Child sexual abuse

Explaining Risk Factors for Successful Family Supervision Orders: Families with Intellectual Disabilities in Child Protection in the Netherlands

Families with mild to borderline intellectual disabilities (MBID) are overrepresented in child protection, and are at higher risk for long and unsuccessful family supervision orders (FSOs). This is worrisome, as many children apparently are exposed to unsafe parenting situations for longer periods of time. Therefore, the present study examined which child and parental factors and child maltreatment are related to the duration and success of an FSO in families with MBID in the Netherlands. Casefile data were analysed of 140 children with an ended FSO. Results from binary logistic regression analyses showed that in families with MBID, young children, children with psychiatric problems, and children with MBID were at higher risk for a longer duration of FSOs. Furthermore, young children, children with MBID and children who were sexually abused had a lower chance of a successful FSO. Unexpectedly, children who witnessed domestic violence or whose parents were divorced, had a higher chance of a successful FSO. The discussion focuses on implications of these results for treatment and care of families with MBID from the perspective of child protection.

Child Sexual Abuse: Comparison of Male and Female Victims

ABSTRACT

In the scientific literature, few authors deal with child sexual abuse (CSA) in boys. In addition, these authors debate this phenomenon in most available articles without statistically evaluating the occurrence of different or similar distributions of variables under sex. In light of the above, the authors compared multiple variables between female and male samples. The aim was to explore the characteristics of boys' CSA, identifying the main differences existing compared with the same phenomenon occurring in girls. The authors selected 2 samples for sex: group A, females; group B, males. The authors statistically compared the main variables between the 2 groups. The study yielded the following main results: the population was characterized by 607 children (476 were females-group A; 131 were males-group B); the variables' source of the referral and the type of anogenital findings were statistically significant. These data gave new insights into the CSA phenomenon. Because this study pointed out that sexual abuse does not have the same characteristics in boys and girls, researchers and safeguarding agencies should consider the abovementioned differences when planning preventive strategies against CSA.

Exploring Screening Practices for Child Sexual Abuse in School Settings: An Integrative Review

Child sexual abuse (CSA) is a pervasive public health problem. If left undetected, CSA can result in immediate and long-term health problems, which can be mitigated through early identification. Schools are an ideal environment to implement screening measures, and school nurses (SN) are uniquely poised to intervene and respond early. The aim of this review was to systematically examine and synthesize the international evidence related to screening for early identification of CSA in schools. Themes emerging from the analysis were SN behaviors relative to screening, potential instruments or approaches for screening, and SN and school professionals' beliefs about CSA screening practices. This review found little evidence that CSA screening is occurring in schools. However, SNs are aware that screening falls within their scope of practice and many SNs feel they should be screening for it. A constant proactive approach by SNs is necessary to improve early identification and subsequent intervention.

Psychological aftereffects experienced by sexually abused children: Psychopathological characteristics revealed by the K-CBCL

Children who have been sexually abused may experience various short- and long-term psychological sequelae and behavioral problems. This study assessed the mental health of sexually abused children using the Korean-Child Behavior Checklist (K-CBCL) and examined differences from a control group. The participants were 97 children who had been sexually abused and who visited a local Sunflower Center, and 178 control participants. Data were collected via the K-CBCL and analyzed using SPSS version 25.0. T-tests, cross-tabulation, and logistic regression analyses were performed. Scores from the K-CBCL Problem Behavior Syndrome scale were compared between sexually abused children and the control participants. Significant differences were observed between the 2 groups in all the subscales. Compared to the control group, children who were sexually abused showed statistically significant differences in the total problem behavior, internalization, anxiety/depression, withdrawal/depression (withdrawn), somatic symptoms, externalization, rule-breaking behavior (delinquency), aggressive behavior, social immaturity, thought problems, attention problems, and other subscale scores. Sexual violence hurts the overall mental health of children who are abused, including their emotional, behavioral, and social factors. Our findings suggest that multidisciplinary assessment and treatment are required for children who have experienced sexual abuse.

Mental Health and Psychosocial Problems among Children and Adolescents in Jordan: A Scoping Review

Introduction: In Jordan, mental health morbidity among children and adolescents is on the rise. Several studies in Jordan have assessed mental health issues and their associated factors among adolescents; however, there remains a lack of a collation of data regarding such issues. Objectives: To review the prevalence rates of mental health problems among children and adolescents in Jordan to understand the evidence base concerning psychiatric morbidity. Methods: The PubMed database, Cochrane Library, Virtual Health Library (VHL) Lilac, and APA PsycArticles were searched for literature published between January 2010 and May 2023. Studies were included if they were conducted on children and adolescents (≤19 years), were observational studies that reported prevalence data regarding psychosocial problems, and were studies conducted in Jordan. Results: The search yielded 211 records, of which 33 studies were assessed for eligibility and 28 met the inclusion criteria. The sample age ranged from 6-19 years. The prevalence rates ranged from 7.1% to 73.8% for depression, 16.3% to 46.8% for anxiety, 13.0-40.6% for ADHD, 11.7-55.2% for overall emotional and behavioral difficulties, 16.2-65.1% for PTSD, and 12-40.4% for eating disorders. Conclusions: The findings highlight the magnitude of mental health problems among children and adolescents and the heterogeneity of the results. Further studies are needed to investigate the prevalence of eating disorders among refugees, as well as sleeping disorders and substance use disorders among all adolescents.

A Non-Clinical Referral Tool to Help Identify Problematic Child Sexual Behavior: Development, Training, and Initial User Feedback

Early identification of children and youth who engage in problematic sexual behavior is important for all parties involved, such as children who exhibit and are impacted by the behavior. There are several reliable and valid identification tools that can be used to recognize problematic sexual behavior in children and youth (PSB-CY) in clinical practice; however, professionals who work with children in non-clinical settings (i.e., child development centers, youth programs, and schools) often have limited resources and tools when they encounter PSB-CY. This paper describes the development, content, and user feedback of a referral tool (RT) that was designed to help identify incidents of PSB-CY for use with military agencies and schools. Specifically, the RT was designed to help professionals, who may have observed or who may have been made aware of sexual behaviors in children and youth, organize their observations of the behavior in alignment with evidence-based information about PSB-CY and consistently document these occurrences. The RT guides users in determining if the observed behavior is normative, cautionary, or problematic and promotes informed decisions about whether the behavior needs to be referred to those who have experience using clinical tools for further review and the identification of next steps for supporting the children and families involved. Early adopters provided feedback on the use of the RT. The feedback suggested that the tool was user-friendly, understandable, and helpful as they made objective decisions about how to identify and handle referrals of PSB-CY.

Systematic review exploring the relationship between sexual abuse and lower urinary tract symptoms

INTRODUCTION AND HYPOTHESIS

Patients presenting with lower urinary tract symptoms (LUTS) may report a history of sexual abuse (SA), and survivors of SA may report LUTS; however, the nature of the relationship is poorly understood. The aim of this review is to systematically evaluate studies that explore LUT dysfunction in survivors of SA.

METHODS

A systematic literature search of six databases, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, was performed. The last search date was June 2021 (PROSPERO CRD42019122080). Studies reporting the prevalence and symptoms of LUTS in patients who have experienced SA were included. The literature was appraised according to the PRISMA statement. The quality of the studies was assessed.

RESULTS

Out of 272 papers retrieved, 18 publications met the inclusion criteria: studies exploring LUTS in SA survivors (n=2), SA in patients attending clinics for their LUTs (n=8), and cross-sectional studies (n=8). SA prevalence ranged between 1.3% and 49.6%. A history of SA was associated with psychosocial stressors, depression, and anxiety. LUTS included urinary storage symptoms, voiding difficulties, voluntary holding of urine and urinary tract infections. Most studies were of moderate quality. Assessment of SA and LUTS lacked standardisation.

CONCLUSIONS

The review highlights the need for a holistic assessment of patients presenting with LUTS. Although most of the studies were rated as being of 'moderate' quality, the evidence suggests the need to provide a "safe space" in clinic for patients to share sensitive information about trauma. Any such disclosure should be followed up with further assessment.

Facilitators and Barriers to Child Sexual Abuse Interventions: A Qualitative Study of Interventions in Iran

Background: Child sexual abuse is a public health problem in most countries. Sensitization, research, and programs for identifying and preventing child sexual abuse have been carried out at the national level with increased political and social awareness and international commitments to decline its consequences. Objectives: This study investigated the facilitators and barriers to community-based interventions for child sexual abuse. Methods: Semi-structured interviews were conducted between September 2021 and March 2022 with 15 purposefully selected experts. The interviews were audio-recorded, transcribed, and analyzed using the content analysis method. Results: Several barriers and facilitators affected child sexual abuse interventions. The barriers included: (1) sociocultural challenges; (2) legal challenges and gaps; and (3) managerial-structural challenges, while the facilitators were: (1) the improvement of the quality of provided services; and (2) facilitative role of the law. Conclusions: Social interventions for child sexual abuse could consider some items to improve implementation, namely as follow: (1) the intersectional cooperation of organizations and beneficiaries to conduct child abuse interventions for children and their families at the local and national levels; (2) the implementation of empowerment activities for the return of children and parents to the community after child sexual abuse; and (3) the revision of the laws and establishment of more deterrent punishments.

Evaluation of attachment style, parent's attitude, depression and anxiety in adolescents who are sexually abused

Purpose: The aim of this article was to describe the sociodemographic attributes of the adolescents who were sexual abused child and the characteristics of the sexual abuse encountered by adolescents; it was also aimed to compare their attachment styles to their parents, attitudes of their parents, their scale scores of depression and anxiety between healthy control group who haven't had sexual abuse. Materials and Methods: The research sample was formed by 34 adolescents in age range of 13-18 who had sexual abuse and 34 healthy adolescents in age range of 13-18 who haven't had sexual abuse. Sociodemographic data of all adolescents who joined the study were collected. Relationship Scales Questionnaire, Parental Attitude Scale, Children's Depression Inventory, State-Trait Anxiety Inventory were used to compare severity of depression and anxiety, parrental attitudes, the attachment styles to the parents of adolescents who had sexual abuse and adolescents who haven't had sexual abuse. Results: The average age of cases were calculated as 15.29±1.31. The fearful attachment subscale score average of sexual abuse group is significantly higher than the control group. The authoritarian attitude subscale score average of sexual abuse group is significantly higher than the control group. In addition, the depression and state-trait anxiety score average of sexual abuse group is significantly higher than the control group. Conclusion: It is extremely important to define the sociodemographic characteristics, characteristics of abuse and risk factors of children and adolescents who have been sexually abused, to increase mother-child interaction, to have parent trainings for the realization of secure attachment, to adopt a democratic parental attitude in terms of protecting the mental health of children and adolescents.

The association between child maltreatment and sleep disturbances among preschoolers

BACKGROUND

Child maltreatment (CM) can result in lifelong detrimental consequences, but its association with sleep disturbances in young children remains unclear.

OBJECTIVE

This study aimed to investigate the association of CM with sleep disturbances and short sleep duration among Chinese preschoolers.

PARTICIPANTS AND SETTING

Data were from a representative sample of 17,023 children (6.17 ± 0.29 years old, 51.96% boys) at their graduation year of preschool in September 2019, as a subset of the Shanghai Children's Health, Education and Lifestyle Evaluation-Preschool (SCHEDULE-P) study.

METHODS

Parents reported children's CM of different types and the Children's Sleep Habits Questionnaire (CSHQ). Logistic regression was used to evaluate the risk of sleep disturbances and short sleep duration linked to CM.

RESULTS

Of the children, 12,583(73.92%) demonstrated sleep disturbances (CSHQ total score > 41) and 3017(17.72%) demonstrated short sleep duration (<9 h/night). After adjusting covariates, physical abuse (aOR = 1.16, 95%CI = 1.05-1.28) and emotional abuse (aOR = 1.50, 95% CI = 1.39-1.62) were associated with global sleep disturbances. Physical abuse (aOR = 1.16, 95% CI = 1.06-1.28), physical neglect (aOR = 1.29, 95%CI = 1.12-1.49), and emotional abuse (aOR = 1.19, 95% CI = 1.09-1.30) were associated with short sleep duration. Sexual abuse was not significantly associated with global sleep disturbances or short sleep duration. A cumulative association was noted that more CM types were associated with increased global sleep disturbances and short sleep duration.

CONCLUSIONS

CM is associated with sleep disturbances and short sleep duration in young children. This highlights the efforts to prevent and reduce CM in favor of optimal sleep and whole health in young children.

Current of Child Sexual Abuse in Asia: A Systematic Review of Prevalence, Impact, Age of First Exposure, Perpetrators, and Place of Offence

BACKGROUND: Child sexual abuse (CSA) is a serious global problem and challenge for all people because it increases the risk of various issues. AIM: This study investigated the CSA in Asian countries focusing on prevalence rates, impact, victim’s age of first exposure, type of CSA, perpetrator, and places of CSA offence. METHODS: We searched PubMed, Medline, ProQuest, ScienceDirect, CINAHL, Academic Search Complete, ClinicalKey, PsycINFO, Google Scholar, and manual search for studies published between January 2011 and November 2020. Only articles related to CSA in Asia were included in this review. RESULTS: The results showed that prevalence of CSA ranged from 2.2% - 94% for girls and 1.7% - 49.5% for boys. The prevalence rates for non-contact abuse were 12.6% - 56.5% for girls and 0.7% - 68.7% for boys; contact abuse was 5.3% - 67.2% for girls and 2.2% - 53.3% for boys; penetrating abuse was 0.5% - 88.24% for girls and 1.7% - 57.1% for boys. The findings reported most victims’ age of first exposure was preteen. The rate of the violation occurring in the victim’s house was 6.1% - 41.9%; most CSA perpetrators are known by victims. This study reported adverse impacts on CSA victims such as psychological, health, and physical disorders, and changes in behavior. In addition, other findings were found, including recovery, perceptions, values, causes, and expectations of victims of CSA. CONCLUSIONS: The incidence of CSA in Asia is still high and the age of the first victims is early adolescence. The majority of victims are women who already know the perpetrator, and taboo cultural factors are thought to play a role in increasing CSA in Asia. The results indicate the need to develop CSA prevention efforts that involve culture.

Sexual violence: 10 years of case studies in a hospital in Northern Italy

Background: In the past twenty years, the fight against sexual violence has become a common goal of the entire European Union, due to a greater socio-cultural awareness of the population and the need to create guidelines for common action. Italian Law no. 66 of February 15, 1996, regarding the “Rules against sexual violence” which, with the appropriate amendments, is still in force today, defines 3 types of sexual offenses through the articles 609 of the Penal Code.

Design and Methods: This study analyzes the cases relating to one of the hospitals in Northern Italy, during the decade January 2010 - December 2019, relating to suspected/reported cases of sexual violence, group sexual violence and sexual acts with minors. This study was carried out by acquiring information relating to subjects who had been victims of a sexual crime through the analysis of the consultations drawn up by specialist medical staff in the submentioned hospital. These consultations are defined by specific medical protocols that must be activated every time a victim of a suspected sexual offense comes into the Emergency Room (ER). The data were processed with descriptive analyzes, the qualitative variables were synthesized with absolute and percentage frequencies, while the quantitative variables with mean and interpolation of the data, to identify a trend line. In order to hypothesize the possible future trend of the phenomenon, data were collected relating to the type of crime according to the Penal Code, gender and age of the victim. This article also outlines future directions for improving research.

Results: Our data shows that females, of any age, are the most affected in all sexual crimes, often share home with their aggressor, usually a man, and in most cases, they come to the medical observation without any lesion on their body.

Conclusions: In order to provide a global vision of the situation and of the diffusion throughout the territory, studies like this one could be carried out in various Italian provinces. Besides, we hope that the high degree of commitment on the part of society and institutions in combating sexual violence, through information campaigns and incitements to report, will lead in a few years to a reduction in the number of victims of repeated violence (especially in family contexts) and, consequently, also in the total number of acts of violence that comes to the attention of the healthcare facilities. Finally, primary prevention of sexual violence must begin early because a substantial portion is experienced at a young age. It will be necessary to prevent these forms of violence with strategies that address known risk factors for perpetration (e.g., low family support, high poverty, low parental education, absent or single parenting, parental substance abuse, domestic violence, low caregiver warmth), by changing social norms and behaviors and by identifying protective factors that could be strengthened.

The role of stigmatization in developing post-traumatic symptoms after experiencing child sexual abuse by a female perpetrator

BACKGROUND

The context in which individuals are exposed to child sexual abuse (CSA) and reactions to the disclosure of such abuse experiences play a major role in post-traumatic mental health. Female-perpetrated CSA is an under-recognized issue in society and mental health care, and is therefore supposed to be a breeding ground for stigmatization.

OBJECTIVE

The aim of the current study was to examine the mediating role of internalized and anticipated stigma on the effects of so-called victim-blaming experiences and the perception of abuse in the childhood of survivors of female-perpetrated CSA on their post-traumatic symptom severity.

METHOD

A total of 212 individuals who reported experiences of female-perpetrated CSA were assessed in an anonymous online survey. The International Trauma Questionnaire (ITQ) served as the primary outcome parameter for detecting differences in post-traumatic symptom severity within mediation analyses, where victim-blaming and abuse awareness served as predictors and anticipated as well as internalized stigma served as mediator variables.

RESULTS

Internalized stigma fully mediated the deteriorating effect of victim-blaming on post-traumatic symptom severity, while abuse awareness and anticipated stigma showed no statistically significant effects as predictor and mediator variables. Yet, victim-blaming had a significant increasing effect on anticipated stigma.

CONCLUSIONS

Efforts to enhance awareness of female-perpetrated CSA in society are needed and mental health care professionals should pay attention to the adverse effects of victim-blaming and internalized stigma on post-traumatic symptoms in individuals affected by female-perpetrated CSA.

Childhood sexual abuse perceptions and experience among college students of Panchkula

Background and Objective:

Child sexual abuse (CSA) is a global public health and human rights concern. Hence, the present study was conducted to assess childhood sexual abuse perception and experience among college students of Panchkula.

Methodology:

A self-administered anonymous questionnaire which assessed perception and experiences of childhood sexual abuse was given to a convenient sample of 1000 college students. Using descriptive statistics and Chi-square test, perception and the experience of childhood sexual abuse were calculated.

Results:

The study showed that 18% (boys = 20%, girls = 16%) of the students were exposed to CSA, with boys more often affected than girls. The student's perception about abuse was not very clear. Myths and cultural beliefs justified abuse.

Conclusion:

Although preliminary in nature, the present findings are among the first to demonstrate the nature of CSA among students of Panchkula. Further, the study revealed that CSA manifests both as contact and noncontact forms. More boys than girls are exposed to most forms of abuse.

Female Child and Adolescent Sexual Abuse Cases Reported at the Geneva University Hospitals Between 2006 and 2014: A Retrospective Study

STUDY OBJECTIVE

To provide an objective quantification of the demographic characteristics and clinical findings related to female child and adolescent sexual abuse cases reported at the Geneva University Hospitals.

DESIGN

Retrospective study.

SETTING

Obstetrics and gynecology emergency unit.

PARTICIPANTS

Female children (0-12 years old) and adolescents (13-20 years old) seeking primary care after sexual assault.

INTERVENTIONS

None, observational study.

MAIN OUTCOME MEASURES

Delay from assault to time of presentation to primary care presentation, type of perpetrators, and the presence gynecological and bodily lesions.

RESULTS

Compared with children, a significantly higher proportion of adolescents presented to the hospital within 24 hours (134/289 (46.4%) vs 7/33 (21.2%); P = .006). Perpetrators were family members in 15/36 (41.7%) of children and in only 14/304 (4.6%) of adolescent patients (P < .00001); perpetrators were unfamiliar/nonrelated people in 8/36 (22.2%) of children and in 166/304 (54.6%) of adolescent patients (P < .0003). We did not find a significant difference between the 2 age groups with regard to the presence of gynecological lesions (15/35 (42.9%) of children and 91/298 (30.5%) of adolescent patients). However, we found a significant difference in the proportion of patients with bodily lesions such that 11/36 (30.6%) of children and 175/300 (58.3%) of adolescents (P = .002) were afflicted with bodily lesions.

CONCLUSION

To our knowledge this is the first study to evaluate child and adolescent sexual abuse cases on the basis of real-life data collected in Switzerland. Our results highlight important differences in child and adolescent sexual assault in terms of delay in presentation to primary care, perpetrator's relation to the victim, and presence of bodily lesions. This study confirms that gynecological findings alone are not consistently present in the patients who seek primary care after sexual assault.

Immediate and Long-Term Mental Health Outcomes in Adolescent Female Rape Survivors

Rape is considered a stressful trauma and often has long-lasting health consequences. Compared with adult females, limited data exist on the psychological impact of rape in adolescents. The aim of this study was to assess the prevalence and associated factors of emotional distress in a cohort of adolescent rape survivors in Cape Town. Participants in this prospective longitudinal study were 31 adolescent female rape survivors recruited from a rape clinic in Cape Town and assessed within 2 weeks of the assault. Assessment measures included a sociodemographic questionnaire and initial screening with the Child and Adolescent Trauma Survey (CATS), the patient-rated Children's Depression Inventory (CDI), and the Multidimensional Anxiety Scale for Children (MASC). The CATS, CDI, and MASC were repeated at 1, 3, 6, 9, and 12 months post enrollment. Psychiatric diagnoses were made with the clinician-administered Mini International Neuropsychiatric Interview-Child and Adolescent version (MINI-Kid). At baseline, on the MINI-Kid, a definitive diagnosis of major depressive episode was endorsed in 22.6% of the participants. Stress-related disorders were found in 12.9%, whereas 16.1% had anxiety disorders. There was no diminution of symptoms on self-reported psychopathology measures at follow-up assessment over the five follow-up time points, suggesting persistent psychopathology over a 1-year period despite repeated clinical assessments and supportive counseling. Symptoms of anxiety, depression, and posttraumatic stress disorder in this sample of adolescent female rape survivors were high at enrollment and found to be persistent, underlining the need for long-term support, screening, and evidence-based follow-up care.

Predictors of Adherence to HIV Post-Exposure Prophylaxis and Retention in Care After an Episode of Sexual Violence in Brazil

Adherence to nonoccupational post-exposure prophylaxis (nPEP) among sexual violence (SV) victims and their retention in care after SV represent significant challenges. This study aimed at identifying predictors of adherence to nPEP and retention in clinical-laboratory follow-up among SV victims in São Paulo, Brazil. We conducted a retrospective cohort study of SV victims admitted to care and follow-up at the SV unit of the main reference hospital in São Paulo within 72 h following the SV episode. Eligible patients were submitted to a standardized protocol that included nPEP, screening, and management for other sexually transmitted infection as well as emergency contraception. Predictors of adherence to nPEP for 28 days and retention in care until discharge at 180 days after admission were analyzed. A total of 199 SV episodes in 197 victims were recorded from January 2001 to December 2013 (156 months). Of those episodes, 167 were eligible to receive nPEP and 160 (96%) actually received a prescription. Overall 104/160 [65%, 95% confidence interval (CI) 57-72] SV victims, who received nPEP, were fully adherent to nPEP up to 28 days, whereas 89/199 (45%, 95% CI 38-52) were retained in care for 180 days following admission. In multi-variate analysis, patients undergoing at least one psychological consultation (n = 126) were more likely to adhere to nPEP [adjusted odds ratio (adjOR) 8.32; 95% CI 3.0-23.3] and be retained in care for 6 months (adjOR 40.33; 95% CI 8.33-195.30) compared to patients not receiving psychological support. In contrast, study outcomes were not associated with victims' age and sex and with type of perpetrator. In our cohort, provision of psychological care was shown to be associated with enhanced adherence to nPEP and retention in care.

Factors associated with unwanted sexual experiences of young Australian females: an observational study

Background Behavioural and lifestyle factors associated with childhood unwanted sexual experiences (USE) have yet to be investigated in Australian females aged less than 18 years.

METHODS

Women aged 16-25 years living in Victoria were recruited via targeted advertising on Facebook. A web-based validated questionnaire was used to collect information on participant demographics, mental health, USE and sexual behaviours. Multivariable logistic regression was used to determine associations between a history of childhood (<16 years) and adolescent (16-18 years) USE and indices of sexual orientation.

RESULTS

Data were collected from 639 females (mean±s.d. age 22±3 years). Approximately 14% reported childhood USE and 15% reported adolescent USE. Approximately 37% of survivors of childhood USE reported penile-genital contact in relation to their USE. Participants who reported depression were almost four times as likely to have experienced childhood USE than those who did not report suffering from depression (odds ratio 3.6, 95% confidence interval 2.1-6.0, P<0.001). Positive associations between childhood USE, same-sex relationships and smoking were also detected.

CONCLUSIONS

A strong relationship between childhood USE, depression and same-sex sexual behaviours was found, but results did not determine the direction of this association. Longitudinal studies should be conducted to investigate whether there are groups of individuals who are at a high risk of experiencing childhood USE, so that appropriate support systems can be put in place.

Betrayed and Broken: A Study of the Experiences of Victims of Child Sexual Abuse in the Ga Community in Accra, Ghana

Child sexual abuse is increasingly becoming an issue of concern in most societies across the globe, including Ghana. This is a phenomenological study that sought to describe the lived experiences of victims of child sexual abuse in Ghana, using the Ga community as a case study. Purposive and snowball sampling techniques were used to identify 17 sexually abused children in the Ga Community. Using the interpretative phenomenological analysis (IPA), four main themes described the experiences of the victims: (a) forced sex (b) incest (c) joleying and (d) transactional sex. The findings illustrate the different circumstances in which children were sexually abused in the community studied. It also presents socio-cultural factors that normalizes the sexual abuse of children in the Ga Community. These findings underline the need for effective preventive programs and community interventions to protect children and support victims of child sexual abuse.

Situating the Notion of "gbɛkɛfɔŋs" in the Discourse of Child Sexual Abuse Among the Ga in Accra, Ghana

Child sexual abuse (CSA) is a prevalent problem in many societies across the globe. There have been several discussions of the subject and attempts have been made to explain its incidence and find ways to prevent and/or control it. However, despite these efforts, the problem seems to persist in developing countries like Ghana with dire consequences for the children and society at large. This paper sought to glean insights about the persistence of the problem by focusing on the discourse surrounding the subject. Using Focus Group Discussions with adult members in the Ga communities in Accra namely La, Teshie, and James Town where the phenomenon is relatively pervasive, the paper sought to understand the reasoning and the implications of accusing children who were sexually abused in the Ga community of seducing the perpetrators and engaging in sex for money. The paper posits that the labeling of victims of CSA as "gbɛkɛfɔŋs" (children of bad character) disempowers children and perpetuates the abuse of children. Thus, introducing and situating this notion of "gbɛkɛfɔŋs" in the center of the discourse largely results in a victimization of the victims and a vicious cycle of CSA. The conclusions from this study point to the need for a reorientation of parental and communal roles and an empowering of children to identify and resist sexual abuse.

Anogenital warts in pediatric population

The approach to children with anogenital warts in the context of sexual abuse is a challenge in clinical practice. This study aims to review the current knowledge of anogenital warts in children, the forms of transmission, and the association with sexual abuse and to propose a cross-sectional approach involving all medical specialties. A systematic review of the literature was conducted in Portuguese and English from January 2000 to June 2016 using the ISI Web of Knowledge and PubMed databases. Children aged 12 years or younger were included. The ethical and legal aspects were consulted in the Declaration and Convention on the Rights of Children and in the World Health Organization. Non-sexual and sexual transmission events of human papillomavirus in children have been well documented. The possibility of sexual transmission appears to be greater in children older than 4 years. In the case of anogenital warts in children younger than 4 years of age, the possibility of non-sexual transmission should be strongly considered in the absence of another sexually transmitted infection, clinical indicators, or history of sexual abuse. The importance of human papillomavirus genotyping in the evaluation of sexual abuse is controversial. A detailed medical history and physical examination of both the child and caregivers are critical during the course of the investigation. The likelihood of an association between human papillomavirus infection and sexual abuse increases directly with age. A multidisciplinary clinical approach improves the ability to identify sexual abuse in children with anogenital warts.

Factors associated with child sexual abuse confirmation at forensic examinations

Abstract The aim of this study is identify potential factors associated with child sexual abuse confirmation at forensic examinations. The forensic files of children under 12 years of age reporting sexual abuse at the Nina Rodrigues Institute of Forensic Medicine in Salvador, Bahia, Brazil between January 2008 and December 2009 were reviewed. A multivariate analysis was conducted to identify factors associated with finding evidence of sexual abuse in forensic examinations. The proportion of cases confirmed by the forensic physician based on material evidence was 10.4%. Adjusted analysis showed that the variables place of birth, type of abuse reported, family relationship between the child and the perpetrator, and the interval between the reported abuse and the forensic examination were not independently associated with finding forensic evidence of sexual abuse. A report of penetration was associated with a five-fold greater likelihood of confirmation, while the victim being 10-11 years of age was associated with a two-fold of abuse confirmation than younger children. These findings should be taken into consideration when drawing up guidelines for the multidisciplinary evaluation of children suspected of being victims of sexual abuse and in deciding whether to refer the child for forensic examination.

The Effects of Victim Age, Perceiver Gender, and Parental Status on Perceptions of Victim Culpability When Girls or Women Are Sexually Abused

This study investigated perceptions of victim culpability in sexual assaults against girls and women according to victim age, perceiver gender, and perceiver parental status. Overall, 420 jury-eligible participants completed an online survey recording their attributions of guilt, responsibility, and blame toward 10-, 15-, and 20-year-old girls and women in relation to sexual assault. Attributions of culpability were affected by whether the victim physically or verbally resisted the abuse, wore sexually revealing clothes, or was described as having acted promiscuously. Fifteen-year-old victims were perceived as more culpable for the abuse than 10-year-old victims. Implications of these findings are discussed.

Sexual Violence Among Middle School Students: The Effects of Gender and Dating Experience

Sexual violence has been increasingly recognized as a social, rather than strictly individual or family, problem. Unfortunately, providers and policymakers remain divided on the scope and causes of sexual violence, which limits their capacity to develop theory- and evidence-based responses. Such limitations are particularly pronounced in regards to children and adolescents. These youth are rarely addressed in the literature, and when they are, scholars tend to focus on adult victimization of children rather than children's victimization of their peers. This study investigates the prevalence of unwanted sexual contact among middle students. Data are from a sample of 1,371 students attending New York City public middle schools. Drawing from current antiviolence curricula and scholarly literature on sexual violence, gender and dating experience are used as predictors of victimization and perpetration; race, age, and prior exposure to antiviolence programming are included as controls. Data reveal that, while boys' violence towards girls comprises a substantial proportion of sexual violence in this population, same-sex violence and girls' violence towards boys are also prevalent. Analyses conclude with recommendations for future antiviolence programming based on these patterns.

Edutainment as a Strategy for Parental Discussion With Israeli Children: The Potential of a Children's Play in Preventing Sexual Abuse

Edutainment is a communication strategy to influence attitudes and behaviors through the use of the media. Through the children's play "Yael Learns to Take Care of Her Body," designed for joint viewing by children aged 5-8 and their parents, sexual abuse is raised. This qualitative study findings indicate that parents from low socioeconomic subgroups from the secular sector reported that their awareness had been raised by viewing the play and that they received tools for holding a conversation. Conversely, parents from high socioeconomic subgroups in the secular sector and parents from the national-religious sector were more ambivalent regarding the play's effectiveness. In order to make the conversation meaningful, the play has to tailor different messages to different audiences. A single program is not enough but should be part of a series of customized intervention programs for different subpopulations and separate programs for parents and children accompanied by professionals.

Prevalence and pattern of sexual assault in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Introduction

Sexual violence is an important public health problem of growing concern all over the world. This study was conducted to determine the prevalence and pattern of sexual assault managed in Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria.

Methods

It was a retrospective study that looked into cases of sexual assault admitted into the hospital between January 2010 and December 2014. Information on patients’ biodata, and relevant details on the cases were extracted from the patients’ case files and analyzed.

Results

Out of the 5317 gynecological admissions during the period under study, 45 (0.84%) were cases of sexual assault. Of these, only 34 case files were available for data extraction. The patients’ ages ranged from 2 to 37 years (mean = 12.6 + 8.3). About two thirds (61.8%) of those affected were young children (aged 12 years and below). In majority of cases (70.6%) the assault was penetrative, and in most of the cases (91.2%) only a single assailant was involved. In close to two thirds of cases, the assailant was either an acquaintance (38.2%) or a family member (20.6%). Although law enforcement agents were informed in majority (58.8%) of cases, arrests were made in less than half (41.2%).

Conclusion

Although the prevalence of sexual assault in this study appears to be low, a major cause for concern is the fact that those affected were predominantly young children. Parents should be more vigilant in monitoring their children’s movement, and stringent laws should be enacted and enforced to curb this heinous act.

Tools to assess psychological trauma & its correlates in child sexual abuse: A review & current needs in Asia

Absence of visible physical symptoms and limited capacity to express trauma directly, pose significant challenges in assessment of its exact nature of trauma and its correlates in child sexual abuse. There are numerous assessment tools however, deciding upon the appropriateness is often challenging in Asian socio-cultural and health care set up. A review would provide a ready reference to the practioner regarding the exact clinically utility of the tools and also would guide them in the direction of culture specific modifications. Computerized databases namely Medline, PsycINFO, Health and Psychosocial Instruments, and Social Sciences Citation Index were used. 52 scales were obtained and analysed in terms of scale characteristics, reference to theory and DSM, and cultural competency. Despite of a wide variety of methods, and newer instruments, many of the traditionally used techniques of child's internal thinking and emotional assessment appear outdated while reviewing the recent theories of CSA related psychological trauma. An integrated format, incroporating child-parent-clinicain rating, with multiple domain speciafic items and verbal and non-verbal tasks, is the current need in the Asian region.

The knowledge and skills related to sexual abuse prevention among Chinese children with hearing loss in Beijing

BACKGROUND

The prevalence of any child sexual abuse (CSA) experience before the age of 16 years ranges from 10.2 to 35.2% in China,^1-5 but there has been no research so far exploring the level of awareness of CSA prevention and self-protection skills among Chinese children with hearing loss.

OBJECTIVE

The school based survey examines the CSA prevention knowledge and self-protection skills in Chinese children with hearing loss.

METHODS

Fifty-one students (30 boys, 21 girls) from 10 to 16 years old participated in the study. Children's CSA prevention knowledge and self-protection skills were tested by using anonymous self-administered questionnaire which was mainly designed based on previous Chinese CSA research questionnaires, the Personal Safety Questionnaire, and the 'What If' Situations Test (WIST).

RESULTS

There were ten questions assessing the knowledge of CSA but none of the children could correctly answer all and seventy percent of the students could not answer more than five questions correctly. Only three students got the maximum skills score. If sexual abuse occurs, about fifty two percent of the children would report it to trusted adults and most of them would report it to their relatives. Girls received significantly higher scores than boys.

CONCLUSION

Chinese children with hearing loss lack knowledge regarding child sexual abuse and the way to protect themselves. There is an urgent need to develop CSA prevention programs in the school for children with hearing loss in China. Parental training and parent-child interaction on CSA prevention should be developed and promoted as well.

Analysis of acute presentations for child protection medical assessments in a large, culturally diverse metropolitan setting

OBJECTIVE

South Western Sydney has a large culturally diverse population with many vulnerable subgroups; little is known about the health and social outcomes following acute child maltreatment assessments. We aimed to describe acute presentations of maltreatment in South Western Sydney-including examination findings of the assessment, determine health and social outcomes for children following medical assessment, to inform service development.

DESIGN

We gathered data from the acute child protection database on all children <16 years referred for physical abuse and neglect and/or sexual abuse assessment between 2013 and 2015 to one hospital service. We reviewed clinical records of the children assessed, using the reports to classify findings of the examination. We performed simple descriptive analysis on the data.

RESULTS

There were 304 children referred, 279 seen for acute assessment. Most (72%) were female, 204 (73%) referrals were for sexual abuse, 75 (27%) were for physical abuse and neglect. There were age, gender and ethnicity differentials depending on type of maltreatment presentation. Twelve per cent of sexual and 19% of physical abuse cases were found not to be abuse related. Unmet medical, developmental and behavioural concerns were identified in the majority (54%) assessed. Just under half (48%) of all children went home with families with no statutory agency support; those seen for physical abuse were more likely to be placed in care (p<0.001).

CONCLUSIONS

Children assessed for child maltreatment had a range of health and social concerns identified, needing further intervention. Comprehensive medical assessments have a critical role to play in child protection assessments.

Child sexual abuse and the development of psychiatric disorders: a neurobiological trajectory of pathogenesis

Child sexual abuse (CSA) is an important public health problem with long-standing neurobiological, developmental, and psychiatric abnormalities. The present review analyzes the long-term effects of CSA from a developmental, psychiatric morbidity, neurochemical and neurobiological perspective and then tries to posit a developmental neurobiological trajectory from CSA to the genesis of psychopathology in later life. The role of various neurotransmitters such as serotonin and dopamine affected by CSA are discussed. Serotonin abnormalities have been reported in various studies among participants exposed to CSA. Structures such as the prefrontal cortex, superior temporal gyrus, corpus callosum, parietal lobes, hippocampus, and cerebellum all demonstrate volumetric and structural changes in response to the trauma of CSA. Neurocognitive studies demonstrate memory and spatial awareness as well as decrements in general cognitive performance and memory when compared to normal individuals. The hypothalamic-pituitary-adrenal axis has also been implicated in CSA, and there is an alteration in corticotropin-releasing hormone response due to the continuous cumulative trauma of CSA. This paper also reviews a section on the role of genetic and epigenetic factors in the development of psychiatric disorders as a result of exposure to episodes of CSA where studies have demonstrated changes in DNA methylation in response to CSA. This review tries to hypothesize a developmental trajectory framework which is individual for every case where exposure to CSA may lead to psychopathology and psychiatric morbidity later in life. Rapid and emerging fields such as developmental traumatology in relation to CSA are also discussed.

[Complementary exams in child abuse: A French national study in 2015]

INTRODUCTION

Even if there are HAS (French National Health Authority) guidelines on shaken baby syndrome, many other child abuse situations are not included in these recommendations. The aim of this study was to invent the complementary exams in cases of child abuse in France and compare the practice to existing guidelines.

MATERIAL AND METHODS

This was a multicenter study by email to 128 French hospitals (35 university hospitals and 93 general hospitals) that receives children in emergency and hospitalization settings. Three child abuse clinical situations were included in a clinical case multiple-choice format concerning the further explorations. We described the main results and evaluated their adherence to the HAS protocol for case 1.

RESULTS

Of 128 hospitals surveyed, 104 responded, for an 81 % response rate, which corresponded to 274 doctors. Analysis of the results showed great heterogeneity in practices. The majority of physicians (99 %) performed systematic explorations in the situation of physical abuse, while only 27 % undertook such exams in situations of serious neglect. The situation of sexual abuse was the most consensual in terms of diagnostic tests for the detection of sexually transmitted diseases, but other types of associated abuse were not sought. In the first case, the HAS guidelines were respected in less than half of the cases for all complementary exams except the eye fundus exam. Abdominal imaging was insufficiently performed (40 % of cases). Examinations that were not indicated were still prescribed. Moreover, siblings under 2 years of age were examined in only one-third of cases (n=88/274; 32 %). Practices were not influenced by the age of the child.

CONCLUSION

This study illustrates the heterogeneity in the use of complementary exams in cases of child abuse in France. Common protocols throughout the country would be useful, standardizing the most relevant exams for potential medical-legal issues, and facilitating exchanges concerning practices between different centers.

Depression and post-traumatic stress disorder in child victims of sexual abuse: perceived social support as a protection factor

Background Social support has been shown to play a protective role against the development of post-traumatic stress disorder (PTSD) and depression in individuals exposed to trauma. Aims The purpose of this study was to investigate the effect of perceived social support on depression and PTSD in child victims of sexual abuse and to determine the relationship between them. Method In total 182 victims of sexual abuse aged 6-18 at time of interview were assessed. Clinical interviews, the Children's Depression Inventory (CDI) and the Child Posttraumatic Stress Reaction Index (CPTS-RI) were used to assess children's psychological status, while the Perceived Social Support Scale-Revised (PSSS-R) was used to measure social support. Results Girls had significantly higher median CDI and CPTS-RI scores than boys, while no significant difference was determined between boys and girls in terms of PSSS-R scores. A statistically significant negative correlation was determined between CDI and PSSS-R scores, CPTS-RI scores and PSSS-R scores in girls, while no significant correlation was identified in male victims. Conclusions In conclusion, we think that social support networks for victims of sexual abuse need to be broadened and increased, and that importance should be attached to protective approaches in that context.

The impact of childhood sexual abuse on the mental and physical health, and healthcare utilization of older adults

BACKGROUND

The aim of this study is to examine the long-term association between childhood sexual abuse (CSA) and mental and physical health, especially with conditions related to hypothalamic-pituitary-adrenal axis dysfunction such as mood disorders, cardiovascular disorders, gastrointestinal disorders, pain disorders, and measures of frailty and functional mobility. In addition, we examined the impact of CSA on self-reported health and healthcare utilization.

METHODS

Data from the Irish Longitudinal Study on Ageing were employed (N = 8,178). The effects of CSA on mental health, physical health, and healthcare utilization in old age population were estimated by ordinal least square, logistic regression, and Poisson regression, controlling for demographic factors, childhood adversities, and behavioral health.

RESULTS

Six percent of respondents reported CSA with little variation by gender. A significant association was found between CSA and mental health. Those who reported CSA were more likely to have depression, anxiety, worry, loneliness, and low quality of life. Poor self-reported health, lung disease, arthritis, peptic ulcer, chronic pain as well as high levels of total cholesterol and low-density lipoprotein were associated with CSA. Further, those who reported CSA were more likely to report doctor and hospital visits than those without a history of CSA.

CONCLUSIONS

Findings from the present study show that CSA has significant long-term mental and physical consequences, whereby early life events are linked to later life health outcomes.

[Child sexual abuse: clinical perspectives and ethico-legal dilemmas]

OBJECTIVES

In the review of the current literature, the main causing factors of the related conditions with child sexual abuse are the ethical dilemmas and legal implications.

METHODS

A review was conducted on the classic literature on this topic. In this articlesome difficult paradigmatic cases are presented in which the hypothetical dilemmas were solved.

RESULTS

The main characteristics of child sexual abuse enable us to have a better argument to address these situations.

CONCLUSIONS

Taking into account the literature reviewed and predictable courses of action, it is concluded that it is important to take into account each individual each case and its circumstances, and that prudence and clinical objectivity, as well as knowledge of the law, become essential requirements for proper action.

The relationship between parental presence and child sexual violence: Evidence from thirteen countries in sub-Saharan Africa

There are compelling reasons to believe that orphans - many millions due to the AIDS epidemic - are more likely to be sexually victimized during childhood. Few studies have empirically investigated sexual violence disparities, and those that do suffer from methodological limitations and limited geographic scope. We used nationally representative data on female adolescents (15-17 years) from 13 countries in sub-Saharan Africa. We built multilevel logistic models to test for an association between the dependent variables (orphanhood and parental absence) and sexual violence, both within countries and pooled across all countries. Approximately 10% of adolescent girls reported past experiences of sexual violence; a third of those victimized were 14 years or younger at the time of their first forced encounter. Paternal orphaning (OR 1.36, p≤0.01), double orphaning (OR 1.47, p≤0.05), and paternal absence (OR 1.28; p≤0.05) were significantly associated with experiencing sexual violence in pooled analyses. Fewer findings reached significance within individual countries. Our findings suggest that the lack of a father in the home (due to death or absence) places girls at heightened risk for childhood sexual abuse; further research identifying pathways of vulnerability and resilience specific to this population is needed. Our findings also indicate that abuse often starts at an early age; thus promising programs should be adapted for younger age groups and rigorously tested.

Knowledge and attitude towards rape and child sexual abuse--a community-based cross-sectional study in rural Tanzania

BACKGROUND

Violence against women and children is globally recognized as a social and human rights concern. In Tanzania, sexual violence towards women and children is a public health problem. The aim of this study was to determine community knowledge of and attitudes towards rape and child sexual abuse, and assess associations between knowledge and attitudes and socio-demographic characteristics.

METHODS

A cross-sectional study was undertaken between May and June 2012. The study was conducted in the Kilombero and Ulanga rural districts in the Morogoro Region of Tanzania. Men and women aged 18-49 years were eligible for the study. Through a three-stage cluster sampling strategy, a household survey was conducted using a structured questionnaire. The questionnaire included socio-demographic characteristics, attitudes about gender roles and violence, and knowledge on health consequences of rape. Data were analyzed using the Statistical Package for Social Sciences (SPSS) software, version 21. Main outcome measures were knowledge of and attitudes towards sexual violence. Multivariate analyses were used to assess associations between socio-demographic characteristics and knowledge of and attitudes towards sexual violence.

RESULTS

A total of 1,568 participants were interviewed. The majority (58.4%) of participants were women. Most (58.3%) of the women respondents had poor knowledge on sexual violence and 63.8% had accepting attitudes towards sexual violence. Those who were married were significantly more likely to have good knowledge on sexual violence compared to the divorced/separated group (AOR = 1.6 (95% CI: 1.1-2.2)) but less likely to have non-accepting attitudes towards sexual violence compared to the single group (AOR = 1.8 (95%CI: 1.4-2.3)). Sex of respondents, age, marital status and level of education were associated with knowledge and attitudes towards sexual violence.

CONCLUSIONS

Our study showed that these rural communities have poor knowledge on sexual violence and have accepting attitudes towards sexual violence. Increasing age and higher education were associated with better knowledge and less accepting attitudes towards sexual violence. The findings have potentially important implications for interventions aimed at preventing violence. The results highlight the challenges associated with changing attitudes towards sexual violence, particularly as the highest levels of support for such violence were found among women.

Inuit parent perspectives on sexual health communication with adolescent children in Nunavut: "it's kinda hard for me to try to find the words"

BACKGROUND

For Inuit, the family unit has always played a central role in life and in survival. Social changes in Inuit communities have resulted in significant transformations to economic, political and cultural aspects of Inuit society. Where the family unit was once the setting for dialogue on family relations and sexuality, this has largely been replaced by teachings from the medical community and/or the school system.

OBJECTIVE

The purpose of this study was to explore Inuit parent perspectives on sharing knowledge with teenage children about sexual health and relationships.

METHOD

A qualitative Indigenous knowledge approach was used for this study with a focus on Inuit ways of knowing as described in the Piliriqattigiinniq Community Health Research Partnership Model. Interviews were conducted with 20 individual parents in 3 Nunavut communities in 2011. Parents were asked about whether and how they talk to their children about sexual health and relationships. An analytical approach building on the concept of Iqqaumaqatigiiniq ("all knowing coming into one"), which is similar to "immersion and crystallization," was used to identify story elements, groupings or themes in the data. The stories shared by parents are honoured, keeping their words intact as often as possible in the presentation of results.

RESULTS

Parents shared stories of themselves, family members and observations of the community. Fifteen of 17 mothers in the study reported having experienced sexual abuse as children or adolescents. Parents identified the challenges that they have and continue to experience as a result of forced settlement, family displacement and the transition of Inuit society. They expressed a desire to teach their children about sexual health and relationships and identified the need for emotional support to do this in the wake of the trauma they have experienced. Parents highly valued elders and the knowledge they have about family relationships and childrearing.

CONCLUSION

There are powerful, unresolved healing issues in Inuit communities. The traumatic experiences of the settlement and residential school era continue to have an impact on present-day family relationships. To support parent-child dialogue on sexual health and relationships, parents identified a need to repair relationships between youth and elders, and to provide culturally sensitive support to parents to heal from trauma.

Examining key design decisions involved in developing a serious game for child sexual abuse prevention

This paper presents a case study of the key decisions made in the design of Orbit, a child sexual abuse prevention computer game targeted at school students between 8 and 10 years of age. Key decisions include providing supported delivery for the target age group, featuring adults in the program, not over-sanitizing game content, having a focus on building healthy self-concept of players, making the game engaging and relatable for all players and evaluating the program. This case study has implications for the design of Serious Games more generally, including that research should underpin game design decisions, game designers should consider ways of bridging the game to real life, the learning that arises from the game should go beyond rote-learning, designers should consider how the player can make the game-world their own and comprehensive evaluations of Serious Games should be undertaken.