A meta-analysis of the published research on the effects of child sexual abuse

A meta-analysis of the published research on the effects of child sexual abuse (CSA) was undertaken for 6 outcomes: posttraumatic stress disorder (PTSD), depression, suicide, sexual promiscuity, victim-perpetrator cycle, and poor academic performance. Thirty-seven studies published between 1981 and 1995 involving 25,367 people were included. Many of the studies were published in 1994 (24; 65%), and most were done in the United States (22; 59%). All six dependent variables were coded, and effect sizes (d) were computed for each outcome. Average unweighted and weighted ds for each of the respective outcome variables were .50 and .40 for PTSD, .63 and .44 for depression, .64 and .44 for suicide, .59 and .29 for sexual promiscuity, .41 and .16 for victim-perpetrator cycle, and .24 and .19 for academic performance. A file drawer analysis indicated that 277 studies with null ds would be required to negate the present findings. The analyses provide clear evidence confirming the link between CSA and subsequent negative short- and long-term effects on development. There were no statistically significant differences on ds when various potentially mediating variables such as gender, socioeconomic status, type of abuse, age when abused, relationship to perpetrator, and number of abuse incidents were assessed. The results of the present meta-analysis support the multifaceted model of traumatization rather than a specific sexual abuse syndrome of CSA.     

Female perpetrators of child sexual abuse: A review of the clinical and empirical literature

Although women have long been viewed as offenders in cases of physical child abuse, it is only recently that clinicians and researchers have begun to seriously consider the problem of female-perpetrated sexual abuse of children. The purpose of the present paper is to review existing clinical and empirical literature on female sex offenders, in order to develop a summary profile of female perpetrators that may be of value to professionals involved in the assessment and treatment process.     

From child pornography offending to child sexual abuse: A review of child pornography offender characteristics and risks for cross-over

In this review, concrete directions are provided for individual risk assessment, treatment planning, and future research on child pornography offending. First, based on reviewing offender characteristics, including demographics, socio-affective difficulties, cognitive distortions and psychosexual issues, it is concluded that despite individual differences, many child pornography offenders have psychological difficulties in multiple areas of functioning. Based on earlier child pornography offender typologies, it is proposed that risk factors of individual offenders can be viewed along the lines of two continua: (1) features related to criminal behavior, and (2) sexual deviance/fantasy. These continua not only give insight into psychological differences between offender types, but also allow for variation in the severity of psychological difficulties within offender types and therefore may enhance individual risk assessment and treatment planning. Moreover, risk factors for cross-over are discussed, including individual characteristics, factors related to engagement with the internet, and the offline environment. Future research should focus on the integration of risk domains within particular offending types. Specifically, research is needed on non-offending pedophiles in order to gain more insight into the relationship between pedophilia and child pornography offending in general.     

Pre-trial therapy for child witnesses in cases of sexual abuse: A scoping literature review

Globally, child complainants of sexual abuse are expected to testify in criminal proceedings and in some countries therapy is delayed until after the child testifies as not to contaminate the child’s version of events. We carried out a scoping review of the literature on the provision of pre-trial therapy to child witnesses in cases of sexual abuse, to identity pertinent practice issues. We searched the following data bases: Academic FileOne, CINAHL, Cochrane Library, eBook (EBSCOHost); HeinOnline, OAPEN Library, PscyhARTICLS, PscyhINFO; SocINDEX, ScienceDirect, Google Scholar, and Scopus. We identified white and grey literature for the period spanning 1980 to 2016. Inclusion criteria included studies published in English, experimental studies, literature reviews, and policy documents relating to the provision of pre-trial therapy for child witnesses in criminal cases of sexual abuse. We discovered that an internationally accepted clear definition of pre-trial therapy is needed to ensure a common understanding thereof amongst all role players. A dearth of empirical studies exists and consequently the possible impact of different forms of therapeutic approaches on the child witness’ testimony is yet to be conclusively determined. In the interim, therapists and other role players should be acutely aware of the impact of different forms of therapy on the child witness’s testimony.     

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.     

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.     

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.     

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.     

Male sexual abuse: A review of effects,abuse characteristics,and links with later psychological functioning

Despite the increasing awareness of sexual victimization involving males, there remain a number of factors (e.g., stigma of homosexuality, male ethic of self-reliance) that continue to contribute to the underreporting of such cases. Nonetheless, there appears to be growing recognition of male sexual abuse as a serious problem with potentially numerous debilitating consequences. The clinical and research literature presently contains a number of articles on issues pertaining to males who have experienced sexual abuse during childhood. The purpose of the present paper is to review some of the more recent literature on the short- and long-term effects commonly found among sexually abused males. These effects, which include depression, self-blame, low self-esteem, anger, anxiety, and sexuality problems, are also compared with findings commonly reported among sexually abused females. In addition to sexual abuse effects, the present paper also reviews a number of important sexual abuse characteristics (e.g., age of abuse onset, duration of the abuse, nature of the sexual activity), examines the relationship of these characteristics to later psychological functioning, and explores gender similarities and differences. Finally, the implications of the findings with regard to treatment interventions are briefly discussed.     

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 impact of child sexual abuse on adult interpersonal functioning: A review and synthesis of the empirical literature

The many studies that have examined the long-term impact of child sexual abuse (CSA) on adult functioning have primarily focused on the personal distress of survivors, largely ignoring the impact of CSA on interpersonal relationships. This article reviews empirical findings concerning the interpersonal distress of survivors as expressed in their intimate and sexual relationships. First, current conceptualizations of the relationship between CSA and interpersonal relationships are reviewed, with a focus on the theoretical models that appear to have implications for the long-term interpersonal sequelae associated with CSA. This is followed by a review of the research conducted on intimacy within the area of social psychology and a summary of the empirical findings related to intimacy functioning in CSA survivors. A hypothesized typology of intimacy functioning for survivors is suggested. The effects of CSA on three components of sexuality—sexual dysfunctions, underlying psychological components of sexuality, and sexual orientation—are discussed. Finally, the interpersonal issues believed to be most salient for CSA survivors in the therapeutic setting are discussed, along with implications for the client–therapist relationship. Methodological, assessment, and conceptual issues are discussed throughout. Recommendations for future research and clinical endeavors are suggested.     

Sequelae of child sexual abuse: a child and parent assessment

We present a case example of a 9-year-old, biracial girl and her mother. We integrate data collected from rating scales (e.g., Child Behavior Checklist; Achenbach & Rescorla, 2001), a free response measure (Thematic Apperception Test; Murray, 1943), and a direct observation measure (Parent-Child Interaction Assessment-II; Holigrocki, Kaminski, & Frieswyk, 1999, 2002) and reveal how a child sexual abuse victim's internal representations and symptoms manifest in both an interpersonal context and in the realm of play. We discuss assessment findings regarding how they provide for an idiographic understanding of the child.     

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.     

Probative aspects of the medical evaluation for child sexual abuse

The medical evaluation of a child for sex abuse has been viewed by some as an acid-test for the presence of abuse. This article examines the medical evaluation for child sexual abuse, evidence potentially revealed by the examination, and the probative value of such evidence.     

Family process in the treatment of intrafamilial child sexual abuse

The paper describes the changes in family dynamics that occur throughout the process of family-orientated treatment of families where father–daughter incest or stepfatherr–stepdaughter child sexual abuse has occurred. A detailed step-by-step analysis of the developing family process in incest families during therapy is given. The analysis establishes the nature of the original pattern of family relationships, explores the impact made by crisis intervention on the family structure and then outlines therapy and termination of treatment. Characteristic mechanisms in the family process during therapy are described. A detailed clinical example demonstrates the basic therapeutic moves and the mechanisms involved.     

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.