one year after the implementation of psychotherapy. Children receiving therapy had significantly fewer behavior problems than children not receiving therapy. There was a differential response to therapy on the basis of sex. Boys receiving therapy had significantly lower scores on the following CBC scales than the no treatment group: Total, Internal, External, Somatic, Uncommunicative, Immature, Hostile, Delinquent, Aggressive, and Hyperactive. There were no differences on the Schizoid and Obsessive scales. Girls receiving therapy had significantly lower scores than the no treatment group on the following CBC scales: Total, External, Depressed, Aggressive, and Cruel. There were no differences on the Internal, Anxious, Schizoid, Immature, Somatic, and Delinquent scales.     

Men who were sexually abused in childhood: Coping strategies and comparisons in psychological functioning

ObjectiveCoping strategies of men who were sexually abused in childhood were examined to ascertain their relationship to clinical diagnoses. Time elapsed since the abuse occurred was examined for its relationship to psychological functioning. Clinical psychopathology of this primary sample of sexually abused men was compared to a community sample of men.MethodsA primary sample of 147 Australian men was recruited from agencies and self-help groups who support adults who were sexually abused in childhood. For comparative purposes a secondary data set that consisted of 1,231 men recruited randomly in an Australian community survey was utilized. Both samples were administered the 28-item General Health Questionnaire (GHQ28). The primary sample was administered the 60-item coping style inventory instrument (COPE).ResultsCoping strategies influenced the possibility of being classified as clinical or nonclinical. The most important strategies associated with better functioning were positive reinterpretation and growth and seeking instrumental social support. Whereas strategies that were more associated with a clinical outcome were themed around internalization, acceptance and disengagement. The sample of men who were sexually abused in childhood was up to 10 times more likely to be classified as “clinical” then the sample of community men. Time elapsed since the abuse occurred did not have a moderating effect on men's psychological functioning.ConclusionsMen who have been sexually abused in childhood are more likely to have clinical diagnoses but coping strategies may play an important part in this outcome. Seeking active assistance appears to be important coping strategy in reframing the experience, however, the timing of this help seeking is not critical.Practice implicationsThe findings reinforce the importance of professionals being aware that men's psychiatric symptoms might be the sequel to past child sexual abuse. Coping strategies that focus on internalization or disengagement are potentially damaging to the men's long-term psychological functioning. Importantly there are coping strategies that appear to have a moderating effect on clinical diagnoses. Focus needs to be given to support services to male victims that provide practical strategies and allow for cognitive reframing to assist men to see their strength and positive growth arising from survival.     

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.     

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.     

Treating sexually abused children: 1 year follow-up of a randomized controlled trial

OBJECTIVE: To measure the durability of improvement in response to two alternative treatments for sexually abused children. METHOD: Eighty-two sexually abused children ages 8-15 years old and their primary caretakers were randomly assigned to trauma-focused cognitive-behavioral therapy (TF-CBT) or non-directive supportive therapy (NST) delivered over 12 sessions; this study examines symptomatology during 12 months posttreatment. DATA ANALYSIS: Intent-to-treat and treatment completer repeated measures analyses were conducted. RESULTS: Intent-to-treat indicated significant group x time effects in favor of TF-CBT on measures of depression, anxiety, and sexual problems. Among treatment completers, the TF-CBT group evidenced significantly greater improvement in anxiety, depression, sexual problems and dissociation at the 6-month follow-up and in PTSD and dissociation at the 12-month follow-up. CONCLUSION: This study provides additional support for the durability of TF-CBT effectiveness.