Presenting problems of sexually abused girls receiving psychiatric services

Afraid and Awake: The Interaction Between Trauma and Sleep in Children and Adolescents

Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.

From childhood adversity to latent stress vulnerability in adulthood: the mediating roles of sleep disturbances and HPA axis dysfunction

Childhood adversity is a prominent predisposing risk factor for latent stress vulnerability, expressed as an elevated likelihood of developing stress-related psychopathology upon subsequent exposure to trauma in adulthood. Sleep disturbances have emerged as one of the most pronounced maladaptive behavioral outcomes of childhood adversity and are also a highly prevalent core feature of stress-related psychopathology, including post-traumatic stress disorder (PTSD). After reviewing the extensive literature supporting these claims, the current review addresses the notion that childhood adversity-induced sleep disturbances may play a causal role in elevating individuals' stress vulnerability in adulthood. Corroborating this, sleep disturbances that predate adult trauma exposure have been associated with an increased likelihood of developing stress-related psychopathology post-exposure. Furthermore, novel empirical evidence suggests that sleep disturbances, including irregularity of the sleep-wake cycle, mediate the link between childhood adversity and stress vulnerability in adulthood. We also discuss cognitive and behavioral mechanisms through which such a cascade may evolve, highlighting the putative role of impaired memory consolidation and fear extinction. Next, we present evidence to support the contribution of the hypothalamic-pituitary-adrenal (HPA) axis to these associations, stemming from its critical role in stress and sleep regulatory pathways. Childhood adversity may yield bi-directional effects within the HPA stress and sleep axes in which sleep disturbances and HPA axis dysfunction reinforce each other, leading to elevated stress vulnerability. To conclude, we postulate a conceptual path model from childhood adversity to latent stress vulnerability in adulthood and discuss the potential clinical implications of these notions, while highlighting directions for future research.

Afraid and Awake: The Interaction Between Trauma and Sleep in Children and Adolescents

Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.

Sexual Contact in Childhood, Revictimization, and Lifetime Sexual and Psychological Outcomes

Using data from the 2010 to 2011 wave of the National Social Life, Health, and Aging Project-a nationally representative probability sample of older U.S. adults-this study queried distinctive linkages of mild and of severe childhood sexual contact with lifetime sexual and psychological outcomes among women and men aged 60-99 years (N = 3283). In addition, we examined stratification of these associations by sexual revictimization (forced sex and/or harassment). Among women, sequelae of childhood contact seemed consistently negative for the mild rather than severe variant-but only in the co-presence of revictimization-a pattern that may have remained obscured in previous analysis of event effects. Men's results suggested lifelong eroticizing but not psychological effects of this early experience-with the co-presence of revictimization potentially enhancing rather than lowering their mental health. Overall, findings appeared to reflect gendered patterns of risk-with mild childhood contact potentially channeling women but not men into revictimization and finally to elevated sexuality and poor mental health in late life. Early sexual experiences should thus be conceptualized not as singular events, but as part of a lifelong career with regularities and rhythms that may influence their pathogenic potential.

Associations between nonverbal behaviors and subsequent sexual attitudes and behaviors of sexually abused and comparison girls

This prospective, longitudinal study examined a sample of sexually abused and comparison girls to determine (a) whether there were patterns of behavior that differed between the groups and (b) whether nonverbal behaviors assessed at the initial visit (n = 147; M = 11.11 years; SD = 3.02) might predict sexual attitudes and behaviors at a later point in development (n = 144; M = 18.52 years; SD = 3.52). At the initial assessment, nonverbal behaviors during an interaction with an unknown male interviewer were factor analyzed revealing 3 factors: wary (e.g., pouting), affiliative (e.g., chin resting on hand), and coy (e.g., tongue show). Abused girls scored higher on the coy factor that was related to earlier age at first voluntary intercourse later in development (approximately 7 years later). High scores on the affiliative factor were related to higher sexual permissiveness and less negative attitudes toward sex. Results indicate that sexually abused girls showed early maladaptive patterns in interpersonal interactions, which were subsequently related to risky sexual attitudes and behaviors.

Safe enough to sleep: sleep disruptions associated with trauma, posttraumatic stress, and anxiety in children and adolescents

Sleep disturbance is an essential symptom of posttraumatic stress disorder, and recent evidence suggests that disrupted sleep may play an important role in the development of posttraumatic stress disorder following traumatic stress. The authors review several aspects of sleep as it relates to posttraumatic stress disorder. First, there is an association between traumatic stress and different components of disrupted sleep in children and adolescents. Second, sleep disruption appears to be a core feature of other pediatric anxiety disorders, and the authors consider if this preexisting sleep vulnerability may explain in part why preexisting anxiety disorders are a risk factor for developing posttraumatic stress disorder following a traumatic event. Third, the authors consider attachment theory and the social context of trauma and sleep disruption. This article concludes with a consideration of the therapeutic implications of these findings.

Factor structure of the Adolescent Clinical Sexual Behavior Inventory

The primary goal of this study was to determine if the Adolescent Clinical Sexual Behavior Inventory-Self-Report conformed to the five-factor scale format that was initially used with a clinical sample that included adolescents referred for sexual abuse evaluations. Participants were 141 teenagers, ages 12-19 (M = 15.11, SD = 1.4), and their primary caregivers. None of the participants were referred for sexual abuse evaluations. Principal components analyses found a different though similar set of factors. This sample yielded three factors that were similar to the original five factors identified by Friedrich, Lysne, Sim, and Shamos (2004). That is, the measure was found to reliably assess adolescents' sexual knowledge, risky sexual behaviors, and concerns related to appearance.

Parental knowledge of child sexual abuse symptoms

The purpose of this study was to investigate parental knowledge of symptoms of child sexual abuse (CSA), and to determine the factors associated with that knowledge. A total of 150 parents listed symptoms of CSA in the following areas: physical/medical, emotional, sexual behavior, and behavior towards others. Results suggest that, although most parents are familiar with some of the symptoms of CSA, they are more likely to know emotional or behavioral reactions which could be suggestive of many other life stressors. Parents with higher socioeconomic status listed more symptoms, but race and parenting experience were not significant factors. Results suggest the need to inform parents of more indicative physical or sexual symptoms, and to target parents of lower SES background in awareness efforts. doi:10.1300/ J070v15n04_01.

Sleep disturbances and childhood sexual abuse

OBJECTIVE

This longitudinal, prospective study examined the relationship between childhood sexual abuse and later sleep problems in adolescence while taking into account cooccurring psychopathology that is closely related to sleep disruption [e.g., depression and posttraumatic stress disorder (PTSD)].

METHOD

Sleep disturbances in 147 females (78 sexually abused; 69 comparison) were assessed 10 years after disclosure of substantiated abuse. The follow-up protocol included self-report questions regarding typical sleeping patterns and sleep disturbances as well as measures of depression, PTSD, and lifetime victimization histories.

RESULTS

Sleep disturbances correlated significantly with both depression and PTSD. Hierarchical regression analysis showed that sexually abused participants reported significantly greater rates of sleep disturbances than comparison participants above and beyond depression and PTSD. Sleep disturbances were related to revictimization rates independent of sexual abuse, depression, and PTSD.

CONCLUSIONS

Assessments of sleep disturbances should be integrated into standard of care for adolescents who have experienced sexual abuse.

Assessing sexual behavior in high-risk adolescents with the adolescent clinical sexual behavior inventory (ACSBI)

This study examined the reliability and validity of the Adolescent Clinical Sexual Behavior Inventory (ACSBI), a new 45-item measure, designed to elicit parent-and self-report regarding a range of sexual behaviors in high-risk adolescents. Using this measure, this study also investigated predictors of adolescent sexual behavior. Participants were 174 adolescents and their parents consecutively admitted to one of three clinical settings (i.e., inpatient treatment, partial hospital program, and outpatient clinic). Parent-and self-reports of adolescent sexual behavior were moderately correlated, and there was a strong relationship between high-risk sexual behavior and adolescent emotional and behavioral problems, as well as sexual concerns, distress, and preoccupation. In addition to sexual abuse, physical abuse, life stress, and impaired family relationships also significantly predicted sexual behavior in adolescents.

Stress and psychopathology in children and adolescents: is there evidence of specificity?

Research on the relations between specific stressors and specific psychological outcomes among children and adolescents is reviewed. Specificity, the notion that particular risk factors are uniquely related to particular outcomes is discussed from a theoretical perspective, and models of specificity are described. Several domains of stressors are examined from a specificity framework (e.g., exposure to violence, abuse, and divorce/marital conflict) in relation to broad-band outcomes of internalizing and externalizing symptoms. Studies that tested for specificity conducted within the past 15 years are examined, and definitional problems are highlighted. Little evidence for specificity was found. Methodological problems in the literature and the lack of theory-driven specificity research are discussed, and directions for future research are identified.

Schlafstörungen bei kinder- und jugendpsychiatrischen Erkrankungen

Zusammenfassung: Schlafstörungen als Symptom zahlreicher kinder- und jugendpsychiatrischer Störungsbilder komplizieren häufig den Verlauf und die Behandlung der Grunderkrankung. Organische Störungen wie die Narkolepsie oder das Kleine-Levin-Syndrom können zu differentialdiagnostischen Schwierigkeiten und Fehleinschätzungen führen. Unklar ist, ob spezifische Veränderungen der Schlafarchitektur bereits im Kindes- und Jugendalter bestehen und damit als biologischer Trait-Marker für psychiatrische Erkrankungen zu verstehen sind. Während für das Erwachsenenalter die Bedeutung von Schlafstörungen vor allem für die Entwicklung späterer depressiver Störungen belegt werden konnte, ist derzeit offen, ob es sich bei persistierenden Schlafstörungen im Kindesalter um Vulnerabilitätsmarker für psychiatrische Erkrankungen handelt. In der vorliegenden Literaturübersicht sollen Wechselwirkungen zwischen Schlafstörung und psychischer Störung aufgezeigt und die Bedeutung der Berücksichtigung von Schlafstörungen für Diagnostik und Therapie kinder- und jugendpsychiatrischer Störungsbilder unterstrichen werden.

Concomitance between childhood sexual and physical abuse and substance use problems. A review

This review focuses on the apparent connection between childhood sexual or physical abuse (CSA, CPA) and later substance use problems (SUPs) among adolescents and adults. The rates of CSA among females with SUPs were found to be, on average, nearly two times higher than those found in the general population, and the rates of SUPs among women with CSA histories were found to be similarly elevated. The rates of CSA were not found to be elevated among males with SUPs, but men with histories of CSA were found to be at greater risk for SUPs than men in the general population. Women, girls, and boys with SUPs were found to have elevated rates of CPA relative to the general population, while adult males with SUPs were not found to have elevated rates of CPA. Concomitance rates were not found to vary systematically with regard to either the methodological quality of the studies included nor the year of study publication. Additional descriptive examination of selected studies indicates that among women, childhood abuse is likely to be a factor in the development of SUPs, but that the relationship is mediated by other psychiatric conditions, such as anxiety and depressive disorders.

Relation between childhood sexual and physical abuse and risk of revictimisation in women: a cross-sectional survey

BACKGROUND

Women who are physically and sexually abused in childhood are at increased risk of victimisation in adulthood. Research has concentrated on sexual revictimisation, and has not included investigation of other abusive experiences, nor examination of prevalence and effects of abuse on adult revictimisation. We aimed to examine the relation between childhood trauma and adult revictimisation, and identify confounding factors.

METHODS

We did a cross-sectional survey of 2592 women who were attending primary care practices in east London, UK, with self-administered anonymous questionnaires. We included questions on physical and sexual abuse in childhood; on domestic violence, rape, indecent assault, and other traumatic experiences in adulthood; and on alcohol and other drug abuse. We analysed associations between childhood and adulthood abuse with multiple logistic regression.

FINDINGS

1207 (55%) of 2192 eligible women were recruited and completed the questionnaire. Abusive experiences co-occurred in both childhood and adulthood. Repetition and severity of childhood abuse were independently associated with specific types of adult revictimisation. Unwanted sexual intercourse (<16 years) was associated with domestic violence in adulthood (odds ratio 3.54; 95% CI 1.52-8.25) and with rape (2.84; 1.09-7.35); and severe beatings by parents or carers with domestic violence (3.58; 2.06-6.20), rape (2.70; 1.27-5.74), and other trauma (3.85; 2.23-6.63).

INTERPRETATION

Childhood abuse substantially increases risk of revictimisation in adulthood. Women who have experienced multiple childhood abuse are at most risk of adult revictimisation. Identification of women who have undergone childhood abuse is a prerequisite for prevention of further abuse.

The diagnostic utility of sexual behavior problems in diagnosing sexual abuse in a forensic child abuse evaluation clinic

OBJECTIVE

This study examined the utility of sexual behavior problems as a diagnostic indicator of sexual abuse. The hypothesis was that sexual behavior problems are multiply determined and consequently are variably related to sexual abuse in a clinical sample.

METHOD

A sample of 247 children evaluated for sexual abuse at a multidisciplinary forensic child abuse evaluation clinic were included. Results from the Child Behavior Checklist (CBCL) and the Child Sexual Behavior Inventory (CSBI) were analyzed and compared to the results of a structured abuse assessment performed independent of these scores.

RESULTS

The forensic team assessment found evidence of sexual abuse in 25% of cases, and no evidence in 61%. Children in this sample exhibited an elevated level of both sexual and nonsexual behavior problems. However, considerable variability was noted in sexual behavior problem scores. Thus, in this study a high score or a low score had no relationship to the diagnosis of sexual abuse. Indeed, nonsexually abused children were just as likely to have high CSBI scores as sexually abused children.

CONCLUSIONS

This study found no significant relationship between a diagnosis of sexual abuse and the presence or absence of sexual behavior problems in a sample of children referred for sexual abuse evaluation. The finding suggests that community professionals should use caution in relying on sexual behavior problems as a diagnostic indicator of abuse.

Girls in detention: what are their characteristics? A project to explore and document the character of this target group and the significant ways in which it differs from one consisting of boys

In this article, the differences between male and female juvenile delinquency are discussed, from a behavioural and psychiatric perspective. At first the existence and nature of female juvenile delinquency is described. Further a, mostly literature-based, analysis of gender-related differences in juvenile delinquency and psychopathology is presented. Finally the results are given of a dossier research project into the behavioural aspects of female juvenile delinquency. Girls commit fewer and less serious offences. Girls in a detention centre are younger than boys in the same centre. Few Turkish and Moroccan girls are seen. The majority of girls are placed in a detention centre by a Civil Court Order. A relatively high percentage of retarded girls was found. Multiple sexual contacts from an early age, substance abuse, running away from home and truancy are risk behaviours in the development of female juvenile delinquency. In the majority of cases there was no record of previous contacts with the law. It seems as if there are gender-related factors according to the development of female juvenile delinquency. Answers on age-differences, early sexual development, the relation between behaviour and psychiatric diagnosis, the role of the risk behaviours in the development of the girls, intelligence and the reasons for placing girls in a detention centre should throw light on the development process of female juvenile delinquents.

An ecological approach to understanding sexual revictimization: linking personal, interpersonal, and sociocultural factors and processes

This article applies an ecological model to the problem of sexual revictimization to advance the understanding of how personal, interpersonal, and sociocultural factors contribute to child sexual abuse victims' increased risk of being sexually victimized later in life. This ecological model explores how sexual revictimization is multiply determined by factors related to the victim's personal history (e.g., traumatic sexualization), the relationship in which revictimization occurs (e.g., decreased ability to resist unwanted sexual advances), the community (e.g., lack of family support), and the larger culture (e.g., blaming the victim attitudes). This article represents a step toward integrating findings on sexual revictimization and providing directions for future empirical work.

Problems in differentiating sexually from nonsexually abused adolescent psychiatric inpatients by self-reported anxiety, depression, internalization, and externalization

To ascertain whether self-reported psychopathology differentiated sexually and nonsexually abused adolescents, the Beck Depression Inventory, Beck Anxiety Inventory, and the Achenbach Youth Self-Report were administered to 111 psychiatric inpatients between 13 and 17 years of age who were diagnosed with various psychiatric disorders. Data about 14 background and clinical characteristics that were purported to be associated with sexual abuse were also collected. Forty (67%) of the 60 girls reported sexually abusive experiences, whereas six (12%) of the 51 boys reported such experiences. None of the scales were correlated with sexual abuse in either sex, and a history of physical abuse was the only characteristic that was significantly correlated with sexual abuse for both sexes. Furthermore, none of the scales was correlated with identity of sexual abuser, age of first abuse, age of last abuse, number of abuses, days of abuse, penile insertion, and the reporting of the abuse to the authorities in the sexually abused girls.

A process model for understanding adaptation to sexual abuse: the role of shame in defining stigmatization

While sexual abuse in childhood places the individual at-risk for a variety of problems, research indicates wide variation in victims' adjustment. Limited work is available that attempts to systematically explain processes by which children adjust to the trauma. Few studies have been undertaken to examine any theory about what causes children to be symptomatic. This article presents a theoretical and testable model that specifies psychological processes related to the traumagenic dynamics of stigmatization in child and adolescent victims of sexual abuse. The model proposes that sexual abuse leads to shame through the mediation of cognitive attributions about the abuse and shame, in turn, leads to poor adjustment. Three factors, social support, gender, and developmental period are hypothesized to moderate the proposed stigmatization process. Developmental and clinical research supporting the model is reviewed, specific hypotheses are made, and the relevance of developmental psychopathology for future theory and research is discussed. Unless future research elucidates the process and circumstances whereby the experience of sexual abuse leads to poor adjustment, little progress will be made toward developing more effective treatments.

Childhood sexual victimization as a factor in the treatment of substance misusing adolescents

The impact of childhood sexual abuse on the treatment for substance misuse of 194 adolescents was examined. At treatment onset, adolescents reporting sexual abuse, when compared to those reporting no sexual abuse, demonstrated more serious involvement with substances, a greater incidence of physical abuse and parental substance misuse, and, among males, increased suicidal ideation and school failure. The two groups did not differ on rate of treatment completion nor on change scores obtained from an assessment battery administered at the beginning and end of treatment. There were no differences between the two groups on adolescent ratings of treatment effectiveness. Therapists, however, rated adolescents who reported sexual abuse as showing greater improvement in two areas. Implications for treatment are discussed.

Child maltreatment and substance use: a review of the literature

In this article the author reviews current literature that investigates the connection between a history of childhood physical and/or sexual abuse and subsequent substance use. In general, current research findings have found a link between child maltreatment and substance use. However, the number of studies focusing on the connection between child abuse and substance use and misuse are limited, and many are plagued with a number of methodological weaknesses. Methodological weaknesses are reviewed and implications for future research are discussed.

The significance of emotions in the affective presentation of sexually abused girls

This study examined emotions and internalizing symptoms in sexually abused females. Children seen for outpatient evaluation for sexual abuse were compared to a normative sample on measures of emotional expression, anxiety and depression. The outpatient sample reported higher levels of emotions, lower levels of depression and statistically lower levels of anxiety as compared to non-abused peers. The outpatients also were compared to two inpatient samples: inpatient with no history of abuse, and inpatient with a history of abuse. Results are discussed in terms of the need to find different ways to assess emotional adjustment of sexually abused children.

The effects of forced sexual intercourse on white female adolescents

In the 1987 National Survey of Children the question was asked: "Was there ever a time when you were forced to have sex against your will, or were you raped?" Among White females, aged 18-22, those who answered yes (n = 41) and no (n = 400) were compared on a number of social-psychological and sexual variables that might be thought of as outcomes affected by having had coercive sexual experience(s). Those who reported being forced to have sexual intercourse, compared to those who did not, had more permissive attitudes about 16-17-year-olds having intercourse and a younger age of first voluntary sexual intercourse themselves. They also had lower internal locus of control and higher depression scores, and they needed and received more psychological help than those not reporting forced sexual intercourse. Dividing the forced sexual intercourse group (FSI) into those reporting FSI before versus after their first date, and those whose FSI was before versus after age 12, yielded essentially the same findings. Even in the presence of multivariate control variables. FSI experience remained a significant predictor of age at first voluntary sexual intercourse, locus of control, depression, and perceived need for psychological help. These analyses of national survey data support the clinical perspective that forced sexual intercourse causes or exacerbates various sexual and psychological problems.

A study of the variability of training and beliefs among professionals who interview children to investigate suspected sexual abuse

The study aimed to examine the relationship between professional background, number of qualifications, specific training in child sexual abuse and beliefs about indicators of child sexual abuse in professionals who conduct sexual abuse investigatory interviews. A questionnaire was sent to all professionals within a discrete geographical area who were involved in the investigation of child sexual abuse. One hundred and six of 136 questionnaires were returned (77.9%), 60 of which were from investigatory interviewers. The latter comprised eight different professions. There was a considerable variation in general training and in training in child sexual abuse specifically, both of which were more likely to have been received by medical psychological and social work respondents than residential care workers and police officers. Beliefs about sexual abuse indicators showed a striking variation between respondents. Most of the variation was not accounted for by the respondent variables examined. Where there was evidence for an association, the interviewer's professional background had the strongest effect, followed by the number of qualifications and the number of investigatory interviews conducted per year. Previous training in child sexual abuse had no significant effect on these beliefs. Further research is needed into the optimal training necessary for members of different professions in order to change their beliefs about child sexual abuse.

Sexual behavior problems and psychopathology symptoms in sexually abused girls

OBJECTIVE

This study contrasted a group of sexually abused girls, aged 6 to 12 years, with two demographically comparable control groups, girls from a child psychiatry outpatient department, and girls from a general pediatric clinic to determine whether differences in sexual behavior and psychopathology symptoms could be demonstrated.

METHOD

All girls and their mothers underwent an evaluation protocol composed of two parent-report inventories, the Child Behavior Checklist and the Child Sexual Behavior Inventory.

RESULTS

Sexually abused girls and psychiatric controls manifested more psychopathology symptoms, including internalizing and externalizing behaviors, than the nonpsychiatric controls. Relative to both control groups, sexually abused girls manifested more sexual behavior problems: masturbating openly and excessively, exposing their genitals, indiscriminately hugging and kissing strange adults and children, and attempting to insert objects into their genitals. Abuse by fathers or stepfathers involving intercourse was associated with particularly marked sexual behavior disturbances. There was a subgroup of sexually abused girls who tended to force sexual activities on siblings and peers. All of these girls had experienced prolonged sexual abuse (more than 2 years) involving physical force which was perpetrated by a parent.

CONCLUSIONS

Findings suggest that sexual abuse in preadolescent girls is associated with sexual behavior problems.

Sleep and psychological characteristics of children on a psychiatric inpatient unit

OBJECTIVE

To assess the association of objective measures of sleep-wake patterns and psychological status and abuse history of children hospitalized in a psychiatric inpatient unit.

METHOD

Thirty-nine inpatient children participated in the study. They were monitored for one to three consecutive nights with miniature wrist activity monitors for objective assessment of sleep-wake patterns. In addition, a thorough psychiatric and psychosocial assessment was completed with each child and the parents.

RESULTS

Children's self-ratings of depression, hopelessness, and low self-esteem were significantly correlated with objective sleep measures indicating poorer sleep quality. No significant correlations between intelligence scores and sleep measures were found. Nonabused and sexually abused children had better sleep quality than physically abused children.

CONCLUSIONS

Sleep quality during hospitalization is strongly associated with self experiences of depression, hopelessness, and low self-esteem in children with severe behavior disorders.

Criminal consequences of childhood sexual victimization

Using a prospective cohorts design, we assess the long-term criminal consequences of childhood sexual abuse through an examination of official criminal histories for a large sample of validated cases of childhood sexual abuse, compared to cases of physical abuse and neglect and a control group matched for age, race, sex, and approximate family socioeconomic status. Compared to other types of abuse and neglect, early childhood sexual abuse does not uniquely increase an individual's risk for later delinquent and adult criminal behavior. Childhood sexual abuse victims were at increased risk of arrest as a juvenile for being a runaway. As adults, child sexual abuse victims were at higher risk of arrest for sex crimes than controls, as were victims of physical abuse and neglect. Childhood sexual abuse victims were more likely to be arrested for prostitution as adults than other abuse and neglect victims and controls, regardless of gender. However, there was no support for a direct relationship among child sexual abuse, arrests for running away in adolescence, and adult arrests for prostitution. The findings also suggest an association for males between physical abuse and arrests for violent sex crimes (rape and/or sodomy). Caution is needed in interpreting these findings because of exclusive reliance on official record data and the possible impact of agency intervention.

Somatic, cognitive and emotional characteristics of abused children in a psychiatric hospital

A systematic review of medical records of one hundred consecutive admissions to a children's psychiatric inpatient unit was conducted to assess specific somatic, cognitive and emotional characteristics that distinguish sexually abused children from other hospitalized children. Sexually abused children were characterized by: a lower performance IQ, higher incidence of parasomnia prior to admission, longer length of hospital stay, and comparatively small physical stature.

Childhood victimization and risk for alcohol and drug arrests

Using data from a prospective cohorts design study, this paper examines the relationship between early childhood victimization and subsequent arrest for alcohol- and/or drug-related offenses. Complete official criminal histories are compared for cases of childhood physical and sexual abuse and neglect (n = 908) and a control sample (n = 667). After controlling for relevant demographic characteristics, logistic regression analyses indicate that childhood maltreatment is a significant predictor of adult, but not juvenile, arrests for alcohol- and/or drug-related offenses. Differential responses to maltreatment by race and gender are discussed as well as limitations of the findings and future directions for research.

Cross-gender behavior and gender conflict in sexually abused girls

OBJECTIVE

This study contrasted a group of sexually abused girls, aged 6 to 12 years, with two demographically comparable control groups, girls from a child psychiatry outpatient clinic, and girls from a general pediatric clinic, to determine whether differences in gender role behavior and identity could be demonstrated.

METHOD

All girls underwent an evaluation protocol that included a semistructured interview for children, the Gender Role Assessment Schedule--Child (GRAS-C). The mothers were administered several questionnaires including two parent-report measures of gender-related behavior in their children, the Child Game Participation Questionnaire (CGPQ) and the Child Behavior and Attitude Questionnaire--Female version (CBAQ-F).

RESULTS

Sexually abused girls manifested significantly more cross-gender behavior on the GRAS-C (in the areas of gender role preference and aggression) and gender identity conflict than did nonabused girls in both comparison groups. For the sexually abused and psychiatric control groups, their parents reported greater involvement in traditionally masculine games on the CGPQ, but on the CBAQ-F, no significant group differences were found.

CONCLUSIONS

Findings suggest that sexual abuse in preadolescent girls is associated with cross-gender behavior and gender conflict.

Sexual victimization and sexual behavior in children: a review of recent literature

Empirical research pertaining to sexual behavior in sexually abused children, including record reviews, parent ratings, psychological assessment, self-report, and behavioral observation is reviewed and discussed. Sexual behavior is reported significantly more often in sexually abused children than nonabused children. However, the consistency of this finding varies with the research method.