Munchausen Syndrome by Proxy: Another Form of Child Abuse

Munchausen syndrome by proxy (MSbP) was first described by Dr Roy Meadow in 1977 as a form of child abuse in which illnesses are fabricated in a child by a parent, usually the mother. The parent causes the illness in the child or exaggerates symptoms in the child, resulting in unnecessary medical and psychological treatments and hospitalizations (Meadow, 1985). The presentation of children in a variety of ways to different medical institutions often defies detection (Williams, 1986). Extra vigilance and investigative efforts are required to unravel the complexity of the action in the pathogenic family. In recent years, MSbP has been reported with increasing frequency and it is now recognized as more common in the service delivery system than has been previously documented. Medical, psychological and social information are separate pieces of a puzzle which will remain separate without a coordinating body to integrate and complete the overall picture. This paper explores a particular case in the State of New South Wales, where members of the legal, medical, social work and psychology professions collaborated to establish that the child was in need of care and should be removed from the high-risk environment in the family home. This is the first Munchausen case in New South Wales that has proceeded to the Supreme Court. Highlighted are the difficulties involved in identifying the syndrome. It is proposed that a coordinating body is fundamental for collating retrospective medical records and to provide a pivotal point for the various professionals involved to meet, exchange and share discrete information. It is further suggested that the Child Protection Services within the State be made responsible for this function and a standardized and systematic procedure be adopted when encountering cases of possible MSbP.     

Young Children's Problematic Sexual Behaviors,Unsubstantiated Allegations of Child Sexual Abuse,and Family Boundaries in Child Custody Disputes

ABSTRACT

Allegations of child sexual abuse are sometimes alleged based on a child's problematic sexual behaviors. When the allegations are unsubstantiated, child custody evaluators are asked to make recommendations regarding custody. Historically, it has been believed that if a child engages in problematic sexual behaviors it is strong evidence of child sexual abuse. Recent research finds that there are many reasons, other than overt sexual abuse, for children to engage in problematic sexual behaviors. This article outlines these reasons and provides a methodology for the evaluation of the boundaries in both parents' homes to assist in determining the possible etiology of the problematic sexual behaviors of the child. Suggestions are made regarding visitation and reunification if boundary concerns are found.     

Evaluating Allegations of Child Sexual Abuse Within Complex Child Custody Cases

SUMMARY

This article provides a framework for identifying and assembling the interdependent elements of a child custody evaluation with allegations of child sexual abuse. The identification of several myths regarding child sexual abuse (CSA) introduces the subject matter of this article. A forensic evaluation model (Heilbrun, 2001) is then used to organize the custody evaluator's tasks into the following sequential classifications: (a) preparation; (b) data collection; (c) data interpretation; and (d) communication of results. Through this model, the entwined tasks of evaluating the child's needs and the parents' capacities to meet the child's needs, while simultaneously examining the question of child sexual abuse, are addressed.     

Sexual Abuse Allegations by Children with Neuropsychiatric Disorders

All Swedish court cases from 2004 and 2006 concerning alleged child sexual abuse (sexual harassment excluded) were identified through criminal registers. Fourteen cases (one boy) concerned a child with a neuropsychiatric disorder. The diagnostic groups were mental retardation (10 cases), autism (three cases), and ADHD (one case). Psychiatric experts were engaged in only two cases. When experts were involved, the courts focused on credibility issues. When the courts applied neuropsychiatric arguments in the absence of an expert, they used developmental arguments. When the authors found that significant neuropsychiatric issues were not discussed by the court it concerned interpretations of symptoms and developmental standpoints. The results illustrate the complexity and pitfalls of drawing conclusions about associations between symptoms and personality characteristics on one side and accuracy of sexual abuse allegations on the other. Moreover, the results highlight the importance of a high quality system for providing courts with adequate neuropsychiatric knowledge.     

Munchausen Syndrome by Proxy: Some Practice Implications for Social Workers

The medical and psychosocial complexities involved in cases of Munchausen Syndrome by Proxy typically necessitate carefully organized interdisciplinary responses. The role of social work in the effectiveness of such responses is both crucial and historically under-considered in the existing literature. This article presents the historical and specific diagnostic components of this complex and perplexing condition, along with practice guidelines for clinical responses, with information relevant to child protection issues across multiple settings.     

Child Sexual Abuse Allegations Amidst Divorce and Custody Proceedings

This study describes 18 cases of child sexual abuse allegations investigaled by the Boulder County (Colorado) Sexual Abuse Team which revolved around divorce and custody disputes. Determining whether such allegations are reliable or fictitious presents a challenge to caseworkers who are apt to find themselves caught up in the highly charged atmosphere of divorce and custody proceedings. Initially, only 5.6% of the cases investigated were believed to be founded by the sexual abuse evaluation team. After applying the clinical process of validation used at the Kernpe Center in Denver. Colorado, the cases were subject to further review and categorized as follows: reliable accounts; recantations; unsubstantiated suspicions; insufficienl information; fictitious reports by adults; and fictitious reports by children. Subsequent to applying this clinical Drocess of validation. the number of cases categorized as founded hcreased to 44.4%. Application of a systematic process of validation by clinicians is suggested in the determination of whether reports are likely to be vacd or fictitious. Tentative conclusions are drawn which acknowledge that the atmosphere surrounding divorce/ custody proceedings can affect objectivity by clinicians and which suggest adherence to a systematic clinical process of validation.     

The Frequency of False Allegations of Child Sexual Abuse: A Critical Review

The rate of false allegations has been a topic of research spanning back to as early as the 1970s. Studies have often relied on data gathered by Child Protective Services workers and court administrators. Some researchers have also used hypothetical scenarios to estimate rates. However, given the plethora of sampling methods, there is a large variation in estimated rates of false allegations of sexual abuse depending on the data source and context of the allegation. Additionally, methodological problems such as unclear or invalid criteria used to judge truth or falsity of an allegation, unrepresentative samples, and ignoring important contextual variables such as the stage at which an allegation is made, currently all render the determination of actual rates of false child sexual abuse allegations to be unknown. This examination of literature is intended to gain a firmer understanding of the frequency at which allegations are false and during which stage of prosecution they occur, thus assisting with the legal practice of distinguishing between a false versus positive allegation. Research reviewed supports two general conclusions: (a) the vast majority of allegations are true but (b) false allegations do occur at some non-negligible rate. Suggestions for future research, as well as cautions about claims about specific rates of false allegations in the courtroom, are provided.     

Sexual Abuse by Men Who Work with Children

There is a dearth of knowledge about those who sexually abuse children while working in organizations. Here, we adopt a case study approach to examine this problem. We focus on eight adult males who had been imprisoned for abusing a total of 35 children while working in educational and voluntary settings. We provide a detailed account of abusers' characteristics, their strategies, how victims were selected, how trust was secured, and how victims' silence was ensured. Finally, we reflect on the extent to which our work might contribute toward the prevention of this form of abuse.     

Healing from Childhood Sexual Abuse: A Theoretical Model

Childhood sexual abuse is a prevalent social and health care problem. The processes by which individuals heal from childhood sexual abuse are not clearly understood. The purpose of this study was to develop a theoretical model to describe how adults heal from childhood sexual abuse. Community recruitment for an ongoing broader project on sexual violence throughout the lifespan, referred to as the Sexual Violence Study, yielded a subsample of 48 women and 47 men who had experienced childhood sexual abuse. During semistructured, open-ended interviews, they were asked to describe their experiences with healing from childhood sexual abuse and other victimization throughout their lives. Constructivist grounded theory methods were used with these data to develop constructs and hypotheses about healing. For the Sexual Violence Study, frameworks were developed to describe the participants' life patterns, parenting experiences, disclosures about sexual violence, spirituality, and altruism. Several analytic techniques were used to synthesize the findings of these frameworks to develop an overarching theoretical model that describes healing from childhood sexual abuse. The model includes four stages of healing, five domains of functioning, and six enabling factors that facilitate movement from one stage to the next. The findings indicate that healing is a complex and dynamic trajectory. The model can be used to alert clinicians to a variety of processes and enabling factors that facilitate healing in several domains and to guide discussions on important issues related to healing from childhood sexual abuse.     

Examining the Effects of a Service-Trained Facility Dog on Stress in Children Undergoing Forensic Interview for Allegations of Child Sexual Abuse

Disclosure of child sexual abuse can be a stressful experience for the child. Gaining a better understanding of how best to serve the child, while preserving the quality of their disclosure, is an ever-evolving process. The data to answer this question come from 51 children aged 4–16 (M = 9.1, SD = 3.5), who were referred to a child advocacy center in Virginia for a forensic interview (FI) following allegations of sexual abuse. A repeated measures design was conducted to examine how the presence of a service-trained facility dog (e.g. animal-assisted intervention (AAI) may serve as a mode of lowering stress levels in children during their FIs. Children were randomized to one of the two FI conditions: experimental condition (service-trained facility dog present-AAI) or control condition (service-trained facility dog not present- standard forensic interview). Stress biomarkers salivary cortisol, alpha-amylase, immunoglobulin A (IgA), heart rate, and blood pressure, and Immunoglobulin A were collected before and after the FI. Self-report data were also collected. Results supported a significant decrease in heart rate for those in the experimental condition (p = .0086) vs the control condition (p = .4986). Regression models revealed a significant decrease in systolic and diastolic blood pressure in the experimental condition (p = .03285) and (p = .04381), respectively. Statistically significant changes in alpha-amylase and IgA were also found in relation to disclosure and type of offense. The results of this study support the stress reducing effects of a service-trained facility dog for children undergoing FI for allegations of child sexual abuse.     

The Impact of a History of Child Sexual Abuse on Maternal Response to Allegations of Sexual Abuse Concerning Her Child

Mothers exhibit a wide range of emotional responses to the discovery that their children may have been sexually abused. The clinical lore suggests that a personal history of child sexual abuse (CSA) may influence maternal reactions to such a discovery. Interestingly, however, while the impact of a history of CSA has been examined in many different populations, the impact of such a history has rarely been studied with respect to nonoffending mothers of CSA victims. The current investigation, therefore, aimed to compare nonoffending mothers with and without a history of CSA with respect to demographic variables, psychosocial functioning, and personal responses to the CSA allegations concerning their children. Nonoffending mothers with a history of CSA exhibited more general symptom distress as measured by the SCL-90-R and reported greater feelings of aloneness in facing the crisis of the CSA allegations. However, maternal history of CSA did not differentiate the groups with respect to demographic variables or maternal responses to the CSA allegations concerning their children. Implications of these findings are discussed.     

Re-Collections of Childhood Sexual Abuse: A Biopsychosocial Perspective

A number of theories—biological, psychological, and sociological—inform clinical practice with adults who report memories of childhood sexual abuse. However, each of these theories is inadequate in and of itself. This has several, potentially damaging clinical implications. Therapists might doubt the validity of their clients' reports of traumatic incidents, they may place too heavy an emphasis on the recollection of traumatic events, or they may shy away from discussing these events. Any of these responses can jeopardize the helping relationship, leaving clients without professional assistance in managing a most difficult emotional situation. This paper provides a review of the biological, psychological, and sociological perspectives that lie at the foundation of current practice. These perspectives are then integrated via social work's biopsychosocial perspective. This holistic view provides an empirical base for effective, ethical social work. Specific practice implications are discussed.     

Childhood Sexual Abuse Severity Reconsidered: A Factor Structure of CSA Characteristics

To address the lack of empirically grounded measures of childhood sexual abuse severity, a survey of self-report items was developed following a thorough review of the childhood sexual abuse literature. An exploratory factor analysis was conducted using data collected from a convenience sample of college students that included 275 females and males with a history of childhood sexual abuse. The solution produced seven factors interpreted as the following: (a) less intrusive forms of childhood sexual abuse (e.g., sexual invitations, kissing), (b) more intrusive forms of childhood sexual abuse (e.g., oral sex, intercourse), (c) humiliation/fear, (d) childhood sexual abuse involving photography, (e) familiarity with the perpetrator, (f) physical force/rape, and (g) active digital penetration. Correlations among these factors further suggested the existence of two relatively independent second-order factors, one based on the levels of physical intrusiveness and the other composed of the psychological/emotional factors. While arguably the most common measurement of severity, physical intrusiveness had little association with critical factors such as humiliation, fear, and association with the perpetrator. Consequently, physical intrusiveness appears to be an inadequate stand-alone measure of childhood sexual abuse severity. These results are proposed to lay the groundwork for an improved, more comprehensive measure of childhood sexual abuse severity.     

The Professionalization of Police in Child Sexual Abuse Cases

No abstract available for this article.     

Obstacles to Help-Seeking for Sexual Offenders: Implications for Prevention of Sexual Abuse

ABSTRACT

Persons with potentially harmful sexual interests such as attraction to minors are unlikely to seek or receive treatment before a sexual offense has been committed. The current study explored barriers to help-seeking in a sample of 372 individuals in treatment for sexual offending. Results revealed that the shame and secrecy resulting from stigma associated with pedophilic interests often prevented our respondents from seeking professional counseling, and only about 20% tried to talk to anyone about their sexual interests prior to their arrest. Barriers to seeking and receiving psychological services included concerns about confidentiality, fears of social and legal consequences, personal shame or confusion about the problem, affordability, and challenges finding competent therapists who were adequately equipped to help them. Understanding and ultimately reducing obstacles to help-seeking can improve the quality of life for people with harmful sexual interests and potentially prevent sexual abuse of children or other vulnerable individuals.     

The Diagnostic Utility of the Child Sexual Behavior Inventory for Sexual Abuse: A Systematic Review

Children with alleged child sexual abuse (CSA) need to be assessed systematically. The use of validated instruments during the assessment, like the Child Sexual Behavior Inventory (CSBI), could add diagnostic value. We aim to assess the diagnostic utility of the CSBI to differentiate between sexually abused and non-abused children. We conducted a systematic review. We searched the electronic databases MEDLINE and PsychInfo for studies comparing CSBI scores in sexually abused children and non-abused children (2–12 years old). Two independent reviewers extracted data and assessed the methodological quality. We included 7 (out of 1048) articles. The CSBI total scores were significantly higher in CSA-victims compared with non-abused children (in case–control settings). However, in children with suspected CSA, the results were ambiguous. One study reported significant differences. Another study reported weak diagnostic ability for the CSBI-3 in children with suspected CSA (a sensitivity and specificity of 0.50, with a positive predictive value of 0.28, and a negative predictive value of 0.72). Research on the diagnostic utility of the CSBI for suspected CSA is limited and shows disappointing results. Until more research is done, the CSBI should not be used on its own to differentiate between sexually abused and non-abused children.     

A Child Sexual Abuse Research Project: A Brief Endnote

There is a dearth of research on sexual abuse perpetrated by educators. Although the problem is receiving increasing attention, little emphasis has been placed on abuse directed at younger schoolchildren and on offenders’ accounts of this form of abuse. Here, we attempt to address this gap in knowledge by exploring the narratives of five convicted, imprisoned male child sexual abusers, each of whom worked with children in educational settings in the United Kingdom. We draw on four themes that emerged from detailed interviews with offenders, namely: the power of reputation, authority and control, the “front of invulnerability,” and disclosure of abuse. We conclude by considering the implications of our work for policy and practice.     

Maternal Sexual Abuse of Males

This article presents one aspect of the findings of a qualitative research study which explored the impact of childhood sexual abuse on the lives of a non-clinical sample of 25 adult males who responded to advertisements for adult male survivors of childhood sexual abuse. The author conducted in-depth interviews with the men to discover how their experiences of childhood sexual abuse had influenced their psychosocial development. Thirteen of the 25 men were abused by females. This article focuses on seven men who were abused by their mothers and describes how definition, prevalence and outcomes of maternal sexual abuse are affected by male socialization, creating additional difficulties for these men. The author describes some of the psychological defence mechanisms used by this sample of men, explores some of the reasons for maternal abuse and issues to be considered by practitioners. © 1997 John Wiley & Sons, Ltd.     

Prosecution of Child Sexual Abuse Cases Involving Preschool-Aged Children: A Study of Swedish Cases from 2010 to 2014

Alleged child sexual abuse against preschool-aged children is often considered one of the most challenging cases for a prosecutor to handle. The aim of the current study was to examine differences between prosecuted and discontinued cases of alleged sexual abuse of preschool-aged children. Data from Swedish criminal cases of alleged sexual abuse of children ages 2–6 issued from 2010 to 2014 were analyzed (N = 130). Prosecuted cases were more likely to contain forensic evidence (documentation of abuse, corroborative DNA evidence, or a corroborative medical examination), or a confession from the suspect, while such evidence was not available in any discontinued case. Furthermore, cases where the child was older, where the prosecutor had decided to conduct an interview with the child, and where there was more than one alleged victim were more likely to be prosecuted. Factors that were associated with a decreased likelihood of prosecution were ongoing custody disputes between parents, foster care placements prior to the abuse, and if the report concerned a boy. Boys and younger children were also less likely to be interviewed. The results suggest that prosecution of sexual abuse cases involving preschool-aged children remains difficult and that there is room for improvements in these investigations.     

Domestic Violence and Intergenerational Rates of Child Sexual Abuse: A Case Record Analysis

Using case review at a shelter for battered women and their children, this exploratory study investigated the association between physical abuse, exposure to domestic violence and intergenerational occurrence of child sexual abuse. The charts of 570 children were reviewed in an attempt to explore the relationship between the children's experiences with sexual abuse and their nonoffending parent's own history of having been sexually abused. Results indicated that a significant percentage of nonoffending parents who reported a history of child sexual abuse also had children who were sexually abused. Additionally, we found that most (93%) of the children studied had been exposed to domestic violence, and while the base rate of sexual abuse was relatively low (11%), the rate of physical abuse of the children was substantial (41%). Logistic regression results indicated that children of sexually abused nonoffending parents may be at heightened risk for sexual abuse. Implications for treatment and intervention are discussed.