Why do child sexual abuse victims not tell anyone about their abuse? An exploration of factors that prevent and promote disclosure

Teach to say "NO" - A mixed methods evaluation of a child sexual abuse prevention training for primary school teachers in Phnom Penh, Cambodia

BACKGROUND AND OBJECTIVE

Child sexual abuse is a point of contention around the world. Protecting children from sexual abuse and ensuring primary prevention approaches has been a predominant task for LMICs. The research objective is to evaluate the effectiveness of the "teach to say-NO" blended theory-based CSA prevention program by measuring knowledge and attitudes and analyzing the feasibility and acceptability of the intervention among primary school teachers in a school environment.

PARTICIPANTS AND SETTING

In total, 146 primary schoolteachers from 27 public schools in Phnom Penh, Cambodia were employed. and 29 teachers were employed for the qualitative study.

METHOD

The study was designed as a mixed-method study, consisting of a quasi-experimental study and a qualitative case study. The "teach to say-NO" program was delivered to intervention schoolteachers for 4 weeks. Both groups completed knowledge and attitude questionnaires at baseline, first, and second follow-up. The qualitative study was evaluated through in-depth face-to-face interviews conducted to analyze the feasibility and acceptability of intervention.

RESULTS

Study participants had poor knowledge on CSA and at baseline the knowledge (t = 0.72, d = 0.131) and attitude (t = -0.069, d = -0.011) scores between the intervention and comparison groups were the same. After the intervention participants demonstrated a significant improvement (p < 0.05) within and between groups. The feasibility and acceptability of the intervention "teach to say-NO" themes were coded into three main areas: interest of participation, challenging factors, and benefits.

CONCLUSION

These findings suggest the presence of knowledge gaps concerning child sexual abuse among teachers, thus highlighting the imperative for training in this field to enhance teachers' knowledge on CSA prevention.

Differentiating Between Sexual Offending and Violent Non-sexual Offending in Men With Schizophrenia Spectrum Disorders Using Machine Learning

Forensic psychiatric populations commonly contain a subset of persons with schizophrenia spectrum disorders (SSD) who have committed sex offenses. A comprehensive delineation of the features that distinguish persons with SSD who have committed sex offenses from persons with SSD who have committed violent non-sex offenses could be relevant to the development of differentiated risk assessment, risk management and treatment approaches. This analysis included the patient records of 296 men with SSD convicted of at least one sex and/or violent offense who were admitted to the Centre for Inpatient Forensic Therapy at the University Hospital of Psychiatry Zurich between 1982 and 2016. Using supervised machine learning, data on 461 variables retrospectively collected from the records were compared with respect to their relative importance in differentiating between men who had committed sex offenses and men who had committed violent non-sex offenses. The final machine learning model was able to differentiate between the two types of offenders with a balanced accuracy of 71.5% (95% CI = [60.7, 82.1]) and an AUC of .80 (95% CI = [.67, .93]). The main distinguishing features included sexual behaviours and interests, psychopathological symptoms and characteristics of the index offense. Results suggest that when assessing and treating persons with SSD who have committed sex offenses, it appears to be relevant to not only address the core symptoms of the disorder, but to also take into account general risk factors for sexual recidivism, such as atypical sexual interests and sexual preoccupation.

The prevalence of sexual grooming behaviors among survivors of childhood sexual abuse

BACKGROUND

Childhood sexual abuse (CSA) is a global problem that is preventable. Sexual grooming behaviors have been deemed an integral part of CSA for the purpose of avoiding detection and preventing disclosure. Many of these behaviors are reported more often by adults who experienced CSA as compared to those that did not (Jeglic et al., 2023). Such behaviors form important targets for prevention efforts, as well as the investigation and prosecution of CSA. Consequently, it is important to identify the prevalence rates of sexual grooming behaviors.

OBJECTIVE

The aim of the present study was to identify the prevalence of sexual grooming as reported by adult survivors of CSA.

PARTICIPANTS AND SETTING

A large sample of adults who reported a history of CSA (n = 1045) completed the study online via Prolific.

METHODS

Participants completed an anonymous self-report survey which included the Sexual Grooming Scale - Victim Version (Winters & Jeglic, 2022).

RESULTS

Overall, 99% of participants endorsed experiencing at least one sexual grooming behavior, with an average of 14.25 sexual grooming behaviors out of a possible 42 (range = 0-36) reported per survivor. Participants endorsed behaviors across all five stages of the sexual grooming process: victim selection, gaining access and isolation, trust development, desensitization, and post-abuse maintenance. The most frequently reported sexual grooming behaviors included the perpetrator selecting a child who was compliant/trusting (68%) or had low self-esteem (61%); arranging activities alone with the child (57%); presenting themselves as nice/charming/likeable (70%); showing the child large amounts of attention (56%) or affection (54%); and using seemingly innocent touch (51%).

CONCLUSIONS

Sexual grooming is prevalent based on reports from adult survivors of CSA. These findings will be discussed as they pertain to the prevention, detection, and prosecution of CSA.

Understanding the Narratives of Child Sexual Abuse

This qualitative study consisted of in-depth, retrospective interviews with participants over the age of 18 who experienced child sexual abuse. Through narrative analysis, study findings shed light on three overall findings: the perception of memories, the perception of grooming, and the perception of the lived lives of child sexual abuse survivors. Findings suggest that the narratives elicited from the participants included current views but also past experiences and anticipation about the future, including individual and societal levels of meaning. These narratives are furthermore entangled and inexorably linked - temporally, culturally, generationally, materially, and emotionally - and the results are thus presented from a holistic perspective. Study findings help explain the complex dimensions concerning the lived experiences of child sexual abuse. As such, this research speaks to the field of social and health care practitioners working with children and families facing the complex phenomenon of child sexual abuse.

Unveiling Child Sexual Abuse Disclosure in China: An Ecological Exploration of Survivors' Experiences

Through a thematic analysis of firsthand posts from 258 abuse survivors in online forums from 2016 to 2023, this research examines the barriers that Chinese children encounter when disclosing sexual abuse. The anonymous narratives shed light on the motives behind survivors' reluctance to reveal abuse, the outcomes following disclosure, and the wider implications for survivors and their families under culture. The findings underscore the need for early intervention upon disclosure, aiming to safeguard children from further harm and foster the development of an effective child protection framework.

Ecological approach to the characteristics and determinants of sexual violence against adolescents in Perú

Introduction. Sexual violence against adolescents is a global problem that affects young people around the world. The ecological model examines its forms and determinants through interconnected levels. Objective. To determine the frequency, characteristics, and predictors of sexual violence in adolescents attending school in Perú. Materials and methods. This was a cross-sectional study that secondarily analyzed data from the Encuesta Nacional de Relaciones Sociales (2019). A stratified probabilistic sample involved 1,579 youth aged 12-17 from 93 schools. The questionnaire evaluated physical, psychological, and sexual violence in the family and at school. Models were estimated using logistic regression analysis, calculating odds ratio (OR). Results. Eighteen point sixty eight per cent (95% CI: 16.80-20.60) suffered some type of sexual assault. In addition, 9.75% (95% CI: 8.28-11.21) reported having been touched in some part of the body and 1.84% (95% CI: 1.17-2.50) reported that was a victim of rape. Age was identified as a risk factor in the microsystem (OR = 1.48) (95% CI: 1.26-1.74), while the age of the first experienced sexual violence acted as a protective factor (OR = 0.61) (95% CI: 0.54-0.69). In addition, in the macrosystem, the perception that violence occurs mainly outside the home increased the risk (OR = 2.06) (95% CI: 1.01-4.19). Conclusions. Approximately two out of ten respondents reported having experienced some type of sexual violence, with verbal harassment and invasive personal contact being the most common. No single level or factor can fully explain adolescent sexual violence without considering its ecological interconnectedness.

"Pay Attention! Pay Attention! Pay Attention!!!": The Pivotal Role of Educators and the Educational System as Experienced by Survivors of Child Sexual Abuse

Educational institutions and educators are significant in children's lives, and they have a crucial role in implementing policies, practices, and sexual education to enhance children's safety. Such policies and practices should be based on the voices of CSA survivors. This study explored child sexual abuse (CSA) survivors' viewpoints on their past experiences with educators and the educational system. A qualitative thematic approach was used to analyze 61 written testimonies collected in 2020-2021 by the Israeli Independent Public Inquiry on CSA. Two interrelated themes arose: (1) CSA survivors' retrospective perspectives of educators and the educational system's responses to signs of their CSA, described as ranging from abusive to life-saving. Specifically, they shared three types of responses: (a) harmful and hurtful; (b) dismissive and ignoring; and (c) accepting and attending. (2) The second theme described the survivors' messages to educators to promote constructive change. The survivors conveyed expectations that educators should play a central role in CSA prevention, detection, and intervention and, specifically, the need for educators to receive professional training, provide beneficial sexual education, and identify and respond to CSA. The findings promoted moving beyond individual-level interventions to focus on improving educational institutional and organizational cultures related to CSA in both national and international contexts.

Dissociative Identity Disorder in Schools Part I

Dissociation is a normal life adaptation that can become pronounced and disruptive in the setting of repeated or extreme exposure to trauma. Children and adolescents may experience dissociation due to a trauma or stressor-related disorder, anxiety, or depressive disorders. Children and adolescents also may mimic behavior they see online as a way of expressing internally painful and intolerable experiences. Myth and misinformation surround the diagnosis of dissociative identity disorder (DID), formerly multiple personality disorder. The purpose of this article is to provide school nurses with evidence-based information on DID and resources for practice regarding how to provide a secure, consistent approach to students who are being traumatized, misunderstood, or excluded at home or at school. Part 1 of this two-part series describes DID foundations and DID in school-aged children, reviews controversy spurred by social media representation, and presents the Trauma-Informed Care (TIC) model. TIC offers useful perspectives regardless of a student's presentation or diagnostic status. Part 2 will discuss recommendations for managing dissociative presentations using a team-based approach, focusing on the school nurse's roles and responsibilities.

Understanding how peers respond to online child maltreatment disclosures: A qualitative content analysis of family violence discussions on social media

BACKGROUND

Positive, supportive responses to child maltreatment disclosure are critical for victims to receive appropriate resources and support for healing. Young people often prefer to disclose to their peers, frequently on social media platforms.

OBJECTIVE

We assessed young people's use of TalkLife, an online peer-to-peer support platform, to respond to the disclosure of child maltreatment.

METHODS

We conducted a qualitative content analysis of 1090 comments on childhood maltreatment-related posts on TalkLife between 2013 and 2020. We used an iterative, team-based qualitative content analysis approach to understand how peers responded to maltreatment disclosure.

FINDINGS

Peer responses tended to be supportive, including asking questions about the abuse and offering advice, emotional support, and other positive responses. Most commonly, peers advised the victim to report, focus on their strengths instead of the abuse, reach out to adults for more support, or confront the perpetrator. On occasion, however, peers began an irrelevant discussion, joked about the situation, or even directly attacked the discloser.

CONCLUSIONS

Learning about child maltreatment disclosures on social media builds the foundation for research to assist in identifying and applying interventions on online platforms. Further, these findings can inform programs that teach how to provide healthy responses to child maltreatment disclosures.

The Role of Technology in the Perpetration of Childhood Sexual Abuse: The Importance of Considering Both In-Person and Online Interactions

Child sexual abuse (CSA) is a pervasive global problem. To date, prevention efforts have largely focused on legislative efforts, parent and child education, and environmental protections. Due to the proliferation of the Internet, and especially since the COVID-19 pandemic, recent prevention efforts have focused on online CSA. However, the extent to which technology is being used in the perpetration of in-person, contact CSA remains unclear. This study examined the role of technology in the perpetration of in-person, contact CSA using a sample of 332 adult CSA survivors who completed an anonymous online survey. Overall, we found that only 8.5% of the sample reported that they met the perpetrator online through social media, chatrooms, and other online applications. When looking at the role of technology in the perpetration of the abuse, 35% reported texting with the perpetrator, 27% reported engaging in online chats, and 33% spoke to the perpetrator on the phone. Few participants reported sending (11%) or receiving (13%) photographs or videos that were sexual in nature. Technology use was reported more frequently in CSA involving adolescents than CSA involving children aged 12 and under. There were no differences in the use of technology based on the age of the person who perpetrated the CSA. These findings will be discussed as they pertain to prevention efforts for CSA.

Reliability of the Sexual Knowledge Picture Instrument: a potential diagnostic instrument for sexual abuse in young children

OBJECTIVE

To determine the intra-rater and inter-rater reliability of the Sexual Knowledge Picture Instrument (SKPI), a potential diagnostic instrument for young suspected victims of sexual abuse containing three scoring forms, that is, verbal responses, non-verbal reactions and red flags.

DESIGN

Video-recorded SKPI interviews with children with and without suspicion of child sexual abuse were observed and scored by two trained, independent raters. The second rater repeated the assessment 6 weeks after initial rating to evaluate for intra-rater reliability.

SUBJECTS

78 children aged 3-9 years old were included in the study. 39 of those included had known suspicion of sexual abuse and the other 39 had no suspicion.

MAIN OUTCOME MEASURES

Intra-rater and inter-rater reliability of the scores per study group and in the total sample were assessed by Cohen's kappa and percentage of agreement (POA).

RESULTS

The median intra-rater Cohen's kappa exceeded 0.90 and the POA exceeded 95 for all three forms in both study groups, except for the red flag form (median Cohen's kappa 0.54 and POA 87 in the suspected group, and 0.84 and 92, respectively, in the total sample). For the verbal scoring form the median inter-rater Cohen's kappa and POA were 1.00 and 100, respectively, in both groups. For the non-verbal form the median inter-rater kappa and POA were 0.37 and 97, respectively, in the suspected group, and 0.47 and 100, respectively, in the control group. For the red flag form, they were 0.37 and 76, respectively, in the suspected group and 0.42 and 77, respectively, in the control group.

CONCLUSION

The reliability of the SKPI verbal form was sufficient, but there is room for improvement in the non-verbal and red flag scoring forms. These forms may be improved by adjusting the manual and improving rater training.

Child Sexual Abuse and Problems Reported by Survivors of CSA: A Meta-Review

A systematic meta-review of reviews and meta-analyses on problems reported by survivors of Child Sexual Abuse (CSA) was conducted. The aim was to comprise a comprehensive overview of 1) problems reported by survivors of CSA, and 2) variables moderating these relations. Two raters independently conducted a search through PubMed, PsychINFO, Campbell Library, Cochrane Library and Web of Science. Twenty-five reviews and meta-analyses reporting on 53 problems related to CSA were analyzed. All fell into five domains: medical, psychological, sexual, repeated (self-)harm, and a final category of other problems. Thirty-six of all problems (68%) were consistently and significantly more commonly reported by CSA survivors as compared to individuals without a history of CSA. Most moderator analyses did not significantly influence these relationships. In conclusion, CSA is associated with various problems across different domains and overall, these problems are prevalent independent of specific characteristics of and circumstances surrounding the abuse.

Silencing by design: Lessons learned about child sexual abuse from a university sexual assault survey

Background:

University students have been recognized as particularly being vulnerable to sexual victimization.

Purpose:

With little research to date, and acknowledgement for the need of a better understanding of sexual violence, our study analysed the CQUniversity Sexual Assault Survey’s qualitative responses. An open-ended qualitative question allowed students to provide information anonymously.

Methods:

A total of 109 participants contributed responses with 17 respondents commenting on the fact that the survey omitted to ask about child sexual abuse prior to the cut-off age of 12 years.

Results:

University students revealed unexpected disclosures of prepubescent child sexual abuse victimization and ongoing sexual victimization into adulthood. Furthermore, students’ comments indicated negative impacts including distress, mental health and substance use problems, distrust, and interpersonal difficulties. Strong feelings about ‘silencing’ prepubescent child sexual abuse in university surveys were expressed with a request that questions about child sexual abuse prior to the age of 12 years be included.

Conclusion:

Our study found that child sexual abuse victimization is important to students. Recommendations indicate the need for future research about sexual violence among university students without age restrictions to gain a better understanding about the impact of trauma including revictimization experiences.

What Do Survivors of Child Sexual Abuse Believe Will Facilitate Early Disclosure of Sexual Abuse?

The purpose of this study was to explore what adult survivors of child sexual abuse (CSA) believe will facilitate early disclosure of sexual abuse. We conducted semi-structured interviews with 12 adult survivors of CSA aged 18-57 years, and analyzed the transcripts using reflexive thematic analysis. Our analysis resulted in three main themes: Adults making it possible to tell; Adults daring to consider the unthinkable; and Conveying knowledge of CSA that facilitates understanding. The findings highlighted the importance of adults facilitating disclosure and making it possible for survivors to tell about their experiences, but also the responsibility adults have to dare to consider the possibility of CSA when children struggle. Another important finding was the significance of enhancing the general population's understanding of the complexity of CSA, including why disclosure is difficult, so adults are given the tools needed to understand and know what to do when they suspect CSA. The findings also have important implications for the planning and implementation of interventions to facilitate early disclosure of CSA.