Child sexual abuse: psychosocial risk factors.

Child sexual abuse is a problem of epidemic proportions in the United States. Child sexual abuse has been recognized as a predictor of many physical and psychological problems. It is important that clinicians have the ability to recognize the psychosocial dynamics present in families in which child sexual abuse takes place. Studies have shown that early detection and treatment of child sexual abuse leads to better outcomes for the victims. The literature discusses psychosocial risk factors present in families of child sexual abuse victims. An understanding of these characteristics may enable professionals to identify children at risk for child sexual abuse and may lead to earlier detection, protection, and treatment for victims. A case study illustrates psychosocial characteristics present in the family of a sexual abuse victim. Implications for practice are discussed, and a plan to assess families for psychosocial risk factors and intervene appropriately is outlined.     

Study of mechanisms and factors related to sexual abuse in female children and adolescents

OBJECTIVE: To study the frequency of sexual abuse in children and adolescents and its related factors. METHODS: Retrospective analysis of 617 cases of sexual abuse, assisted between July 1994 and August 1999 at the Womeńs Health Reference Center, divided into two groups: 71 children (age <10 years), and 546 adolescents (age > or =10 and <20 years). The analyzed variables were: sexual crime; embarrassment; presumption of violence; characteristics and number of abusers; the victimacute;s situation at the moment of the crime; and occurrence of physical traumas. Epi Info 6 software was utilized to gather data, and the results were analyzed by the chi-square test. RESULTS: Significant statistic results were found. 90.8% of the adolescents were victims of rape, and 46.5% of the children suffered sexual assault. The presupposed violence (PV) was more frequent in the group of children (63.4%) and a serious threat in the group of adolescents (63.2%). Innocentia consilli was exclusive PV among 100% of children and 59.5% of adolescents. 84.5% of children were molested by identifiable abusers, most frequently family members. Perpetrators were unknown in 72.3% of the cases of adolescent abuse. 42.3% of sexual abuse of children occurred in their homes, and 28.2% at the abusers. Adolescents were approached during daily activities (34.8%) and on their way to work or school (28.4%). Most patients did not have genital or extragenital trauma. CONCLUSIONS: Children suffered sexual assault, perpetrated by a known abuser through presupposed violence in private places. Adolescents were raped by unknown individuals, under serious threat, in nondomestic places.     

Developmental approach to preventing the sexual abuse of children

Child sexual abuse is a common and potentially damaging experience. Preventing and detecting abuse should be a part of primary care pediatric practice. A protocol is presented the goal of which is to teach children and parents reasonable protective behaviors.     

Maternal responses to the sexual abuse of their children

To define categories of maternal response and determine their relationship to variable features of the abuse situation, a questionnaire was administered to mothers of 103 children returning for a routine 2- to 3-week follow-up of a sexual abuse episode. Three categories of response were identified: nonsupportive, supportive without emotional changes, and supportive with emotional changes. Nonsupportive mothers (n = 32) believed that the abuse complaint was a lie, a misunderstanding, or the child's fault. They rarely considered pressing charges or requested counseling. Supportive mothers (n = 71) believed that the child was telling the truth and that the assailant was primarily responsible. Anger, fear, anxiety, and guilt were commonly expressed. Thirty-nine of the supportive mothers reported behavior or mood changes including sleep, appetite, or somatic complaints and recurrent crying. Most were pressing charges (79%) and sought counseling for themselves (74%) and their children (82%). The 32 supportive mothers without behavior or mood changes also frequently pressed charges (88%) but sought counseling for themselves (6%) and the children (53%) less often (P less than .001). Individual personality and coping mechanisms may determine the maternal response. Maternal emotional responses do not appear to be related to variable features of the abuse situation but are significantly related to the approach to subsequent psychologic and legal issues.     

Newborns' sleep-wake patterns: the role of maternal,delivery and infant factors

Objective: The purpose of this study was to assess the sleep-wake patterns of fullterm (≥37 weeks) newborns and to evaluate the effects of specific factors including maternal gestational diabetes, infant size and anthropometric measures, gender, gestational age and delivery variables. Methods: Two-hundred twenty newborns were studied in the hospital nursery for a continuous 24-h period with miniature activity monitors attached to the infants' ankles. The sample consisted of 102 infants of gestational diabetic mothers (IGDM) and 118 controls. Anthropometric measurements were obtained and maternal and infant characteristics were recorded. Results: The newborns had a discernible diurnal steep pattern and slept twice as much during the nighttime as daytime hours (P < 0.001). Higher skinfold measurements correlated significantly with increased quiet and motionless sleep (P < 0.05) for the IGDM but not for controls. Sleep of infants born at later gestational ages was characterized by increased percent of quiet and motionless sleep (P < 0.0001). No direct gender effects were identified. Conclusions: Multiple factors were associated with the sleep-wake patterns of the newborns on our study cohort including maternal glucose values during pregnancy, increased measures of adiposity in IGDM, increased gestational age, mode of delivery and delivery Sequence. Investigation of the sleep-wake characteristics of neonates using activity monitors is a noninvasive method for gaining new understanding of the relationships between sleep wake activity patterns and infant characteristics.     

Child sexual abuse: recognition and response when there is a suspicion or allegation

Child sexual abuse is a clear violation of children's rights with known lifelong devastating consequences. It occurs across all ages, sexes and cultures. Cases are underreported and may not be disclosed at first due to its secretive and hidden nature. It is clear that children do try to disclose but are not always heard or believed. In this paper we delve deeper into the recognition and response to suspected cases of child sexual abuse and the importance of working within a multidisciplinary team to best safeguard the victims. We emphasise the importance of asking questions in a direct, empathic and developmentally appropriate manner, such that the child feels believed and supported. The physical and behavioural changes are described in suspected cases and possible differential diagnoses. We propose a holistic model to the management and prevention of child sexual abuse based on the ecological approach to child maltreatment.     

The revictimization of child sexual abuse survivors: an examination of the adjustment of college women with child sexual abuse, adult sexual assault, and adult physical abuse

Child sexual abuse (CSA) is associated with greater vulnerability to victimization in adulthood. Such experiences may have a cumulative effect. This study compared the adjustment of 633 women experiencing revictimization, multiple adult victimizations, single adult victimization, CSA only, or no victimization. Somatization, depression, anxiety, interpersonal sensitivity, hostility, and post-traumatic stress disorder (PTSD) symptomatology were examined. Results support the cumulative effect of trauma but do not indicate differential effects for child to adult revictimization. Women with revictimization and multiple adult assaults reported more difficulties compared to women with only one form of adult abuse or no victimization. Women with CSA only reported similar symptoms as revictimized women and women with multiple adult assaults reported higher levels of distress than nonabused women and appeared somewhat more likely to experience anxiety and PTSD-related symptoms as compared to women with only adult abuse. Women with adult assault only and no abuse reported similar levels of distress.     

The sexual abuse of young people with a disability or chronic health condition

For several reasons, children and youth with a disability or chronic health condition are at an increased risk of sexual abuse. Health care providers, along with parents and caregivers, need to maintain a high level of suspicion concerning possible sexual abuse of this population. Physicians especially need to advocate for policies to prevent or detect abuse in hospitals, schools and other institutional settings. Such policies include the thorough screening and monitoring of employees and volunteers; chaperoning physical examinations and treatment procedures; supervising outings; and ensuring an institutional culture that promotes patient privacy. In addition, physicians should promote patient self-awareness and empowerment, and provide early anticipatory guidance concerning sexuality, personal empowerment and abuse risks. The present document replaces the previous Canadian Paediatric Society position statement published in 1997.     

A resilience-based approach to the recognition and response of child sexual abuse

Child sexual abuse is a clear violation of children's rights with known lifelong devastating consequences. It occurs across all ages, sexes and cultures. Cases are underreported and may not be disclosed at first due to its secretive and hidden nature. It is clear that children do try to disclose but are not always heard or believed. In this paper we delve deeper into the recognition and response to suspected cases of child sexual abuse and the importance of working within a multidisciplinary team to best safeguard the victims. We emphasize the importance of asking questions in a direct, empathic and developmentally appropriate manner, such that the child feels believed and supported. The physical and behavioural changes are described in suspected cases and possible differential diagnoses. We propose a resilience-based framework to the management and prevention of child sexual abuse.