Child sexual abuse treatment: misinterpretation and mismanagement of child sexual behavior

OBJECTIVE: The purpose of the study was to examine caregiver understanding of the impact of child sexual abuse and the management of abused children in residential treatment. METHODS: A purposive sample of 20 registered nurses and child care workers were interviewed about their experiences working in residential treatment and their knowledge about child development and child sexual abuse and its application to practice. Data from interviews and field notes were analysed using dimensional analysis. FINDINGS: Caregivers had limited knowledge of the sequelae of child sexual abuse. Developmentally appropriate behaviour of sexually abused children, as well as behavioural manifestations of child sexual abuse, were often misinterpreted and mismanaged. CONCLUSION: Residential care of sexually abused children should be based on sound developmental principles and caregiver sensitivity.     

Adult disclosures of childhood sexual abuse and section 3 of the child care act 1991: past offences,current risk

In the Republic of Ireland Section 3(1) of the Child Care Act 1991 places an obligation and legal duty upon the State child protection services “to promote the welfare of children in its area who are not receiving adequate care and protection.” This article focuses on a specific element of this duty; the social worker’s responsibility to accept and assess retrospective reports of childhood sexual abuse. Retrospective disclosures of abuse are referrals made by adults of experiences they encountered as children. This article argues that current social work practice in this area lacks clarity and cohesion and while new policy and practice approaches are emerging ultimately there is a sense of confusion for both social workers and those adults affected by childhood abuse who come forward to disclose. This article presents an examination of the key judgement of Justice Barr in M.Q. v. Robert Gleeson and Ors [1998] 4 IR 85 and subsequent, related, precedents and how they relate to current Irish social work policy in this area. Adult disclosures of childhood abuse have the potential to bring alleged abusers to justice and thereby protect current and future children from harm. This article seeks to provide clarity, to social workers and those working with adults affected by abuse, regarding the Irish legal framework relating to adult disclosures of abuse as it stands. The article ultimately argues that further research and policy guidance is required.     

Expert psychological testimony in cases of alleged child sexual abuse

Concurrent with the rapid rise in allegations of child sexual abuse, psychologists are increasingly assuming the role of experts for the courts. In this position, a new and more controversial role is often assumed by the expert, that of psychological investigator. A review of the common legal contexts for such a role as well as the theoretical and empirical basis for the investigatory role is presented. Ethical issues are also considered. A literature review reveals that many assessment instruments do not meet jurisprudential standards. Suggestions for improving the role of psychological experts in the courtroom include educating the legal audience regarding the limits of psychological testimony, providing standards for qualifications of experts, and emphasizing the data-based probabilistic nature of psychological expert testimony.     

Patterns of sexual abuse and assault

Patterns of sexual abuse and sexual assault are analyzed from 162 reports involving victims with disabilities. Results suggest that abuse and assault are frequently repeated and chronic, often result in significant harm to the victim, and are rarely reported to child welfare or law enforcement authorities. Many offenses are committed by paid service providers and occur in disability service settings, but other offenses occur in the same situations as sexual abuse and assault of victims without disabilities. Victims are predominantly female and offenders are predominantly male. Charges and convictions are rare. Victims with disabilities often experience difficulty obtaining treatment services that are accessible and appropriate to their needs. Discussion considers a multifactorial, ecological model of abuse and recommends some possible prevention strategies.     

Professionals' beliefs about indicators of child sexual abuse

The objective of the study described here was to obtain information on the beliefs of professionals concerning possible indicators of a child having been sexually abused. Data were collected by means of self-administered questionnaires, distributed at meetings on child sexual abuse. The respondents were professionals working in the field of child sexual abuse. Twenty-three social workers, 14 psychologists, 12 nurses, eight medical doctors, including three paediatricians and three psychiatrists, three policemen and two nurses participated. The variables studied were the perceived prevalence of sexual abuse in British children under the age of 10 and the perceived prevalence of various possible signs of sexual abuse in two sub-groups of these children: those who had been sexually abused, and those who had not. The signs investigated were: behavioural problems, somatic complaints, enuresis, chronic urinary infections, fear of toileting, sexualized language, sexualized behaviour, comments suggestive of sexual activity, allegations of sexual abuse, sexually transmitted diseases and reflex anal dilatation. The results indicate that these professionals have widely differing beliefs about signs which might indicate that a child has been sexually abused. We conclude that data on the prevalence of indicators of child sexual abuse are essential to ensure that appropriate informed and consistent decisions can be made.     

Prevalence and co-occurrence of violence against children in the Quebec population

OBJECTIVE: A literature review on the incidence of different forms of child maltreatment revealed that rates in Australia and Quebec (Canada) were similar. This study sought to determine the prevalence and co-occurrence of various forms of violence (physical, sexual and psychological) and explore gender and age difference. METHODS: A telephone inquiry was conducted with a representative sample of 1,002 adults from the province of Quebec. RESULTS: More than one in three adults (37%) reported having experienced at least one of three forms of violence in childhood. Twelve per cent (12%) of the adults experienced two forms of violence while 4% of the respondents reported having experienced all three forms of violence in childhood. Psychological violence (22%) was the form most frequently reported, followed by physical violence (19%) and sexual violence (16%). The different prevalence rates did not vary as a function of age. However, regarding gender, women were more likely to report having been sexually victimised (rape and fondling) and less likely to report having experienced physical violence. A lower percentage of women reported having sustained no form of childhood victimisation and a higher percentage of women reported have experienced both sexual and psychological violence compared to men. CONCLUSION: These results, including both the global rates and those particular to each gender, are comparable to findings in similar North American studies. The co-occurrence rates noted are salient enough to necessitate particular attention to diverse clinical clientele and need to be considered in future research exploring the risk factors of violence and its subsequent repercussions.     

Effective techniques in treating survivors of child sexual abuse: Problematic areas in their application to the deaf population

Problems exist in identifying and treating deaf “survivors” of child sexual abuse. Even once they are identified, there are still problems in effectively applying existing regimens of therapy to this special population. While we believe we are effectively mainstreaming the deaf person into society, and believe that such an act is progressive, careful consideration, respect, and acknowledgement must be given to the special culture of the deaf person. Employing existing therapeutic methods, with only the adjustment of supplying an interpreter for the Deaf, is usually not enough.     

Child sexual abuse: Description and evaluation of a K-6 prevention curriculum

This article describes and evaluates a K-6 child sexual abuse prevention curriculum that was piloted in a large northwestern school district 1986–89. Paired t-tests using pre-test and post-test scores from a random sample of 1,391 K-6 students indicates that significant learning occurred at all grade levels. Analysis of variance results suggest that, overall, learning is not related to students' gender or to the school's socioeconomic level. Responses by 197 teachers concerning their evaluations of curriculum materials and training were positive. Study limitations and future research plans and needs are discussed. Presented at American Educational Research Association Convention, New Orleans, Louisiana, April, 1994.     

广州市男男性行为者儿童期性虐待经历对成年后高危性行为的影响

目的  了解广州市男男性行为者（men who have sex with men,MSM）的儿童期性虐待（childhood sexual abuse,CSA）情况,分析CSA对成年后高危性行为的影响。 方法  采用非概率抽样方法招募广州市≥ 18周岁的MSM,通过电子问卷收集调查对象的社会人口学资料、CSA经历和近6个月高危性行为情况。采用χ²检验比较不同社会人口学特征的MSM的CSA经历和近6个月的高危性行为情况,用Logistic回归分析模型分析探讨CSA对高危性行为的影响。 结果  调查对象的平均年龄为（28.35±6.83）岁。26.95%（263/976）的MSM遭受过CSA,近6个月多性伴（multiple sexual partners,MSP）率和无保护肛交（unprotected anal intercourse,UAI）率分别为61.68%（602/976）和47.95%（468/976）。调整了年龄、民族、户籍、本地居住时间、婚姻状况、文化程度、工作状况、个人月收入和性取向之后,有CSA者近6个月发生MSP的风险高于无CSA者（aOR=1.62,95% CI：1.19~2.22）,但近6个月UAI与CSA关联的差异无统计学意义。 结论  广州市MSM经历CSA的比例较高,CSA可增加成年后的高危性行为的风险,因此,制定MSM高危性行为干预措施可能需要考虑CSA的影响。     

A meta-analytic examination of the relationship between child sexual abuse and eating disorders

OBJECTIVE: This study had two goals. The first was to assess the magnitude and consistency of the relationship between child sexual abuse (CSA) and eating disorders (ED). The second was to examine methodological factors contributing to the heterogeneity of this relationship. METHOD: Meta-analysis was used to examine both questions. Fifty-three studies were included in the analysis. RESULTS: A small, significant positive relationship between CSA and ED emerged. The relationship was marked by heterogeneity. Effect sizes were largest when CSA was the grouping variable, the Eating Disorders Inventory (EDI) or the Eating Attitudes Test (EAT) was used as the measure of eating disorders, and nonclinical groups were compared with clinical samples. DISCUSSION: Models of CSA and ED need to more clearly specify what aspects of ED (e.g., body image or binge eating) are most influenced by which types of CSA. These specific relationships then need to be examined empirically.     

Working Sensitively with Child Sexual Abuse Survivors: What Female Child Sexual Abuse Survivors Want from Health Professionals

Adult survivors of child sexual abuse are high users of health and mental health services. Health professionals are well placed to improve health outcomes for them by delivering positive interventions post-abuse. The current study explored female child sexual abuse survivors' opinions on how health professionals could work better with child sexual abuse survivors. Sixty-one women, from 22–65 years old, who had been sexually abused before the age of 16 years, completed postal questionnaires in late 2004. A model was developed to guide the development of knowledge, skills, and practices for working more sensitively with child sexual abuse survivors. The model consisted of six chronological training steps: (1) knowledge on effects of child sexual abuse; (2) establishing the relationship with child sexual abuse survivors; (3) asking about child sexual abuse; (4) responding to disclosure; (5) sensitive provision of medical examinations; and (6) follow-up post examination. A systematic approach to training is proposed to assist with improving delivery of services sensitive to child sexual abuse survivor needs.     

Physical disability: The long-term effects of child sexual abuse

Purpose of the Study: To determine if there was a relationship between a physical disability and accessing memories of childhood sexual abuse. Procedure: Literature review, personal exploration, interviews of professionals in the field of disability and child sexual abuse, along with asmall study of adult women with acquired physical disabilities, utilizing a questionnaire and debriefing interviews. Findings: There are a variety of issues and responses, and states of readiness to deal with a history of child abuse that occur when confronting a new physical disability. However there is a commonality, that memories can be triggered. Conclusion: The shock of becoming physically disabled can trigger memories of trauma. Excerpted from Physical Disability: The Long Term Effects of Child Sexual Abuse, an Investigative Project, Sonoma State University, Rohnert Park, California.     

Young adult women who report childhood intrafamilial sexual abuse: Subsequent adjustment

Young adult women who had experienced incest and a matched comparison group were examined for differences in interpersonal functioning, sexual functioning, self-esteem, and emotional adjustment. Those reporting incest reported significantly poorer general social adjustment, especially in dating relationships. They had significantly lower levels of sexual satisfaction, lower self-esteem, and distorted body images, as well as greater depression and lower positive affect. These characteristics may be related not only to the incest experience but to the general family environment in which incest occurred, as significant differences in family characteristcs were also observed.Preparation of this article was supported in part by a grant from the office of the Vice President for Research, University of Georgia.     

Young women's management of victim and survivor identities

Images of child sexual abuse survivors have been strongly mediated by professional and self-help ideologies that espouse ‘healthy’ and ‘unhealthy’ responses to trauma. Drawing on interviews taken with five self-identified survivors of child sexual abuse, this paper maps the impact of psychological and popular discourses on victim/survivor identities and, in particular, the centrality of themes such as disclosure and ‘healing’ in accounts from survivors. Investment in these particular versions of recovery has operated to shift the focus of the survivor movement away from its political beginnings, such that private healing has replaced public discontent. As the excerpts from survivors in this paper suggest, the language commonly captured in both therapeutic and popular accounts of trauma may guide and delimit the subject positions available to survivors. Utilising the concept of ‘wounded attachment’, this paper identifies some of the outcomes associated with internalised notions of healing for survivors, as well as the dilemmas that might be impeding disclosure.     

Prevalence of childhood sexual abuse among Mexican adolescents

Background   To determine the characteristics and prevalence of previous child sexual abuse among a group of Mexican junior high school students.
Methods   A total of 1067 adolescents of both genders were selected to fill out a survey about child sexual abuse.
Results   The prevalence of child sexual abuse was 18.7% ( n  = 200). It was more frequent in girls (58%) than in boys (42%). Sexual abuse involved physical contact in 75% of those cases reporting abuse. The aggressors were neighbours (50.3%), relatives (36.8%) and strangers (13.9%). Abuse was committed through deception in 90% of the cases and involved physical mistreatment in 10% of the cases. Of the victims, 14.4% had spoken about the problem and 3.7% had taken legal action. And 9.6% of those surveyed stated that they required psychological counselling.
Conclusions   In the population studied, the prevalency of child sexual abuse was greater than that reported in Mexico City (4.3–8.4%), although it was similar to that found in the Spanish child population (15–23%). The risk of sexual abuse is greater for girls and the principal aggressors are male neighbours, family friends and relatives; the abuse is committed in the home of the aggressor or the victim and very few cases are reported to the authorities.     

Child sexual abuse and later disordered eating: a New Zealand epidemiological study

OBJECTIVE: This community-based study examined how some women who have experienced childhood sexual abuse (CSA) develop an eating disorder (ED), whereas others develop depression and anxiety, and others show no adverse psychological sequelae. METHODS: A two-stage random community sampling strategy was used to select two groups of women: (1) women with CSA prior to age 16 years and (2) a comparison group of women reporting no abuse. Both groups completed the Parental Bonding Instrument (PBI), the Present State Examination, and additional ICD-10 eating disorders questions. Information on the nature and frequency of the CSA was obtained at interview. CSA women with ED (CSA+ED) were compared with CSA women without ED (CSA-noED) and with CSA women with anxiety and/or depression (psychiatric comparison group). RESULTS: Higher rates of EDs in women who have experienced CSA were confirmed in this study. Belonging to a younger age cohort, experiencing menarche at an early age, and high paternal overcontrol on the PBI independently increased the risk of developing an ED in women who had experienced CSA. Low maternal care was specifically associated with the development of anorexia nervosa, whereas early age of menarche differentiated women with bulimia nervosa. Younger age and early age of menarche also differentiated the CSA+ED women from the psychiatric comparison group. DISCUSSION: Early maturation and paternal overcontrol emerged as risk factors for ED development in women with CSA. Although these variables are also risk factors in the general population, women with CSA may be vulnerable to ED development because these risk factors are particular domains of concern that emanate from experiences of CSA.     

北京市三所学校初一学生预防性侵犯教育影响评价

目的 评价学校预防性侵犯教育对初一年级学生知识和技能的影响,为在初中生中开展预防性侵犯教育和研究提供科学依据。方法 采用方便取样。选取北京市3所学校初一年级学生作为研究对象。将学生以班级为单位分为教育组和对照组。由学校教师使用统一编写的教案,在学校对学生开展预防性侵犯教育。分别于教育前、教育后1周和教育后4个月对学生进行问卷调查,比较两组学生预防性侵犯知识和技能的差异。结果 有关预防性侵犯知识和技能,教育前,教育组与对照组学生得分（知识 2.17 vs 2.21;技能 1.97 vs 1.97）比较差异均无统计学意义（P>0.05）;教育后1周和教育后4个月,教育组学生知识和技能得分均明显高于对照组学生得分（教育后1周,知识：3.20 vs 2.35,技能：2.72 vs 2.09;教育后4个月,知识：3.00 vs 2.58,技能：2.58 vs 2.20）,差异有统计学意义（P<0.01）。结论 学校预防性侵犯教育,可有效地帮助初一年级学生学习预防性侵犯知识和技能。     

北京市幼儿家长预防儿童性侵犯知识、态度及亲子间交流状况研究

目的了解幼儿家长预防儿童性侵犯知识、态度和亲子间交流状况及其影响因素,为做好幼儿家长预防儿童性侵犯教育工作提供参考依据。方法本调查对象来自同意参加这项研究的2所北京市幼儿园儿童家长。采用不记名自填式问卷调查方法。结果 45.8%的家长能认识到对儿童进行性侵犯的人多为儿童熟悉的人,超1/4的家长担心预防儿童性侵犯教育可能会使儿童对"性"知道得太多而产生不好的影响,53.5%家长与儿童谈论过不要保守性侵犯这样的秘密,要告诉信任的人。结论要重视幼儿家长预防性侵犯教育工作,促进亲子间预防性侵犯问题的交流。