Play Room as a psychological assessment method in cases of alleged child sexual abuse

This article presents an example of how psychoanalytic theory can be implemented in practice. The aim is to introduce and discuss the semi-projective material ‘Play Room’ which was originally developed to support prevention of sexual abuse among vulnerable children in Denmark. However, a recent study has shown that, when measured with a scale called Ability to Answer, children exposed to sexual abuse talked about the illustrations in Play Room in a significantly different way than did a clinical sample and a normal control group. The finding indicates the potential for expanding the scope of Play Room from prevention into clinical assessment, in cases of alleged child sexual abuse. Taking its starting point in the theory of Jean Laplanche, this article will discuss how psychoanalytic concepts such as seduction, translation, asymmetry, absence, and listening to listening can be used to describe the practice around Play Room. It is argued that, through the use of Play Room, the psychologist can encircle the lack of symbolization and inhibited creation of psychic representations that children exposed to sexual abuse typically convey. The discussion of Play Room’s assessment potential will be further fed by data from interviews with clinical child psychologists.     

The assessment of child sexual abuse allegations: using research to guide clinical decision making

As reports of child sexual abuse (CSA) have risen, greater attention has been focused on how clinicians evaluate allegations of abuse. A common theme in the CSA assessment literature is to encourage comprehensive, multimodal assessments. This recommendation, however, is rarely accompanied by suggestions regarding how clinicians might integrate and differentially weight the information gathered. The present article is designed to address the issue of which sources of information clinicians should rely upon when conducting CSA assessments. Specifically, the commonly used indicators and procedures for assessing allegations of abuse are identified and then examined in light of their respective empirical literatures. It is concluded that medical examinations and the child's report are among the best sources of information, and should therefore be most heavily relied upon to arrive at accurate decisions. Clinicians are encouraged to adopt the mind set of a scientist conducting an a priori, hypothesis-driven research investigation. This approach should help clinicians avoid the temptation of post hoc analyses that reflect personal biases more than the actual data. © 1998 John Wiley & Sons, Ltd.     

Risk factors for child sexual abuse

We review the risk and protective factors for child sexual abuse. Overall, characteristics of perpetrators, victims, and families of victims were moderate to strong risk factors for child sexual abuse. However, it is difficult to distinguish between risk factors for extra-familial and intra-familial child sexual victimization because most of the studies combined these two types of child sexual abuse, although the risk factors for these two types of child sexual abuse most likely differ. Research in this area is difficult because etiological and prevention models of victimization would differ substantially from those of perpetration. Given the low yearly prevalence of child sexual victimization, very large samples would be necessary to obtain sufficient power. Thus, most studies have used lifetime prevalence, which may provide much useful information but which add substantial time confounds. Finally, child sexual victimization is probably a misnomer, as the nature, impact, and etiology of sexual victimization most likely differs over the large age span of childhood and gender. Because improved models and prevention programs require improved etiological models (based on knowledge of risk and protective factors), we hope that this review will focus stakeholders on the need for continued research in this area.     

Neurobehavioral sequelae of child sexual abuse.

This study examined intellectual and memory functioning in a sample of sexually abused children compared to demographically and age-matched controls. The severity of abuse and other pertinent factors were also examined in relation to cognitive performance. Elevated levels of psychopathology were present in the abused children, as well as diminished performance on tasks influenced by attention/concentration. However, after controlling for differences in IQ and socioeconomic status (SES), significant differences in memory function were not found. Results are discussed in the context of stress effects on cognition and the potential resiliency of cognitive function in children undergoing treatment for sexual abuse.     

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.     

Testimony and evidence: a scientific case study of memory for child sexual abuse

Although case studies can provide insight into children's eyewitness memory, the typical lack of objective record limits evaluation of accuracy. In contrast, in this ‘scientific case study’, a detailed record of child sexual assault, documented by a ‘sex ring’ leader and confiscated by police, was available. In police interviews and courtroom hearings, four girls (8 to 15 years old at time of report) testified about sexual exploitation that involved eight adult men. The girls' allegations were compared with evidence contained in photographic and audiotaped records of the abuse. Overall, there was supportive evidence for about 80% of the allegations (85.6% of the alleged sexual acts; 42.9% of the alleged coercive acts; and 82.5% of the alleged preparatory acts). Levels of support for sexual act allegations were similar for all four girls, regardless of age, but the younger child made more unsupported allegations of coercive behaviour. Additionally, there were high levels of omission errors. Findings are discussed in the context of research on eyewitness testimony and child sexual abuse. Copyright © 2000 John Wiley & Sons, Ltd.     

Ethics and the forensic expert: a case study of child custody involving allegations of child sexual abuse

Psychologists who participate as forensic evaluators in custody and visitation cases involving allegations of child sexual abuse must possess advanced assessment skills and a thorough knowledge of child development, child sexual abuse, and child interviewing techniques. This case study illustrates the types of problems that are inevitable when psychologists violate the boundaries of their role as an independent evaluator and fail to uphold their ethical obligation to be knowledgeable and competent in the area in which they profess expertise.     

The assessment of child abuse potential and the prevention of child abuse and neglect: A policy analysis

A frequently advocated strategy for increasing the efficiency of child abuse prevention programs is to deliver prevention services to "high-risk" populations. This article critically reviews procedures for the reliable and valid assessment of child abuse potential within an ecological perspective. Factors that limit the usefulness of child abuse risk assessment are discussed. These factors include the uncertain criteria of child abuse and neglect, the low base rate of the phenomenon, and the financial and social costs of such procedures. Finally, the prevention implications of the current and future state of the art in child abuse risk assessment are considered and preventive interventions that do not depend on individual case risk screening are advocated.     

Evaluation of school-based child sexual abuse prevention program

The aim of the present work is to evaluate the efficacy of a program entitled "Prevention of child sexual abuse" the first structured program in Spain designed to prevent such risks. With this purpose, we carried out a study of 382 minors with ages ranging between 8 and 12 years. The result s show that the program has a very positive impact, increasing the awareness of the minors about this type of risk and improving their skills for coping with a possible event of sexual abuse. The efficacy of the program is also apparent, at the level of secondary prevention, in that it increased the likelihood that the children would reveal such events. Finally, exploration of the possible adverse effects of the program showed that the negative effects observed by parents and educators are negligible.     

The child sexual abuse victim: Assessment and treatment issues and solutions

Particular attention is given in this paper to the assessment process with child sexual abuse victims and recommendations are made regarding practical issues both in the assessment and the treatment phases of therapeutic work with child victims.     

Involving parents in child sexual abuse prevention programs

Conclusion The importance of involving parents in child sexual abuse prevention programs has been given much lip-service by prevention educators, but relatively little time, energy or resources in reality. This seems short-sighted at best, if the goal of these programs is truly prevention as they purport. Although the results of this study may have limited generalizability because of its sample size and its highly educated respondents, it is the first study to compare the knowledge of attending versus nonattending parents of a typical one-shot parent workshop. The results indicated that the parents as a whole were fairly well versed in the facts of sexual abuse, although as in previous studies, they did not extend the statistics on sexual abuse to their own children. However, probably the most important results were the enthusiastic responses for parent programs and involvement but in different formats, at different times, and in different environments than the current typical PTO evening, one-time meeting. Clearly child sexual abuse prevention programs should experiment with innovative ways to reach parents. If prevention programs can involve a small minority of motivated parents as they seem to be able to do, then together these parents and the educators may be able to develop methods and resources to involve the large majority of currently uninvolved parents. Such an integrated and involving community approach to the prevention of child sexual abuse seems necessary if the goal of prevention is ever going to be reached.     

A parenting group for women dealing with child sexual abuse and substance abuse

This article describes a group developed to address the parenting needs of women dealing with child sexual abuse and substance abuse. A solution-focused 12-week group intervention is described, and the results of an evaluation are presented. Participants included 29 women who attended seven parenting groups. The results suggest that the group was perceived as beneficial by the women, who reported an increase in self-esteem, parenting satisfaction, and parenting self-esteem and an improvement in their attitudes toward their children.     

Self-centeredness and the adult male perpetrator of child sexual abuse

Self-centeredness has been identified as a quality of the adult male perpetrator of child sexual abuse, but little or no effort has been expended toward defining the concept clearly. In this paper, the research literature on the perpetrator and psychoanalytic writings on narcissism are reviewed for the purpose of developing a comprehensive definition of self-centeredness. Literature related to the social and developmental context of child sexual abuse also is discussed. In the final section of the paper, implications for primary prevention and treatment are drawn.This is a revised version of a paper presented at the Groves Conference on Marriage and the Family, July, 1986, in London, England. Support for the paper was provided through the Minnesota Agricultural Experiment Station and the Faculty Summer Research Fellowship Program, Graduate School, University of Minnesota.     

Prevention of child sexual abuse. Myth or reality

Programs to prevent child sexual abuse have proliferated as a result of increased public awareness and professional documentation of its incidence. We describe the content and format of these prevention programs in general and examine selected programs for effectiveness. Although there is limited evidence for an increase in knowledge for program participants, most evaluations suffer from basic design problems and present few results indicative of either primary prevention or detection. Overall, we argue that self-protection against sexual abuse is a very complex process for any child and that few, if any, prevention programs are comprehensive enough to have a meaningful impact on this process. Finally, we discuss several untested assumptions that guide these programs. We conclude that it is unclear whether prevention programs are working or even that they are more beneficial than harmful.