A systematic review of the effectiveness of interventions designed for mothers who experienced child sexual abuse

BACKGROUND

Past experiences of child sexual abuse (CSA) have been shown to have a pernicious effect on the parenting behaviors of mothers. As a result, interventions have been developed to address these effects. However, a systematic synthesis of the effectiveness of such interventions has not been conducted.

OBJECTIVE

To conduct a systematic review of existing literature on interventions that have been developed and evaluated for mothers who experienced CSA.

METHODS

Studies were located through a sensitive search strategy in nine academic databases and search engines, and through handsearching reference lists of included studies and their subsequent citations. Two authors independently completed screening, full text review, data extraction, and quality appraisal.

RESULTS

Searches revealed a paucity of literature, with four intervention studies located. All four interventions consisted of therapy, with three of these interventions using a group-based format. One of the included intervention studies used reiki as an adjunct to therapy. Decreases in negative mental health symptoms were reported through both validated measures and interviews. No validated measures to assess parenting were used in any intervention, though some qualitative results indicated changes in parenting. Qualitative results also suggested that most mothers were satisfied with the interventions. Studies were of limited quality - none used a randomized trial design, and only one a control group.

CONCLUSIONS

Given the limitations of the identified intervention studies for mothers who experienced CSA, there is a clear need to develop evidence-based interventions for this population given the unique detrimental effects of CSA on parenting. Avenues for future intervention development are discussed.

Evaluating the quality of meta-analytical reviews using the AMSTAR-2: A systematic review of meta-analytical reviews regarding child sexual abuse interventions

BACKGROUND

Effects of treatment for child sexual abuse (CSA) victims have important implications. Assessing Risk of Bias (RoB) is a vital step to inform interpretations of treatment effects for these victims. The AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews) offers a comprehensive critical appraisal, allowing users to distinguish high quality reviews.

OBJECTIVE

The aim of this article is two-fold: 1) to provide an up-to-date systematic review of treatment program meta-analytical reviews on interventions for CSA victims; and 2) to evaluate the quality of meta-analytical reviews using the AMSTAR-2. This is the first systematic review to examine the quality of meta-analyses on the effectiveness of CSA interventions using the AMSTAR-2.

METHOD

Eight electronic databases were searched for articles published up to April 2019. Meta-analytical reviews that assessed the effectiveness of any treatment modality for sexually abused children and adolescents up to 18 years old were considered. Outcome measures included physical and mental symptoms, and disorders, measured through validated instruments. Of 2794 articles, nine meta-analyses met the eligibility criteria. There was a variety of interventions, including: trauma-focused cognitive-behavioral therapy CBT, psychodrama, play therapy, and eclectic interventions. The most common outcomes measured were post-traumatic stress disorder/trauma, externalizing, internalizing, and sexualized behaviors.

RESULTS

Although effect sizes were moderately significant, with treatment having a positive effect, all meta-analyses showed a high RoB.

CONCLUSIONS

To use the best available evidence in clinical decision-making for CSA victims, reviewers should conduct meta-analyses that employ RoB tools.

Parents' Knowledge, Attitudes, and Experiences in Child Sexual Abuse Prevention in El Salvador

Childhood sexual abuse (CSA), a global public health problem, is often underreported especially in low-income countries such as El Salvador, and prevention efforts are needed. The purpose of this study was to examine knowledge, attitudes and experiences of CSA prevention and characteristics related to greater knowledge and openness to engaging in child abuse prevention among Salvadoran parents. Salvadoran parents (N = 478) completed questionnaires regarding demographics, definition and signs and symptoms of child abuse, personal experiences of CSA, CSA prevention training, and knowledge, attitudes and practices about preventing CSA. Most parents were knowledgeable about CSA, viewed CSA prevention as their responsibility, and had talked with their children about CSA, although 65.7% incorrectly believed that children are more likely to be abused by strangers. Parents with lower income were less knowledgeable and willing to participate in CSA prevention. CSA programing needs to involve parents and specifically target low-income parents.

Media Coverage of Child Sexual Abuse: A Framework of Issue-Specific Quality Criteria

Sensationalist, stereotyping or otherwise biased media coverage of Child Sexual Abuse (CSA) can harm survivors and is detrimental to rational, solution-oriented public debates on the issue. While the Public Interest Model (PIM) of normative media theory promotes generic quality dimensions, there currently is no framework of issue-specific media quality for reporting about CSA. This paper aims at developing such a framework, working deductively with PIM and inductively with different expert sources regarding quality criteria (QC) for CSA reporting. Our data collection covered four types of expert sources: journalistic guidelines, scientific publications, surveys with survivors and with counseling centers. All sources were content analyzed using reliable codebooks (κ = .79-1.00). Descriptive and inferential statistical analyses were run. We present a framework comprised of 10 QC. Eight inductively generated QC for CSA media coverage are (1) thematic framing, (2) non-sensational reporting, (3) use of appropriate terms, (4) inclusion of stakeholders, (5) non-stereotypical reporting, (6) inclusion of prevention/intervention, (7) ethical treatment of survivors in interviews and (8) lawful reporting. Two deductively generated QC are (9) balance of survivors' and alleged perpetrators' interests and (10) disclosure and reflection of official sources. Limitations and implications for future media research and journalistic practice are discussed.

How Do Childhood and Parental Anxiety Features Affect the Consequences of Child Sexual Abuse?

The purpose of the study was to investigate the anxiety features of children who experience child sexual abuse (CSA) and their parents, along with the features and consequences of sexual abuse in the environment of Child Advocacy Centers (CAC). The sample of this study comprised 150 children affected by CSA and one of their parents who were admitted to İzmir CAC between June 2016 and November 2016.The children-age range 9 to 13 years-and one of their parents were asked to complete the State-Trait Anxiety Inventory separately. The children also completed the Childhood Anxiety Sensitivity Index (CASI). During psychiatric evaluations of the children, sociodemographic characteristics and features of sexual abuse were noted and all psychiatric conditions were examined. The statistical analyses yielded significant correlations between the STAI scores of the parents and STAI-C and CASI scores of the children. There were statistically significant differences between the CASI scores, STAI-C subscale scores, and STAI subscale scores according to some variables of CSA along with their psychiatric diagnosis. Our findings showed that having higher anxiety sensitivity and trait anxiety levels and having parents with higher trait anxiety might be considered as risk factors for being diagnosed as having a psychiatric disorder due to CSA.

A mixed methods investigation of the association between child sexual abuse and subsequent maternal parenting

BACKGROUND

Child sexual abuse (CSA) is associated with a number of pernicious outcomes, including adverse parenting outcomes among mothers who experienced CSA (M_CSA). Despite the large literature on these outcomes, gaps and uncertainties in the literature exist. Specifically, while previous literature has shown that some M_CSA have their parenting negatively affected by CSA, others do not, and potential mechanisms explaining these variations, such as mental health and characteristics of the CSA experience, have not been fully explored.

OBJECTIVES

To investigate (1) how M_CSA believe their CSA experiences have affected their parenting, if at all; (2) what factors may be contributing to these perceived effects; and (3) what resources or intervention components M_CSA believe they need to cope with their experiences.

PARTICIPANTS AND SETTING

Participants were M_CSA primarily from the UK and the Republic of Ireland.

METHODS

M_CSA were recruited through partner organizations specializing in parenting, child abuse, and mental health to complete an online survey with both qualitative and quantitative components. Qualitative data were thematically synthesized and subgroup analyses were conducted.

RESULTS

M_CSA reported that their CSA experiences most affected their desire to protect their child from experiencing abuse. Additionally, breastfeeding, child-rearing practices, the mother-child relationship, and perceptions of motherhood and the child were reported to be affected.

CONCLUSIONS

Given that M_CSA have reported their CSA experiences to negatively affect several aspects of parenting, evidence-based interventions are needed. Participant concerns regarding parenting and suggestions made by participants in this study for interventions may aid in intervention development.

Sexual assault trauma: Does prior childhood maltreatment increase the risk and exacerbate the outcome?

BACKGROUND

Some individuals who have been sexually assaulted as adolescents or adults have also been abused in childhood, although it is not clear how different forms of childhood maltreatment are related to adolescent/adult sexual assault, and how earlier abuse alters the relationship between sexual assault and current symptomatology.

OBJECTIVE

We sought to determine which types of child maltreatment are associated with adolescent or adult sexual assault, whether such child maltreatment interacts with sexual assault to predict more severe symptoms, and if sexual assault has unique symptom correlates after controlling for prior child maltreatment.

PARTICIPANTS AND SETTING

Participants were 398 women recruited online.

RESULTS

A total of 36 % of women had experienced unwanted sexual contact at age 13 or younger (childhood sexual abuse [CSA]), 32 % had experienced unwanted sexual contact at age 14 or later (adolescent/adult sexual assault), and 24.4 % had experienced both. Of all forms of child maltreatment, only CSA was associated with sexual assault, doubling the risk relative to those without a history of CSA. CSA and sexual assault were each uniquely associated with current symptomatology, however there was no interaction between sexual assault and CSA on psychological symptoms.

CONCLUSIONS

CSA is associated with a greater risk of later sexual assault, and both CSA and sexual assault have additive effects on adult symptomatology. However, prior sexual abuse does not appear to exacerbate the effects of sexual assault, and sexual assault is associated with lasting psychological sequelae even when controlling for sexual abuse.

Self-Blame, Shame, Avoidance, and Suicidal Ideation in Sexually Abused Adolescent Girls: A Longitudinal Study

Depressive symptoms, posttraumatic stress disorder, and suicidal ideation are among the most prevalent problems associated with sexual abuse. Based on the Traumagenic dynamic of stigmatization model, the aim of this study was to investigate whether self-blame, shame, and maladaptive coping strategies predicted posttraumatic stress disorder, depressive symptoms, and suicidal ideation among sexually abused adolescent girls using a longitudinal design. A total of 100 adolescent girls completed a series of questionnaires at the initial visit at the intervention center (T1) and 6 months later (T2). Path analysis reveals shame at T1 predicted posttraumatic stress disorder symptoms at T2 whereas self-blame at T1 predicted depressive symptoms at T2. Furthermore, avoidance coping at T1 and depressive symptoms at T2 predicted suicidal ideation at T2 and accounted for 54% of the variance. These findings suggest that interventions designed for sexually abused adolescent girls should target shame, self-blame, and avoidance coping to foster recovery in this vulnerable population.

Demystifying ritual abuse - insights by self-identified victims and health care professionals

Empirical evidence on organized and ritual child sexual abuse (ORA), that is, organized child sexual abuse with an ideological framework, is rare and definitions of the term "ritual" are often vague or inhomogeneous. The aim of the current study is to analyze contents, purposes and acts of violence in ORA.In a project of the Independent Inquiry into Child Sexual Abuse in Germany, 165 adults who identified themselves as ORA victims as well as 174 health care professionals who supported ORA victims were recruited via various sources and completed anonymous online surveys.Both samples report experiences with ideological frameworks in organized child sexual abuse contexts at the same ratio (88%). Ideologies are mostly perceived as a means to facilitate violent acts (e.g. commercial sexual exploitation). Positive correlations between the manifestation of ideologies and all violent acts suggest that organized and ritual perpetrator groups use the same violent strategies, but ritual or ideological groups, in which perpetrators are more often family members, use them to a greater extent.A modified narrative of "ritual abuse" as a (pseudo-)ideological, domestic and more violent subtype of organized child sexual abuse could enhance the credibility and visibility of ORA in science as well as in society.

Emotion Dysregulation in Sexually Abused Preschoolers: Insights from a Story Completion Task

Child sexual abuse (CSA) during the preschool period can seriously undermine children's ability to develop emotional competency. Narrative tasks, such as the MacArthur Story Stem Battery (MSSB), are particularly adapted to gain a better understanding of young children's self-regulation processes. To explore the emotion regulation competencies of sexually abused preschoolers, we developed a coding grid and undertook a detailed analysis of abused and non-abused children's narratives using the MSSB. A sample of 62 sexually abused and 65 non-abused preschoolers 3½ to 6½ years old was recruited and children were presented with nine stories and an expressive vocabulary test. Analyses were performed to compare abused and non-abused children's narratives and to assess the contribution of CSA to children's narratives. CSA was associated with fewer demonstrations of empathy, help, and comfort, and less coherent and resolved stories. The narratives of CSA victims also included less emotions and emotional variations. The influence of CSA appeared the strongest in the stories involving fear. These findings suggest the presence of emotion dysregulation among sexually abused preschoolers, but also insecure attachment, and a sense of betrayal, isolation, and powerlessness.

"I never told anyone until the #metoo movement": What can we learn from sexual abuse and sexual assault disclosures made through social media?

BACKGROUND

Social media is providing new avenues for survivors to disclose sexual abuse and/or assault. Since the creation of #MeToo (2017), and the larger MeToo movement founded by American activist Tarana Burke in 2006, millions are disclosing sexual assaults and past childhood sexual abuse on-line.

OBJECTIVE

Social media for disclosing the highly stigmatized problem of sexual abuse/assault was studied to build knowledge about on-line disclosures.

PARTICIPANTS AND SETTING

Participants were tweeters and posters on Twitter and Reddit. Purposive sampling captured on-line sexual abuse/assault disclosures from September 28, 2018 to October 16, 2018 for thematic analysis.

METHOD

Using a phenomenological design 171 social media posts were analyzed for deeper understanding into new options for disclosing sexual abuse and/or sexual assault. Posts were independently coded by the authors. Sampling was stopped when categorical saturation was reached with no new information coming forward on the research question.

RESULTS

Themes that emerged showed the MeToo/#MeToo movement is precipitating sexual abuse/assault disclosures on social media in unprecedented ways; posters identified internal barriers, mixed responses from family, and friends/peers, as well as variable responses from professionals. While some conditions for sexual abuse/assault disclosures have improved, barriers still exist.

CONCLUSION

Social media represents an environmental shift for disclosing sexual violence. Sexual abuse/assault survivors have found voice through social media after periods of silence and being silenced, turning to posting on-line when people and systems have failed to validate and support them. Further investigation is needed on the impacts of on-line sexual abuse and/or assault disclosures.

The extent of child sexual abuse in Botswana: hidden in plain sight

Introduction

Child Sexual Abuse (CSA) is a worldwide persisting public health problem which has generated interesting discussions within child protection scholarship. Globally as well as in Botswana, CSA estimates prove challenging to establish. This study sought to establish the extent of CSA in Botswana by use of existing data as well as narratives from key informants.

Methods

CSA existing data was extracted from the Botswana police services records and Botswana statistics for the year 2013, 2014, 2015 & 2016. In-depth interviews, semi-structured interviews, were used to collect data from policymakers, child protection practitioners, and caregivers respectively. The study sites were Gaborone city and Letlhakeng village. Qualitative data were analysed using NVivo qualitative data analysis computer software. Whereas the quantitative data I analysed using the excel Microsoft office 365.

Findings

According to CSA existing data, in 2013 defilement among children was 97 (0.2%). Whereas 901 children were reported pregnant in 2013, almost ten times more than defilement cases. In the same year, there was a high number (1058) of children who stayed away from school. Participants' narratives reported CSA to be an escalating problem in Botswana.

Conclusion

The finding that teenage pregnancy statistics are higher than defilement statistics needs further research to categorise and inform child sexual abuse programming in Botswana.

Disorganized attachment and emotion dysregulation as mediators of the association between sexual abuse and dissociation in preschoolers

BACKGROUND

Child sexual abuse (CSA) is a prevalent social problem associated with a plethora of difficulties in preschool children. Young victims are likely to show dissociation symptoms that may significantly impede their adaptation. Yet, mechanisms linking CSA with later dissociative symptoms remain unclear. The aim of the present study was to explore whether disorganized attachment and emotion dysregulation could act as mediators of the association between CSA and dissociation.

METHODS

A sample of 424 preschool children (274 CSA victims, 150 comparison group children; 3.5-6 years old) and their parents were recruited. Parents reported on children's emotion dysregulation at initial assessment while attachment representations were assessed through children's narratives using the Attachment Story Completion Task (Bretherton et al., 1990) coded with the Q-Sort (Miljkovitch et al., 2004). Parents reported on children's dissociative symptoms one year later.

RESULTS

Mediation analysis showed that disorganized attachment and emotion dysregulation mediated the association between CSA and dissociation. CSA was linked to greater disorganization scores that were associated with higher scores of emotion dysregulation. Emotion dysregulation was in turn associated with increased severity of dissociation symptoms in preschool children one year later.

LIMITATIONS

Given that attachment and emotion dysregulation were both assessed at T1, the temporal sequencing of mediators remains to be validated in a longitudinal design.

CONCLUSIONS

Findings highlight the relevance of fostering healthy parent-child relationships, as well as the development of optimal emotion regulation skills in young CSA victims to prevent the emergence of dissociation symptoms in this vulnerable population.

The medical evaluation of prepubertal children with suspected sexual abuse

Child sexual abuse is an important and not uncommon problem. Children who have been sexually abused may present to a physician's office, urgent care centre, or emergency department for medical evaluation. A medical evaluation can provide reassurance to both child and caregiver, identify care needs, and offer an accurate interpretation of findings to the justice and child welfare systems involved. Given the potential medico-legal implications of these assessments, the performance of a comprehensive evaluation requires both current knowledge and clinical proficiency. This position statement presents an evidence-based, trauma-informed approach to the medical evaluation of prepubertal children with suspected or confirmed sexual abuse.

Female-Perpetrated Child Sexual Abuse: Prevalence Rates in Germany

Research on female-perpetrated child sexual abuse, especially maternal sexual abuse, is scarce. Prevalences are assumed to be lower compared to male-perpetrated abuse; however, representative studies including female perpetrators are rare. Experiences of male- and female-perpetrated child sexual abuse were examined in a representative German sample. Questions included experiences of hands-on and penetrative sexual abuse. The perpetrator-victim relationship was assessed to calculate prevalences of maternal sexual abuse. A total of 2516 participants (54.53% female, 14-91 years) were questioned and prevalences, as well as group differences between victims of male perpetrators compared to female perpetrators, were calculated. Overall, 10.5% of all participants reported experiences of child sexual abuse. Female perpetrators were involved in 9.9% of the cases, i.e. 1.0% of all participants. Victims of female perpetrators were significantly more often male. A quarter of the adult female perpetrators were the mother figure of the child. The findings suggest that the share of female perpetrators in cases of child sexual abuse is rather small; concurrently, female perpetration is insufficiently recognized. Especially male victims seem to be at risk for sexual abuse by female perpetrators. Contacts for children especially within the professional support system need to be aware of the existence of female perpetrators.

Gendered Perceptions of Sexual Abuse: Investigating the Effect of Offender, Victim and Observer Gender on the Perceived Seriousness of Child Sexual Abuse

Sexual abuse of children is a pervasive, global issue. Perpetrators of this kind of abuse are often stereotyped as male, meaning that research comparing perceptions of abuse by male versus female offenders is limited. This is an important omission as recent evidence attests to the unexpectedly high frequency of sexual crimes perpetrated by women. The gender of child sex abuse victims and observers of abuse have also been shown to impact perceptions of the offense. Thus, the present study aimed to explore the effect of offender, victim and observer gender on the perceived seriousness of an act of child sex abuse. To do this, we used a 2 (offender gender: male vs female) × 2 (victim gender: male vs female) × 2 (observer gender: male vs female) between-participants experimental design. We presented members of the British public (N = 213) with a vignette describing a hypothetical interaction between an offender and victim and asked them how serious they thought the offense was. They then reported their own gender. We found that abuse was considered more serious when the offender was male, or the observer was female. We also found a novel three-way interaction. Implications and future research directions are discussed.

Preventing child sexual abuse: A systematic review of interventions and their efficacy in developing countries

BACKGROUND

Research on prevalence, risk factors, and prevention interventions for child sexual abuse has continued to focus on western and developed countries. Where country-level prevalence data or large-scale research exists, rates of child sexual abuse are consistently higher in developing and non-western countries than their western and developed counterparts.

OBJECTIVE

We systematically reviewed research on the nature of child sexual abuse interventions in developing countries, the settings and populations included to identify types of child sexual abuse prevention initiatives being implemented in developing countries and their effectiveness.

METHODS

Following PRISMA guidelines, we conducted a systematic search of six databases and identified eight studies to include in our analysis.

RESULTS

Most empirically evaluated interventions in developing countries have focused on preschool and primary school-aged children. Most have focused on interventions delivered in educational settings, with a lack of focus on population-level interventions to prevent child sexual abuse. Researchers have used outcomes measuring knowledge or skills for young people in self-protection and help-seeking, not deployment of those skills, actual reduction in prevalence of CSA, or improvements in conditions of safety in organizational contexts.

CONCLUSIONS

If the focus on school-based strategies to prevent child sexual abuse continues in developing countries, a significant gap in knowledge of the efficacy of population-level interventions outside of school contexts, and consistency across the application of interventions will remain. Evaluations are needed that address the efficacy of broader government-led or whole-of-community prevention interventions to reduce actual prevalence of child sexual abuse, or that can link increased knowledge and skill with reduced victimization.

Psychological evaluation of children victims of sexual abuse: development of a protocol

Sexual abuse (SA) is associated with significant psychological problems in childhood, making it increasingly important to develop evaluation protocols. This study examined clinical aspects and cognitive measures of 49 children (24 with SA history and 25 controls). It employed a SA assessment questionnaire, clinical evaluations of posttraumatic stress disorder, risk indicators and neuropsychological tests in order to elaborate a specific forensic psychological evaluation protocol for this population. Conflicting couples (80%), separated parents (68%) and parents' alcohol/drug abuse (76%) were revealed as major risk factors. Fathers represented the primary perpetrator (24%). The main cognitive complaint was difficulty concentrating. Regarding the association between clinical and cognitive variables, it was observed that children who were anxious or referred to having fear, difficulties with operational memory and difficulty sleeping, had more trouble performing tasks that required attention and memory (operational, immediate and late). Children with SA history demonstrated inferior performance in visual attention/task switching and memory; with an emphasis in the loss of set in the Wisconsin test. The findings suggest the possibility of a primary attention deficit in children with SA history, possibly influencing the performance of other cognitive functions.

Factors predicting conviction in child stranger rape

BACKGROUND

Public knowledge of child stranger rape is shaped largely by media portrayals of a small number of cases, often marked by sensational trials, which may result in juror misconceptions of this offense. It is important to understand the factors that may influence jury verdicts in order to maximize the chance of guilty defendants being convicted.

OBJECTIVE

The aim is to explore the factors that predict juries' decisions to convict or acquit in child stranger rape cases.

PARTICIPANTS AND SETTING

The study utilizes a police database of recorded child stranger rape cases from a UK urban force from 2001-2015. Seventy cases that were tried by jury were analyzed. We investigated the extent to which 19 child-, accused- and offense-related factors predict jury verdicts.

METHODS

A four stage analytic process was employed: (a) Kendall's tau-b measured inter-correlations among the factors; (b) Chi-Square and Welch t-tests measured associations between factors and verdicts; (c) binary logistic regression measured the power of factors in predicting verdicts; and (d) Stein's formula was used to cross-validate the model.

RESULTS

Verdicts were predicted by two offense-related factors. A weapon increased the odds of conviction by 412%. An outdoor location increased the odds by 360%.

CONCLUSIONS

The findings have potential implications for prosecution case building and courtroom policy. Prosecutors could gather as much information as possible from victims about the factors found to be of importance to juries. Judges could challenge incorrect beliefs and stereotypes by instructing juries.

Factors that prevent, prompt, and delay disclosures in female victims of child sexual abuse

BACKGROUND

Several studies conducted in clinical and non-clinical settings have described why and when children disclose sexual abuse. Yet, there is incomplete understanding of how adolescents and young children may differ in factors that delay, prompt and deter disclosure that could inform strategies for clinical practice and prevention.

OBJECTIVE

The aim of this study was to identify factors that prevent, prompt, and delay disclosure among pediatric patients presenting for acute and non-acute medical evaluations of sexual abuse or assault, and to examine any differences in disclosure tendencies among female adolescents and pre-adolescents.

PARTICIPANTS AND SETTING

A chart review of a consecutive sample of pediatric patients presenting to the emergency department or outpatient clinic identified 601 patients who were diagnosed with sexual abuse and were willing to answer examiner questions about their disclosure.

METHODS

Data collection included attainment of patient narratives which were utilized to gather information about abuse disclosures. Recursive abstraction was applied to categorize patient statements for further analysis, while Pearson chi square and logistic regression were utilized for quantitative data.

RESULTS

Young age (<11 years) at abuse onset was the strongest predictor of, and fear of consequences to self was the most common reason for, disclosure delay in both adolescent and pre-adolescent females. Severity of abuse, adult perpetrator, and self-blame predicted delays only in pre-adolescent females.

CONCLUSIONS

Social and moral development during middle childhood likely has a strong influence on disclosure tendency. Strategies to promote disclosure should consider reducing fear of consequences associated with the adult-child paradigm.

Pathways to Understanding - How Adult Survivors of Child Sexual Abuse Came to Understand that they had been Sexually Abused

While child sexual abuse is recognized as a global challenge in need of attention, all too often it takes years before sexual abuse is disclosed. We therefore need to understand more of the process leading to disclosure of child sexual abuse. The purpose of this study was to investigate how adult survivors of child sexual abuse came to understand that they had been sexually abused. We conducted semi-structured interviews with 8 women and 3 men (18-57 years old) and analyzed the interview transcripts using a hermeneutic-phenomenological approach to thematic analysis. Our analysis resulted in three main themes: The ambiguity of memory: "To remember the catastrophic"; The language of the body: "Let the body speak"; and Encountering an observant other: "The significance of being seen and recognized". The findings highlighted the complexity of the individual process of understanding that one has been sexually abused. The availability and intrusiveness of traumatic memories, bodily sensations and symptoms, and encounters with others proved to be contributing factors in the process. The findings give insights into why disclosure of sexual abuse can be difficult and have important implications for health professionals and policy makers working to help victims of child sexual abuse.

Featured counter trafficking program: The law enforcement first responder protocol

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficking children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes the Law Enforcement First Responder Protocol, which trained law enforcement to recognize youth engaged in sex work as survivors of commercial sexual exploitation, rather than as "prostitutes", and to connect these survivors immediately with social services, advocates, timely medical care and ongoing follow-up.

Child Sexual Abuse: The Need for a Perpetration Prevention Focus

In the evolution of efforts to reduce child sexual abuse (CSA) rates in the United States, there has been a gradual shift to add preventive measures to after-the-fact interventions (i.e., interventions and policies implemented after the abuse has already happened, such as services and treatment for victims and punishment, treatment, and management of offenders). Prevention of CSA perpetration, however, is often missing from these efforts, despite decades of experts calling for broader prevention solutions. The current paper describes the scope of the problem of CSA, highlights problems with an over-reliance on after-the-fact interventions, and describes promising perpetration-focused CSA prevention interventions. While most existing preventive efforts focus on teaching children to protect themselves from incurring sexual harm, perpetration prevention efforts may hold more promise by addressing the onset of harmful behavior. As such, perpetration prevention efforts can contribute to a more robust and comprehensive approach to CSA - an approach that focuses on prevention of harm from occurring in the first place, as well as responding once harm has occurred.

Perceived Skill and Willingness to Address Child Sexual Abuse: Assessing Serbian and Montenegrin Pediatricians

Most research on pediatricians' reporting of child sexual abuse (CSA) is based in western countries. Only recently have studies focused on low-income countries. We are the first to survey pediatricians in Serbia and Montenegro on their encounters, competence and beliefs regarding CSA. Pediatricians in Serbia (n = 358) were recruited during a professional conference; pediatricians in Montenegro (n = 121) were sent an online survey. Demographic information was not obtained. Frequencies and percentages were calculated. A quarter of pediatricians in both countries felt competent detecting medical evidence of CSA. Twenty-seven percent in Serbia and 7% in Montenegro felt adequately trained to assess and diagnose CSA. Forty percent believed that CSA occurs predominately in poor, unstable or disorganized families. Twenty-nine percent in Montenegro and 15% in Serbia believed that complete strangers perpetrate CSA. Both Serbian (23%) and Montenegrin (30%) pediatricians were uncomfortable asking questions about possible abuse. One third of pediatricians in both countries were interested in further training. CSA is underreported at a concerning rate in Serbia and Montenegro, yet only a third of pediatricians in both countries were interested in further training. Future studies should focus on barriers to reporting in these regions, to increase awareness and competencies related to CSA.

A retrospective approach to examining child abuse disclosure

BACKGROUND

Often times, a child's disclosure is the only forensic evidence available in child abuse cases. Therefore, understanding disclosure patterns of suspected child abuse victims plays a critical role in the forensic investigations of both child physical abuse (CPA) and child sexual abuse (CSA) cases.

OBJECTIVE

To explore adults' retrospective reports about childhood disclosure of CPA and CSA.

PARTICIPANTS AND SETTING

College students (N = 907) were screened for reported histories of CSA (n = 94) or CPA (n = 109).

METHODS

Through an online survey, participants provided anonymous information regarding CSA and CPA experiences along with information about any disclosure events or opportunities that they have encountered since the abuse.

RESULTS

Among the adults reporting CSA histories, 50 % indicated disclosing the abuse during childhood; 80 % indicated any lifetime disclosure. Among the adults indicating CPA histories, 32 % reportedly disclosed the abuse to someone during childhood with 52 % reporting any lifetime disclosure. For both groups, length of delay until disclosure was bimodal with many individuals reporting immediately and many waiting considerable time. Among adults reporting CSA, a minority (16 %) indicated the abuse came to the attention of authorities, with even fewer CPA cases (8%) reporting authorities were aware of their abuse. Denial and recantation in a formal setting was infrequent regardless of abuse type reported.

CONCLUSIONS

Given that participants experiencing CSA and CPA both reported low levels of denial and recantation, forensic investigators and practitioners may benefit from considering consistent interviewing approaches and protocols, regardless of the type of abuse suspected.