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.     

The Relationship Between Child Sexual Abuse and Alexithymic Symptoms in a Population of Recovering Adult Substance Abusers

ABSTRACT

Recovering substance abusers with a history of childhood sexual abuse (n = 69) or no history of childhood sexual abuse (n = 68) completed the Toronto Alexithymia Scale (TAS) and a background survey assessing demographic data and (In the case of sexually abused respondents) parameters of the childhood abuse experienced. The sexually abused group scored significantly higher than the non-abused group on the TAS. Within the abused group, measured alexithymic symptomatology was found to be related positively to the duration of the abuse. Alexithymia was significantly higher when the sexual abuse first occurred after the victim had reached the age of 12, when a perpetrator of the sexual abuse was a father or stepfather, and when the abuse involved oral, vaginal, and/or anal penetration. Results were interpreted as indicating that the development of alexithymic symptoms may represent another defense victims may employ to insulate themselves from painful affect, along with dissociative symptoms and substance abuse, which have been shown previously to characterize adult survivors of child sexual abuse.     

Medical advances in child sexual abuse

This volume is the first of a two-part special issue detailing state of the art practice in medical issues around child sexual abuse. The six articles in this issue explore methods for medical history evaluation, the rationale for when sexual examinations should take place, specific hymenal findings that suggest a child has been sexually abused, the healing of genital injuries, approaches to interpretation of medical findings, and the neurological harm of sexual abuse. From the initial history to the process of the medical examination, the mechanics of what a genital examination might show, and the neurobiological consequences, it is demonstrated that the harm of sexual abuse is has more effect on the brain than the genital area.     

Sexual at-risk behaviors of sexually abused adolescent girls

The present study investigated sexual at-risk behaviors of sexually abused adolescent girls. Variables of interest were presence of consensual sexual activity, age at first consensual intercourse, number of sexual partners, condom use, and pregnancies. Participants were 125 sexually abused adolescent girls aged 12 to 17 years. Results showed that severity of sexual abuse (e.g., penetration, multiple perpetrators, physical coercion, multiple incidents of abuse) was related to a greater number of sexual at-risk behaviors. For instance, adolescents with a history of sexual abuse involving penetration were 13 times as likely to have been pregnant. Although family characteristics were significantly associated with being sexually active, their effect proved non-significant in the final hierarchical regression. Regression analyses clearly showed that the likelihood of engaging in sexual at-risk behaviors increased as a function of the number of severity factors.     

Parental functioning and child sexual abuse

Eighty-two mothers and 46 fathers of emotionally disturbed youth in a day treatment program completed the Family Assessment Device (FAD) at time of intake. Interviews with therapists enabled classification of families into three groups: those whose client (the youth) had been sexually abused, those where sexual abuse was suspected but not confirmed, and those without a sexual abuse history. All cases of abuse were non-incestuous. Comparisons of the confirmed abuse and non-abuse groups were made, using three types of analyses. ANOVA of parental responses to the FAD by group yielded significance for mothers but not for fathers, with mothers of abused children reporting more family dysfunction in problem-solving and roles than mothers of non-abused children. Second, significant differences between parents according to group were found in the abused sample in problem-solving, communication, and general functioning, but not in the non-abused sample; mothers reported significantly greater pathology in their families than did fathers. Third, comparison of differences between mothers and their children within families yielded a greater number of differences in the non-abused group. Significance was obtained in affective responsivity and behavior control in both samples. Additionally, however, significant differences in communication and roles were obtained in the non-abused group. Caution in differentiating between incestuous and non-incestuous families is suggested. Implications of this research for family interventions, especially with regard to mother/child perceptual congruence, are discussed.     

Media Impact on Biased Perceptual Processing of Threat-Relevant Imagery Among Patients Who Recovered Memory of Childhood Sexual Abuse Prior to the Onset of Treatment

ABSTRACT

Several recent studies have indicated that patients who report a history of sexual abuse, on the basis of recovered or delayed recall of memory, process Rorschach stimuli in ways that substantially deviate from non-abused patients. They exhibited sensitivity to threat-relevant imagery that was highly similar to the biased perceptual processing found among patients with continuously held memories of sexual abuse. In the present study, perceptual processing of threat-relevant imagery was examined as an artifact of media exposure in 40 patients who recovered memories of childhood sexual abuse as adults and in 40 patients who were not sexually abused. The two patient samples were divided into high and low media groups on the basis of a composite measure of media exposure. The results indicated that information gained from media exposure was unrelated to patients' responses to Rorschach stimuli. Recovered memory patients produced threat-relevant imagery that is reminiscent of trauma irrespective of the level of media exposure; non-abused patients did not. That this imagery remained essentially unnoticed by even the most active consumers of the sexual abuse media among non-abused patients suggests that the popular media does not play a contagious role in the perceptual processing of threat-relevant imagery.     

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.     

The sexual abuse questionnaire: a preliminary examination of a time and cost efficient method in evaluating the presence of childhood sexual abuse in adult patients

This paper provides the results of two studies designed to evaluate a newly constructed self-report instrument, the Sexual Abuse Questionnaire (SAQ). The SAQ was designed as a brief screening device to aid in the identification of a childhood sexual abuse history. A "unique" feature of the SAQ is the inclusion of a number of non-face valid questions derived from clinical experience. Both studies used an undergraduate population of self-reported abused and non-abused participants. Based upon the combined results of the two studies, the final version of the SAQ was developed, which is comprised of 45 items that manifest good test-retest reliability, internal consistency, and convergent and discriminative validity. The SAQ can discriminate between abused and non-abused male and female participants.     

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.     

The frequency of sexual abuse and depression in a sample of street children of one of deprived districts of Tehran

The purpose of this study was to determine the frequency of sexual abuse and depression among street children who live in a deprived district of Tehran. The researchers used the K-SADS questionnaire and a clinical interview were used to evaluate depression and sexual abuse in 87 street children in Tehran. Eighteen (20.9%) of the children had been sexually abused. Depressed children were 3.2 times more likely to be sexually abused than non-depressed children. Furthermore, 26 girls (86.7%) and 27 boys (48.2%) suffered from depression. The frequency of depression demonstrated a significant association with the father's or breadwinner's history of imprisonment or unemployment. Interventional programs providing education and support should be implemented for street children.     

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: Effects of group therapy on pre-adolescent girls

This article describes the effectiveness of a group therapy program used at the University of Manitoba with pre-adolescent girls who have experienced sexual abuse. Thirty-five girls, ranging in age from 7 to 12, were referred to structured therapy groups of 9 to 12 weeks' duration. Issues addressed in weekly sessions included feelings about the offender, problem-solving, sex education, and prevention of further abuse. Measurements of self-esteem, anxiety, and internalizing and externalizing behaviour problems were taken for participating children prior to and following treatment at 1 and 9 to 12 month intervals. Parent- and child-reported social validity data were also collected following treatment. Comparison group data for self-esteem and anxiety were provided by a non-random sample of 35 girls with no known history of sexual abuse. Results indicated that following group therapy, self-esteem increased and anxiety and behaviour problems decreased. Comparison group data further supported the effectiveness of group treatment in improving the self-esteem of sexually abused girls. Social validity reports of children and parents also suggested that treatment was helpful and worthwhile. Implications of the findings are discussed as are difficulties encountered in conducting treatment outcome research with children who have been sexually abused.     

Factors Influencing Believing and Blaming in Reports of Child Sexual Abuse: Survey of a Community Sample

ABSTRACT

Believing and blaming of alleged victims of child sexual abuse (CSA) was measured in a community sample of 202 adults. Subjects completed a questionnaire consisting of vignettes in which 11-year-old girls reported being sexually abused. A majority of respondents viewed the girl's report of sexual abuse as truthful; however, alleged victim retractions significantly reduced the credibility ratings for those reports. The effect of perpetrator socioeconomic status (SES) did not reach significance on either alleged victim believing or blaming. Females were significantly more likely than males to believe the girl's report of abuse, and more likely to believe children's reports in general. Females were significantly less likely than males to blame the girl for the occurrence of the abuse. Gender differences on believing and blaming remained significant when effects of respondent age and education were removed as covariates. Estimates of the prevalence of CSA varied widely, with no significant gender difference. Over half of the respondents believed that alleged victims aged five years or younger should be allowed to testify in court in CSA cases.     

Longitudinal Study of the Psychological Effects of Sexual Abuse in African American Girls in Foster Care and Those Who Remain Home

This study longitudinally examined the effects of foster care placement versus remaining at home upon the psychological functioning of 64 African-American, sexually abused girls aged 5-16 years. The children were intitially evlauted with a multi-method assessment protocal within six months following report of the abuse and then reevaluated approximately one year later. The findings indicate that the group as a whole showed a decline in affective distress and depression. However, the children continued to show disturbed perceptions of relationships and high levels of stress relative to their adaptive coping skills. The caregivers continued to rate the children as showing many behavioral problems, low social competence, considerable sexual abuse-related anxiety and sexual acting-out behavior. Overall, there were no significant differences in the psychological functioning of the girls who remained at home and those who were placed in foster care. In supplementary, cross-sectional analyses involving 24 additional subjects, several maternal variables were found to be related to the child's adaptation.     

Gender Differences in Sexually Abused Children and Adolescents: A Multicenter Study in Turkey

The purpose of this study was to examine gender-based differences in abuse-related characteristics and post-abuse psychiatric disorders among sexually abused children and adolescents. The researchers retrospectively examined files, judicial reports, and social examination reports of 1,250 sexually abused youth cases. Results showed that boys were more often victimized by penetration, force, and physical violence. Incidence of sexual abuse by family members, familiar persons, and multiple persons was higher among girls. In addition, a higher rate of major depressive disorder as well as alcohol consumption and cigarette smoking were found in sexually abused girls. No difference was observed between boys and girls in terms of post-traumatic stress disorder, conduct disorder, and other mental disorders. Intellectual disability was more frequent in boys.     

Self-destructive and delinquent behaviors of adolescent female victims of child sexual abuse: rates and covariates in clinical and nonclinical samples

Self-destructive and delinquent behaviors were assessed in three samples of adolescent females. The first sample (N=140) were substantiated victims of sexual abuse recruited from clinical settings. They were contrasted to a second sample (N=430) of secondary school students, and a third sample from the same school setting (N=94), that reported that they had been sexually abused. Few differences were found between the two groups of sexually abused girls, and both groups reported significantly more at-risk behaviors than nonabused girls. Family adversity was a consistent predictor of both self-destructive and delinquent behaviors. However, violence during the abuse, lower quality mother-daughter relationships, and depression were also related to self-destructive behaviors, while family economic problems and self-blame for the abuse were the only correlates of delinquent behavior.     

Multiple sexual victimizations among adolescent boys and girls: prevalence and associations with eating behaviors and psychological health

The purpose of this study was to assess the prevalence of sexual abuse, including multiple victimizations, among adolescents and to examine associations among history of sexual abuse, disordered eating behaviors and psychological health. The sample included 81,247 students (40,946 girls and 40,301 boys) in 9th and 12th grade in Minnesota public schools. Sexual abuse was reported by 14.7% of girls and 6.2% of boys. Sexual abuse was associated with unhealthy eating behaviors, suicidal thoughts and attempts, and lower emotional well-being and self-esteem. Students who reported a single or multiple forms of sexual abuse were more likely than their non-abused peers to binge-eat (Odds Ratio: girls = 1.93-2.32; boys = 2.26-5.61), fast (OR: girls = 1.68-2.34; boys = 1.33-2.32), use diet pills (OR: girls = 1.50-4.30; boys = 2.99-17.29) or laxatives (OR: girls = 1.87-5.11; boys = 3.89-29.22), vomit (OR: girls = 1.75-4.06; boys = 2.82-24.16), and have suicidal thoughts/attempts (OR: girls = 3.01-6.12; boys = 3.35-9.46). Boys and girls reporting multiple sexual victimizations and had the highest odds ratios for disordered eating behaviors. Future research should explore strategies for primary prevention of revictimization and secondary prevention of detrimental effects of abuse.     

The relationship of sexual abuse to symptom levels in emotionally disturbed girls

This research study examined symptom levels and sexual abuse status of emotionally disturbed girls in residential treatment. Sexually abused girls had poorer self esteem, higher levels of anxiety, and a trend toward more depression than the nonabused girls on self-report measures. Measures completed by the residents' therapists also found sexually abused girls as being more symptomatic in a number of areas.This research was made possible by a grant awarded to both authors from the Faculty Research and Innovation Fund of the University of Southern California and a Rhoda G. Sarnat Junior Faculty Endowment to Dr. Mennen.