Child extrafamilial sexual abuse: predicting parent and child functioning1

doi:10.1016/S0145-2134(98)00103-3

Child Abuse & Neglect

Volume 22, Issue 12, December 1998, Pages 1285-1304

https://doi.org/10.1016/S0145-2134(98)00103-3 Get rights and content

Abstract

Objective: This study evaluated the emotional and behavioral adjustment of parents and children within 3 months and 1 year after the discovery of child extrafamilial sexual abuse.

Method: Ninety-two case parents (63 mothers, 29 fathers) and 56 children were compared to a nonclinical comparison group of 136 parents (74 mothers, 62 fathers) and 75 children. Parent adjustment was assessed using self-report measures while child functioning was assessed using a combination of child-, parent- and teacher-report measures.

Results: Mothers, fathers and sexually abused children experienced clinically significant effects both initially and at 12 months post-disclosure. Children’s perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symtomatology at 3 months and 1 year post-disclosure. Child age and gender also significantly contributed to the prediction of many of the child outcome measures. No abuse-related variable was related to any child self-report measure. Mothers’ satisfaction in the parenting role, perceived support and intrusive symptoms predicted their initial emotional functioning. Avoidant symptoms, child’s internalizing behavior and mothers’ initial emotional functioning were significant predictors of longer-term emotional functioning.

Conclusions: Results emphasize the need to address children’s abuse-related attributions and underscore the need to expand our focus beyond the child victims to the traumatized families.

Résumé

Objectif: Cette étude a évalué l’adaptation émotionnelle et du comportement chez des parents et des enfants, trois mois suivant une expérience d’abus sexuels extra-familiaux, puis un an plus tard.

Méthode: On a comparé 92 parents (63 mères et 29 pères) et 56 enfants à un groupe de comparaison non clinique composé de 136 parents (74 mères et 62 pères) et 75 enfants. L’adaptation des parents a été évaluée à partir d’une auto-évaluation de la situation tandis que l’adaptation des enfants a été mesurée en se fiant à des rapports obtenus des enfants, des parents et des enseignants.

Résultats: Les mères, les pères et les enfants abusés sexuellement ont connu des effets cliniques importants, dès l’expérience et dans les 12 mois qui ont suivi. Le blâme que les enfants s’attribuaient et les sentiments de culpabilité, ainsi que la gravité du traumatisme vécu servaient à prédire les symptômes qu’ils disaient vivre, tant au 3 mois qu’au douzième mois. L’âge et le sexe de l’enfant étaient aussi des facteurs importants. Pour ce qui est des variables non reliées aux mauvais traitements, on a remarqué aucun lien. La satisfaction que les mères éprouvaient dans leur rôle maternel, les appuis qu’elles considéraient avoir obtenus et les symptômes graves étaient reliés à leur fonctionnement émotionnel. Les symptômes de contournement, l’intériorisation des enfants par rapport à leur comportement et le fonctionnement initial de la mère se sont avérés des facteurs importants pour prédire les troubles d’adaptation à longue échéance.

Conclusions: Les résultats soulignent l’importance de se pencher sur la façon dont les enfants attribuent les mauvais traitements sexuels et d’élargir nos préoccupations au delà de l’enfant, pour considérer les traumatismes de la famille entière.

Resumen

Objetivo: Este estudio evaluó el ajuste emocional y conductual de los padres y los hijos desde los tres meses hasta un año después de descubrir el abuso sexual extrafamiliar en la niñez.

Método: Noventa y dos casos de padres (63 madres, 29 padres) y 56 niños fueron comparados con un grupo no clı́nico de 136 padres (74 madres, 62 padres) y 75 niños. El ajuste parental fue evaluado utilizando medidas de auto-reporte mientras que el funcionamiento infantil fue evaluado utilizando una combinación de medidas reportadas por el niño, los padres y el maestro.

Resultados: Las madres, los padres y los niños sexualmente abusados experimentaron efectos clı́nicamente significativos tanto inicialmente como a los 12 meses post-descubrimiento. Las percepciones infantiles de auto-sanción y culpa por el abuso y la intensidad del trauma predijo su sintomatologı́a autoreportada a los 3 meses y al año después del descubrimiento. La edad y el sexo del niño también contribuyeron significativamente a la predicción de muchos de los resultados de las medidas en el niño. Ninguna variable relacionada con el abuso se relacionó con cualguiera de las medidas de auto-reporte. La satisfacción de la madre en el rol parental, el apoyo percibido y los sı́ntomas invasivos predecı́an su funcionamiento emocional inicial. Los sı́ntomas de evitación, la conducta infantil de internalización y el funcionamiento inicial emocional de las madres eran predictores significativos de funcionamiento emocional a largo plazo.

Conclusiones: Los resultados destacan la necesidad de responder a las atribuciones relacionadas con el abuso a los niños y acentúan la necesidad de ampliar nuestro enfoque más allá del niño vı́ctima hasta sus familias traumatizadas.

Section snippets

Case group

One hundred and fifty-one families in which a child had been sexually abused by someone outside of the family were contacted by the Child Protection Team of the Children’s Hospital of Eastern Ontario (CHEO), Crown Attorneys’ offices, and Children’s Aid Societies in the Ottawa-Carleton Region. Of these, 66 families agreed to participate. Families were selected if the sexual abuse occurred no longer than 1 year prior to its disclosure. The present study defined ESA as one or more sexual

Recruited case participants versus refusers

Throughout recruitment, 151 case families meeting the definitional and inclusion criteria of the study were contacted. Of these, 85 (56.3%) declined to participate. Case participants and refusers were compared on major demographic characteristics (child’s age and gender; parents’ age and occupation; family income; single vs. two-parent status) and variables related to the nature of reported sexual abuse based on the NAEF collected from referring agencies. There were no differences on major

Discussion

This study demonstrated that child victims of ESA show adjustment problems in both emotional and behavioral domains. The pattern of adjustment difficulties, however, differs depending on who rates the behavior. The only group difference for child self-report measures was for Depression. Case children had higher Depression scores than control children and these scores were higher initially than at 12 months post-disclosure for both case and control children. For parent and teacher reports, case

References (72)

T. Achenbach et al.
Manual for the Child Behavior Checklist and Revised Child Behavior Profile
(1983)
P. Alexander et al.
Family characteristics and long-term consequences associated with sexual abuse
Archives of Sexual Behavior
(1987)
S. Anderson
Parental stress and coping during the leave home transition
Family Relations
(1988)
Anderson, S., Bach, C., & Griffith, S. (1981). Psychosocial sequelae in intrafamilial victims of sexual assault and...
J. Beitchman et al.
A review of the short-term effects of child sexual abuse
Child Abuse & Neglect
(1991)
Bernbaum, B. (1986). Increasing parent knowledge of extrafamilial child sexual abuse through development and...
P. Birleson
The validity of depressive disorder in childhood and the development of a self-rating scaleA research report
Journal of Child Psychology and Psychiatry
(1981)
S. Burge
RapeIndividual and family reactions
A. Burgess et al.
Parental response to child sexual abuse trials involving day care setting
Journal of Traumatic Stress
(1990)
A. Burgess et al.
Response patterns in children and adolescents exploited through sex rings and pornography
American Journal of Psychiatry
(1984)

A. Burgess et al.

Abused to abuserAntecedents of socially deviant behaviors

American Journal of Psychiatry

(1987)

J. Cohen et al.

Psychological symptoms in sexually abused girls

Child Abuse & Neglect

(1988)

J. Connolly

Social self-efficacy in adolescenceRelations with self-concept, social adjustment and mental health

Canadian Journal of Behavioural Science

(1988)

J. Conte

The effects of sexual abuse on childrenA critique and suggestions for future research

Victimology

(1985)

J. Conte et al.

Factors associated with an increased impact of child sexual abuse

Child Abuse & Neglect

(1987)

Cosentino, C., & Collins, M. (1996). Sexual abuse of children: Prevalence, effects, and treatment. In J. A. Sechzer, S....

L. Derogatis

The SCL90–RAdministration, scoring, and procedures manual-I

(1977)

L.R. Derogatis et al.

The Brief Symptom Inventory (BSI)Administration, scoring and procedures manual-I

(1982)

L. Dunn et al.

Peabody Picture Vocabulary Test-RevisedManual for Forms L and M

(1981)

A. Einbender et al.

Psychological functioning and behavior of sexually abused girls

Journal of Consulting and Clinical Psychology

(1989)

S. Esquilin

Family responses to the identification of extra-familial child sexual abuse

Psychotherapy in Private Practice

(1987)

K. Faller

The spectrum of sexual abuse in day careAn exploratory study

Journal of Family Violence

(1988)

Figley, C. (1983). Catastrophes: An overview of family reactions. In C. Figley & H. McCubbin (Eds.), Stress and the...

C. Figley

Helping traumatized families

(1989)

D. Finkelhor

Sexually victimized children

(1979)

D. Finkelhor

Child sexual abuseNew theory and research

(1984)

D. Finkelhor et al.

Sexual abuse in the National Incidence Study of child abuse and neglectAn appraisal

Child Abuse & Neglect

(1984)

D. Finkelhor et al.

Sexual abuse in a national survey of adult men & womenPrevalence, characteristics and risk factors

Child Abuse & Neglect

(1990)

D. Finkelhor et al.

Nursery crimesSexual abuse in day care

(1988)

W. Friedrich

Mothers of sexually abused childrenAn MMPI study

Journal of Clinical Psychology

(1991)

W. Friedrich et al.

Children from sexually abusive familiesA behavioral comparison

Journal of Interpersonal Violence

(1987)

Gibaud-Wallston, J., & Wandersman, L. (1978). Development and utility of the Parent Sense of Competence Scale. Paper...

B. Gomes-Schwartz et al.

Child sexual abuseThe initial effects

(1990)

C. Haase et al.

Non-familial sexual abuseWorking with children and their families

M. Horowitz et al.

Impact of Event ScaleA measure of subjective stress

Psychosomatic Medicine

(1979)

R. Janoff-Bulman

Shattered assumptionsTowards a new psychology of trauma

(1992)

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L’impact traumatique lié à la révélation d’une agression, au moment de l’annonce de l’abus, mais aussi dans la vie quotidienne de la famille, bouleverse le système familial dans son ensemble. Cette étude veut comparer la perception du parent et de son enfant lorsque l’enfant a été victime d’une agression sexuelle, psychologique et/ou physique extrafamiliale notamment autour des émotions, de la culpabilité et du vécu de victimisation. La démarche de recherche est exploratoire à travers l’analyse qualitative du contenu d’entretiens réalisés avec des parents et des enfants suivis en unité médico-judiciaire (UMJ) et unité d’accueil des jeunes victimes (UAJV). Nos résultats montrent la présence significative d’un fort état émotionnel chez les parents qui se traduit en colère, ainsi qu’une difficulté à nommer les émotions chez leurs enfants. Les enfants éprouvent des difficultés à exprimer leurs émotions, en revanche, leur quotidien semble moins difficile que pour les parents. Malgré les limites dues au faible échantillon et aux conditions de recueil des données, des préconisations pour la prise en charge de la famille sont proposées.
The traumatic impact linked to the revelation of an assault, at the time of the announcement of the abuse, but also in the daily life of the family, disrupts the family system. This study aims to compare the perception of the parent and his child when the child has been the victim of a sexual, psychological and/or physical extra-family assault, particularly around emotions, guilt and the victimization experience. The exploratory research approach is through the qualitative analysis of the content of interviews conducted with parents and children received by the Medico-Judiciary Unit (UMJ) and the Youth Victims Reception Unit. (UAJV). Our results show the presence of a strong emotional state in parents that results in anger, as well as a difficulty in naming emotions in their children. Children have difficulty to express their emotions, but everyday life seems less difficult than parents. Despite the limitations due to the small sample and the conditions for data collection, recommendations for clinical treatment of families are proposed.
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In order to assess the effects of child/adolescent sexual abuse (CSA/ASA) on the victim's probability of developing symptoms of depression and anxiety, to quantify injury in populational terms, to establish the probability of injury, and to determine the different effects of moderators on the severity of injury, a meta-analysis was performed. Given the abundant literature, only studies indexed in the scientific database of reference, the Web of Science, were selected. A total of 78 studies met the inclusion criteria: they measured CSA/ASA victimization or injury in terms of depression or anxiety symptoms, measured the effect size or included data for computing them, and provided a description of the sample. The results showed that CSA/ASA victims suffered significant injury, generally of a medium effect size and generalizable, victims had 70% more probabilities of suffering from injury, and clinical diagnosis was significantly a more adequate measure of injury than symptoms. The probability of chronic injury (dysthymia) was greater than developing more severe injury, i.e., major depressive disorder (MDD). In the category of anxiety disorders, injury was expressed with a higher probability in specific phobia. In terms of the victim's gender, females had significantly higher rates of developing a depressive disorder (DD) and/or an anxiety disorder (AD), quantified in a 42% and 24% over the baseline, for a DD and AD respectively. As for the type of abuse, the meta-analysis revealed that abuse involving penetration was linked to severe injury, whereas abuse with no contact was associated to less serious injury. The clinical, social, and legal implications of the results are discussed.
Con el objetivo de conocer los potenciales efectos de la victimización de abuso sexual infantil/adolescente (ASI/ASA) en el desarrollo de sintomatología depresiva y ansiosa así como cuantificar, en su caso, el potencial daño en términos poblacionales, la probabilidad de manifestación de daño y el efecto diferencial de moderadores en la severidad del daño manifestado, se planificó una revisión meta-analítica. Dada la gran proliferación de literatura se seleccionaron aquellos estudios indexados en la base de datos de referencia de calidad científica, la Web of Science. Setenta y ocho estudios cumplieron los criterios de inclusión: medida de la victimización de ASI/ASA, medida del daño en sintomatología depresiva o ansiosa, medida del tamaño del efecto o inclusión de datos que permitieran computarlo y descripción de la muestra. Los resultados mostraron que la victimización de ASI/ASA conlleva un daño significativo de un tamaño en general moderado y generalizable, que las víctimas tienen un 70% más de probabilidades de presentar daño y que el diagnóstico clínico es una medida significativamente más adecuada del daño que la sintomatología. La probabilidad de cronificación del daño (distimia) es mayor que la de un daño más grave (depresión mayor). En la categoría de los trastornos de ansiedad, el daño se manifiesta con mayor probabilidad en fobia específica. En cuanto al género de la víctima, las mujeres presentan una tasa significativamente mayor de desarrollo de un cuadro depresivo, cuantificado en un 42% sobre la línea base, y ansioso, cuantificado en un 24%. Por el tipo de abuso, los meta-análisis evidencian que el abuso con penetración conlleva más daño y el abuso sin contacto un daño menor. Se discuten las implicaciones clínicas, sociales y legales de los resultados.
Sexual abuse in sport: What about boys?
2012, Children and Youth Services Review
Citation Excerpt :
These different findings point to the importance of specifying both the kind of abuse a boy has experienced and the context in which such abuse has occurred. Indeed, it has been shown that the characteristics of extrafamilial sexual abuse are different from those of intrafamilial sexual abuse (Bolen, 2000; Fischer & McDonald, 1998; Grosz, Kempe, & Kelly, 2000; Manion et al., 1998; Proulx, Perreault, & Ouimet, 1999). Unfortunately, as noted by several authors, the literature has hardly dealt with the issue of extrafamilial sexual abuse (Bolen, 2000; Edinburgh, Saewyc, & Levitt, 2006; Wolfe, Jaffe, Jetté, & Poisson, 2003).
In Quebec, over 500,000 young people are involved in organized sport and the majority of these participants are boys. However, despite this high number of young males participating in sport, the issue of sexual abuse among male athletes has been mainly overlooked. Researchers who have studied sexual abuse in the context of sport have primarily focussed on female victims. And yet, some studies have shown that between 2% and 6% of male athletes have suffered sexual abuse in the context of their sport. Thus, studies currently provide very little insight into the problem of sexual abuse among boys in sport. This article presents the current knowledge on the topic and highlights the importance for the academic community to study this issue.
Relationship of personal, familial, and abuse-specific factors with outcome following childhood sexual abuse
2010, Aggression and Violent Behavior
Citation Excerpt :
A particular strength of the Fergusson et al. (1996) study was the use of a longitudinal design, following a cohort of children over 18 years, and comparing children with a history of CSA to those with no history, but who had other similar life experiences. In contrast to Fergusson et al. (1996), Manion et al. (1998) discovered that severity of abuse was not significantly predictive of outcome for the victim nor was it related to the parent's report of their own symptoms either immediately post-disclosure or one year following disclosure. All of the victims were abused for less than one year by someone outside the family or a distant relative, however, which may have an impact on the severity of abuse experienced.
An examination of the literature on factors related to outcome following child sexual abuse (CSA) revealed many factors that may contribute to symptoms displayed by victims. Factors are divided into three categories: Personal Factors, Familial Factors, and Abuse-Specific Factors. Personal factors are those inherent to the victim, including age, gender, developmental disability, attributions regarding the abuse, and treatment following abuse. Familial factors are defined as those factors associated with other family members. These include parental history of abuse, parental reaction to the disclosure, parental support of the victim, parental mental health, family stress, and treatment following abuse for the parent and other family members. Finally, factors related to the abuse are delineated, including severity of abuse, duration of the abuse, and victim–perpetrator relationship. Directions for future research are discussed.
Pregnancy complications in women with childhood sexual abuse experiences
2010, Journal of Psychosomatic Research
Citation Excerpt :
Between 74% and 96% of women exposed to CSA present physical and emotional long-term consequences [5]. Although consequences of CSA show individual differences [6], an increasing number of case reports and published clinical experiences of obstetrical health care providers as well as few systematic investigations suggest that exposure to CSA is associated with an increased risk for pregnancy complications [7–10]. For example, there seems to be an association between CSA experiences and the risk for preterm birth (delivery <37 weeks' gestation) [11–13].
Childhood sexual abuse (CSA) has an estimated prevalence of 20% and has a constantly growing list of known long-term consequences on physical as well as psychological health which may also influence obstetrical care attributed to it. However, scientific data on the association of CSA and pregnancy are sparse. Therefore, the study investigated pregnancy complications in women exposed to CSA.
The study was designed as a cohort study comparing 85 women exposed to CSA with 170 matched unexposed women. CSA was identified by interview using modified questions from Wyatt [Child Abuse Negl 9 (1985) 507–519]. Data on pregnancy complications were collected by questionnaire and based on entries in a booklet (Mutterpass) in which all relevant data on pregnancy are documented at each prenatal consultation for any women attending prenatal care in Germany. Statistical analysis was performed with chi square, Fisher's Exact Test, and multiple logistic regression analysis to control the association between CSA and pregnancy complications for confounders significant in univariate analysis, i.e., physical abuse, other adverse experiences during childhood, abuse during pregnancy, substance abuse, and occupation.
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Therefore, health care providers should adapt prenatal care to the specific needs of women exposed to CSA.
Understanding child sexual behavior problems: A developmental psychopathology framework
2009, Clinical Psychology Review
Children exhibiting sexual behavior have increasingly gained the attention of child welfare and mental health systems, as well as the scientific community. While a heterogeneous group, children with sexual behavior problems consistently demonstrate a number of problems related to adjustment and overall development. In order to appropriately intervene with these children, a comprehensive understanding of etiology is imperative. The overarching goal of the present paper is to review the extant research on mechanisms associated with the development of problematic sexual behavior in childhood within a developmental psychopathology framework. What is known about normative and nonnormative sexual behavior in childhood is reviewed, highlighting definitional challenges and age-related developmental differences. Further, the relationship between child sexual abuse and child sexual behavior problems is discussed, drawing attention to factors impacting this relationship. Risk factors for child sexual behavior problems, beyond that of sexual abuse, are also reviewed utilizing a transactional–ecological framework. Finally, we conclude with a discussion of implications of a developmental psychopathology perspective on problematic child sexual behaviors to inform future research and intervention efforts. Such implications include the need for attention to normative childhood sexual behavior, developmental sensitivity, and examinations of ecological domain in concert.

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^☆: The Extrafamilial Child Sexual Abuse Study was supported by the National Health Research Development Program (6606–4689-FV), Health Canada, Ottawa, Ontario, Canada.

²: Submitted for publication November 4, 1997; final revision received April 24, 1998; accepted May 3, 1998.

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Original ArticlesChild extrafamilial sexual abuse: predicting parent and child functioning1 2☆,

Abstract

Résumé

Resumen

Section snippets

Case group

Recruited case participants versus refusers

Discussion

Manual for the Child Behavior Checklist and Revised Child Behavior Profile

Family characteristics and long-term consequences associated with sexual abuse

Archives of Sexual Behavior

Parental stress and coping during the leave home transition

Family Relations

A review of the short-term effects of child sexual abuse

Child Abuse & Neglect

The validity of depressive disorder in childhood and the development of a self-rating scaleA research report

Journal of Child Psychology and Psychiatry

RapeIndividual and family reactions

Parental response to child sexual abuse trials involving day care setting

Journal of Traumatic Stress

Response patterns in children and adolescents exploited through sex rings and pornography

American Journal of Psychiatry

Abused to abuserAntecedents of socially deviant behaviors

American Journal of Psychiatry

Psychological symptoms in sexually abused girls

Child Abuse & Neglect

Social self-efficacy in adolescenceRelations with self-concept, social adjustment and mental health

Canadian Journal of Behavioural Science

The effects of sexual abuse on childrenA critique and suggestions for future research

Victimology

Factors associated with an increased impact of child sexual abuse

Child Abuse & Neglect

The SCL90–RAdministration, scoring, and procedures manual-I

The Brief Symptom Inventory (BSI)Administration, scoring and procedures manual-I

Peabody Picture Vocabulary Test-RevisedManual for Forms L and M

Psychological functioning and behavior of sexually abused girls

Journal of Consulting and Clinical Psychology

Family responses to the identification of extra-familial child sexual abuse

Psychotherapy in Private Practice

The spectrum of sexual abuse in day careAn exploratory study

Journal of Family Violence

Helping traumatized families

Sexually victimized children

Child sexual abuseNew theory and research

Sexual abuse in the National Incidence Study of child abuse and neglectAn appraisal

Child Abuse & Neglect

Sexual abuse in a national survey of adult men & womenPrevalence, characteristics and risk factors

Child Abuse & Neglect

Nursery crimesSexual abuse in day care

Mothers of sexually abused childrenAn MMPI study

Journal of Clinical Psychology

Children from sexually abusive familiesA behavioral comparison

Journal of Interpersonal Violence

Child sexual abuseThe initial effects

Non-familial sexual abuseWorking with children and their families

Impact of Event ScaleA measure of subjective stress

Psychosomatic Medicine

Shattered assumptionsTowards a new psychology of trauma

Original Articles
Child extrafamilial sexual abuse: predicting parent and child functioning¹ 2☆,