Parents' knowledge,attitudes and practices about preventing child sexual abuse: a literature review

Increased concern about high rates of child sexual abuse has led to the demand for more prevention programmes, particularly those aimed at parents. Research on how parents manage and reduce the risk of child sexual abuse can help plan programmes. This literature review explores published research on the knowledge, attitudes and practices of parents on the risk and prevention of child sexual abuse and identifies gaps and needs for further research. The majority of studies reviewed originated in North America and Asia, were quantitative, surveyed mainly mothers and were more than ten years old. Recommendations are made for more current and country specific research, further research to gain a deeper understanding of how parents manage the risk of child sexual abuse, more comprehensive research covering a range of knowledge, attitude and practice variables, and greater inclusion of fathers in research. Copyright © 2009 John Wiley & Sons, Ltd.     

Resilience and risk factors associated with experiencing childhood sexual abuse

The effects of child sexual abuse are wide‐ranging and impact on children, families and health/social care systems. The authors review this literature, examining the shortcomings of the ‘victim–offender’ model, and consider the complex, multifactorial nature of this question. Factors associated with a progression from victim to perpetrator are explored and the prevalence of abuse in the general population is also discussed. Protective as well as risk factors are considered and the pivotal role of ‘personal reliance’ is considered as it relates to empowering damaged young people to become healthy adults. The authors also discuss implications for the treatment of young people who become abusers. Two case examples are brie?y reported upon and the article concludes with a consideration of ways to helpfully address the needs of children who become sexual perpetrators. Copyright © 2004 John Wiley & Sons, Ltd.     

Playing safe: Media coverage of child sexual abuse prevention strategies

This paper examines the media coverage of preventing child sexual abuse. It draws on a content analysis of all press and TV news coverage about child sexual abuse that appeared in the UK during a complete 12-month period. The findings demonstrate that the bulk of the coverage was case-based, for example focusing on the Orkney case. There was very little opportunity for broader discussion of general issues of concern, including how sexual assaults against children might be prevented. The coverage of ‘prevention’ which did exist drew on a very narrow range of debates and was disproportionately concerned with abuse outside the home (abductions by strangers, or abuse within institutions such as schools or children's homes). Discussions about prevention were dominated by reactive news stories generated by particular ‘scandals’. The coverage was also largely drawn from a small constituency of official source agencies (such as government officials, court proceedings and police statements). There were few attempts to address the broader social conditions which might facilitate or inhibit sexual violence or to examine explicitly political analyses of the problem. The paper argues for a more diverse discussion about ways of preventing sexual violence against children, especially assaults by fathers, uncles, brothers and friends of the family. This demands close attention to the ways in which the mass media operate, as well as the priorities of source agencies. The paper points to factors within news production practices which both obstruct and facilitate debate about prevention and concludes by suggesting strategies to promote this issue as a vital part of the public agenda.     

Ritual,and child sexual abuse,but not ritual child sexual abuse

Central to the controversy over ritual (satanic) child sexual abuse have been claims concerning agency ‘diagnoses’ of cases. Specifically, it has been alleged that agency findings of ritual abuse have been erroneous and are the product of poor practice. There is, though, little systematic information regarding agency assessment of suspected ritual abuse cases. This paper presents two cases where there was evidence both of child sexual abuse and ‘ritual’ but where agencies adjudged that these aspects occurred independently of one another and were not indicative of ritual child sexual abuse. The existence of these cases underlines the need for a broader and more balanced debate in respect of ritual abuse in general and the agency handling of these cases in particular. Copyright © 2000 John Wiley & Sons, Ltd.     

Toward a culturally sensitive child sexual abuse prevention program for latinos

A culturally sensitive sexual abuse prevention program for Latinos is proposed which makes recommendations regarding style of interaction, discussion topics of importance, and other areas which need he considered in the design and implementation of such a program. The role of the child, parents, professionals, and others involved is discussed.     

Sexual abuse in sport: a model to prevent and protect athletes

Several studies clearly show that sexual abuse exists in sport. Currently, very few studies have examined the prevention and management of this problem in sports organisations. This article explores the measures used to prevent sexual abuse in sports organisations as well as the perceptions of the sports actors affected by these measures (parents, athletes, administrators and coaches). The results demonstrate that several factors affect the implementation of measures and the management of this problem in sports organisations. Moreover, few measures exist to prevent and manage cases of sexual abuse in these organisations, thus jeopardising the protection of athletes. Copyright © 2010 John Wiley & Sons, Ltd.     

Cognitive behavioural psychotherapy intervention in childhood sexual abuse: identifying new directions from the literature

The short‐ and long‐term consequences of childhood sexual abuse have been extensively reported. However, for many years there has been an absence of psychological conceptual frameworks for understanding and treating abuse trauma symptoms. This paper reviews a number of outcome studies for the treatment of child sexual abuse where a post‐traumatic stress disorder (PTSD) conceptualization was used to plan treatment interventions. The paper concludes that, contrary to some concerns expressed by clinicians, sexually abused children and their non‐abusing carers can signi?cantly bene?t from cognitive behavioural interventions which use reliving and confrontation of the abusive experience. Notwithstanding this, there is a need for further controlled outcome research of cognitive behavioural interventions using reliving techniques to explore how and why these interventions help in reducing abuse‐related PTSD symptoms. Copyright © 2004 John Wiley & Sons, Ltd.     

Childhood and adult sexual abuse: relationships with alcohol and other psychoactive drug use

Questions concerning sexual abuse before and after the age of 16 years were included in a general population survey of a representative sample of 1052 UK women and 975 UK men. A total of 12.5% of women reported experiencing some form of sexual abuse before the age of 16 years. The corresponding ?gures for men in this category were 11.7%. After the age of 16, the ?gure for women remained at this level. However, the proportion of men reporting these traumatic experiences dropped to 3.2%. Sexual abuse both pre and post age 16 was associated with being single or cohabiting, with higher levels of cigarette‐smoking, alcohol consumption, experience of alcohol‐related problems and use of illicit drugs. The relationship between drinking and other forms of psychoactive drug use and sexual abuse is complex. Some possible explanations for this connection and its therapeutic and practical implications are discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

A comparison of two programmes for victims of child sexual abuse: a treatment outcome study

This study aimed to evaluate the comparative effectiveness of individual therapy and combined individual and group therapy in the treatment of the psychological sequelae of child sexual abuse. The Child Behaviour Checklist (CBCL), the Youth Self Report form (YSR), the Children's Depression Inventory (CDI) and the Trauma Symptom Checklist for Children (TSCC) were administered before treatment and 6 months later to a group of 20 young people who participated in individual therapy (IT) programmes and to a group of 18 young people who participated in programmes that involved combined individual and group therapy (IGT). For both types of programmes, statistically significant improvement occurred on the following scales: the total problems, internalizing problems, externalizing problems, withdrawn, somatic complaints, anxious/depressed, social problems, attention problems and aggressive behaviour problems CBCL scales; the total depression, interpersonal problems and anhedonia CDI scales; and the depression and anger TSCC scales. The only scale for which one therapy programme led to greater improvement than another was the CDI ineffectiveness scale. The IGT programme led to a reduction in the mean CDI ineffectiveness score, whereas a slight increase in the mean ineffectiveness score occurred in the IT group. There were no significant differences in the rates of clinically significant improvement associated with the two treatments and no major differences between cases who improved and those that did not improve over the course of therapy. From this study, it may be concluded that after 6 months, individual therapy and combined individual and group therapy were equally effective in the treatment of the psychological sequelae of child sexual abuse. Copyright © 2002 John Wiley & Sons, Ltd.     

Impact of child sexual abuse disclosure on the health of nonoffending parents: A longitudinal perspective

The impact of child sexual abuse (CSA) disclosure on parents’ psychological health has been documented among samples of nonoffending parents. Much less is known about the parents’ physical health. This study assesses the longitudinal impact of CSA disclosure on both the mental and physical health of parents and explores potential gender differences. Interviews with 92 mothers and 32 fathers were completed approximately 12 months and 18 months following disclosure. Generalized as well as mixed model analyses revealed that mothers reported more psychological distress, Posttraumatic Stress Disorder (PTSD) symptoms and activity limitation than fathers. With the exception of PTSD symptoms which showed a significant reduction over time, all other psychological and physical symptoms persisted. The findings highlight the importance of ensuring services for an extended period for the small proportion of parents who display especially high vulnerability.     

Exploring the link between sexualized behaviour and sexual abuse in a clinical setting

This study examined the issue of sexualized behaviour in children as an indicator of sexual abuse. The purpose was to develop alternative explanations for sexualized behaviour if sexual abuse was not confirmed or suspected. Other possible explanations explored were the presence of frequent disruptions to family life, previous unresolved exposure to sexual abuse or contact with a sexualized child. Data were collected on 81 cases of sexualized behaviour referred to a specialist child protection assessment unit over a 7‐year period. It was found that in very few cases was sexual abuse considered an explanation for the sexualized behaviour. Of the remaining cases, a substantial number showed evidence of family disruption, which could lead to sexualized behaviour developing as a comforting response for the child. Furthermore, a number of children also had experienced sexual abuse in the past, which might have been unresolved for the child, or had contact with another sexualized child, and this might have accounted for their behaviour. It would appear that many of the children were facing difficulties in their lives and might require therapeutic intervention, even if concerns about recent sexual abuse had been allayed. Copyright © 1999 John Wiley & Sons, Ltd.     

The prevalence and nature of child sexual abuse: evidence from a female university sample in the UK

It is well established that child sexual abuse is a considerable international problem, yet evidence regarding its prevalence in the United Kingdom is extremely sparse, with the most comprehensive study conducted over a decade ago. The aim of this study is to establish a current estimate of the prevalence and nature of child sexual abuse in the United Kingdom, using a sample of female university students. Of the 213 female undergraduate students who completed questionnaires, 28 were sexually abused, giving a prevalence rate of 13.14%. Information was also obtained regarding the nature of the abuse. These results show that a substantial proportion of female students in the United Kingdom, who appear to be coping with tertiary education, have been sexually abused in childhood. The implications regarding the benefits of prevalence rates to health practitioners are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

A review of the epidemiological research on child sexual abuse. Clinical samples

This article reviews the major empirical studies which have been carried out in an attempt to estimate the prevalence of child sexual abuse among females in clinical inpatient and outpatient samples. Along with the earlier review (Pilkington and Kremer, 1995) dealing with community and student samples, this paper likewise highlights a number of unresolved methodological issues which may contribute to the variance in reported prevalence rates. These include a myriad of definitions of child sexual abuse and different methods of eliciting information on possible histories of abuse. These issues are here discussed in the context of the findings of both review articles.     

Prevention of child sexual abuse: implications of programme evaluation research

Thirty child abuse prevention programme evaluation studies were selected according to a set of methodological criteria following an extensive manual and computer literature search. Targets for intervention in 17 studies were children; in three parents; in four teachers; and in six studies multisystemic programmes were evaluated where some combination of children, parents and teachers was targeted for intervention. From a review of the 30 studies, it was concluded that child abuse prevention programmes can lead to significant gains in children's, parents' and teachers' safety knowledge and skills. Best practice guidelines arising from the review include the use of multisystemic programmes; child‐focused curricula which cover a wide range of safety skills and concepts; and the use of didactic instruction and discussion, video modelling and active behavioural skills training techniques in programme delivery. The curricula for parents' and teachers' programmes should cover child protection issues and local child protection procedures along with an overview of the children's programme lesson plans. Longer programmes conducted by trained staff are preferable and such staff may include teachers, parents, mental health professionals and law enforcement officers. Copyright © 2000 John Wiley & Sons, Ltd.     

Mothers' abusive childhood predicts child abuse

To examine the intergenerational transmission of abuse, the study compared 25 mothers whose child had been under the supervision of the child protection services (CPS) with 25 mothers who had had no contact with the CPS. The groups were compared with respect to their own self‐reported childhood abuse, their abuse of their own child and punitiveness. The data were gathered using interviews and files. There were no significant differences between the groups in self‐reported childhood physical abuse, but the CPS mothers had experienced more childhood psychological abuse, especially rejection, accusations, terrorizing and corrupting. The groups did not differ in the self‐reported physical or psychological abuse inflicted upon one's own child. In the total sample of 50 mothers, hierarchical regression analyses showed, however, that the mothers' childhood abuse experiences predicted their abuse of their own child. Punitiveness was best predicted by maternal childhood psychological abuse. The results thus provide evidence for the cycle of abuse model. Copyright © 1999 John Wiley & Sons, Ltd.     

Child sexual abuse and HIV transmission in sub‐Saharan Africa

The purpose of this paper is to examine the risks of HIV transmission to children through sexual abuse and exploitation in sub‐Saharan Africa. The paper is based on a review of pertinent literature. Child sexual abuse in this region must be defined broadly enough to encompass widespread coercion or violence in early sexual relations in some regions, the practice of ‘transactional sex’ and constructions of masculinity, emphasising multiple sexual partners and power over women and girls. The high HIV prevalence in sub‐Saharan Africa is briefly described. Research evidence showing the link between child sexual abuse and HIV transmission is reviewed, although this is a topic where very little direct empirical work has been conducted. Particular methodological and ethical difficulties have been encountered by researchers. Future research directions are indicated. Copyright © 2008 John Wiley & Sons, Ltd.     

Cleveland 20 years on: what have we learned about intervening in child sexual abuse?

This is the first of two linked papers. It examines the main changes in approach to child sexual abuse that have occurred since the events in Cleveland 20 years ago. Comparison between estimated prevalence rates and registrations for sexual abuse suggests that we are aware of only the tip of the iceberg. It is argued that in many cases uncertainty may have to be accepted, and that protection may be better achieved through a protective parent than through the child protection system. Clinical examples of cases presenting to a specialist child and adolescent mental health service are given. It is argued that, although society is now more willing to recognise the existence of child sexual abuse and professionals are better at dealing with families, outcomes for this group of children are not much improved. Copyright © 2008 John Wiley & Sons, Ltd.     

Cross‐examination,sexual abuse and child witness identity

This paper presents extracts from cross‐examinations with child witnesses who are alleged victims of child sexual abuse. The manner in which cross‐examination may present a challenge to the child's identity as child, victim and witness is discussed. Specifically, the child may be portrayed as ‘unchildlike’, for example in their experience of sexual relationships or in their sexual knowledge. They may be portrayed as less than innocent, through references to previous contacts with social services or to other behaviours such as delinquency. Child witnesses may be depicted as instigators rather than victims, seducing the adult or seeking revenge through sexual allegations. Finally, children are easily accused of being poor witnesses, as being confused, untruthful and having fallible memories. The paper considers the dynamics and potential impact of such cross‐examination practice within Finkelhor's framework of four traumagenics of sexual abuse: traumatic sexualization, betrayal, powerlessness and stigmatization. The potential for poorly conducted cross‐examinations to create further problems for child witnesses, particularly in the area of identity, is highlighted, and it is suggested traumagenic factors in such cross‐examinations may resemble those of abuse. The paper discusses practice implications for cross‐examination, judicial intervention and witness support following implementation of the Youth Justice and Criminal Evidence Act 1999 in England and Wales. Copyright © 2002 John Wiley & Sons, Ltd.     

Child sexual abuse: from prevention to self‐protection

There are a growing number of child abuse prevention and education programmes, including primarily group‐based parent and child education, which are taught by teachers within the school system. This article reviews some of the existing sexual abuse education and/or body safety programmes, as well as the research surrounding them. Advantages as well as criticisms of such programmes are reviewed. Issues such as target populations (i.e. children, teachers, parents), programme components and methodological limitations are addressed. Major findings include: children as young as three can be effectively taught self‐protection skills, parental and family involvement in training is important, and repeated exposure helps children maintain knowledge gains. The components of successful programmes include teaching children to identify and resist inappropriate touching, reassuring children that it is not their fault and learning the proper names of their genitals. Finally, future directions for programme development, research and policy are explored. Copyright © 2008 John Wiley & Sons, Ltd.     

Child sex abuse and the Irish criminal justice system

The aims of this study were to develop scales to assess experiences of sexually abused children in the Irish criminal justice system (CJS); identify aspects of the CJS which children experience as negative; compare the perceptions of children, parents and professionals of sexually abused children's experiences of the CJS; and determine correlations between perceptions of children's CJS experiences and current psychological adjustment. Forty‐three children, 101 parents, 32 mental health professionals, 27 police officers and 21 lawyers completed parallel versions of the Criminal Justice System Questionnaire (CJSQ) which assessed satisfaction with aspects of the CJS relevant to sexually abused children, specifically: Gardaí (police), medical examination, Director of Public Prosecutions, waiting for court, court professionals, court context and the CJS. Fifteen scales were developed by conducting principal component analyses. Children gave negative ratings on nine of these, and on seven children, parents and professionals differed in their perceptions of how children experienced the CJS with mental health professionals viewing the impact of the CJS as more problematic than parents and children. Scores of children and parents on CJSQ scales correlated with indices of current psychological adjustment. These results point to the importance of making the Irish CJS more child‐friendly and for evaluating these reforms with the CJSQ. Copyright © 2011 John Wiley & Sons, Ltd.