Mental representations of physically and sexually abused latency-aged females

The mental representations and self-concept of 20 sexually abused, 20 physically abused, and 20 nonabused but distressed females, ages 7-12, were studied using the TAT and the Piers-Harris Children's Self-Concept Scale. Results were analyzed both statistically from objective scoring systems, and clinically from direct observations and from an analysis of the interaction of abused children with the examiner. The results show that while the mental representations did not statistically differ between the sexually and physically abused children, the abused groups did differ in their internal images compared to nonabused but distressed children. Also, abused children tended to split off from consciousness the more negative aspects of their perceptions. The results demonstrate that it is abuse per se, and not simply family distress, that results in impaired object relations. Implications of these results are discussed.     

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.     

Peer group interaction of physically abused children

The aim of this research study was to test the assumption that physically abused children differ significantly from their non-abused peers along dimensions which characterize abusing adults and other social deviants. Nineteen 5-10 year-old physically abused children and 38 non-abused peers were assessed by video-taped behavioral observations during free-flowing social interaction in a playroom. The dimensions tapped were: aggression, warmth, fear, pleasure, concentration, imagination and social participation. The dimension social participation was split into three variables: total social participation, negative participation and positive participation. The data from these nine dimensions was subject to a Pearson's correlation. Given the high correlation amongst these variables the data was subject to a principal components analysis with varimax rotation. From this analysis two components emerged which explained 76.9% of the total variance. These components were designated "social interaction" (component 1) and "hostility" (component 2) and were then subject to analyses of variance. A significant difference was found between the two groups on the "social interaction" component. The implications of these findings were explored and treatment possibilities examined.     

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.     

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.     

Exploration and validation of clusters of physically abused children

OBJECTIVE: Cluster analysis was used to enhance understanding of heterogeneity in social adjustment of physically abused children. METHOD: Ninety-eight physically abused children (ages 5-10) were clustered on the basis of social adjustment, as measured by observed behavior with peers on the school playground and by teacher reports of social behavior. Seventy-seven matched nonabused children served as a comparison sample. Clusters were validated on the basis of observed parental sensitivity, parents' self-reported disciplinary tactics, and children's social information processing operations (i.e., generation of solutions to peer relationship problems and attributions of peer intentions in social situations). RESULTS: Three subgroups of physically abused children emerged from the cluster analysis; clusters were labeled Socially Well Adjusted, Hanging in There, and Social Difficulties. Examination of cluster differences on risk and protective factors provided substantial evidence in support of the external validity of the three-cluster solution. Specifically, clusters differed significantly in attributions of peer intent and in parenting (i.e., sensitivity and harshness of parenting). Clusters also differed in the ways in which they were similar to, or different from, the comparison group of nonabused children. CONCLUSIONS: Results supported the contention that there were clinically relevant subgroups of physically abused children with potentially unique treatment needs. Findings also pointed to the relevance of social information processing operations and parenting context in understanding diversity among physically abused children. PRACTICE IMPLICATIONS: Pending replication, findings provide support for the importance of considering unique treatment of needs among physically abused children. A singular approach to intervention is unlikely to be effective for these children. For example, some physically abused children might need a more intensive focus on development of prosocial skills in relationships with peers while the prosocial skills of other abused children will be developmentally appropriate. In contrast, most physically abused children might benefit from training in social problem-solving skills. Findings also point to the importance of promoting positive parenting practices in addition to reducing harsh discipline of physically abusive parents.     

Dissociation predicts later attention problems in sexually abused children

OBJECTIVE: The goals of this research are to develop and test a prospective model of attention problems in sexually abused children that includes fixed variables (e.g., gender), trauma, and disclosure-related pathways. METHODS: At Time 1, fixed variables, trauma variables, and stress reactions upon disclosure were assessed in 156 children aged 8-13 years. At the Time 2 follow-up (8-36 months following the initial interview), 56 of the children were assessed for attention problems. RESULTS: A path analysis involving a series of hierarchically nested, ordinary least squares multiple regression analyses indicated two direct paths to attention problems including the child's relationship to the perpetrator (beta=.23) and dissociation measured immediately after disclosure (beta=.53), while controlling for concurrent externalizing behavior (beta=.43). Post-traumatic stress symptoms were only indirectly associated with attention problems via dissociation. Taken together, these pathways accounted for approximately 52% of the variance in attention problems and provided an excellent fit to the data. CONCLUSIONS: Children who report dissociative symptoms upon disclosure of CSA and/or were sexually abused by someone within their family are at an increased risk of developing attention problems. PRACTICE IMPLICATIONS: Findings from this study indicate that children who experienced sexual abuse at an earlier age, by someone within their family, and/or report symptoms of dissociation during disclosure are especially likely to benefit from intervention. Effective interventions should involve (1) providing emotion regulation and coping skills; and (2) helping children to process traumatic aspects of the abuse to reduce the cyclic nature of traumatic reminders leading to unmanageable stress and dissociation.     

Locus of control, persistence, and use of contingency information in physically abused children

Abused children are believed to develop in a harsh environment with minimal contingency of parental responses to their behavior. Seligman proposed that noncontingent caregiving produces helplessness. In this study, helplessness was assessed by measures of persistence and locus of control and by an experimental manipulation which varied contingency feedback. Compared to matched nonabused peers, abused children showed no less persistence in working for rewards, made equivalent use of contingency information to maintain persistence, and assumed equivalent responsibility for success. However, they took less responsibility for failure. Family learning history may render abused children helpless primarily in avoidance of aversive outcomes.     

A validational study of the structured interview of symptoms associated with sexual abuse (SASA) using three samples of sexually abused, allegedly abused, and nonabused boys

Objective: With the rapid rise of sexual abuse allegations, there is a growing need to develop instruments to help clinicians determine the likelihood that sexual abuse has occurred.Method: This study evaluated the discriminant validity of a structured parent interview regarding emotional, behavioral, and physical symptoms by comparing results among three subsamples of age matched boys: 22 sexually abused boys whose perpetrator confessed, 47 boys evaluated in a sexual abuse clinic but without a history of perpetrator confession and 52 nonabused boys selected after rigorous screening.Results: In comparison with the nonabused (NA) boys, the sexually abused boys were significantly more likely to demonstrate sudden emotional and behavioral changes, frequent stomachaches, more knowledge about sex and sexual activities than expected for age, unusual agressiveness toward playmate or toy's private parts, crying easily, difficulty getting to sleep, and a change to poor school performance. The internal reliability of the SASA was determined to be .83 and scoring of an abbreviated 12-item scale demonstrated a sensitivity of 90.9% and a specificity of 88.5%.Conclusions: The findings suggest that Structured Interview of Symptoms Associated with Sexual Abuse (SASA) is an effective tool which may help in the comprehensive assessment of boys who may have been sexually abused.     

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.     

Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering post-traumatic stress symptoms

OBJECTIVE: The present study sought to determine whether the 12-session pre- to posttest therapeutic gains that had been found by Deblinger, Lippmann. and Steer (1996) for an initial sample of 100 sexually abused children suffering posttraumatic stress disorder (PTSD) symptoms would be sustained 2 years after treatment. METHOD: These sexually abused children, along with their nonoffending mothers, had been randomly assigned to one of three cognitive-behavioral treatment conditions, child only, mother only, or mother and child, or a community comparison condition, and were followed for 3 months, 6 months, 1 year, and 2 years after treatment. RESULTS: A series of repeated MANCOVAs, controlling for the pre-test scores, indicated that for the three measures of psychopathology that had significantly decreased in the original study (i.e., externalizing behavior problems, depression, and PTSD symptoms), these measures at 3 months, 6 months, 1 year, and 2 years were comparable to the posttest scores. CONCLUSIONS: These findings suggest that the pre- to post-treatment improvements held across the 2-year follow-up period. The clinical and research implications of these findings are discussed.     

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.     

Friendship quality and sociometric status: between-group differences and links to loneliness in severely abused and nonabused children.

OBJECTIVE: There were two main aims: first, to illuminate the difference between abused children's general popularity with classmates and success in close friendships; second, to examine the specific interactional qualities of abused children's friendships and their links to loneliness. METHOD: Thirty-five severely abused children and 43 matched, nonabused children were compared on peer-rated sociometric status, self-reported loneliness, and observed and self-reported friendship quality. RESULTS: Abused children were not rated significantly lower sociometrically, nor did they differ significantly from control children on several measures of friendship quality, such as resolving conflicts and helping each other. However, abused children were observed to be more negative and less proactive in their interactions. They also reported their friendships as being more conflictual, and as higher on betrayal and lower on caring. Only observational friendship variables predicted loneliness. CONCLUSIONS: The results challenge the assumption that abused children's peer relationships are uniformly more maladaptive than nonabused children's, and point to the possible benefits of structured interventions for "normalizing" their friendship interactions. The pattern of difficulties exhibited by abused children (e.g., conflict) provides foci for more specific interventions. Multi-method assessments are necessary and the multi-dimensional nature of children's social adjustment is important to understand.     

Catch-up growth assessment in long-term physically neglected and emotionally abused preschool age male children

OBJECTIVE: To assess the catch-up growth of long-term physically neglected and emotionally abused preschool male children who have entered foster residential care and remained 1 year after initial placement. METHOD: Longitudinal study over a 7-year period (1994-2001). So that a child was eligible for the study, three selection criteria were included: (1) aged between 24 and 48 months at the time of entry into residential facility, (2) having suffered both long-term (more than 6 months) physically neglected and emotionally abused, and (3) having stayed in foster care for 1 year after initial placement. Weight, height, and head circumference were established upon entry and re-assessed 1 year after initial placement, calculating the annual growth velocity. Results were compared with normal regional longitudinal standards of reference (Z score). Student's t test was used to assess statistically significant differences. RESULTS: During the study period, 87 children aged between 24 and 48 months (54 male/33 female) were admitted to residential facility after having suffered both long-term physical neglect and emotional abuse. Nevertheless, only 20 children (23% of the total admissions) met the third selection criteria (having remained 1 year after initial placement). Of these children, all were males and at placement they were between the ages of 30 and 42 months, with an average age of 36 months (1.9 SD). At placement, the analyzed parameters were below the normal standards, showing a statistically significant difference for height (Z score = -1.29; p = .008) and weight (Z score = -.75; p = .038). The annual growth velocity for all parameters was above the normal standards showing a statistically significant difference for height (Z score = +1.43; p = .009). One year after initial placement, the significant differences for height (Z score = -.68; p = .102) and weight (Z score = -.31; p = .435) with respect to the normal standards disappeared, though still remained below, showing a significant catch-up growth for height (improvement height Z = +.61 SD). CONCLUSIONS: At placement, the both long-term physically neglected and emotionally abused preschool age male children showed a mild form of chronic malnutrition with growth failure. Growth failure was reversible after the first year of stay, which demonstrates that this delay in growth was secondary to nutritional and psychosocial factors. Placement in foster residential care was beneficial for the catch-up growth of these patients.     

Psychological symptoms in sexually abused girls

This study examined psychological symptoms exhibited by children who had recently been sexually abused. Twenty-four girls aged 6 to 12 years old were evaluated within six months of being abused using a variety of standardized child psychiatric instruments. Results showed a marked discrepancy between child and parent reports of symptoms. The abused children did not exhibit significant depressive, anxiety, or low self-esteem symptoms by self-report; however, their parents rated them as having significantly more behavioral problems than a normative sample but as somewhat less pathological than a clinical sample. The implications of these findings in relation to our current understanding of the psychological problems manifested by sexually abused children and for future research are discussed.     

Predicting resilience in sexually abused adolescents

This research examined factors that predicted resilience in sexually abused adolescents. Using Bronfenbrenner's Process-Person-Context-Time (PPCT) ecological model, this study considered the proximal and distal factors that would contribute to adolescents' reactions to sexual victimization. This correlational study used hierarchical regression analysis (n=237) with cross-sectional data from the National Survey of Child and Adolescent Well-Being Wave I (NSCAW, Dowd et al., 2002). This study found that school engagement, caregiver social support, hope and expectancy, caregiver education and SES predicted resilience. In line with the PPCT model, findings suggest that placing a greater emphasis on the contextual environment could improve support for adolescent resilience. Augmenting interventions that focus on individual change with those that address environmental factors may increase the benefits to adolescents affected by sexual abuse.     

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.