Psychiatric status of intrafamilial child sexual abuse victims

The initial psychiatric profile of a large sample of sexually abused children who presented at an outpatient child psychiatry clinic was assessed. The results identified a wide diversity in victim responses to incest. The older the victim, the closer the relationship of the offender to the child, the greater the frequency of abuse incidents, the longer the duration of the abuse, the offender having a history of alcohol abuse, and the victim being a victim of physical abuse as well as sexual abuse were all related to the presence of a DSM-III axis I clinical disorder.     

Specific Risk Assessment Based on Victim Type in Child Sexual Offenders

Actuarial instruments for assessing sex offender recidivism have limited utility for specific risk assessment questions, such as the risk posed to particular types of victim. In order to obtain variables that discriminate between offenders with different classes of victim, data were coded from 324 files of child sexual offenders from a community-based sexual offender treatment program. Offenders with single or multiple victims were compared, as were offenders who did or did not offend against victims of both genders, and offenders with only intra-familial or extra-familial victims versus offenders with victims in both relationship categories. Variables that discriminated single-victim and multiple-victim offenders were similar to those identified in actuarial risk assessment scales, with the exception of history of childhood sexual abuse. With the exception of physical abuse history, the same variables discriminated specific offender groups according to victim gender and victim relationship, although in different combinations. There was limited support for the notion of specific risk variables.     

Allegations of child sexual abuse in child custody disputes: a therapeutic assessment model

Guidelines are set forth for judges and others who must make decisions in custody disputes that include allegations of child sexual abuse. The focus is on the protection of the child and the model highlights the role of mental health professionals, prescribing separate therapists for child and parent where possible. Allegations of sexual abuse are seen as an indicator of emotional risk for the child, even in cases where the allegations are untrue.     

“Sex,Lies and Videotapes”: Gathering and Assessing Evidence of Child Abuse in Family Law Cases

Determining the veracity of allegations of child abuse raised in post-separation parenting disputes is difficult, because family courts in Australia do not have their own investigatory power or capacity. They rely on evidence brought before them from State/Territory child protection authorities, police, and other experts who may have interviewed and assessed the child/family. This article describes the gap between Commonwealth and State/Territory responsibilities and mechanisms, and data from a recent evaluation of an innovative program designed to bridge this jurisdictional gap: the Family Court of Australia's “Magellan” case-management model. The views of judges and other key stakeholders from the Family Court and intersecting agencies are presented about the evidence that is put forward in family law disputes in which child sexual abuse or serious physical abuse is alleged. It is important to ensure children's best interests are served, even when it is difficult to adduce evidence and distil truth.     

Les pédophiles sont-ils tous des agresseurs sexuels d’enfants ?

In popular discourse, the terms pedophile and child sex. offender are generally understood to be synonymous : pedophiles are considered to be individuals who have sexually assaulted a child and child sex. offenders are necessarily defined as individuals with a sexual preference for children. Although previous studies have shown that sexual preference for children plays an important role in the offending process and in recidivism, it is but one factor among others (e.g. lack of empathy, cognitive distortions). In this interview, the researchers provide some nuance by, among other things, delimiting several concepts such as child sexual abuse and by addressing the different types of sexual offenses, the characteristics and profiles of child sexual offenders and the differences between pedophilia and child sexual abuse. The researchers conclude by introducing the concept of the non-offending pedophile, an individual with a sexual preference towards children but who has never committed a sexual offense. The researchers discuss the resources available to this type of individual, the difficulties they may experience on a daily basis and suggest areas of further reflection in terms of support and treatment.     

Child pornography possession/receipt offenders: developing a forensic profile

Child pornography possession/receipt offenders are a controversial offender group due to mixed and occasionally divergent evidence about their risk profile, offending history and psychopathology. Using a population of male offenders who ever perpetrated a sexual offense from a federal jurisdiction in the central United States, the current study developed an exploratory post hoc empirical profile of these offenders. The profile has some success in the validation component of our study and showed significant associations with self-reported sexual abuse of child victims ages 3–12 years, but non-significant associations to adolescent and adult victims. It significantly linked to the conceptually expected victim group and the significant statistical effect withstood controls for generally robust indicators of antisocial conduct including antisocial personality disorder, arrest onset, total adverse childhood experiences, age and race. We view the findings as exploratory and encourage additional empirical study of this important offender group.Key words: child pornography, forensic science, paraphilic disorder, sex offender, violence     

The assessment of custody and access disputes in cases of sexual abuse allegations

Sexual abuse allegations directed at one parent can arise in the context of custody and access disputes. The role of the clinician, when such allegations occur, is to provide an assessment of the total situation, taking the allegations into account. To assess the probability that sexual abuse has occurred involves a thorough assessment of the accuser, the accused, the accusation, the child, and different family subsystems. Particular attention should be paid to interviewing the young child with detailed focus on the interviewing process, how the interviews are reported and what conclusions may be drawn from them. Following a thorough assessment, the clinician may reach one of three conclusions: that the sexual abuse has probably occurred, has probably not occurred, or is unsure. A strong caution is given against becoming entangled in an endless process of trying to find out whether the allegations are true or false. Whatever conclusions are reached are but one factor in the recommendation regarding custody and/or access. Ultimately the recommendation will be made according to the best interests of the child, taking into account the child's relationships and attachments, as well as the sexual abuse allegations.     

Filial dependency and recantation of child sexual abuse allegations

OBJECTIVE: Controversy abounds regarding the process by which child sexual abuse victims disclose their experiences, particularly the extent to which and the reasons why some children, once having disclosed abuse, later recant their allegations. This study examined the prevalence and predictors of recantation among 2- to 17-year-old child sexual abuse victims. METHOD: Case files (n = 257) were randomly selected from all substantiated cases resulting in a dependency court filing in a large urban county between 1999 and 2000. Recantation (i.e., denial of abuse postdisclosure) was scored across formal and informal interviews. Cases were also coded for characteristics of the child, family, and abuse. RESULTS: A 23.1% recantation rate was observed. Multivariate analyses supported a filial dependency model of recantation, whereby abuse victims who were more vulnerable to familial adult influences (i.e., younger children, those abused by a parent figure and who lacked support from the nonoffending caregiver) were more likely to recant. An alternative hypothesis, that recantations resulted from potential inclusion of cases involving false allegations, was not supported. CONCLUSION: Results provide new insight into the process by which children reveal interpersonal trauma and have implications for debates concerning the credibility of child sexual abuse allegations and treatment in dependency samples.     

Alcohol expectancies in convicted rapists and child molesters

BACKGROUND: Previous findings suggest that cognitive factors and expectancies related to drinking can mediate subjective sexual arousal as well as aggression in men. Our aim was to investigate the drinking habits and alcohol-related expectancies that might predispose men to sexually aggress in two groups of sexual offenders. METHOD: Men convicted of rape (n = 10) were compared with men convicted of child molesting (n = 10) and with control subjects (n = 31). Current drinking habits (while not in prison) were assessed by self-report, and the extent of alcohol abuse was mapped by the Michigan Alcoholism Screening Test (MAST; Selzer, 1971). Cognitive expectancies related to alcohol use were explored by the standard Alcohol Expectancy Questionnaire (AEQ; Brown et al., 1980). RESULTS: The majority of the men who committed rape (70%) but only a third of the men convicted of child molesting were diagnosed with antisocial personality disorder. Alcohol abuse was common in men convicted of both rape and child molesting and the men convicted of rape expected significantly more positive effects from drinking than the control group. Both sex offender groups were the only groups to express significant alcohol-related cognitive expectancies linked to arousal and aggression. Expectancy patterns were directly linked to the antisocial personality characteristics. CONCLUSION: Alcohol abuse is common in men who commit both rape and child molesting. Heavy drinking and the anticipation of alcohol effects such as sexual enhancement, arousal and aggression may facilitate sexual aggression in offenders with antisocial personality disorder.     

Sexual and physical abuse during early childhood or adolescence and later drug addiction

Sexual or physical abuse of children are discussed as possible causes or risk-factors for psychiatric disorders like posttraumatic stress disorder, alcohol and drug addiction. The aim of this study was to identify possible differences between sexually or physically abused and non-abused patients with polytoxic drug abuse. METHOD: 100 patients with polytoxic drug abuse were interviewed during their therapy about a history of sexual abuse prior to the age of sixteen. Using different questionnaires we tried to find possible differences between drug users being sexually abused or not and risk factors for later drug addiction. RESULTS: 70% of the female and 56% of the male drug users had been sexually abused as children, 40% of the male and 50% of the female participants had a history of severe sexual abuse with sexual intercourse. In over 50% friends or relatives were the perpetrators committed the crime, in no case the parents had. More than 40% showed also a history of physical abuse. Significantly more drug users than alcohol abusers had a sexual trauma. Especially severe sexual abuse was associated with abuse of hard illegal drugs. Furthermore, we could find significantly more symptoms such as autoaggressive and suicidal behaviour, social isolation, reduced emotional binding to others, tendency to be persistently victimized, prostitution and violence against others in the group of sexually abused. Many of these symptoms are not only characteristic of addiction, but can be found also in other psychiatric diseases such as borderline and eating disorder. In conclusion, we could not find a significant correlation between sexual abuse and later drug addiction. 80% of the drug users themselves did not relate the fact of being sexually abused as child to later drug abuse. However, there seems to be a positive correlation between sexual abuse and a more severe addiction to illegal drugs as well as higher rates of symptoms with a negative course of the disease. For this group of patients with an unfavourable prognosis special therapeutic concepts are needed.     

Psychopathology of sexual abuse in young people with intellectual disability

The present study addressed two issues using a sample of child and adolescent victims and perpetrators of sexual abuse: (1) the extent of post‐traumatic stress disorder (PTSD) in the sample; and (2) the possible distinction between perpetrators whose motivations were sexually impulsive, and those who were controlling and abuse‐reactive. Retrospective case material from 43 cases (21 victims only, and 22 perpetrators, of whom 16 were also victims) provided the data. Post‐traumatic symptomatology was not common. Only one case of PTSD was found. Perpetrators could be distinguished by whether they had suffered sexual abuse alone, sexual and physical abuse, or neither. The proposed distinction between perpetrators received support. Sexual abuse directed at younger victims was associated with earlier experience of multiple forms of abuse. The present data does not support the view that post‐traumatic symptoms following victimization are a mediator of sexual abuse perpetration. It is argued that an elaboration of the Williams & New developmental model of perpetration better fits the data.     

False allegations of sexual abuse by children and adolescents

The frequency of false allegations of sexual abuse by children and adolescents is of significant legal and clinical importance. The rate of false allegations of sexual abuse is examined in a large sample of Child Protective Services (CPS) cases. The criteria used by CPS workers in judging the validity of allegations are considered, and the relationship between substantiation rates and attitudes about the trustworthiness of child reports of abuse is explored. Many professionals in the field of child sexual abuse are more skeptical of child and adolescent claims of sexual abuse than available research suggests is warranted.     

Response to Sparks and Duncan's “Do No Harm” Critique of the Use of Stimulant Medications to Treat ADHD in Children and Adolescents

The literature on child sexual abuse suggests family functioning and support may be intervening variables which serve to ameliorate the long-term effects of such abuse. We advocate family therapy as effective treatment for extrafamilial child sexual abuse (especially in preschool children), and we present the essential elements of the family treatment process. Our supporting evidence is provided in the clinical evaluation and treatment of 10 children (and their families), ages 2-6 years, who reported sexual abuse in a daycare setting.     

The medical evaluation of sexual abuse in children

A number of questions must be addressed in order to effectively manage cases of sexual abuse in children. The author discusses when sexual abuse should be suspected, why physicians are often reluctant to manage such cases, who should perform the medical examination, the possibility of children contracting various sexually transmitted diseases, how to distinquish sexual fantasy from actual abuse, and reasons that a child might delay or retract a report of abuse.     

Dissociation, abuse and the eating disorders: evidence from an Australian population.

OBJECTIVE: A number of European and Northern American studies have investigated a possible association between dissociative phenomena, eating disorders, child sexual abuse and self-mutilation. However, there has been little confirmation from other countries and cultures, and the Australian experience of these interrelationships has not previously been studied. METHOD: Dissociative symptomatology and self-reported history of abusive experiences, physical and sexual, were retrospectively studied in a sample of Australian eating disordered patients using a self-report measure, the Dissociation Questionnaire (DIS-Q). RESULTS: As hypothesised, dissociative symptoms were particularly frequent in those who reported child and adult sexual abuse and in those who self-mutilated. A correlation between multiple forms of abuse and higher dissociation scores was only partially upheld. CONCLUSIONS: Interrelationships between victimisation and dissociation are discussed within the context of current knowledge in the field, and brief suggestions for therapeutic strategies are offered.     

Understanding Children's Medium for Disclosing Sexual Abuse: A Tool for Overcoming Potential Misconceptions in the Courtroom

Complainants in child sexual assault trials are often questioned by the defence about disclosure of the alleged abuse. The defence will often ask the child how they disclosed the alleged sexual abuse, including to whom the initial disclosure was made. Such questions are legitimate and directed towards testing the complainant's allegations. Sometimes, such questions are used to impeach the complainant's credibility. It is not uncommon in such instances for the defence to suggest that certain modes of disclosure are more consistent with having been sexually victimized and that a complainant who has disclosed otherwise is more likely to have fabricated the allegations of abuse. This article reviews the findings of empirical research on whom victims of child sexual abuse most commonly disclose their abuse to and by what means such disclosure is commonly made. This understanding is important to challenge misconceived views about how victims disclose child sexual abuse.     

Child sexual abuse in the etiology of depression: A systematic review of reviews

Background: Despite a large amount of research, there is considerable controversy about the role that child sexual abuse plays in the etiology of depression. To prevent interpretative difficulties, mistaken beliefs, or confusion among professionals who turn to this literature for guidance, this article addresses the best available scientific evidence on the topic, by providing a systematic review of the several reviews that have investigated the literature on the issue. Methods: Seven databases were searched, supplemented with hand search of reference lists from retrieved papers. The author and a psychiatrist independently evaluated the eligibility of all studies identified, abstracted data, and assessed study quality. Disagreements were resolved by consensus. Results: Four reviews, including about 60,000 subjects from 160 studies and having no limitations that could invalidate their results, were analyzed. There is evidence that child sexual abuse is a significant, although general and nonspecific, risk factor for depression. The relationship ranges from small‐to‐medium in magnitude and is moderated by sample source. Additional variables may either act independently to promote depression in people with a history of sexual abuse or interact with such traumatic experience to increase the likelihood of depression in child abuse survivors. Conclusions: For all victims of abuse, programs should focus not only on treating symptoms, but also on reducing additional risk factors. Depressed adults who seek psychiatric treatment should be enquired about early abuse within admission procedures. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Assessing Alleged Child Sexual Abusers in Noncriminal Contexts: Proposed Guidelines for Practice

Assessing child sexual abuse allegations is a challenging task for any child protection or mental health professional given that the secretive nature of sexual abuse is often associated with limited medical evidence and a lack of independent corroborative information. In addition to the scant evidence available to help decide the case, there are controversies surrounding the legal standard of proof and immense pressure to act quickly to ensure the safety of the children who are allegedly abused. Unfortunately, there is currently a lack of literature pertaining to the assessment of alleged child sexual abusers. This article examines the standard of proof and legal conundrum pertaining to alleged child sexual abuse cases. More importantly, it proposes guidelines for mental health professionals conducting an assessment of such persons. Assessments, if conducted effectively, can assist the court and child protection services in managing the risk of future inappropriate sexual behaviors.