Treatment Of Child Sexual Abuse Research Articles

Treatment of Childhood Sexual Abuse: An Updated Review

Childhood sexual abuse (CSA) involves multiple complex factors that make the evaluation of therapeutic interventions especially complicated. PTSD prevalence rates of CSA are approximately 37 % -53 %. Several other psychiatric sequelae of CSA exist. CSA appears to disrupt brain and body physiology. One co-located service delivery model reported a 52 % linkage rate of CSA survivors with mental health treatment. This article reviews current literature on the treatment of CSA, including psychosocial interventions, pharmacotherapy, and early preventative interventions. It also provides an update on the short- and long-term sequelae of CSA and implications for future research directions. A literature search of papers published in the last 3 years was conducted using the keywords treatment, sexual abuse, childhood, epigenetics, resilience and review, and searching the following databases: PsycInfo, PubMed, Substance Abuse and Mental Health Services Administration, and Centers for Disease Control.

“I Need Your Eyes to See Myself”1: Multi-Agency Team Consultation as Reflecting Turn Taking

Recent research and knowledge on risks, protection, and treatment of child sexual abuse and violence is growing. It is generally accepted that extensive collaboration across services and professions is beneficial to the professionals and the clients in this area of clinical practice. Critical reviews of studies of multi-agency and multidisciplinary team approaches show that issues such as descriptions of design and structure, collaborative processes, and context-specific studies have not been addressed, and that team members often do not respect each other's knowledge contribution and do not sufficiently focus on collective performance to provide effective assistance. Conclusions have been drawn to recommend presentation of a united knowledge front to perform effective consultation. This paper presents a multi-agency and multidisciplinary team approach in cases of child sexual abuse, violence, and maltreatment—elucidating the design, context, and building blocks to promote collaborative consultation proce...

Child sexual abuse and pediatricians

Child sexual abuse is not a rarely encountered problem. Child sexual abuse is a pediatric disease entity with lifelong impact. Child sexual abuse, different from sexual assault, is not always accompanied by violent force and usually repeated over a period of time. Child sexual abuse should be approached by multidisciplinary team experts. Every pediatrician should know the child protection network in his district and be competent in the child sexual abuse medical evaluation and treatment as a primary doctor. In order to accomplish that goal, the Korean Pediatric Society should change the pediatric residency training curriculum and foster child sexual abuse experts. Pediatricians have responsibilities to do their active role in response to children at risk. Language: ko

Cochrane review: School‐based education programmes for the prevention of child sexual abuse

AbstractBackgroundChild sexual abuse is a significant problem that requires an effective means of prevention.ObjectivesTo assess: if school‐based programmes are effective in improving knowledge about sexual abuse and self‐protective behaviours; whether participation results in an increase in disclosure of sexual abuse and/or produces any harm; knowledge retention and the effect of programme type or setting.Search strategyElectronic searches of Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, CINAHL, Sociological Abstracts, Dissertation Abstracts and other databases using MESH headings and text words specific for child sexual assault and randomised controlled trials (RCTs) were conducted in August 2006.Selection criteriaRCTs or quasi‐RCTs of school‐based interventions to prevent child sexual abuse compared with another intervention or no intervention.Data collection and analysisMeta‐analyses and sensitivity analysis, using two imputed intraclass correlation coefficients (ICC) (0.1, 0.2), were used for four outcomes: protective behaviours, questionnaire‐based knowledge, vignette‐based knowledge and disclosure of abuse. Meta‐analysis was not possible for retention of knowledge, likelihood of harm, or effect of programme type and setting.Main resultsFifteen trials measuring knowledge and behaviour change as a result of school‐based child sexual abuse intervention programmes were included. Over half the studies in each initial meta‐analysis contained unit of analysis errors. For behaviour change, two studies had data suitable for meta‐analysis; results favoured intervention (OR 6.76, 95% CI 1.44, 31.84) with moderate heterogeneity (I2=56.0%) and did not change significantly when adjustments using intraclass coefficients were made. Nine studies were included in a meta‐analysis evaluating questionnaire‐based knowledge. An increase in knowledge was found (SMD 0.59; 0.44, 0.74, heterogeneity (I2=66.4%). When adjusted for an ICC of 0.1 and 0.2 the results were SMD 0.6 (0.45, 0.75) and 0.57 (0.44, 0.71) respectively. Heterogeneity decreased with increasing ICC. A meta‐analysis of four studies evaluating vignette‐based knowledge favoured intervention (SMD 0.37 (0.18, 0.55)) with low heterogeneity (I2=0.0%) and no significant change when ICC adjustments were made. Meta‐analysis of between‐group differences of reported disclosures did not show a statistically significant difference.Authors' conclusionsStudies evaluated in this review report significant improvements in knowledge measures and protective behaviours. Results might have differed had the true ICCs from studies been available or cluster‐adjusted results been available. Several studies reported harms, suggesting a need to monitor the impact of similar interventions. Retention of knowledge should be measured beyond 3‐12 months. Further investigation of the best forms of presentation and optimal age of programme delivery is required.Plain language summarySchool‐based programmes for preventing child sex abuse may improve knowledge and self‐protective behaviours but also increase anxiety; further research is needed Childhood sexual abuse is a serious problem for school aged children worldwide. There is no consistent definition of sexual abuse. Some studies restrict sexual abuse to instances of sexual body contact with the child, while others define sexual abuse as any sexual behaviour in a child's presence. Whatever its form, childhood sexual abuse can have a very negative impact on a child. The United Nations' Convention on the Rights of the Child states that “children have the right to be protected from being hurt and mistreated, physically or mentally” and the international community needs to investigate ways this can be done effectively. One widespread method used is to teach school aged children, using school‐based programs, about child sexual abuse and how to protect themselves from it. It is important to know if this approach works, for how long it works and if it causes any unintended harm to children and adolescents. This is the purpose of this systematic review.While this review found improvements in knowledge and protective behaviours among children who had received school‐based programs, these results should be interpreted with caution. The reasons for a need for caution is that there were problems with the way that many of the original studies were analysed, children's knowledge was tested only a short time period after the program, the studies were conducted in North America and therefore may not apply to other countries and cultures, and several studies reported harms, such as increased anxiety in children. Potential harms need to be closely monitored in future studies and existing school based programs. It is difficult to know if the changes in children's knowledge and protective behaviours seen in the studies will result in prevention of child sexual abuse. As such, school‐based programs should, at best, be seen as part of a community approach to the prevention of child sexual abuse.

Group work with female survivors of childhood sexual abuse: Evidence of poorer outcomes among those with eating disorders

Objective This study explored levels of depression and self-esteem after childhood sexual abuse (CSA) group treatment for survivors with and without histories of eating disorders (ED). Methods Fifty adult female survivors completed a 15-week CSA group treatment program and were assessed at intake, pre-group treatment, discharge, and six months follow-up using the Beck Depression Inventory, the Generalized Contentment Scale and the Index of Self-Esteem. They were also asked to report on their CSA histories and comorbid psychiatric issues including histories of ED. Results Survivors with reported histories of anorexia nervosa or bulimia nervosa were significantly more depressed (minimum p < .05) and tended to have significantly less self-esteem (minimum p < .10) at discharge and six-month follow-up than those without ED. The size of these effects suggested their potential clinical significance as well. Seven to nine of every ten clients with histories of ED were more depressed and had lower self-esteem than the typical client without ED at discharge and at six-month follow-up. Conclusion The findings suggest that CSA treatment programs should assess survivors for ED as they might benefit from a more specialized focus on their emotional responses to the abuse.

Community Treatment of Child Sexual Abuse: A Survey of Practitioners in the National Child Traumatic Stress Network

Practitioners from numerous agencies who sought training in Trauma-Focused Cognitive-Behavioral Therapy in several regional sites under the auspices of the National Child Traumatic Stress Network completed a baseline survey to describe their backgrounds, settings, practices, attitudes, and perceived outcomes with sexually abused children and youth. The results documented a range of experiences and common treatment practices, and identified contributors to practitioners' use of gradual exposure and perceived levels of positive treatment outcome. The results were not accounted for by geographic region or agency. The findings support recommendations to optimize research and training related to the dissemination of evidence-based treatments in the child abuse field.

Childhood sexual abuse and substance abuse in relation to depression and coping

Objectives: To examine relationships between childhood sexual abuse (CSA), substance abuse, substance abuse relapse, depression and coping styles in an Australian sample. Methods: Participants were 79 adults actively seeking treatment for substance abuse or CSA. CSA and substance use history were assessed using a purpose built questionnaire. Depression was assessed using the Beck Depression Inventory Second Edition (BDI‐II), and coping styles were evaluated using the Coping Scale for Adults.Results: Among substance abusers, self‐reported CSA history was associated with (1) severe depression; (2) less optimistic coping; (3) longer duration of substance abuse; and (4) the use of drugs to alleviate negative moods. A non‐substance‐abusing CSA group was remarkably similar to the CSA substance‐abusing group on all measures. Penetrative abuse, younger age at CSA onset, and lack of confidence in dealing with CSA were associated with more severe depression in CSA victims.Conclusions: Despite several limitations of the present study, these findings have implications for treatment of substance abusing CSA victims and suggest directions for future research on the CSA‐substance disorder relationship.

Filial Dependency and Recantation of Child Sexual Abuse Allegations

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. 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. 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. 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.

School‐Based Education Programmes for the Prevention of Child Sexual Abuse

School‐based education programmes on the prevention of sexual abuse may increase children's knowledge and protective behaviour but this does not necessarily reduce the number of incidents of abuse. The programmes should be seen as part of a community approach to prevent child sexual abuse. This is the conclusion of this Campbell/Cochrane systematic review of the best international research findings.AbstractBackgroundChild sexual abuse is a significant problem that requires an effective means of prevention.ObjectivesTo assess: if school‐based programmes are effective in improving knowledge about sexual abuse and self‐protective behaviours; whether participation results in an increase in disclosure of sexual abuse and/or produces any harm; knowledge retention and the effect of programme type or setting.Search strategyElectronic searches of Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, CINAHL, Sociological Abstracts, Dissertation Abstracts and other databases using MESH headings and text words specific for child sexual assault and randomised controlled trials (RCTs) were conducted in August 2006.Selection criteriaRCTs or quasi‐RCTs of school‐based interventions to prevent child sexual abuse compared with another intervention or no intervention.Data collection &amp; analysisMeta‐analyses and sensitivity analysis, using two imputed intraclass correlation coefficients (ICC) (0.1, 0.2), were used for four outcomes: protective behaviours, questionnaire‐based knowledge, vignette‐based knowledge and disclosure of abuse. Meta‐analysis was not possible for retention of knowledge, likelihood of harm, or effect of programme type and setting.Main resultsFifteen trials measuring knowledge and behaviour change as a result of school‐based child sexual abuse intervention programmes were included. Over half the studies in each initial meta‐analysis contained unit of analysis errors. For behaviour change, two studies had data suitable for meta‐analysis; results favoured intervention (OR 6.76, 95% CI 1.44, 31.84) with moderate heterogeneity (I2=56.0%) and did not change significantly when adjustments using intraclass coefficients were made. Nine studies were included in a meta‐analysis evaluating questionnaire‐based knowledge. An increase in knowledge was found (SMD 0.59; 0.44, 0.74, heterogeneity (I2=66.4%). When adjusted for an ICC of 0.1 and 0.2 the results were SMD 0.6 (0.45, 0.75) and 0.57 (0.44, 0.71) respectively. Heterogeneity decreased with increasing ICC. A meta‐analysis of four studies evaluating vignette‐based knowledge favoured intervention (SMD 0.37 (0.18, 0.55)) with low heterogeneity (I2=0.0%) and no significant change when ICC adjustments were made. Meta‐analysis of between‐group differences of reported disclosures did not show a statistically significant difference.Reviewers’ conclusionsStudies evaluated in this review report significant improvements in knowledge measures and protective behaviours. Results might have differed had the true ICCs from studies been available or cluster‐adjusted results been available. Several studies reported harms, suggesting a need to monitor the impact of similar interventions. Retention of knowledge should be measured beyond 3‐12 months. Further investigation of the best forms of presentation and optimal age of programme delivery is required.

Evidence for a Dissociative Subtype of Post-Traumatic Stress Disorder Among Help-Seeking Childhood Sexual Abuse Survivors

ABSTRACT This study examined evidence for a dissociative subtype of post-traumatic stress disorder (PTSD) among women seeking psychotherapy for childhood sexual abuse (CSA). One hundred and twenty-two women seeking treatment for CSA completed a battery of questionnaires assessing PTSD, dissociative symptoms, and child maltreatment. Using signal detection analysis, we identified high and low dissociation PTSD subgroups. A constellation of three PTSD symptoms-hypervigilance, sense of foreshortened future, and sleep difficulties–discriminated between these two subgroups (OR = 8.15). Further evidence was provided by the finding of a nonlinear relationship between severity of childhood maltreatment and dissociation in the women with PTSD. These results provide support for a dissociative subtype of PTSD that may stem from more severe childhood experiences of neglect and abuse.

Increasing the Usability of Cognitive Processing Therapy for Survivors of Child Sexual Abuse

ABSTRACT There is an ongoing need for empirically based treatments for child sexual abuse (CSA) that are time-efficient and cost-effective. This article describes a modification of cognitive processing therapy for child sexual abuse (CPT-SA) that increases the therapy's usability by reducing the number of individual therapy sessions required. The modifications are based on the developing literature on stage-based approaches to the treatment of CSA and incorporate dialectical behavior therapy skills training into the treatment protocol. Initial pilot data (N = 6) on modified CPT-SA suggests the therapy may be effective for the treatment of posttraumatic stress disorder (PTSD) and depression.

Child sexual abuse reporting behaviour by school counsellors and their need for further education

Objective To examine a statewide sample of school counsellors' reporting behaviour of suspected cases of child sexual abuse, and their need for further education in this area. Design A questionnaire using four hypothetical vignettes on child sexual abuse requested information on the degree of suspicion, reporting behaviour and familiarity with the reporting procedures for child sexual abuse in state schools in particular, and the state in general. Setting Although school counsellors in Queensland, Australia have been delegated with responsibilities regarding child sexual abuse, little is known about whether or not they have the appropriate reporting behaviours to fulfil these roles, and their training needs. Metliod Some 283 questionnaires were mailed to all school counsellors employed by the Department of Education across Queensland. The final sample of 122 counsellors consisted of 52 males (43 per cent) and 70 females (57 per cent); a ratio comparable to the membership of the state Counselling Association. Results There was a tendency for school counsellors to under-report their suspicions of child sexual abuse. School counsellors were more likely to suspect abuse than report cases to the appropriate authorities. A considerable proportion of school counsellors in Queensland also believe they have little knowledge of the symptoms that identify cases of child sexual abuse, lack counselling skills and procedures to work with sexually abused children, and do not have the necessary training and knowledge to act as resource persons. All school counsellors expressed interest in attending in-service education programmes addressing knowledge, detection, intervention, prevention and treatment of child sexual abuse and other forms of child abuse. Conclusion School counsellors are in a unique position to aid in the battle against child sexual abuse. However, the results of the present study suggest that they lack confidence in their ability to identify and work with children who have been sexually abused. Consequently, the develop ment and implementation of training programmes to increase school counsellors'skills and knowledge of child sexual abuse seem to be crucial in fighting this crime against children. Because of the significant deficits found here in counsellors' professional responses to child sexual abuse, it seems necessary, then, for future research to address the type, nature and duration of support school counsellors need in this area, including emotional factors, which may well intervene in the process. Research could also address the range of policies that could identify quality of relationships and inter-professional partnerships with other helping professionals and government organisations such as the Department of Families, Department of Health, Children's Commission, police, social workers, private counsellors, and, of course, school teachers, in order to promote whole school approaches to enhancing the welfare of all children.

The Science of Child Sexual Abuse

Child sexual abuse (CSA) involving sexual contact between an adult and a child has been reported by approximately 20% of women and 5 to 10% of men worldwide. A history of CSA leads to serious mental and physical health problems, substance abuse, and criminality in adulthood. Scientific study of CSA is currently underfunded, obscured by contentious forensic controversy, and fragmented by discipline. From public health, economic, ethical, and scientific perspectives, the authors of this Policy Forum recommend interdisciplinary consensus panels and increased intellectual investment in CSA research, prevention, intervention, and education.

Use of sexual intercourse to reduce negative affect as a prospective mediator of sexual revictimization

Increased risk of adult sexual assault (ASA) among women who experienced child sexual abuse (CSA) is well established. The strategies these women use to reduce negative affect secondary to CSA, such as sexual contact, may mediate the link between CSA and later ASA. Two waves of data from a racially diverse sample (i.e., 46% Black, 46.1% White, 7.9% other) of community women (N = 776) were analyzed using structural equation modeling. A history of CSA was associated with a twofold increase in the likelihood of experiencing ASA between the two measurement occasions (approximately 6 years). Psychological distress (i.e., depression, anxiety) and use of sex to reduce negative affect partially mediated the relation between CSA and prospective ASA. Implications for the treatment of CSA and prevention of sexual assault are discussed.

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

AbstractThe 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 significantly benefit 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 &amp; Sons, Ltd.

Sexual abuse in prepubertal children and adolescents.

Medical involvement in the diagnosis and treatment of child sexual abuse (CSA) has a well-defined role within a multidisciplinary concept. Due to the increasingly high rate of normal anogenital findings in victims of CSA, forensic aspects are of limited value in establishing the diagnosis. In selected cases however, medical findings may play an important role in corroborating a child’s history. Correct evaluation of normal and abnormal findings, normal variations and several differential diagnoses requires sound knowledge in pediatric gynecology. In some cases, physical consequences of CSA (injuries, infections, and pregnancy) need to be diagnosed and treated (prevented) accordingly. The majority of abused children have an altered and distorted body image. It is of paramount importance to reassure the child that its body is normal, physically undamaged, intact or that it will heal (‘primary therapeutic aspect of the medical examination’). Thus, the medical examination has an enormous potential to incorporate a therapeutic message into the diagnostic procedure if performed in a qualified and sensitive manner. By communicating with the psychosocial und jurisdictional systems, physicians may initiate proper child protection and therapy. Therefore, medical evaluation of sexually abused children must always be integrated into a multiprofessional concept of child protection.

Pharmacology for post-traumatic stress disorder related to childhood sexual abuse: a literature review.

Post-traumatic stress disorder (PTSD) related to pharmacotherapy responses in general and specifically to noncombat symptomatology related to childhood sexual abuse. To explore findings related to pharmacological advances in the treatment of PTSD and relate the findings to the treatment of childhood sexual abuse. Published literature. The literature on pharmacotherapy for PTSD in general and childhood trauma and PTSD in particular is small and inconsistent, but we need to be aware of any and all advances.

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. J Pediatr Health Care. (2002). 16, 187-192.

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. J Pediatr Health Care. (2002). 16, 187-192.

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

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. 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. 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. Residential care of sexually abused children should be based on sound developmental principles and caregiver sensitivity.