Irish child sexual abuse victims attending a specialist centre

We profiled a cohort of CSA cases referred for assessment to a specialist child sexual abuse (CSA) centre in a national paediatric hospital in Ireland. Historical and clinical data were drawn from records of 171 cases. The majority of cases were referred by social workers following purposeful disclosure of CSA. Three quarters of the cases were female with a mean age of 9 years. They were from a wide spectrum of socioeconomic groups and many had suffered a range of family adversities. In most cases, the abuse involved masturbation of the child by the abuser. Almost all of the perpetrators were male with a mean age of 28 years and in 60% of cases extrafamilial abuse had occurred. In 23% of cases, the perpetrator had a history of previous sexual offending. Anxiety was the most common emotional problem before disclosure and after disclosure the most common emotional problem was guilt. Before disclosure school refusal was the most common behavioural problem and after disclosure fighting was the most prevalent behavioural difficulty. The most common factors supporting the credibility of CSA allegations were labile mood, the child's ability to differentiate fact from fantasy and a detailed disclosure of contextual details. More adolescents showed deterioration in schoolwork after disclosure and for more pre school children clinginess following disclosure was a significant emotional problem. More primary school aged children were abused by perpetrators who had abused a number of children. For children abused by such perpetrators, vaginal intercourse was less common. Vaginal intercourse was more common in 6–11‐year‐old victims and those who were abused on a daily basis. The threat that disclosure posed to the integrity of the family structure was more often a factor hindering disclosure in victims abused by father figures and abused very frequently. Copyright © 2003 John Wiley & Sons, Ltd.     

Abuse of children in day care centres: Characteristics and consequences

While day care sexual abuse cases share features in common with sexual abuse in other settings, many characteristics of abuse in day care settings merit special attention. These factors include the young age of the child victims, the involvement of multiple victims and multiple perpetrators, females as perpetrators, use of extreme threats, severity of the abuse, and in some instances ritualistic activities. Research findings support clinical impressions that children are negatively impacted by sexual abuse in day care. Consequences of abuse in day care include anxiety, excessive fearfulness, behavioural disturbances, sexual acting out and sleep disorders. Parents whose children are abused in day care centres also experience psychological distress with symptom profiles consistent with post-traumatic stress disorder. Abuse of children in day care settings warrants a specialized treatment approach. A major goal of treatment is to decrease symptomatology among all family members.     

False allegations in child sexual abuse: the pattern of referral in an area where reporting is not mandatory

SUMMARY. This retrospective study considers all referrals received by child health, social services and police of suspected child sexual abuse between the years 1986–1989, within South Glamorgan, Some 410 children were referred and of these 197 were found to have been abused. Of those cases where abuse was not proven, only 63 were judged to be due to false allegations, some of which were considered |malicious. This pattern, of approximately half of referrals being unsubstantiated, is similar to that reported from the United States, where reporting is mandatory. The criteria for diagnosis, and the identifying and presenting features surrounding possible explanations of false allegations are discussed.     

Abusing victims: detention of child sexual abuse victims in secure accommodation

Sexually abused children and adolescents, in limbo between revelation of abuse and trial of an alleged offender, or in emotional turmoil after such abuse, need special care and support. Evidence indicates that a number of such children are held in local authority secure centres, on various grounds: to protect them from further sexual assaults by an adult offender; because of their persistent absconding from non-secure residential centres; and because of their disturbed behaviour (including suicidal behaviours), which may have been caused by the assault. Victims of sexual abuse are held with juveniles on remand for serious crimes (including rape and murder), or (because they are too young for youth detention centres) with young adolescents who are held in detention following conviction for such crimes. Evidence is produced from case histories, and from a survey of 15 of the 27 secure detention centres for children and young people in England, that the mix of abused, disturbed and very aggressive children is highly problematic. In worst case scenarios, victims of child sexual abuse are sexually assaulted by juvenile rapists with whom they are housed. © 1998 John Wiley & Sons, Ltd.     

Diagnosing physical abuse using Bayes' Theorem: a preliminary study

Objectives. To perform a preliminary study to compare the patterns of bruises in a physically abused group of children and a control group; to investigate whether these could be modelled statistically to enable probabilities of typical bruise patterns to be calculated; to apply Bayes' Theorem to find the probability that a child with a given bruise pattern has been the subject of physical abuse. Design. An observational study. Setting. Cardiff and Vale of Glamorgan. Subjects. Children who have suffered child physical abuse, 0–14 years. The diagnosis was confirmed at a case conference in all cases. A control group of 289 children who presented to the Accident and Emergency Department at the Cardiff Royal Infirmary after an accidental injury. Main outcome measures. The distribution bruise pattern in three regions of the body. The posterior probability of abuse for a given bruise pattern. Results. The bruise distribution in physically abused and control children was well described by a negative binomial distribution. There was a different distribution for the three different regions of the body in physically abused children. The bruising frequency and distribution for the physically abused group was very different from that of the controls. We were able to use parameters derived from these distributions to calculate posterior probabilities of physical abuse given a particular pattern of bruises using Bayes' Theorem. Conclusions. This preliminary study demonstrates that we can use Bayes' Theorem to combine prior probabilities of physical abuse with observed patterns of bruising in given children to obtain posterior probabilities of abuse. This principle has considerable potential for better diagnosis of the physically abused child. © 1998 John Wiley & Sons, Ltd.     

Organized abuse: NSPCC experience

A survey of a national child protection agency's experience of organized abuse in 1990–1991 found awareness of incidents among 41% of the participants and direct involvement with children in 20%. The 19 cases where there was direct involvement with 61 children from 43 families were categorized by the workers as network (N = 10), ritual (N = 6) and child pornography (N = 3) and came from England, Wales and Northern Ireland. The children in the three types presented different profiles from each other and from that of the sexually abused children placed on child protection registers. The children in the network cases were more likely to be boys and abused by non-relatives, the majority of whom were charged and convicted. The children in the ritual cases were the youngest, more likely to be abused by extended family members and most often the subjects of legal protection. The inherent difficulties in fully describing an organized abuse ‘case’ are outlined.     

Back to basics: child psychiatry after Cleveland

SUMMARY. In this personal view of recent developments, the author suggests that child psychiatrists were taken by surprise when they began receiving a rapid increase of referrals involving sexual abuse. Many saw their prime role as needing to adapt psychiatric techniques to determine whether abuse had occurred. Child sexual abuse was seen as being outside of normal psychiatric conditions. These responses led to major controversy within the profession. It is argued that the Cleveland Inquiry should now allow child psychiatrists to work with sexually abused children in a more traditional way, their main function being to assess and treat the whole child and its family and evaluate the significance of the abuse in a wider context     

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.     

Sexual abuse and juvenile delinquency

Case records were reviewed of 214 young women admitted to a Juvenile Classification Home in Japan for delinquent behaviour between 1983 and 1987. In 10 cases there were reports of a history of sexual abuse and these were 3 times more likely to be admitted to a Detention Home than other cases. All 10 women came from disrupted and economically disadvantaged family backgrounds. Most were depressed with low self-esteem. Five women were physically abused prior to sexual abuse, but behavioural problems were only concurrent and consequent to the sexual abuse. Most of the women were not believed by their mothers at the time of disclosure. Those women who were later believed by their mothers were more likely to return home (with the perpetrators no longer present) and less likely to continue to be victims of sexual abuse.     

Where do families stand after the Cleveland Inquiry?

SUMMARY. One of the most important contributions of the Butler-Sloss Inquiry into Child Abase in Cleveland is to acknowledge the existence and the seriousness of child sexual abuse. The Family Rights Group know from their advice work how difficult it is for families to believe that children have been sexually abused; how fearful mothers are of the implications of accepting the possibility of abuse by their partners; and that often people will not listen to children. In looking at the lessons of the Inquiry this paper seeks to focus on some aspects of law and practice and the way they impinge on family members     

Sexual abuse histories of youth in child welfare residential treatment centers: analysis of the Odyssey Project population

This multi-site examination of sexual abuse histories of youth in residential treatment centers asked, for the sample as a whole and by youth's gender: (a) How many perpetrators did each youth have? (b) What was the gender of the perpetrator? (c) What proportion of youth was abused by family members? (d) What proportion of youth was abused in a child welfare setting? And, (e) what proportion of sexually abused youth were also victims of physical abuse and/or neglect? Results revealed that males were more likely to have one perpetrator, a female perpetrator, and to have been abused in a child welfare setting and less likely be abused by a family member. Implications for refining programs and practices are discussed.     

Abusers gaining custody in family courts: A case series of over turned decisions

Abstract

This article presents findings and recommendations based on an in-depth examination of records from 27 custody cases from across the United States. The goal of this case series was to determine why family courts may place children with a parent that the child alleges abused them rather than with the nonoffending parent. We focused on “turned around cases” involving allegations of child abuse that were at first viewed as false and later judged to be valid. The average time a child spent in the court ordered custody of an abusive parent was 3.2?years. In all cases we uncovered the father was the abusive parent and the mother sought to protect their child. Results revealed that initially courts were highly suspicious of mothers' motives for being concerned with abuse. These mothers were often treated poorly and two-thirds of the mothers were pathologized by the court for advocating for the safety of their children. Judges who initially ordered children into custody or visitation with abusive parents relied mainly on reports by custody evaluators and guardians ad litem who mistakenly accused mothers of attempting to alienate their children from the father or having coached the child to falsely report abuse. As a result, 59% of perpetrators were given sole custody and the rest were given joint custody or unsupervised visitation. After failing to be protected in the first custody determination, 88% of children reported new incidents of abuse. The abuse often became increasingly severe and the children's mental and physical health frequently deteriorated. The main reason that cases turned around was because protective parents were able to present compelling evidence of the abuse and back the evidence up with reports by mental health professionals who had specific expertise in child abuse rather than merely custody assessment.     

Characteristics of Sexually Abused Children and Their Nonoffending Mothers Followed by Child Welfare Services: The Role of a Maternal History of Child Sexual Abuse

Considering the importance of mother’s support in the adaptation of a sexually abused child, it is relevant to determine if the mothers and children involved in an intergenerational cycle of child sexual victimization differ from dyads in which only the child has been abused. The purpose of this study was to compare mother–child dyads with sexually abused children according to whether the mother had herself been victim of child sexual abuse. The sample included 87 dyads with sexually abused children aged 3–18 years old and their mothers (44 reporting maternal and child abuse), followed by social welfare services of the province of Quebec (Canada). The two groups of mothers were compared on their past family abuse experiences and past family relations, their mental health history, their current psychological distress, their parenting behaviors, and their current levels of family functioning. Children were compared on their adaptation. Multivariate analyses indicated that mothers reporting child sexual abuse were more likely to report more other maltreatments in their childhood and greater prevalence of lifetime history of alcohol abuse disorders, dysthymia, and panic disorder compared with mothers who had not experienced CSA. Compared to children whose mothers had not experienced CSA, those whose mothers had experienced CSA showed higher rates of problems behaviors and were more likely to report having been sexually abused by a trusted person. These results highlight the specific clinical needs for the assessment and treatment for sexually abused children whose mothers experienced child sexual abuse.     

Racial Differences in Abused Older African American Males, Caucasian Males, and their Abusers

This study examined racial differences between mistreated and abused older African American and Caucasian men. The racial and gender differences of their perpetrators were also examined. Data from a single elder abuse provider agency in the State of Illinois were analyzed. Differences with respect to physical abuse, emotional abuse, physical neglect, deprivation, confinement, and financial exploitation were examined, as were demographic characteristics and limitations of victims and abusers.     

No Place is Safe: Sexual Abuse of Children in Rural Bangladesh

During July 2007 to June 2010, BRAC, a nongovernment organization in Bangladesh, reported 713 incidents of rape and attempted rape of children (< 18 years) in rural Bangladesh. This study explores these 713 incidents to identify possible patterns related to the victims, perpetrators, and different dynamics of the incidents. Rape and attempted rape, particularly of young girls, constituted 64% of all reported incidents of violence against children. Children were found to be abused by men from all walks of life, mainly by non-family-members (83%). Similar diversity was seen in the location, time, and context of the incidents. The present study attempts to put forward an overall picture of the depth of the problem of child sexual abuse in rural Bangladesh, linking the incidents with the socially constructed gender relations of power and how it perpetuates sexual abuse of children, especially girls.     

Factors influencing the development of psychiatric disorders in the victims of sexual abuse: A study on Turkish children

The purpose of this study is to test empirically whether there are sex differences in childhood sexual abuse characteristics and psychiatric disorders, and there is an association with sexual abuse characteristics and psychiatric disorders caused by abuse. Files of 482 cases referred to the Child Surveillance Center due to sexual abuse between September 2012 and September 2014, for whom legal reports were prepared, were investigated retrospectively. Of the abused children, 82.2% (n = 396) were girls and 17.8% (n = 86) were boys. The mean age of girls was 14.1 ± 2.9 years, while that of boys was 11.6 ± 3.8 years. The most common type of abuse was sexual touching in girls, while it was anal penetration in boys. The rate of being diagnosed with at least one psychiatric disorder was found to be 68.9% (n = 273) in girls, while it was 38.4% (n = 33) in boys. When the abuser was from the family or someone close to the victim, when the numbers of abuse incidents and abusers were greater than one, and in cases of force and violence, the rate of being diagnosed with a psychiatric disorder was found to be higher. With greater duration of time passing after the abuse, in those who became pregnant due to abuse, and in those who did not tell their parents about the incident, the rate of psychiatric diagnosis was significantly higher. In addition, it was found that when there were more than one abused people in the same event, the rate of psychiatric diagnosis was lower. Among all these variables, independent variables affecting the development of psychiatric disorders in victims were gender, number of abuse, presence of force and physical violence, and presence of more than one abuse victim in the same event. Because of high rates of psychiatric disorders in children exposed to sexual abuse, it is crucial to evaluate these children in a careful and closely manner by clinicians.     

Beyond the Call: Mothers of Children with Developmental Disabilities Responding to Sexual Abuse

A qualitative, interdisciplinary study was undertaken to examine the experiences of mothers of children with developmental disabilities who were sexually abused. In-depth interviews were conducted with four mothers, their children, and the professionals involved with each case. The dual impact of caring for a child with a disability together with dealing with the aftermath of child sexual abuse, both personally and systemically, was considered. Individual professionals went out of their way to try to help, but, nonetheless, the abuse increased what was already a significant burden of care and further reinforced stigmatization, marginalization, and powerlessness. At the same time, the study painted a picture of committed and determined mothers who were devoted to their children.     

Identifying abused children using assessments and observations in the classroom: a preliminary study

The paper presents two pilot studies that attempt to identify maltreated children in the classroom. The aim of pilot study 1 was to determine whether six British physically abused children performed signi?cantly worse than matched non‐abused children on a battery of tests and rating scales over an 18‐month period. The aim of pilot study 2 was to concurrently identify maltreated children from a classroom of children using standardized tests and observed negative behaviours. The method used in study 1 was a cross‐comparison design with six physically abused and 12 comparison children, all between 4 and 8 years old. They were assessed over 18 months at four time‐points on a battery of standardized tests and rating scales. Study 2 was based on a concurrent prediction of child abuse in a class of 30 children (18 male and 12 female) 10 years old. They were assessed on a battery of standardized assessments and by the direct observation of negative behaviour in order to predict those who were on the child protection register (CPR) for actual or suspected abuse and those who were not. The results of study 1 showed signi?cant differences on the teacher rating scales and on a measure of sibling dependency. Study 2 used standardized assessments and identi?ed three of ?ve abused children. Direct observations identi?ed one of ?ve abused children. These two preliminary studies suggest standardized assessments are more useful than behavioural observations in identifying abused children in the classroom setting. Further con?rmation is required using larger‐scale investigations. Copyright © 2003 John Wiley & Sons, Ltd.     

Facilitating interviews with children who may have been sexually abused

The introduction of the Memorandum of Good Practice on interviewing children who have been sexually abused has had an important unifying effect on professional practice. However, because of the traumatic nature of sexual abuse there will be a group of children about whom there are high levels of suspicion and where arrangements need to be made for their future care, protection and treatment. These include children who have learning disabilities or communication problems, have psychiatric disorders associated with abuse, or where there have been considerable delays since allegations were first made. Such children require a second-stage facilitative assessment interview. These include different forms of questioning, and the use of a wide range of prompting materials including art work, free and structured play context and the use of anatomically correct dolls. These approaches are reviewed and illustrated through case studies.     

Relationships between maternal adult attachment security, child perceptions of maternal support, and maternal perceptions of child responses to sexual abuse

This study assessed the relationships between maternal adult attachment style, children's perceptions of maternal support following disclosure of sexual abuse, and maternal perceptions of children's behavioral and emotional responses to sexual abuse among African-American child sexual abuse victims aged 4 to 12 (n=96) and a comparison group of non-abused subjects (n=100). Mothers with insecure attachment styles reported significantly higher rates of internalizing behaviors in their sexually abused children than did securely attached mothers. Among mothers of non-abused children, those with insecure adult attachment styles reported significantly higher rates of externalizing behaviors shown by their children in comparison with mothers with a secure adult attachment style. Mothers with insecure adult attachment styles also reported higher rates of overall behavior problems in their non-abused children that approached statistical significance. Sexually abused children's perceptions of maternal support were not related to maternal attachment style nor to child functioning. Contrary to our prediction, mothers of sexually abused children did not show lower rates of secure attachments when compared to mothers of non-sexually abused children. Our findings indicate that fostering parent- child attachment is important in order to decrease the risk for behavior problems and symptomatology in sexually abused children.