School age children's coping with sexual abuse: abuse stresses and symptoms associated with four coping strategies

Disengagement coping and sleep problems among trauma-exposed adolescents

BACKGROUND

The formation of healthy sleep patterns is a critical component of positive adolescent development. Dysregulated sleep habits can put youth at risk for the development of a multitude of inimical outcomes, particularly among those who are exposed to a traumatic event.

DESIGN AND METHODS

The present study investigated the links between voluntary disengagement coping (e.g., avoidance, denial, wishful thinking) and sleep outcomes among 86 trauma-exposed and non-exposed adolescents between the ages of 12-17 (Mage = 15.44, SD = 1.51; 41.9% female).

RESULTS

The relationship between voluntary disengagement coping and sleep outcomes was significant only among trauma-exposed adolescents, such that greater use of voluntary disengagement strategies was associated with greater sleep disturbances and greater daytime dysfunction.

CONCLUSIONS

Targeting disengagement coping may be an important strategy to improve sleep health among trauma-exposed adolescents. Continued efforts in improving the efficacy of trauma-exposed adolescent intervention strategies are needed.

The adverse impact of excessive internet use during the COVID-19 pandemic on adolescents' coping skills: A case study in Hanoi, Vietnam 2021

Introduction

The COVID-19 pandemic has created significant stressors in Vietnamese adolescents' lives. Coping skills play important roles in helping adolescents contend with stress. This study aimed to evaluate adolescents' coping skills during the COVID-19 pandemic and examine how those skills are impacted by excessive internet use during this pandemic.

Methods

The study used respondent-driven sampling and Google online survey forms to collect data. The study sample included 5,315 high school students aged 11- 17 years in Hanoi's rural and urban areas. The Kid Coping Scale was applied to examine adolescents' coping, and the coping score was compared among adolescents with different levels of internet use.

Results

The average coping score measured by Kid Coping Scale was 20.40 (std = 2.13). About half of adolescents often "avoid the problem or the area where it happened" when experiencing a hard time. One-third of adolescents often stopped thinking about the problem they faced. More than one-fourth of respondents stayed online for at least 8 h per day. The online time for learning/other activities showed a reverse dose-response relationship with the coping score; the longer the internet use duration, the lower the coping score.

Conclusion

The mean score of coping of Hanoi adolescents was moderate. Internet use has an adverse impact on their coping skills.

Children's Coping and Perceptions of Coping Efficacy After Sexual Abuse: Links to Trauma Symptoms

Despite an emphasis on coping following childhood sexual abuse (CSA) to reduce trauma-related symptoms, very few studies have researched the associations between sexually abused children's coping and trauma-related difficulties, and perceived coping efficacy has been largely overlooked. The current study investigated whether children's use and perceived efficacy of avoidant, internalized, angry, and active/social coping strategies were associated with caregiver- and child-reported posttraumatic stress symptoms (PTSS), and caregiver-reported internalizing and externalizing symptoms among 202 sexually abused children (8-12 years; M = 10.47 years, SD = 1.70 years). Children reported using approximately eight types of coping strategies (M = 8.29, SD =2.50). Regression models indicated that internalized and angry coping were associated with child-reported PTSS. In contrast to expectations, none of the types of coping strategies were linked with caregiver's reports of PTSS or internalizing and externalizing symptoms. Interestingly, perceived efficacy of coping was largely unrelated to symptoms, with only perceived efficacy of avoidant coping inversely related to child-reported PTSS. Perceived efficacy was not tied to caregiver's reports of children's symptoms. Coping strategies may be associated with children's, but not caregiver's, reports of children's trauma-related difficulties. Furthermore, perceived efficacy of coping strategies may also be largely unrelated to children's symptoms, or children may have limited insight regarding the efficacy of their coping strategies. To further inform trauma-focused interventions that support effective long-term coping, future research should investigate which coping strategies children perceive to be efficacious, as well as potential reasons why.

Indirect Effects From Childhood Sexual Abuse Severity to PTSD: The Role of Avoidance Coping

Men who have sex with men (MSM) disproportionately experience childhood sexual abuse (CSA) compared with heterosexual men, often resulting in continued trauma-related sequelae, including symptoms of posttraumatic stress disorder (PTSD) such as avoidance. The variability in trauma-related sequelae may be associated with chronicity or duration of CSA. The relationship between duration of CSA and later PTSD symptom severity is not well understood, including the extent coping strategies account for these relationships. We used linear regression to examine these relationships and to assess the indirect effects of avoidance (behavioral disengagement and denial) and adaptive coping strategies on the relationship between CSA duration and adult PTSD symptom severity on a diverse sample included 290 MSM with a history of CSA. In adjusted models, CSA duration was significantly associated with adult PTSD symptom severity (standardized β = .23, p < .000) and with avoidance coping (standardized β = .19, p = .002). Separating this out, behavioral disengagement was significantly associated with CSA duration (standardized β = .20, p = .001) but denial was not. In adjusted analyses assessing indirect effects, avoidance coping partially accounted for the relationship between CSA duration and total trauma symptom severity (standardized β reduced from .23 to .17; Sobel = 2.90, p = .004). Similarly, behavioral disengagement partially accounted for the association between CSA duration and total symptoms (standardized β reduced from .23 to .18; Sobel = 2.68, p = .007). Avoidance coping, and behavioral disengagement specifically, may play a role in the severity of PTSD symptoms experienced by MSM with CSA histories. This work emphasizes the need for clinicians to consider behavioral disengagement in understanding PTSD symptom severity among MSM with histories of CSA.

A Review of Mediators in the Association between Child Sexual Abuse and Revictimization in Romantic Relationships

Child sexual abuse (CSA) is a widespread adverse experience that has multiple detrimental impacts in the long-term, affecting mental, sexual, and physical health of survivors. In addition, CSA may impede interpersonal functioning, and be associated with a heightened risk of revictimization. Recent review articles have summarized the possible risk factors associated with sexual revictimization, yet an increasing body of literature suggests that CSA may be a key risk factor for multiple forms (i.e., psychological, physical, sexual) of victimization occurring specifically in the context of intimate relationships, either in adolescence (dating violence) or adulthood (partner violence). Our understanding of the mechanisms linking CSA and dating violence or intimate partner violence is still limited. This systematic review of the literature is aimed at summarizing the identified mediators of the association between CSA and revictimization in romantic relationships in past empirical reports. A total of 18 studies meeting criteria were identified. Apart from PTSD, few potential mediators have been explored in more than one study. In addition, few studies have investigated protective factors that may reduce the risk of revictimization. Several limitations in the current literature were identified including issues related to definitions and measurement. Studies relying on longitudinal designs with representative samples are clearly needed to orient future prevention efforts and break the revictimization trajectory.

The Relevance of Cognitive Behavioral Models of Post-Traumatic Stress Following Child Maltreatment: A Systematic Review

While it is known that young people exposed to maltreatment or abuse are at elevated risk of developing post-traumatic stress disorder (PTSD), much of our current knowledge of mechanisms that link trauma to childhood PTSD is based on single-incident, often noninterpersonal, trauma. Theoretical models highlight psychological processes of appraisals, memory, and coping as important for the development of PTSD. The aim of this review was to synthesize the literature on the role of these key psychological processes in relation to PTSD in maltreated children and teens. Studies were included if they (1) identified a sample of maltreated individuals, ≤18 years old; (2) measured (a) trauma memory, (b) appraisals, or (c) post-trauma cognitive or behavioral responses; and (3) measured PTSD symptoms. The systematic search of three electronic databases (American Psychological Association PsychNet, PubMed, and Published International Literature on Traumatic Stress) resulted in the inclusion of 36 papers, which described 31 studies and 33 unique samples. The review found cognitive behavioral models of PTSD appeared appropriate for understanding outcomes following maltreatment, but further research is needed on all processes, particularly trauma memory. Overall, there remain significant gaps in our knowledge of how psychological processes link maltreatment to PTSD. There is limited evidence concerning how maltreatment-related characteristics (e.g., chronicity, duration, and type of abuse) influence psychological processes and in turn affect outcomes. This review recommends further research in this area and suggests that, at the very least, comprehensive assessment should be conducted with all young people reporting maltreatment to identify appraisals and coping strategies that will potentially impact on their ongoing adjustment.

Internalizing, Externalizing Problems and Psychiatric Hospitalizations: Examination of Maltreatment Chronicity and Coping Style in Adolescents in Foster Care

Child maltreatment is associated with internalizing and externalizing problems in adolescents, as well as psychiatric hospitalizations, which represent severe mental health difficulties and substantial burden on individuals and the health care system. These negative outcomes are especially prevalent in youth in foster care. Not all youth exposed to maltreatment, however, demonstrate poor mental health outcomes. Additional factors, such as maltreatment chronicity and coping style, may help explain why some (but not all) youth develop major psychiatric problems. The purpose of the present study was to examine how maltreatment chronicity and coping style were associated with internalizing, externalizing, and psychiatric hospitalizations, and whether coping style moderated the relation between maltreatment chronicity and mental health in a sample of foster adolescents. Participants were 283 adolescents ages 12-19 residing in foster care. Youth reported on maltreatment, coping, and mental health; caregivers reported on mental health. Psychiatric hospitalizations were obtained from medical records. Youth who experienced more maltreatment had higher caregiver- and self-reported internalizing, and more psychiatric hospitalizations. Youth who approached problems directly had lower caregiver-reported internalizing and externalizing, while youth who dealt with stressors alone had higher self-reported internalizing and externalizing, and more psychiatric hospitalizations. Youth who avoided facing their problems had less psychiatric hospitalizations. Further, a significant interaction revealed that youth with more maltreatment who avoided problems had less psychiatric hospitalizations, suggesting that avoiding problems may be more protective for youth with the most chronic abuse and neglect. Findings highlight the importance of examining both maltreatment and coping.

The role of coping strategies in the pathway between child maltreatment and internalizing and externalizing behaviors

BACKGROUND

Child maltreatment has been repeatedly linked to internalizing and externalizing disorders, though few studies have examined the mechanisms of this pathway. Furthermore, children cope with difficult demands from their environments in a variety of ways, using emotion-focused (e.g., crying and verbal aggression), avoidant (e.g., disengaging), or problem-focused (e.g., seeking help from an adult) strategies.

OBJECTIVE

The current investigation examined if the coping strategies children employ when faced with everyday environmental stresses are a potential mechanism in the pathway between child maltreatment and internalizing and externalizing symptoms.

PARTICIPANTS AND SETTING

Participants included 198 maltreated and 222 non-maltreated children ages 4-12 who attended a day summer camp for 2 consecutive years.

METHODS

The study utilized a longitudinal design by following the children at two time points to determine if coping at Time 1 mediated the pathway between maltreatment and internalizing and externalizing symptoms at Time 2 (measured one year later).

RESULTS

Results from path analyses showed that maltreatment was associated with increased emotion-focused (b = .20, SE = .05, p < .001) and decreased problem-focused coping (b = -.25, SE = .05, p < .001). Results also indicated that emotion-focused coping represents a mechanism by which maltreated children are at increased risk for externalizing behaviors (with an indirect effect estimate of 0.023, SE = 0.053; CI: 0.004, 0.23).

CONCLUSIONS

The results highlight the impact maltreatment can have on coping strategies and that these strategies can play an important role in the development of psychopathology. This has important implications for clinicians, who could integrate reducing emotion-focused coping into intervention efforts for maltreated children.

Precursors and Correlates of Women's Violence: Child Abuse Traumatization, Victimization of Women, Avoidance Coping, and Psychological Symptoms

Path modeling assessed (a) the influence of child abuse traumatization on women's use of violence and their experiences of being victimized, (b) the association of these three variables to depressive and posttraumatic stress symptoms, and (c) the indirect pathways from women using violence and their being victimized to psychological symptoms through avoidance coping. Among 108 primarily African American women recruited from the community who used violence with a male partner, women's use of violence, but not their experiences of being victimized, was predicted by child abuse traumatization. Women's use of violence did not directly or indirectly predict symptomatology. In contrast, child abuse traumatization and women's experiences of being victimized were predictive of both depressive and posttraumatic stress symptoms, and being victimized also was related indirectly to depressive symptoms through avoidance coping.

Post-traumatic stress symptoms in children and adolescents with chronic pain: A topical review of the literature and a proposed framework for future research

BACKGROUND AND OBJECTIVE

The co-occurrence of chronic pain and post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) has gained increasing research attention. Studies on associations among pain and PTSS or PTSD in youth have largely been conducted in the context of acute injury or trauma. Less is known about the risk for co-occurrence with paediatric chronic pain. In this review, we (1) propose a conceptual framework to outline factors salient during childhood that may be associated with symptom severity, co-occurrence and mutual maintenance, (2) present relevant literature on PTSS in youth with acute and chronic pain and identify research gaps and (3) provide recommendations to guide paediatric research examining shared symptomatology.

DATABASES AND DATA TREATMENT

Electronic databases (PubMed and Google Scholar) were used to identify relevant articles using the search terms 'child, adolescent, paediatric, chronic pain, acute pain, post-traumatic stress symptoms and post-traumatic stress disorder'. Studies were retrieved and reviewed based on relevance to the topic.

RESULTS

Our findings revealed that existing biobehavioural and ecological models of paediatric chronic pain lack attention to traumatic events or the potential development of PTSS. Paediatric studies are also limited by lack of a conceptual framework for understanding the prevalence, risk and trajectories of PTSS in youth with chronic pain.

CONCLUSIONS

Our new developmentally informed framework highlights individual symptoms and shared contextual factors that are important when examining potential associations among paediatric chronic pain and PTSS. Future studies should consider bidirectional and mutually maintaining associations, which will be aided by prospective, longitudinal designs. WHAT DOES THIS REVIEW ADD?: This review presents relevant literature on pain and PTSS in youth and proposes a conceptual framework to examine factors salient during childhood that may be associated with symptom severity, comorbidity and mutual maintenance of chronic pain and PTSS in paediatric populations. We highlight dynamic factors that may change across children's development and provide recommendations to guide paediatric research examining potential associations among PTSS and chronic pain.

Resilience in Survivors of Child Sexual Abuse: A Systematic Review of the Literature

OBJECTIVE

This review article summarizes empirical research on resilience in survivors of child sexual abuse (CSA) and discusses protective factors that are associated with adaptive functioning in spite of sexual victimization.

METHODS

A literature search to identify studies published up to November 2013 was performed within the databases PsycINFO, MEDLINE/PubMed, Web of Science, and PSYNDEXplus. Additional relevant studies were retrieved using a snowball technique. A total of 37 articles met the inclusion criteria and were included in the final sample.

RESULTS

In the studies included in this review, the percentage of CSA survivors who were found to have a normal level of functioning despite a history of sexual abuse ranged from 10% to 53%. The protective factors that had the best empirical support were found to be education, interpersonal and emotional competence, control beliefs, active coping, optimism, social attachment, external attribution of blame, and most importantly, support from the family and the wider social environment.

CONCLUSIONS

Preventive and clinical interventions for survivors of CSA should utilize psychoeducation and cognitive strategies that are adapted to the developmental level of the victim and that seek to enhance social support from significant others. Future research should focus on longitudinal research designs considering resilience rather as a dynamic process with multiple dimensions in a social and developmental context.

An Investigation of Depression, Trauma History, and Symptom Severity in Individuals Enrolled in a Treatment Trial for Chronic PTSD

OBJECTIVE

To explore how factors such as major depressive disorder (MDD) and trauma history, including the presence of childhood abuse, influence diverse clinical outcomes such as severity and functioning in a sample with posttraumatic stress disorder (PTSD).

METHOD

In this study, 200 men and women seeking treatment for chronic PTSD in a clinical trial were assessed for trauma history and MDD and compared on symptom severity, psychosocial functioning, dissociation, treatment history, and extent of diagnostic co-occurrence.

RESULTS

Overall, childhood abuse did not consistently predict clinical severity. However, co-occurring MDD, and to a lesser extent a high level of trauma exposure, did predict greater severity, worse functioning, greater dissociation, more extensive treatment history, and additional co-occurring disorders.

CONCLUSION

These findings suggest that presence of co-occurring depression may be a more critical marker of severity and impairment than history of childhood abuse or repeated trauma exposure. Furthermore, they emphasize the importance of assessing MDD and its effect on treatment seeking and treatment response for those with PTSD.

Child sexual abuse: report of 311 cases with review of literature

Child sexual abuse (CSA) is a global problem that has significant consequences for public health; it has been a prominent topic of public concern for more than a decade, but many basic facts about the problem remain unclear or in dispute. We conducted a study of 311 cases of CSA in order to highlight the epidemiological features and negative impact on victims’ well-being and to emphasize the need for a multidisciplinary approach to the primary prevention and management of CSA. We noted an increase in cases number with male predominance. Most of our patients came from lower socioeconomic classes. The perpetrators were male in 100% of cases; acquaintances in 70% of cases and family members in 22 cases. Physical examination were normal in 61% of cases, however, a range of psychological and physical effects were identified with dramatic health consequences: three cases of attempted suicide, five pregnancies and one case of HIV virus infection.

Behavioral markers of coping and psychiatric symptoms among sexually abused children

The current study examined coping and psychiatric symptoms in a longitudinal sample of sexually abused children. Coping was behaviorally coded from children's forensic interviews in the aftermath of sexual abuse. Using principal components analysis, coping behaviors were found to cluster into 3 categories: avoidant, expressive, and positive affective coping. Avoidant coping had predictive utility for a range of psychiatric symptoms, including depressive, posttraumatic stress, anxiety, and dissociative symptoms as well as aggression and attention problems measured 8-36 months following the forensic interview. Specific behaviors, namely fidgetiness and distractibility, were also found to be associated with future symptoms. These findings suggest the predictive utility of avoidant behaviors in general, and fidgetiness and distractibility in particular, among sexually abused children.

Predicting resilience in sexually abused adolescents

This research examined factors that predicted resilience in sexually abused adolescents. Using Bronfenbrenner's Process-Person-Context-Time (PPCT) ecological model, this study considered the proximal and distal factors that would contribute to adolescents' reactions to sexual victimization. This correlational study used hierarchical regression analysis (n=237) with cross-sectional data from the National Survey of Child and Adolescent Well-Being Wave I (NSCAW, Dowd et al., 2002). This study found that school engagement, caregiver social support, hope and expectancy, caregiver education and SES predicted resilience. In line with the PPCT model, findings suggest that placing a greater emphasis on the contextual environment could improve support for adolescent resilience. Augmenting interventions that focus on individual change with those that address environmental factors may increase the benefits to adolescents affected by sexual abuse.

Maternal influences on youth responses to peer stress

Understanding how youths develop particular styles of responding to stress is critical for promoting effective coping. This research examined the prospective, interactive contribution of maternal socialization of coping and peer stress to youth responses to peer stress. A sample of 144 early adolescents (mean age = 12.44 years, SD = 1.22) and their maternal caregivers completed questionnaires and semistructured interviews in 2 waves over a 1-year period. Results revealed that mothers' disengagement coping suggestions predicted maladaptive responses to stress, particularly for youths who received low levels of engagement suggestions, and engagement coping suggestions protected youths against maladaptive responses to stress. Importantly, these effects emerged only in the context of heightened peer stress. This research suggests that maternal socialization of coping has the potential to support or undermine youths' development of an effective repertoire of responses to stress.

Disclosure of sexual abuse, and personal and familial factors as predictors of post-traumatic stress disorder symptoms in school-aged girls

OBJECTIVE

The aim of the present study was to analyze predictive factors of post-traumatic stress disorder (PTSD) symptoms in school-aged girls.

METHODS

A group (n=67) of seven- to 12 year-old girls consulting a paediatric hospital following disclosure of sexual abuse were compared with a group (n=67) of nonabused girls. The girls answered questionnaires related to PTSD, coping, sense of hope, self-esteem, sibling relationships and perceived social support. Mothers answered questionnaires related to family relationships, family violence, perceived support given and psychological distress.

RESULTS

The mean +/- SD age of the girls was 9+/-1.5 years. In the sexual abuse group, single-parent families were more frequent (53.7% versus 32.3%; P<0.01), mothers were less educated (10.8% versus 13.1%; P<0.0001) and socioeconomic level was lower (36.8% versus 47.9%; P<0.0001). A history of sexual abuse in childhood was reported by 50% of mothers of sexually abused children and 37% of mothers of the comparison group children. A higher prevalence of PTSD clinical scores was found for the girls reporting sexual abuse (46.3% versus 18.5%; P<0.001). Regression analyses controlling for parental education level and family structure revealed that group membership (sexual abuse group versus comparison group) was predictive of the level of PTSD symptoms. In addition, the mother's level of support, the child's perception of parental support and the child's reliance on avoidance coping predicted PTSD symptoms. Sense of hope and the child witnessing interparental physical violence were marginally associated with the level of PTSD symptoms.

CONCLUSIONS

PTSD was common in the present study's sample of sexually abused girls. Because predictive factors relate to both child-related variables and familial context, interventions for this population should target not only the child, but also the family.

[How does collective violence shape the health status of its victims? Conceptual model and design of the ISAVIC study]

OBJECTIVES

Epidemiologic research on collective violence (violence exerted by and within groups in pursuit of political, social or economic goals) is very scarce despite its growing recognition as a major public health issue. This paper describes the conceptual model and design of one of the first research studies conducted in Spain aiming to assess the impact of collective violence in the health status of its victims (study known as ISAVIC, based on its Spanish title Impacto en la SAlud de la VIolencia Colectiva).

METHODS

Starting with a comprehensive but non-systematic review of the literature, the authors describe the sequelae likely produced by collective violence and propose a conceptual model to explain the nature of the relationships between collective violence and health status. The conceptual model informed the ISAVIC study design and its measurement instruments.

RESULTS

The possible sequelae of collective violence, in the physical, emotional and social dimensions of health, are described. Also, the review distinguishes the likely impact in primary and secondary victims, as well as the interplay with the social environment. The mixed methodological design of the ISAVIC study supports the coherence of the conceptual model described.

CONCLUSIONS

The ISAVIC study suggests that collective violence may affect the main dimensions of the health status of its victims, in intimate relation to the societal factors where it operates. It is necessary to validate these results with new studies.

Effects of Hurricane Katrina and Other Adverse Life Events on Adolescent Female Offenders: A Test of General Strain Theory

This study tested Agnew's General Strain Theory (GST) by examining the roles of anger, anxiety, and maladaptive coping in mediating the relationship between strain and three outcomes (serious delinquency, minor delinquency, and continued involvement in the juvenile justice system) among adolescent female offenders (N = 261). Strains consisted of adverse life events and exposure to Hurricane Katrina. Greater exposure to Hurricane Katrina was directly related to serious delinquency and maladaptive coping. Hurricane Katrina also had an indirect effect on minor delinquency and Post-Katrina juvenile justice involvement mediated through maladaptive coping. Adverse life events were associated with increased anger, anxiety, and maladaptive coping. Anger mediated the relationship between adverse life events and serious delinquency. Anxiety mediated the relationship between adverse life events and minor delinquency. Maladaptive coping strategies were associated with minor delinquency and juvenile justice involvement. Findings lend support to GST.

Coping with child sexual abuse among college students and post-traumatic stress disorder: the role of continuity of abuse and relationship with the perpetrator

OBJECTIVE

The purpose of this study was to examine the effects of child sexual abuse (CSA) on the use of coping strategies and post-traumatic stress disorder (PTSD) scores in young adults, as well as the role of avoidance and approach coping strategies in those PTSD scores in CSA victims. The role of coping strategies was studied by considering their possible interactive effect with the continuity of abuse and the relationship with the perpetrator; the effect of coping strategies on PTSD was also compared between CSA victim and non-CSA victim participants.

METHOD

The sample was comprised of 138 victims of CSA and another 138 participants selected as a comparison group. Data about child sexual abuse were obtained from a questionnaire developed for this purpose. Coping strategies were assessed with the How I Deal with Things Scale (Burt & Katz, 1987), while PTSD scores were assessed with the "Escala de Gravedad de Síntomas del Trastorno de Estrés Postraumático" (Severity of Symptoms of PTSD Scale; Echeburúa et al., 1997).

RESULTS

Participants who had been victims of CSA showed significantly higher PTSD scores and lower approach coping strategies scores. However, differences in avoidance coping strategies between groups were not consistent and did not always follow the expected direction. Only the use of avoidance coping strategies was related to PTSD, participants who used these showing higher scores. The effects of avoidance strategies were stronger in continued than in isolated abuse, in intrafamilial than in extrafamilial abuse and in CSA victims than in non-victims.

CONCLUSIONS

These results confirm the idea of CSA as a high-risk experience that can affect the victim's coping strategies and lead to PTSD to a lesser or greater extent depending on the coping strategy used. Moreover, the role of these strategies varies depending on whether or not the participant is a victim of CSA and on the characteristics of abuse (continuity and relationship with the perpetrator).

PRACTICE IMPLICATIONS

In terms of intervention, a reduction of avoidance-type strategies appears to have a beneficial effect, especially in the case of intrafamilial and/or continued CSA victims. The encouragement of "spontaneous" approach strategies (devised by the victim herself, without counseling) would probably not lead to more positive outcomes in terms of PTSD symptomatology. However, encouraging CSA survivors to engage in therapy aimed at developing effective approach strategies, as other studies have suggested, may help reduce PTSD symptoms.

Mindfulness and experiential avoidance as predictors of posttraumatic stress disorder avoidance symptom severity

Mindfulness reflects an awareness of present moment experiences through an attitude of acceptance and openness (Bishop et al., 2004; Cardaciotto, Herbert, Forman, Moitra, & Farrow, 2008). Experiential avoidance, by contrast, refers to attempts to change, alter, or avoid private experiences (e.g., thoughts, feelings, sensations), and it is believed to underlie a number of psychopathologies, including PTSD (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). We were interested in the ability of mindfulness to predict the variance of PTSD avoidance symptom severity above and beyond experiential avoidance. 378 introductory psychology students were administered self-report measures of PTSD, mindfulness, experiential avoidance, thought suppression, alexithymia, and avoidant coping. Mindfulness, specifically nonjudgment of experiences, accounted for a unique portion of the variance in PTSD avoidance symptoms.

How are we measuring resilience following childhood maltreatment? Is the research adequate and consistent? What is the impact on research, practice, and policy?

The authors review the literature on resilience following childhood maltreatment and describe how variation in the measurement of outcomes at various developmental stages affects research findings, practice implications, and policy recommendations. Although the 21 studies reviewed considered competent functioning in similar domains as evidence of resilience following maltreatment, few provided prevalence estimates for specific indicators or across domains of functioning. Using the National Survey of Child and Adolescent Well-Being (NSCAW), the authors explored different ways of operationalizing resilience. The number of children demonstrating competence following maltreatment varied greatly by the indicators used; furthermore, competence in one domain (behavioral, emotional, or educational) did not guarantee competence in another. About one in five children were functioning poorly in all three domains. Because findings vary according to the operational definition of resilience, researchers must use caution in conceptualizing their analytic variables and interpreting findings. Furthermore, given the lack of cross-domain competence, services to maltreated children and their families should be comprehensive.

Symptomatology in adolescents following initial disclosure of sexual abuse: the roles of crisis support, appraisals and coping

OBJECTIVE

The present study examined possible explanations for symptom development and variability in sexually abused adolescents. A theoretical model of sexual abuse, in which appraisal, coping and crisis support play prominent roles, was tested in a clinical group of 100 sexually abused adolescents.

METHOD

Participants, aged 12-18 years, completed questionnaires regarding severity of abuse, negative appraisals, crisis support, coping strategies, and trauma-related stress symptoms.

RESULTS

Since severity of abuse had no influence on the association between appraisals and symptoms it was eliminated from our model. Structural equation modeling analyses showed a significant interrelationship between the examined concepts. Adolescents who appraised the abuse as more threatening showed more internalizing and externalizing trauma symptoms. Moreover, more negative appraisals were associated with more avoidance as well as with more active coping strategies. Direct crisis support was associated with less negative appraisals and with the use of more active coping strategies.

CONCLUSIONS

The study showed that especially the buffering role of crisis support and the role of negative appraisals explained symptom development and variety in sexually abused adolescents.

PRACTICE IMPLICATIONS

Adaptation to sexual abuse includes the ways in which adolescents perceive the event as threatening and harmful, how they cope with the abusive experience, and how they receive direct support from their family. Clinicians, therefore, need to expand the focus of their assessments beyond age- and trauma-specific symptoms, to age- and trauma-specific appraisals, coping, and social support. The assessment of these factors should take place as soon as possible after the disclosure of the abuse. Individualized treatment plans and clinical interventions need to be based on these personal and environmental variables, rather than reliance on the influence of abuse-related characteristics, such as the severity or type of abuse.

Thought control strategies as mediators of trauma symptoms in young women with histories of child sexual abuse

The current retrospective study examined thought control strategies, or cognitive techniques individuals use to deal with unpleasant thoughts following stressful events, as potential mediators of adjustment in young women with histories of child sexual abuse (CSA). In a sample of 76 undergraduate women who self-reported on abuse experiences, thought control strategies, and current trauma symptoms, several key findings emerged: (i) Greater severity of the CSA event was associated with greater reported use of worry and punishment strategies and less use of social control strategies; (ii) Increased use of worry and punishment strategies following the CSA event was associated with greater levels of trauma symptoms, while increased use of social control strategies following the CSA event was associated with lower levels of trauma symptoms; and (iii) Worry, punishment, and social control strategies served as mediators between CSA severity and trauma symptoms. The results suggest that thought control strategies, specifically increased worry and punishment, and decreased social control, play a vital role in understanding adjustment after CSA. Future research should examine the roles of these cognitive control strategies as possible avenues of intervention following CSA.

Trauma coping strategies and psychological distress: A meta-analysis

The identification of adaptive and maladaptive coping strategies following traumatic events has been the subject of much scientific inquiry. The current study sought through meta-analysis to evaluate the relationship between the use of approach and avoidance strategies (both problem-focused and emotion/cognitive focused) following trauma and psychological distress. Thirty-nine studies of coping following two types of traumatic events (interpersonal violence and severe injury) were retained in the meta-analysis. There was a consistent association between avoidance coping and distress, overall r = .37, but no association between approach coping and distress, overall r = -.03, but some important moderators existed. Implications of the results for future research regarding coping and trauma recovery are discussed.

Factors linked to distress in mothers of children disclosing sexual abuse

The aim of the present study is to investigate the variability in clinical level of psychological distress experienced by mothers of sexually abused children by exploring the role of (a) abuse-related variables (length, severity, and identity of perpetrator), (b) a history of childhood sexual abuse and partner violence experienced in the past year, and (c) mothers' coping and feelings of empowerment. Data were collected through self-report measures completed by 149 French-speaking mothers of girls aged 4 to 12 years disclosing sexual abuse. Results revealed that more than half of the mothers reported clinical levels of psychological distress and experienced child sexual abuse, and 1 of 4 mothers experienced physical partner violence. Logistic regression analysis revealed that mother's sexual abuse and partner violence as well as avoidance coping and empowerment contributed to scores reaching clinical levels of psychological distress. In addition, mothers of child victims of intrafamilial sexual abuse are more likely to report clinical levels of distress. Results underscore the importance of evaluating for trauma history and taking coping strategies and empowerment into account in treatment interventions.

PTSD and stress sensitisation: a tale of brain and body Part 1: human studies

Post-traumatic stress disorder (PTSD) is a chronic, debilitating psychiatric disorder that can follow exposure to extreme stressful experiences. It is characterised by hyperarousal and increased startle responses, re-experiencing of the traumatic event, withdrawal or avoidance behaviour and emotional numbing. The focus of this review is on aspects that have received less attention. PTSD develops only in a substantial minority of people exposed to traumatic stress, and possible individual traits that increase vulnerability are discussed. An overview is given of the wide variety of physiological disturbances that accompany PTSD and may contribute to disability, including neuroendocrine, cardiovascular, gastrointestinal and immune function and pain sensitivity. Brain imaging and pharmacological studies have generated some insight into the circuitry that may be involved in the generation of PTSD symptoms. Major limitations of human studies so far are the issue of causality and our lack of understanding of the underlying molecular substrates in the brain, which are easier to address in relevant animal models and will be discussed in a companion paper.

A typological analysis of behavioral profiles of sexually abused children

A cluster analysis is used to explore differential outcomes in 123 French Canadian children reporting sexual abuse contrasted with 123 control children. Mothers' reports of behavioral problems on the Child Behavior Checklist, abuse-related variables, personal factors, and family characteristics are used as potential variables discriminating clusters. Results reveal four clusters: (a) anxiety constellation group refers to children displaying behavior problems on a subset of scales, (b) the severe distress group refers to children showing a broader array of behavior problems, (c) victims of less severe sexual abuse (SA) group consists of children disclosing mostly extrafamilial SA, and (d) resilient children refers to children who, while disclosing severe abuse, rely less on avoidance coping. Findings underscore the need to go beyond abuse-related variables to orient treatment for children disclosing sexual abuse and for tailoring interventions to distinct subgroups.

Report of the APSAC task force on attachment therapy, reactive attachment disorder, and attachment problems

Although the term attachment disorder is ambiguous, attachment therapies are increasingly used with children who are maltreated, particularly those in foster care or adoptive homes. Some children described as having attachment disorders show extreme disturbances. The needs of these children and their caretakers are real. How to meet their needs is less clear. A number of attachment-based treatment and parenting approaches purport to help children described as attachment disordered. Attachment therapy is a young and diverse field, and the benefits and risks of many treatments remain scientifically undetermined. Controversies have arisen about potentially harmful attachment therapy techniques used by a subset of attachment therapists. In this report, the Task Force reviews the controversy and makes recommendations for assessment, treatment, and practices. The report reflects American Professional Society on the Abuse of Children's (APSAC) position and also was endorsed by the American Psychological Association's Division 37 and the Division 37 Section on Child Maltreatment.

Predictors of trauma symptomatology in sexually abused adolescents: a 6-month follow-up study

This study examines the natural course of trauma-specific symptoms 6 months after disclosure. Furthermore, this study investigates whether severity and type of abuse (intrafamilial or extrafamilial sexual abuse), negative appraisals, coping strategies, and crisis support measured at time of disclosure can be predictive of trauma symptoms 6 months later. Sixty-five sexually abused Flemish adolescents are reassessed 6 months after disclosure. Information from the participants is obtained through self-report questionnaires. Forty-six percent of the adolescents report clinically significant trauma symptoms. Although internalizing symptoms significantly decreases after 6 months, externalizing symptoms persist. Type or severity of the abuse does not account for differences in symptomatology. Two predictors of ongoing trauma symptomatology are identified: postdisclosure trauma symptomatology and a lack of initial crisis support. Information on the victims' postdisclosure symptomatology as well as information on the initial received social support is critical in understanding which abused adolescents are most at risk for poor outcomes in the long term.

Pathways to PTSD, part II: Sexually abused children

OBJECTIVE

The goal of this research was to develop and test a prospective model of posttraumatic stress symptoms in sexually abused children that includes pretrauma, trauma, and disclosure-related pathways.

METHOD

At time 1, several measures were used to assess pretrauma variables, trauma variables, and stress reactions upon disclosure for 156 sexually abused children ages 8 to 13 years. At the time 2 follow-up (7 to 36 months following the initial interview), the children were assessed for posttraumatic stress disorder (PTSD) symptoms.

RESULTS

A path analysis involving a series of hierarchically nested ordinary least squares multiple regression analyses indicated three direct paths to PTSD symptoms: avoidant coping, anxiety/arousal, and dissociation, all measured during or immediately after disclosure of sexual abuse. Additionally, age and gender predicted avoidant coping, while life stress and age at abuse onset predicted symptoms of anxiety/arousal. Taken together, these pathways accounted for approximately 57% of the variance in PTSD symptoms.

CONCLUSIONS

Symptoms measured at the time of disclosure constitute direct, independent pathways by which sexually abused children are likely to develop later PTSD symptoms. These findings speak to the importance of assessing children during the disclosure of abuse in order to identify those at greatest risk for later PTSD symptoms.

Temporal Concordance of Anxiety Disorders and Child Sexual Abuse: Implications for Direct Versus Artifactual Effects of Sexual Abuse

This study examined the temporal concordance between the onset of childhood anxiety disorders and the points of onset and ending of child sexual abuse (CSA). Sexually abused children (N = 158) were assessed with structured diagnostic interviews. Onset ages for lifetime prevalence anxiety disorders were combined and sequenced with the onset and ending of sexual abuse. Hazard rates were calculated. Departures from the overall linear hazard trajectory for onsets were modeled using piecewise growth curve analyses. Increases from the overall trajectory were found around the point of sexual abuse onset for most childhood anxiety disorders. Decreases were found around the ending of sexual abuse. The risk for developing new anxiety disorders after the onset of sexual abuse showed a positive dose-effect relation with abuse severity. The findings add support to the idea that CSA can have a direct link to childhood anxiety disorders, apart from confounded vulnerability factors, postabuse events, or stable family background factors. The findings are contrasted with those from cross-sectional partial correlation studies that have suggested that there is little direct connection between sexual abuse and mental health outcomes.

Disclosure, reactions, and social support: findings from a sample of adult victims of child sexual abuse

Information about abuse characteristics, disclosure, and current social support was collected through semistructured interviews and questionnaires from 122 adult women reporting exposure to child sexual abuse by someone close. Women who used an active disclosure strategy in childhood reported more physical and violent abuse. Moreover, women who reported more severe abuse had more often received negative reactions from the social network. Furthermore, a relation was found between current social support and positive-but not negative-reactions.

Coping with incest: the relationship between recollections of childhood coping and adult functioning in female survivors of incest

One hundred and one adult female survivors' recollections of coping with childhood incest, abuse characteristics, and current functioning in adulthood were studied. Analyses controlling for characteristics of the trauma indicated that recollections of using avoidance coping and seeking social support were related to poor adult functioning whereas recollections of using distancing coping were related to better functioning. As a set of variables, abuse characteristics also predicted a significant amount of variance in adult functioning. Implications for future research were discussed.

Ten-year research update review: child sexual abuse

OBJECTIVE To provide clinicians with current information on prevalence, risk factors, outcomes, treatment, and prevention of child sexual abuse (CSA). To examine the best-documented examples of psychopathology attributable to CSA. METHOD Computer literature searches of and for key words. All English-language articles published after 1989 containing empirical data pertaining to CSA were reviewed. RESULTS CSA constitutes approximately 10% of officially substantiated child maltreatment cases, numbering approximately 88,000 in 2000. Adjusted prevalence rates are 16.8% and 7.9% for adult women and men, respectively. Risk factors include gender, age, disabilities, and parental dysfunction. A range of symptoms and disorders has been associated with CSA, but depression in adults and sexualized behaviors in children are the best-documented outcomes. To date, cognitive-behavioral therapy (CBT) of the child and a nonoffending parent is the most effective treatment. Prevention efforts have focused on child education to increase awareness and home visitation to decrease risk factors. CONCLUSIONS CSA is a significant risk factor for psychopathology, especially depression and substance abuse. Preliminary research indicates that CBT is effective for some symptoms, but longitudinal follow-up and large-scale "effectiveness" studies are needed. Prevention programs have promise, but evaluations to date are limited.

Social reactions to child sexual abuse disclosures: a critical review

Recent studies have examined disclosure of child sexual abuse to determine the correlates and consequences of telling others about this form of victimization. The present article reviews the current empirical literature on disclosure and reactions to adult survivors to assess what is known about the process of disclosure and whether telling others is therapeutic and leads to positive outcomes. Most studies assessing social reactions in detail have concerned adult survivors retrospectively reporting on their disclosures of child sexual abuse. Few empirical studies have been conducted in this area but research suggests that few victims tell anyone about child sexual abuse as children, and that the type of reactions to disclosure vary according to when disclosure occurs (childhood or adulthood), the extent and nature of the disclosure, and the person to whom one discloses. Clear evidence shows that negative social reactions are harmful to survivors' well-being, but better assessment of specific reactions and their effects are needed in theoretically-based studies to evaluate how these responses affect survivors' recovery in the context of other variables. Suggestions for future research on social reactions of others to adult survivors disclosing child sexual abuse are presented.

Attribution retraining with sexually abused children: review of techniques

Clinicians increasingly use empirically based cognitive-behavioral techniques in their treatment of child victims of sexual abuse. Attribution retraining is often a primary component of this work, and it involves various techniques aimed at decreasing abuse-related self-blame and encouraging the child to attribute responsibility for the abuse to the perpetrator This article reviews literature that highlights the complexity of self and other blame for sexually abused children in terms of developmental status, the multifaceted nature and interrelationships of abuse-specific attributions, and the psychological effects of self-blame and perpetrator blame. A review of written attribution retraining techniques developed by diverse authors for use with sexually abused children and their nonoffending parents is provided, including written and verbal techniques and techniques using games and the arts. The relative utility of different approaches with children of various stages of development is discussed, along with the need for empirical research regarding the effectiveness of these techniques.

Attributions and adjustment following child sexual and physical abuse

Individuals who experience child physical orsexual abuse are at greater risk for adjustment problems. However, the heterogeneity of symptomatology observed across individuals following child abuse suggests that outcome is determined by multiplefactors. The authors review literature examining the relationships among childhood physical or sexual abuse, attributions, and adjustment. Implications for application and future research are discussed.

Predicting the impact of child sexual abuse on women: the role of abuse severity, parental support, and coping strategies

Female Navy recruits (N = 5,226) completed surveys assessing history of childhood sexual abuse (CSA), childhood strategies for coping with CSA, childhood parental support, and current psychological adjustment. Both CSA and parental support independently predicted later adjustment. In analyses examining whether CSA victims' functioning was associated with CSA severity (indexed by 5 variables), parental support (indexed by 3 variables), and coping (constructive, self-destructive, and avoidant), the negative coping variables were the strongest predictors. A structural equation model revealed that the effect of abuse severity on later functioning was partially mediated by coping strategies. However. contrary to predictions, the model revealed that childhood parental support had little direct or indirect impact on adult adjustment.

Coping styles and psychosomatic problems: are they related?

A number of recent studies have shown avoidant coping to be related with diverse types of somatic and mental pathology. In order to investigate the relevance of coping for both psychological and somatic problems in delinquent subjects, 185 boys from juvenile correction and 96 boys from secondary schools in Arkhangelsk, Northern Russia, were assessed by means of the Coping Scale for Children and Youth, the Youth Self-Report and the Giessen Subjective Complaints List - youth form. The results from the delinquent subjects partly confirmed previous findings on the dominant role of behavioural avoidance in the relationships between coping styles and both behavior/emotional problems and somatic complaints. Further implications of the results are discussed.

[Resilience factors in the victims of sexual abuse: state of affairs]

OBJECTIVE

The aim of this literature review is to examine factors leading to the recovery of child sexual abuse survivors.

METHOD

This paper provides a definition of resilience and presents the individual and environmental protective factors. A methodological examination of the studies is carried through.

RESULTS

Researchers have documented that 20% to 44% of adult who were sexually abused during their childhood show no apparent signs of negative outcome. However, very few studies as been interested in resilient women and their protective mechanisms. Recent research on protective factors reveal that searching for support, disclosing the abuse and giving a meaning to the abuse are all adaptative cognitive strategies. Furthermore, the perception of benefits and having an external attributional style are both related to less psychological distress. Social support, in general and after the revelation, also appears as a determinant of resilience. However, avoidance, even if victims find it very useful, proves to be a non-adaptative strategy, which may lead to be a catalyst to victims' symptomatology. Definitional problems and the lack of longitudinal studies limit the conclusions that can be drawn.

CONCLUSION

The rare studies involving resilient victims show that social support as well as certain cognitive coping strategies may lead to recovery. However the extent of their contribution remains unknown.

Coping strategies and social support as mediators of consequences in child sexual abuse victims

OBJECTIVE

The main objective of this study was to evaluate the mediator role of coping strategies and social support on the adaptation of children following CSA. Empirical studies indicate that short-term consequences of child sexual abuse (CSA) are multiple and varied (Kendall-Tackett, Williams, & Finkelhor, 1993; Wolfe & Birt, 1995). While abuse-related characteristics were first studied to explain the variability of CSA outcome, more recently, the influence of other variables such as coping strategies and social support have been considered.

METHOD

Fifty sexually abused children aged between 7 and 12 participated in this study. The Child Behavior Checklist (Achenbach, 1991) and the Perceived Competence Scale for Children (Harter, 1985) were used to measure victims' adjustment. Coping strategies were evaluated by the Self-Report Coping Scale (Causey & Dubow, 1992) and the children completed the Perceived Social Support (Harter, 1985). A French version of the History of Victimization (Wolfe, Gentile, & Bourdeau, 1987) was used to gather abuse-related characteristics from medical records.

RESULTS

Results indicate that sexually abused children exhibit internalizing and externalizing behavior problems following CSA. Coping strategies and social support exert direct effects on victims' adjustment instead of the mediator influences originally expected. Among abuse-related variables, only the perpetrator's identity is directly related to internalizing symptoms.

CONCLUSIONS

The absence of mediational effects of coping and social support is discussed in light of the measures used and the cross-sectional nature of the study. Results highlight the importance of parental implication and the consideration of coping strategies in designing therapeutic interventions with this population.