Assessment of sexually abused children with anatomically detailed dolls: A critical review

The use of anatomically detailed (AD) dolls is widespread, especially with young children who have been, or may have been, sexually abused. A number of empirical studies have compared the responses of sexually abused and non-abused children to AD dolls. Additional research has assessed AD doll play among non-abused children only. Methodological limitations notwithstanding, virtually all empirical data support the use of AD dolls for data gathering in cases of sexual abuse.     

Sexually abused children and post-traumatic stress disorder

Sexually abused children often develop post-traumatic stress disorder, a distressing and debilitating condition that is typically unresponsive to non-directive counselling. Empirically supported abuse-confronting, structured interventions are urgently required for use by counselling psychologists responsible for the management of this challenging clinical population. Given the success of cognitive-behavioural interventions with adult trauma victims, it has been suggested that this treatment approach be applied to sexually abused children. This paper presents a cognitive-behavioural treatment framework comprising two levels of intervention: child therapy and parent training. We selectively review emerging empirical support for the efficacy and acceptability of this treatment approach.     

Sexually abused children suffering from post-traumatic stress disorder: assessment and treatment strategies

Child sexual abuse is a highly prevalent problem that frequently occasions the onset of post-traumatic stress disorder in the victimized youngster. This selective review addresses recent advances in the assessment and treatment of sexually abused children with post-traumatic stress disorder. Firstly, we outline the diagnostic criteria for post-traumatic stress disorder and significant moderating variables in the development of post-traumatic stress disorder. Secondly, we address the clinical assessment of post-traumatic stress disorder in sexually abused children, recommending a developmentally sensitive, multi-informant approach. Thirdly, we consider a family-wide cognitive-behavioural treatment framework for sexually abused children with post-traumatic stress disorder that involves both child and non-offending caregivers. Fourthly, we examine the results of recent evaluation studies supportive of cognitive-behavioural therapy in the treatment of sexually abused children. Lastly, we consider conclusions for clinical practice and directions for future research.     

Child sexual abuse and literacy achievement in a sample of South African primary school children

This study investigated child sexual abuse (CSA) and literacy achievement among South African primary school children. Data on self-reported experience of CSA and actual literacy achievement were collected from a convenience sample of 160 learners from a Soweto school in Johannesburg. The literacy tests measured five domains of reading and spelling competencies. The results show a statistically significant relationship between CSA and literacy scores, with learners who were sexually abused scoring significantly lower on the literacy tests used in this study. Specifically, learners with CSA experience performed noticeably lower in the real word test, followed by spelling, words spelt correctly, reading fluency, and non-word spelling. School psychologists could adopt a social justice framework in providing psychological and literacy support for children who are sexually abused.     

No Man's Land?: The Role of Men Working with Sexually Abused Children

Most sexual abusers of children are men. It is argued that sexually abused children may be anxious about contacts with men, especially when these include discussions of sexuality or of their abusive experiences. The implications of this for the role of men working with sexually abused children are explored. It is suggested that disclosure interviews should not usually be carried out by men, but that men do have a role to play in the post-disclosure therapeutic process.     

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.     

The case against the routine provision of psychotherapy to children/adolescents labeled “sexually abused”

Whether symptomatic or asymptomatic, children labeled sexually abused are routinely offered treatment at considerable financial cost. One result of this is that mental health professionals are being charged with exploiting the problem of child sexual abuse (CSA). Is the routine provision of psychotherapy for children and adolescents labeled sexually abused warranted? In this paper, it is argued that the evidence indicates it is not warranted. Further, its provision is not in the best interests of either the children or mental health professionals. A number of recommendations are given which follow from the evidence.     

Self-Reported Depression in Mothers of Children Who Have Experienced Sexual Abuse

The Beck Depression Inventory-II (BDI-II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996) was administered to 164 biological mothers of sexually abused children to determine the psychometric characteristics of the BDI-II and to estimate the prevalence of self-reported depression in this population. The study also sought to ascertain whether the mothers’ BDI-II total scores were correlated with various psychosocial characteristics of the mothers and their children. It was found that there was only one dimension underlying the 21 BDI-II responses, and the internal consistency of the BDI-II total scores was high. Twenty-six percent of these mothers had scores indicative of clinical depression. The mothers’ BDI-II total scores were significantly correlated with their husbands’ or paramours’ having sexually abused their children and their ratings of the children’s internalizing behaviors. These results were discussed as supporting the use of the BDI-II with mothers of sexually abused children to measure self-reported depression.     

The Development,Process, and Evaluation of Group Psychotherapy With Sexually Abused Preschool Girls

The development, process, and evolution of group psychotherapy specifically designed for sexually abused preschool aged females is presented. Utilization of male and female cotherapists, group structure, individual and family dynamics, the role of children's mothers in treatment, and process of treatment are examined. Issues regarding countertransference phenomena, cotherapy relations, in-depth involvement of the children's mothers, and specifics related to structuring of a time-limited group are beyond the initial intent and scope of this paper, and are not discussed here.

The cotherapists conclude that group psychotherapy for children of this age group is both clearly valuable and highly indicated as an adjunct treatment modality. In future group psychotherapy with sexually abused preschool aged children, based upon clinical experience and evaluation, the cotherapists advocate a time-limited approach whereby each session would focus upon specific issues as illustrated in Table 1, and include structured and purposeful involvement of the girls' caretakers.     

Family Functioning Moderating the Effects of Childhood Sexual Abuse on Memory Specificity

The main goal of this study was to investigate if adults sexually abused as children who were raised in a functional family are more able to generate specific autobiographical memories and suffer fewer depressive symptoms than sexually abused adults who were raised in a dysfunctional family. We found that abused males retrieved fewer specific memories than nonabused males, abused females, and nonabused females. The three latter groups did not differ from each other. Further, childhood sexual abuse did not predict depression among males and females. After accounting for family functioning, there were no group differences regarding memory specificity. Functional families appear to have beneficial effects on the adjustment of male victims of childhood sexual abuse.     

Even When You Win You Lose: Targeted Parents' Perceptions of Their Attorneys

The author attempts to deal with three important issues in relation to child sex abuse allegations. These are (1) some potential signs in the behavior of children who might have suffered sexual abuse; (2) how an evaluation of an allegedly sex abused child can be carried out; (3) the possible long term affects on a child who has suffered from being sexually abused. The complexity of drawing the right conclusions are considered when there are false positives due to the overlap of evidence between sexually abused and non abused children.     

Child molestations by homosexual foster parents: Illinois, 1997--2002

Do those who engage in homosexuality disproportionately sexually abuse foster or adoptive children as reported by child protective services? Illinois child services reported sexual abuse for 1997 through 2002. 270 parents committed "substantiated" sexual offenses against foster or subsidized adoptive children: 67 (69%) of 97 of these mother and 148 (86%) of 173 of these father perpetrators sexually abused girls; 30 (31%) of the mothers and 25 (14%) of the father perpetrators sexually abused boys, i.e., 92 (34%) of the perpetrators homosexually abused their charges. Of these parents 15 both physically and sexually abused charges: daughters by 8 of the mothers and 4 of the fathers, sons by 3 of the mothers, i.e., same-sex perpetrators were involved in 53%. Thus, homosexual practitioners were proportionately more apt to abuse foster or adoptive children sexually.     

Child sexual abuse and adolescent prostitution: a comparative analysis

In several studies, child sexual abuse has been identified as a characteristic of adolescent prostitution. The implication of these findings, especially for girls, is that the two phenomena are related in that childhood sexual abuse perhaps leads to prostitution. The present study explored the relationship between sexual abuse and adolescent prostitution by comparing 70 sexually abused children with 35 prostitution-involved children on 22 variables. Findings suggest that the relationship is not directed, but involves runaway behavior as an intervening variable. It is not so much that sexual abuse leads to prostitution as it is that running away leads to prostitution. Implications for treatment of both sexually abused and prostitution-involved children also are discussed.     

Group therapy with sexually abused boys: leadership, projective identification, and countertransference issues

Group therapy is an essential component of the treatment of sexually abused children. Since the painful effects associated with the abuse are often dissociated or acted out, the group leaders learn of the affective experience of the abuse through the process of projective identification. The leaders must be aware of this process, set limits on the abusive acting out in the group, and help moderate, label, and empathize with the affect. It is through this difficult process that the children have a chance to reintegrate and work through their abuse experiences so they no longer feel compelled to act them out through repetitive abusive relationships. Specific leadership, countertransference, and projective identification issues in group therapy with sexually abused boys are discussed.     

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.     

Multigenerational Sexual Abuse: A Cognitive Developmental Approach to Understanding Mothers in Treatment

This paper takes a cognitive developmental perspective in the qualitative analysis of 9 interviews of women who were sexually abused as children and whose children were also sexually abused. It discusses ways in which the development of cognitive self-understanding can by stymied by childhood sexual abuse and how this, in turn, can affect a woman's ability to parent her children and take full advantage of psychotherapy. It studies the recovery process that participants describe at various stages of a social cognitive developmental model of self-understanding. Finally, it promotes the use of a cognitive developmental perspective in clinical work and offers suggestions for counselors addressing issues of childhood sexual victimization.     

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.     

Childhood Sexual Abuse and Female Spiritual Development

Religiously involved lay women (N = 266), 31% of whom had been sexually abused in childhood, filled out the revised Spiritual Experience Index (SEI-R). Results showed higher SEI-R scores for the sexually abused group, with a more accepting attitude compared with those with a striving attitude. A subscale of the SEI-R revealed that the sexually abused may turn to their faith and spirituality for support. Those with the highest educational achievements, Catholics, and those who experienced emotional abuse scored high on the Spiritual Openness subscale. Implications for spiritual development and counseling are discussed.     

Group Therapy with Sexually Abused Boys: Leadership,Projective Identification,and Countertransference Issues

Group therapy is an essential component of the treatment of sexually abused children. Since the painful affects associated with the abuse are often dissociated or acted out, the group leaders learn of the affective experience of the abuse through the process of projective identification. The leaders must be aware of this process, set limits on the abusive acting out in the group, and help moderate, label, and empathize with the affect. It is through this difficult process that the children have a chance to reintegrate and work through their abuse experiences so they no longer feel compelled to act them out through repetitive abusive relationships. Specific leadership, countertransference, and projective identification issues in group therapy with sexually abused boys are discussed.     

Support Person Presence and Child Victim Testimony: Believe it or Not

This study examined the effects of support person presence on participants’ perceptions of an alleged child sexual abuse victim and defendant. Two hundred jury-eligible community members (n = 100 males) viewed a DVD of an 11-year-old girl's simulated courtroom testimony either with or without a female support person seated next to her. Participants found the child victim to be less accurate and trustworthy, and the defendant to be less guilty and less likely to have sexually abused children, when the support person was present. Participants who viewed the female support person (n = 100) believed that she had probably coached and spent a great deal of time with the child victim before testifying. Female participants perceived the child to be more accurate, and the defendant to be more guilty and likely to have sexually abused children, than male participants. The degree to which the child victim's testimonial behavior violated participants’ expectancies mediated the negative relation between support person presence and child victim accuracy and trustworthiness. Support person presence was positively associated with expectancy violation, which in turn was negatively associated with child victim accuracy and trustworthiness. These preliminary findings suggest that seating a support person next to an alleged child victim in court may have the unintended effect of decreasing the child's perceived credibility and, if replicated, suggest that alternative seating arrangements might be necessary. Copyright © 2015 John Wiley & Sons, Ltd.