Comparison of behaviors of suspected sexually abused and nonsexually abused preschool children using anatomical dolls

Using anatomical dolls, the play behaviors of nine sexually abused preschool children (five males, four females), ranging in age from 3 to 5 years, were compared with nine preschool children for whom there was no suspicion of sexual abuse and who were matched on the basis of age, gender, race, family status, and socioeconomic status. There was no significant difference between the two groups on explicit sexual behavior (vaginal, oral, and anal intercourse with thrusting motions between the dolls or between the child and the dolls and masturbation by the child). The groups were significantly [t(8)=2.19, p <.05; Wilcoxon W=6, p <.05) different when behaviors with suspicious sexual implication were combined with explicit sexual behaviors. There were no differences between the groups on measures of nonsexual behavior. The occurrence of the suspicious sexual behaviors is discussed and reviews of previous doll research and physical evidence of child sexual abuse are provided.This project was supported in part by a grant from The Graduate College of Western Michigan University, Kalamazoo, Michigan.     

The use of anatomically detailed dolls in sexual abuse evaluations: The state of the science

In child sexual abuse investigations, anatomically detailed dolls (ADDs) are used frequently with the intention of facilitating expression or demonstration in children who do not disclose abuse verbally. We review and critique research that examines the play of nonabused children with ADDs, compares the ADD play of abused children with that of nonabused children, or compares ADD-aided interviews with interviews using other data-gathering methods. We conclude that the APA Council of Representatives' recent statement (February 8, 1991) endorsing the use of ADDs by certain examiners and the current research on this topic are incompatible.     

Children's use of anatomically detailed dolls to report genital touching in a medical examination: developmental and gender comparisons

The influence of anatomically detailed dolls on 3- and 4-year-old children's reports of a routine medical exam was examined. During the exam, half the children received a genital examination and half the children did not. Immediately after the exam, all children were asked to demonstrate various events on an anatomically detailed doll and on their own bodies. Although there were age differences in the number of accurate demonstrations of how the doctor used different instruments, there were no age differences on measures that assessed reports of genital touching. Among girls, commission errors were more frequent when dolls were used because some children falsely showed insertions into the anal or genital cavity. The authors conclude that dolls should not be used in interviews with children below the age of 5 years.     

Social relations of sexually abused children: A social information processing analysis

The implications of sexual abuse for the child’s interpersonal functioning and environment have been insufficiently understood, and this has repercussions that may limit comprehensive assessment and effective treatment. We suggest that clinicians and researchers need to address the new social challenges that may confront a sexually abused child. A social information processing model and its implications for therapy, and understanding the social difficulties of the sexually abused child, is presented.     

Treatment for sexually abused children and adolescents

The authors review research demonstrating the variable effects of childhood sexual abuse, the need for intervention, and the effectiveness of available treatment models. The well-controlled treatment-outcome studies reviewed do not focus on sensationalistic fringe treatments that treat sexually abused children as a special class of patients. Instead, studies demonstrate empirical evidence for extending and modifying treatment models from mainstream clinical child psychology to sexually abused children. The authors propose a continuum of interventions to meet the needs of this heterogeneous group. Interventions range from psychoeducation and screening, to short-term, abuse-focused cognitive-behavioral therapy with family involvement, to more comprehensive long-term plans for multiproblem cases. Last discussed are gaps in the research and suggestions for future research to address the pressing dilemmas faced by clinicians and policymakers.     

Activities and games for group psychotherapy with sexually abused children

As increasing attention is given to the practice of group psychotherapy with sexually abused children, clinicians are using games and activities designed to address issues related to sexual abuse and its prevention. This paper describes how specific games and activities can be used in group therapy with child victims. These games and activities include: prevention films, role plays, and communication board games. Benefits and risks associated with the use of these resources are also discussed.     

Adults sexually abused as children: Legal actions and Issues

This article first briefly discusses the problem of delayed memories and long-term effects of child sexual abuse and the current trend to bring civil lawsuits or criminal prosecutions for childhood sexual abuse. The article addresses the primary obstacle to such actions—the statute of limitations—which in most states places a time limit on when legal actions can be commenced. It describes the purpose of the statute of limitations and the need for changing or extending it in child sexual abuse cases; it then summarizes and analyzes the methods used by state legislation and judicial decisions to change or extend the statute of limitations in both criminal and civil actions. The article examines the pros and cons of bringing legal actions for child sexual abuse many years later, and concludes with a discussion regarding the current debate about the accuracy and authenticity of long-term memory and the advisability of legal reforms to extend or eliminate the statute of limitations in this area.     

Sexual dysfunction in women sexually abused as children

Women who were sexually victimized as children report problems in relating to both men and women. Studies have found that victims are less satisfied with their current sexual relationships and with the quality of their relationships with men in general. Fear of sex, arousal dysfunction and desire dysfunction were the most common sexual disturbances found in incest victims.The purpose of this paper was to examine the differences in sexual functioning in abused women who perceived themselves to be adjusted to the trauma of their sexual abuse and those who did not.A sample of 57 nonclinical adult women who had been sexually abused as children was studied. Data were analyzed by means of cross-tabulation, chi square statistics, analysis of variance, and multiple regression.Orgasm was experienced by 63% of the women. There was a significant interaction among ability to be an orgasmic, sexual esteem and adjustment to abuse. Over 56% of the women experienced physical discomfort during intercourse and 36% indicated that they needed sex therapy. The implications of these and other findings are discussed.     

A time-limited group therapy model for men sexually abused as children

This article explores the clinical dimensions of male child sexual abuse, and its effects upon these children in their adult lives. The number of men receiving therapeutic help for their sexually abusive past is unknown. Prevalence figures are equally elusive, but reporting of this abuse has steadily increased over the last decade. The majority of these children never tell anyone about their sexual victimization, and enter their adulthoods with long-term psychological difficulties. A short-term psycho/educational model is presented in order that more clinicians will treat this vastly underserved population.This article is dedicated to Marion Dragoon, with special thanks to Len Solomon, James Garland, and the staff of St. Luke's.     

Transference and countertransference issues with sexually abused clients

Abstract

This paper explores some of the therapeutic issues which arise when working with sexually abused clients. It is suggested that both the client and the therapist may at moments take any of the three positions in the Oedipal triangle and that the mother, father and child status are interchangeable in the transference and counter-transference. It is also suggested that the Oedipus myth represents the failure of a family to contain sexual and murderous passions. I describe a Hindu myth which takes a similar triangle of passion but illustrates how containment is possible. It is proposed that this implies we need to re-evaluate the presence of the erotic in therapy in a more positive light. It is further suggested that the sexually abused client needs to experience the containment of passion if a healing process is to occur.     

Internalizing and externalizing characteristics of sexually and/or physically abused children

This study evaluates the behavioral consequences of childhood abuse (sexual, physical, or both), with particular focus on prevalence of posttraumatic stress disorder (PTSD). Three abuse type groups and nonabused controls were contrasted on behavioral rating scales and on structured psychiatric interview data. The participants (109 abused children and 16 normal control children) were recruited from Arkansas Children’s Hospital and local agencies for abused children. As expected, proportionately more females than males were sexually abused. Overall, males were rated as more disturbed than females. Type of abuse did not consistently influence behavioral ratings. Externalizing scores were significantly higher than internalizing scores in all abused groups. PTSD was diagnosed in 50% of the abused children, with a higher rate for boys who had been sexually abused as opposed to physically abused only (58% versus 13%). The most frequent comorbid condition with PTSD was Separation Anxiety. Sexually abused boys were hospitalized for psychiatric treatment at a higher rate than were other abused children.     

Utility of cognitive-behavioral procedures for social skills training with children: A critical review

Thirty-three studies that have used cognitive-behavioral social skills training procedures were critically reviewed. These studies were classified under four broad categories: (a) modeling, (b) coaching, (c) treatment packages, and (d) social problem solving. Seven criteria were used to critically evaluate these studies: (a) subject characteristics, (b) treatment specification, (c) out come measures, (d) statistical analyses, (e) experimental design, (f) generalization, and (g) cost effectiveness.     

Multimethod assessment of depression in sexually abused girls

This study measured depression in sexually abused Black girls using the Children's Depression Inventory (Kovacs & A. T. Beck, 1977), the Internalization scale of the Child Behavior Checklist (Achenbach & Edelbrock, 1983), and the Rorschach Depression Index (Exner, 1986). There were no significant correlations between these self-report, behavior observation (by parental report), and projective measures. The abused subjects had high scores on the behavior observation and Rorschach scales. Consistent with past research, negative results were obtained with the self-report instrument. We suggest that the low scores on self-report measures of distress produced by sexually abused children may be the result of guardedness or defensiveness rather than a genuinely low level of dysphoria in this population. There were no significant relations between abuse characteristics and scores on the depression measures. Scores on Rorschach measures of organizational activity (Zf) and available coping resources (EA) were generally positively related to depression within the abuse group and negatively related to depression within the control group.     

Young children make scale errors when playing with dolls

Prior research (DeLoache, Uttal & Rosengren, 2004) has documented that 18- to 30-month-olds occasionally make scale errors: they attempt to fit their bodies into or onto miniature objects (e.g. a chair) that are far too small for them. The current study explores whether scale errors are limited to actions that directly involve the child's body. We investigated whether children would also make scale errors with a doll and objects that were much too small for the doll (e.g. a chair, a bed). Many participants did try to fit the doll into or onto the miniature objects. Thus, the previously documented phenomenon of scale errors extends to situations in which the relevant size difference is between two objects. This finding supports the view that scale errors occur when visual information about object size fails to influence the decision to act on an object. The results are discussed in terms of the use of visual information for the planning and control of actions.     

Case history of Farida: A year of psychotherapy with a girl who said she was sexually abused

This paper discusses how thinking about a playroom involves our thinking about the setting in psychoanalytical work with children in general - the physical as well as the human aspects - and how this encourages us to rethink some of the basic aims in psychoanalytic work. The paper describes the importance of the setting being such as to help the therapist to have the freedom to think and to feel what is going on in the child and himself. Links are then made with aspects of transference and counter-transference, and brief examples given.     

Parenting behaviors of women who were sexually abused as children in their families of origin.

This research explored links between a childhood history of family sexual abuse and current parenting behaviors of mothers of school-age children, using observations of family interaction and interviews with the mothers. Videotaped family interaction tasks, analyzed with Benjamin's Structural Analysis of Social Behavior, showed that women who had been sexually abused in their childhood families were more self-focused, rather than child-focused, compared to nonabused women. In interviews, the women who had been abused gave strong evidence of greater reliance on their children for emotional support. These findings lend support to theoretical and clinical impressions of highly permeable intergenerational boundaries, including parent-child role reversal, in family systems marked by child sexual abuse, even when the abuse occurred in the previous generation.     

Rorschach assessment of psychological functioning in sexually abused girls

We measured psychological functioning in a group of 79 Black females between the ages of 5 and 16 and a comparison group of nonabused girls using the Rorschach. In addition to Exner's (1985) Comprehensive System, the Elizur (1949) Rorschach Content Test Scale (RCT), the Mutuality of Autonomy Scale (MOA; Urist, 1977; Urist & Shill, 1982), and the Barrier and Penetration Scales (Fisher & Cleveland, 1968) were used. Sexually abused girls were found to show more disturbed thinking, to experience a higher level of stress relative to their adaptive abilities, to describe human relationships more negatively, and to show more preoccupation with sexuality than the comparison group. The distress experienced by the victimized children was more related to internal mediating variables then to abuse characteristics. Sexually abused girls who are cognitively and emotionally active also experienced high levels of distress compared to abused girls who are psychologically constricted.