The challenge of defining child sexual abuse

Although child sexual abuse has been a concern for many researchers, therapists, and advocates for the past 3 decades, several fundamental issues regarding child sexual abuse remain unresolved. In particular, the term child sexual abuse has never been unequivocally defined. The lack of a commonly accepted definition of child sexual abuse continues to inhibit research, treatment, and advocacy efforts. Early researchers used broad and inclusive definitions of child sexual abuse--definitions that often continue to be used today. The consequences of these definitions are discussed, and strategies for developing other definitions of child sexual abuse are suggested.     

Risk of sexual revictimization: A theoretical model

Survivors of child sexual abuse suffer serious short- and long-term psychological consequences. Sexual revictimization as an adult is one of the consequences that has been reported. At present, there is no theoretical model identifying the risk factors that result in child sexual abuse survivors being at greater risk of experiencing an adult sexual assault. The proposed model is designed to integrate existing research, stimulate further empirical work, and eventually aid in the development of a program to prevent revictimization. The variables hypothesized to play a mediating role in the pathway to revictimization include: severe psychological symptoms as a consequence of the child sexual abuse, poor coping styles, an insecure attachment style, hyperfemininity, delinquent behavior, drug use, and high risk sexual behavior.     

Attitudes toward consequences of pregnancy in young women attending a family planning clinic

This study examines the relationship between young women's knowledge and attitude concerning pregnancy and their sexual behavior. The study involved 78 young women (14-20 years of age) who had attended a midwestern family planning clinic. Primarily from a larger socioeconomic status, 70% of the participants said that they had never been pregnant. Adapting the testing methods of previous investigations, the study presented the participants with various exams intended to measure the following: 1) knowledge concerning "how babies are made"; 2) knowledge regarding intercourse and pregnancy; 3) anticipation of future consequences of adolescent childbirth; 4) anticipation of immediate consequences or fears of adolescent pregnancy. The study also examined the participants' contraceptive behavior and pregnancy history. The findings indicate that knowledge concerning understanding "how babies are made" does not influence sexual behavior, with no significant difference found between contraceptive users and non-contraceptive users. Also, the participants generally had accurate knowledge concerning intercourse and pregnancy. But the study did reveal significant differences in the evaluation of the consequences of pregnancy and childbirth. Those women who had previously been pregnant -- including those who had terminated their pregnancies -- showed a less negative attitude towards the consequences of pregnancy and childbirth than those who had never been pregnant. Furthermore, as the age of the women increased, the attitude became more positive. However, the study found that the attitude towards the consequences of pregnancy and childbirth had no impact on contraceptive behavior.     

Adolescent pregnancy: implications for prevention strategies in educational settings

Over 1 million teenagers become pregnant each year in the U.S. The most alarming increases have occurred among adolescents who are younger than 15 years of age. Variables strongly associated with teen pregnancy include minority status, low socioeconomic status, low academic achievement and occupational aspirations, and growing up in a single- parent household. A majority of teenage pregnancies are unintended, and pregnancy is the largest contributor to school dropout rate for U.S. adolescent females. During pregnancy, adolescent mothers suffer higher rates of health complications, and after childbirth they receive less education, have more children, and are more likely to be dependent on welfare. Psychologists employed in educational settings are in a unique position to be involved in adolescent pregnancy prevention efforts, and schools are increasingly considered to be appropriate environments for this purpose. Progressive school-based family planning programs have been established by the St. Paul/Ramsey Medical Center in St. Paul, Minnesota, and by the Johns Hopkins University Medical Center in Baltimore, Maryland. Both programs emphasize the distribution of contraceptives. An increasing number of school programs focus their efforts on helping adolescents become more responsible in their approach to sexual relationships, though they do not distribute contraceptives. A number of innovative community-based programs have also been formed that utilize multiple strategies to provide positive alternatives to pregnancy. Before setting up teen pregnancy prevention programs, school psychologists should try to learn from the lessons offered by established programs. They should also consult with teachers, administrators, students, and parents, and they should decide what instructional approaches are appropriate for their own situations.     

La fausse couche : du côté des hommes

ObjectiveThe experience and psychological consequences of a miscarriage have been widely studied but mainly among women. This qualitative study aims to examine the experience of men whose woman has had a spontaneous abortion.MethodThirteen men who have lost an early pregnancy during the five past years participated to a semi-directive interview. The interview was based on the analytical framework previously established and took into account various themes such as psychological experience, marital relationship, guilt, coping strategies, social support given to the spouse, and significance of the loss. All the interviews have been transcribed and studied with a thematic analyse.ResultsResults underline the difficulties linked to the experience of miscarriage among men. Many of them were shocked and have had a sustainable significant distress expressed by sadness, tears or depressive symptoms. In addition to their own difficulties, men have to confront women's distress and want to be a support. Guilt was expressed more or less directly, concerning the miscarriage but also concerning men's reactions toward women. Some of them who encountered psychological problems found very difficult not to be able to support their wife. A miscarriage is a difficult event for a couple and two men interviewed separated shortly after. Several coping strategies were used by men, the most common were seeking social support and avoidance. As in women, significance of the loss was different among men, some of them have lost a child, others an embryo or a life project.ConclusionResults show the variety of feelings and reactions of men that highlight the need to consider their psychological distress. While all men are not equally involved in miscarriage, difficulties encountered by some of them can last several months. Given this results, support interventions for males seems interesting.     

Adolescent sexuality and public policy

In recent decades, various attempts have been made to determine the level of sexual activity among adolescents. This information has been used in the planning and evaluation of sex-related programs. However, there is a flaw in using only the initial estimates of the behavior--that a sexually active person is defined as one who has had sexual intercourse. This narrow definition distorts the perception of adolescent sexual behavior. Sexual activity can more accurately be designated by focusing on the actual frequency with which teenagers have sex. In this research report, adolescents were considered sexually active if they had had sex within the last four weeks. Using this definition, adolescents were found to be substantially less sexually active than has been previously reported. This finding was then used to look at various policy decisions in the areas of sex education, family planning, and sexually transmitted disease prevention.     

Consequences of Child and Adult Sexual and Physical Trauma among Deaf Adults

The purpose of this study was to evaluate the consequences of sexual and physical trauma among a sample of deaf adults. Thirty-two men and 45 women completed the Life Event Checklist (LEC), the Clinician Administered PTSD Scale (CAPS), the Trauma Symptom Inventory (TSI), the Somatoform Dissociation Questionnaire–20 (SDQ–20) and a sociodemographic questionnaire. In this sample, 40.6% of the male participants and 53.3% of the female participants had experienced some type of sexual trauma during their lifetimes. Physical trauma was reported by 75% of males and 71.1% of female participants. For those who had experienced childhood sexual trauma, the odds ratio of revictimization in adulthood was 6.69. Sexual trauma also rarely occurred by itself. Two thirds of all participants with sexual trauma histories also reported some type of physical abuse. Participants with sexual trauma histories displayed significantly more symptoms of PTSD and depression than people without such trauma history. Physical and sexual abuse represent significant problems in the deaf community. The authors include a call for the development of targeted intervention attempts to prevent further victimization in deaf child and adolescent populations.     

Long-term correlates of child sexual abuse: Theory and review of the empirical literature

Since Browne and Finkelhor's (1986) seminal review of the impact of child sexual abuse, there has been a dramatic increase in the child sexual abuse literature. Because of this tremendous growth in the literature, a more current review is warranted. The focus of this paper is a review of the long-term correlates of child sexual abuse published since 1987. Sexually abused subjects report higher levels of general psychological distress and higher rates of both major psychological disorders and personality disorders than nonabused subjects. In addition, child sexual abuse survivors report higher rates of substance abuse, binge eating, somatization, and suicidal behaviors than nonabused subjects. Adult survivors of child sexual abuse report poorer social and interpersonal relationship functioning, greater sexual dissatisfaction, dysfunction and maladjustment including high-risk sexual behavior, and a greater tendency toward revictimization through adult sexual assault and physical partner violence. The long-term correlates of child sexual abuse are conceptualized within a theoretical framework based on a theory of emotional avoidance. Although more recent empirical findings have demonstrated improved designs and methodology, these studies continue to be limited in their generalizability. Recommendations for future research are discussed.     

重要他人情境对青少年意图判断诺布效应的影响*

设置了母亲、朋友、老师三类重要他人,副作用结果为积极和消极两种性质的实验故事共六个,选取311名中学生阅读故事并回答问题,以此探讨青少年诺布效应的特点及其与心理状态理解的关系。结果表明：（1）青少年在对不同重要他人的积极副作用情境进行意图判断时,表现出典型的诺布效应,但在对不同重要他人的消极副作用情境进行意图判断时,没有表现出诺布效应;（2）母亲、朋友和老师这三类重要他人对于青少年意图判断的影响没有显著差异;（3）初中生和高中生、男生和女生的意图判断没有显著差异;（4）青少年认为,由消极副作用引起的被行为者的情绪以负性情绪为主,而行为者的情绪则以正性情绪为主。本研究的结论是：青少年在进行意图判断时仅出现了不完全的诺布效应。     

Sibling Child Sexual Abuse Research Review and Clinical Implications

SUMMARY

Although sex play is a part of normal childhood development, some sexual activity may be coerced or forced and may have negative long-term consequences and, thus, be considered abusive. However, childhood sexual abuse perpetrated by siblings, cousins, or peers receives relatively little attention from either researchers or practitioners. In the present article, the literature on sibling child sexual abuse is critically reviewed, and particular attention is focused on defining sibling sexual abuse, and determining its scope and effects. Clinical Implications are derived as well. Although the article focuses on sibling sexual abuse, the concepts considered here also apply to other forms of same-age (or near same-age) child sexual relationships.     

The sentiments of love and aspirations for marriage and their association with teenage sexual activity and pregnancy

This study questions the findings of most research claiming that teenage pregnancies are generally unwanted, unplanned and unintended. It starts with the question of why most sexually active teenagers put themselves at risk of becoming pregnant if they do not desire it. The hypothesis is that sentiments of "love" and "aspirations for marriage" are related to starting sexual activity and subsequent pregnancy. The sample is 123 school-age mothers. It was found that sentiments of "love" were associated with becoming pregnant more than with starting sexual activity. Most of the respondents who were "in love" at the onset of pregnancy were hoping to marry their sex partners and, in fact, many thought that marriage would occur in the very near future following the outcome of pregnancy. These findings suggest that more research needs to be directed at the development of affective bonds with and the aspirations for marriage to the sex partners. Such research may explain why these teenagers put themselves at risk.     

Suicidal behaviour and suicidal ideation in adolescents: A problem for counsellors in education

Some of the research findings on the prevalence, causes and possible prevention of suicidal behaviour and suicidal ideation in adolescents, including students, are reviewed. Both completed and attempted suicide (parasuicide) in teenagers is increasing. A number of factors appear to be associated with suicidal behaviour: cultural factors such as those arising from the stresses of discrimination; disorganised and unstable family life, especially that which involves the child in early separation from a parent; sexual imbalances in educational institutions; and an increase in anomie which is associated in the young with a variety of self-indulgent behaviour. Some data on suicidal ideation in a sample of English adolescents are reported, with suggestions for using such questionnaire data for identifying teenagers in need of counselling.     

Little girls and sex: A glimpse at the world of the “baby pro”

The literature on child prostitution is limited. There is some historical documentation, but data on contemporary empirical observations is generally unavailable. Moreover, most studies have focused on teenagers rather than on children. Drug abuse was the original concern of this investigation. During the course of the research, nine girls between the ages of 8 and 12 were encountered who admitted involvement in prostitution and/or pornography. They were not runaways. Rather, they had been introduced to their careers by relatives. Their initiation into sex seemed to be motivated by fear of rejection, their drug involvement did not appear to be associated with their sexual activities, and they did not seem to be traumatized by their early association with sex.     

Prevalence of Children's Exposure to Domestic Violence and Child Maltreatment: Implications for Prevention and Intervention

The purpose of this paper is to review research on the prevalence of children's exposure to domestic violence, to consider the available literature on the co-occurrence of domestic violence and child maltreatment, and to gain more understanding about the impact of exposure on children. There is clear evidence indicating that both severe and moderate violence occurs frequently in homes among family members and that children are exposed to this violence. However, because of differing definitions of what constitutes domestic violence and variability in research methodologies for collecting the data, there are significant discrepancies in prevalence reports across studies. Of great concern is the immediate impact on the children and the long-term consequences for their later relationships. Fewer studies have been done on the co-occurrence of domestic violence and child maltreatment. However, it is likely that children who live in homes where domestic violence occurs are more likely to be abused and neglected. On the basis of available research, there is little doubt that vast numbers of children are exposed to domestic violence and that children's responses vary widely depending on their risk and vulnerability, as well as the structure of their environments. A developmental risk and protective factors framework will be used to integrate the information on children's exposure to violence.     

Predicting Risky Sexual Behavior: the Unique and Interactive Roles of Childhood Conduct Disorder Symptoms and Callous-Unemotional Traits

Conduct disorder (CD) symptoms and callous-unemotional (CU) traits have been shown to be uniquely associated with risky sexual behavior (RSB) in adolescence and early adulthood, yet their interactive role in predicting RSB remains largely unknown. This study aimed to investigate the predictive value of CD symptoms and CU traits, as well as their interaction, on several RSB outcomes in adolescence and early adulthood. A total of 683 participants (41.7 % female, 47.4 % African American) were followed annually and self-reported age of first sexual intercourse, frequency of condom use, pregnancy, contraction of sexually transmitted infections, and engagement in sexual solicitation from grade 7 to 2-years post-high school. CD symptoms predicted age of first sexual intercourse, condom use, and sexual solicitation. CU traits predicted age of first sexual intercourse and pregnancy. Their interaction predicted a composite score of these RSBs such that CD symptoms positively predicted the composite score among those with high levels of CU traits but not among those with low levels of CU traits. The current findings provide information regarding the importance of both CD symptoms and CU traits in understanding adolescent and early adulthood RSB, as well as the benefits of examining multiple RSB outcomes during this developmental period. These findings have implications for the development and implementation of preventive efforts to target these risky behaviors among adolescents and young adults.     

Predictive Testing of Eighteen Year Olds: Counseling Challenges

Genetic counseling of teenagers is challenging and complex. The ability to think abstractly, a sense of self and independence from family all develop during adolescence. Predictive genetic testing counseling protocols presuppose that these qualities exist, requiring the at-risk individual to consider the short and long term consequences of testing as well as their motivations. Eighteen year olds are in transition from adolescence to adulthood; eligible for predictive genetic testing, they may not yet be independent of their family or able to articulate their feelings. This paper presents case studies from the authors' clinical practice to illustrate some of the difficulties faced by genetic counselors when 18 year olds request predictive testing for Hereditary Non-Polyposis Colorectal Cancer. By reflecting upon their experiences with these young adults and their families, the authors' intention is to generate discussion about genetic counseling strategies, particularly for predictive genetic testing, that are both age-appropriate and family-sensitive.     

Attribution of control and teenage pregnancy

In rural Appalachia in Tennessee, data on 13 female adolescents who had experienced a pregnancy (mean age=16 years, 7 months) were compared with those on 38 female adolescents who had not experienced a pregnancy (mean age-16 years, 4 months) to test the hypothesis that teenagers who experience a pregnancy have external attributions of control over their life events. The Nowicki-Strickland Locus of Control Scale for Children was administered to determine their beliefs about causes of events in their lives. All the girls were white and matched for socioeconomic status, housing, and cultural background. The mean attribution of control to external agents score stood at 14.5 for girls who had experienced a pregnancy compared with 12.7 for those who had not experienced a pregnancy, but the difference was not significant (p=.08).54% of the cases exhibited external attributional orientation compared with 16% of the controls (p.02). This finding concurred with that of earlier studies. The fact that not all the girls who had experienced a pregnancy had external attributional orientation suggested that it is not the only factor linked to adolescent pregnancy. Studies have not identified whether external attributional orientation is a causal factor or consequence of adolescent pregnancy. A 1980 study found that women who had shown more external locus of control scores during pregnancy and tended to castigate themselves had a high probability of postpartum depression. Another study indicated that rises in depression among adolescents were linked to prechange orientations toward external attributions of control. Practitioners should selectively pay attention to teenagers who have extreme attributional orientations since many teenagers carry their pregnancies to term and choose to rear their infants. These orientations appear to pose risks for the adolescent mother and her children.     

Information and attitudes about HIV/AIDS in Portuguese adolescents: state of art and changes in a four year period

The incidence of infection with HIV/AIDS among the heterosexual population has been increasing in young adults. The goal of this research was to deepen knowledge of preventive sexual behavior in Portuguese adolescents, including knowledge and attitudes about HIV/AIDS, and assessing whether they changed from 2002 to 2006. Data were collected through a self-administered questionnaire from the Portuguese sample of the Health Behavior in School-aged Children (HBSC), a collaborative WHO study. The study provides national representative data of 7093 Portuguese adolescents, randomly chosen from those attending 8th and 10th grade of high school. Results showed there was an increase in the age of first sexual intercourse and a decrease in the number of teenagers who reported having had sexual intercourse, also in the level of information regarding HIV/AIDS transmission/prevention and in positive attitudes towards people with HIV/AIDS. In general, adolescents have good knowledge about how to protect themselves from becoming infected. However, comparing to 2002, there was a reduction of knowledge and consequent increase in the doubts regarding HIV/AIDS. Given the incipient state of sex education in 2006, the results cannot be attributed to sex education, but they will be relevant for comparison with the 2010 HBSC results.     

Accounting for sex differences in depression through female victimization: Childhood sexual abuse

Unipolar depression is nearly twice as prevalent is women as men (Nolen-Hoeksema, 1987). Several theories attempting to account for this disparity have been proposed, but none has yet systematically considered women's victimization experiences as a possible significant contributor to their high risk for later depression. One type of victimization that is much more common in females than males is child sexual abuse. Recent research indicates that the long-term effects of child sexual abuse include anxiety, depression, and low self-esteem. In this paper, we review research suggesting that child sexual abuse can account for a significant portion of the differences in the rates of depression between females and males.