"Systemic trauma": the impact on parents whose children have experienced sexual abuse

Vicarious Growth, Traumatization, and Event Centrality in Loved Ones Indirectly Exposed to Interpersonal Trauma: A Scoping Review

It is well-known that interpersonal traumatic events can impact the physical and mental health of those indirectly exposed to the events. Less studied are populations of loved ones who have been indirectly exposed to interpersonal trauma. We conducted a scoping review to synthesize literature related to potential consequences of indirect interpersonal trauma exposure, specifically vicarious traumatization (VT) and vicarious posttraumatic growth (VPTG). We used the Joanna Briggs Institute methodology. Inclusion criteria included: (1) participants were indirectly exposed to the interpersonal trauma of a loved one in adulthood, (2) discussion of VT, VPTG, or related terms, (3) published peer-reviewed empirical journal articles, and (4) available in English. We used a three-step search strategy to find relevant articles. Keywords found from the first two steps were entered into PsycINFO, PsycArticles, PubMed, Scopus, and Web of Science databases. Reference lists of the included articles were also examined. The identified articles were then screened using the inclusion and exclusion criteria. Twenty-eight articles met inclusion and exclusion criteria. Twenty-six articles referenced VT or related terms, one referenced VPTG, and one referenced vicarious trauma keywords. Results of this scoping review are summarized by definitions, measures, key findings, and knowledge gaps. Future research should focus on vocabulary management, diverse samples, and VPTG in this population, including the identification or creation of appropriate measures.

Family characteristics, responses, and dynamics associated with sibling sexual abuse: A scoping review

BACKGROUND

Sibling sexual abuse (SSA) is influenced by and occurs within an interconnected family system, because of this there is a growing move towards recognising SSA as a family issue. Families also play a vital role in the disclosure of SSA and in the aftermath of recovery. Nevertheless, a descriptive review consolidating the known family dynamics, characteristics, and responses associated with SSA is absent from research.

OBJECTIVE

A scoping review was conducted to synthesise known family characteristics and dynamics associated with SSA. The review also sought to explore how families respond following the disclosure/discovery of SSA.

METHOD

Arksey and O'Malley's (2005) five-part scoping review framework was used. Web of Science, PsycInfo, ProQuest, Google Scholar and specialist journals were searched for empirical research and results were assessed for eligibility, leaving 28 studies in the final review.

RESULTS

SSA was related to: (1) family demographics, (2) a history of abuse and neglect within the family, and (3) household stressors and environmental factors. The review also found that families largely respond using strategies of minimisation.

CONCLUSIONS

Research and practice need to ensure that SSA is understood within the context of family dynamics and histories, in a way that may not be necessary when understanding other 'types' of child sexual abuse (CSA). Consideration must be given to the fact that children affected by SSA can be situated in families where, as well as SSA, there is a history of abuse and neglect within the family, and various environmental stressors are present.

Parents' Vicarious Event Centrality of Their Child's Interpersonal Trauma

This study aimed to understand parents' process of centering their child's interpersonal traumatic event in their lives post-disclosure. Specifically, how it informed their understanding of themselves, their lives, and the world. This phenomenon of centering a traumatic event in one's life is termed event centrality and has not been previously applied to qualitative research or this population. Participants were 17 primary caregivers (14 maternal caregivers and 3 paternal caregivers) of 27 victims of child interpersonal trauma (14 males and 13 females) located in Canada. The age of participants ranged from 35 to 75 years (average = 54.5 years) and majority self-identified as Caucasian (70.6%). Grounded theory was used to analyze the data. The resulting model was labeled Vicarious Event Centralization and Decentralization, indicating that parents center their child's interpersonal trauma across many areas of their lives, which orients them to focus on protecting and healing the child. After the child's functioning improves, parents are then able to reorient to life beyond the trauma, representing decentralization. The grounded theory consists of three phases: Centralization, Decentralization Gateway, and Decentralization. These results illustrate that parents' centralization of the trauma may be an adaptive mechanism that promotes child recovery, which in turn allows parents to begin to decentralize the trauma and move toward recovery. This study supports that parents are affected by their child's trauma in a myriad of ways and require unique services to address their needs. This study can help practitioners understand the post-trauma experience for parents and target areas likely to increase recovery.

Non-offending caregivers reflections on the use of a film encompassing child sexual abuse perpetrator's testimonies for potential child protection initiatives in South Africa

BACKGROUND

Child sexual abuse (CSA) remains a challenge in South Africa, despite various legislative developments to address child abuse. Despite non-offending caregivers (NOC) playing a critical role in child safeguarding, and supporting disclosure and recovery, very little research has focused on understanding what works in assisting them in supporting child victims in South Africa.

OBJECTIVES

The study examines the exposure of NOC who watched a short film based on the testimonies of four CSA perpetrators in therapy, with a view to exploring whether this film could be useful for CSA prevention, disclosure and support initiatives.

PARTICIPANTS AND SETTING

A convenience sample of eight NOC attending a community support service in KwaZulu-Natal, South Africa.

METHODS

After viewing the film, the NOC completed a questionnaire, and were asked to discuss usefulness of film content based on perpetrator testimonials in sensitizing NOC around disclosure of sexual abuse and support of the child. Thematic data analysis combined their perceptions of sexual abuse experienced by their children/grandchildren and the effect that content of the film had on their perceptions.

RESULTS

Five themes emerged; Awareness of CSA and available child protection programs; Views toward CSA disclosure; Emotive responses; Lessons learnt for identification of CSA and child protection; and Recommendations for future programs.

CONCLUSIONS

The process of viewing and discussing the film stimulated a shift for NOC to identify risk, facilitate disclosure of CSA, and become more supportive toward child victims. The study highlights the potential of using film to guide NOC targeted child protection and safeguarding initiatives.

What Can We Learn About the Others Present During Incidents of Child Abuse?: Key Lessons and Future Directions Based on a Scoping Review

Child abuse (CA) is a global problem that has received attention from policymakers, researchers, and practitioners. The majority of studies have focused on the phenomenon's epidemiology and consequences, alongside groundbreaking writing on victims and perpetrators. The concept of others who are present during the abuse is understudied and underdeveloped, despite its vital importance in better understanding children's experiences as well as their disclosure. The current study was designed to spotlight the phenomenon of others' presence, beyond the victims and perpetrators, during child abuse incidents. The current literature review was guided by a scoping review strategy. The results revealed scant empirical data, with only 15 studies meeting the inclusion criteria of the study. The articles that met the inclusion criteria addressed other people's presence during CA incidents, were published in peer-reviewed journals, and were written in the English language. These articles' analyses addressed the relations of the survivors with these others, pointing mainly to two identities: accidental bystanders who are not familiar with the child and family members of the child. The results provided a glance into the process that accidental bystanders go through during the abuse and the meaning of their presence for those who are family members. The perceptions and experiences of the children themselves with respect to the presence of the others during the abuse are noticeably lacking. The key conclusion from the current scoping review pinpoints the urgent need to advance the empirical knowledge on the presence of others during incidents of child abuse, especially others who are familiar to the children and are a significant part of their lives. The conceptualization of this phenomenon has the potential to better adapt prevention and intervention efforts in the field of child abuse.

Parenting Stress in Non-Offending Caregivers of Sexually Abused Children

The non-offending caregiver (NOC) population is under studied despite their role in the recovery of child victim-survivors of sexual abuse. Research suggests that NOCs experience significant distress following a child's disclosure of sexual abuse. Trauma has been demonstrated to negatively impact the caregiver-child relationship. This study informs about common NOC stress reactions in response to child sexual abuse (CSA) disclosures and has clinical implications for treating families affected by CSA. Participants included 66 NOCs (age 23-66, M = 41.09, SD = 10.26) who participated in clinical intakes at a CSA treatment program and completed a self-report measure of parenting stress. Depending on the child's age, NOCs were administered either the Parenting Stress Index-fourth edition, Short Form (PSI-4-SF) or the Stress Index for Parents of Adolescents (SIPA). NOCs reported higher than average parenting stress. Statistically significant differences between the clinical and normative samples were found on all PSI-4-SF domains and on majority of SIPA domains. High to Clinically Significant scores were reported by 42% of NOCs for Parent-Child Dysfunctional Interaction. Stress related to their child's social withdrawal was reported by 56% of NOCs. This study provides comparison data for evaluations of NOCs. NOCs may require treatment and family-based approaches are implicated.

A sexual abuse case series of infants and toddlers by a professional caregiver: A qualitative analysis of parents' experiences during the initial crisis period post-discovery

BACKGROUND

The discovery that one's child has been sexually abused may be one of the worst events a parent can experience. The importance of parental support for the recovery of child sexual abuse (CSA) victims emphasizes the need to gain insight in difficulties parents face after disclosure.

OBJECTIVE

To improve crisis intervention by exploring how parents of very young, mostly male CSA victims involved in a large unique CSA case, look back on their initial reactions after disclosure, the impact of media coverage, and their experiences with service responses during the immediate aftermath of CSA discovery.

PARTICIPANTS AND SETTING

We conducted 18 qualitative interviews with 21 parents enrolled in the longitudinal Amsterdam Sexual Abuse Case (ASAC) study.

METHODS

We used thematic analysis, combining a deductive and inductive approach.

RESULTS

We identified four themes regarding parents' initial experiences after disclosure: shock, uncertainty, roller coaster and survival mode. Four themes emerged regarding the impact of media coverage: vulnerable to exposure, fear that the child would recognize the suspect, no escape possible, and burden versus acknowledgement. Parents' experiences regarding the actions of professionals also generated four themes: stressful and confronting, need for support, need for information, and need for professional competence.

CONCLUSIONS

Disclosure of extrafamilial CSA left parents in shock, affecting their sense of control. Media coverage exacerbated stress for many parents, although some also drew support from it. Actions of professionals defined by parents as helpful included: being supportive, compassionate, accessible, and competent, providing information, and promoting autonomy. Implications for professionals are discussed.

The relations between childhood maltreatment, shame, guilt, depression and suicidal ideation in inpatient adolescents

BACKGROUND

Previous studies demonstrated positive relations between various forms of maltreatment and suicidal ideation in youth; however, mechanisms underlying these relationships are not well understood. We propose that the experience of maltreatment in childhood may lead to high levels of generalized guilt and shame, resulting in an increase of depressive symptoms and suicidal thoughts in adolescents. The aim of the current study was to test our model of relations between these constructs using path analysis.

METHODS

112 inpatient adolescents aged 12-17 years completed the Childhood Trauma Questionnaire to measure various types of maltreatment, the Personal Feelings Questionnaire to evaluate generalized guilt and shame, the Beck Depression Inventory-II to assess depressive symptoms, and the Columbia-Suicide Severity Rating Scale to assess suicidal ideation.

RESULTS

Findings partly confirmed the theoretical model. Indirect positive effects of sexual and emotional abuse, as well as emotional and physical neglect on suicidal ideation via generalized self-conscious emotion and/or depression were demonstrated. In contrast to our predictions, indirect negative effects of physical abuse on suicidal thoughts via generalized guilt and shame and depression were found.

LIMITATIONS

Sample characterized by predominately Caucasian inpatient adolescents from financially stable and well-educated environments, over-reliance on self-report measures and the lack of a longitudinal design were main limitations of the study.

CONCLUSIONS

The study provides novel information on the potential mechanisms underlying the association between childhood maltreatment and suicidal ideation in adolescents. Generalized guilt and/or shame could be possible targets for interventions for victims of some forms of maltreatment to reduce depressive symptoms and suicidal ideation.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Parenting Among Mothers Who Experienced Child Sexual Abuse: A Qualitative Systematic Review

Child sexual abuse (CSA) represents a significant public health problem. While CSA is associated with several adverse outcomes, recent attention has been given to its effect on maternal parenting. Despite a growing literature on this topic, a comprehensive systematic review has not been conducted. Thus, this review aimed to fill this gap. Several search strategies were used, including searches in academic databases. Two reviewers completed screening, full-text review, data extraction, and quality determinations. Extracted qualitative data were synthesized for the 108 studies meeting inclusion criteria. The primary themes emerging from women's accounts of the effects of CSA on their current parenting included abuse of child, breastfeeding, child-rearing practices, coping related to parenting, mother-child relationship, perceptions of child, perceptions of motherhood, and protection of children from abuse. Given the current lack of interventions designed for these mothers, the results of this review may aid in the development of evidence-based interventions.

Sexual abuse in very young children: a psychological assessment in the Amsterdam Sexual Abuse Case study

Background: Child sexual abuse (CSA) is a worldwide problem affecting children of all ages and socioeconomic backgrounds. A knowledge gap exists regarding the psychological outcomes for children, boys in particular, who are abused during their early lives. Objective: To provide a descriptive psychological profile of children who experienced sexual abuse as infants or toddlers from a male daycare worker and babysitter, and to assess the psychopathological impact on their parents. Method: Parents of children involved in the Amsterdam Sexual Abuse Case (41 parents; 44 children, age range 3-11 years, 30 boys, 14 girls) completed measures on post-traumatic stress disorder (PTSD), dissociation, sexual and non-sexual behaviour problems, and attachment insecurity in their children, as well as on parental psychological well-being, 3 years after disclosure. Sexual abuse characteristics were obtained from police records. Results: We found that 3% of confirmed child victims had PTSD, 30% sexual behaviour problems, 24% internalizing problems, 27% attachment insecurity, and 18% any psychiatric disorder (including PTSD); 39% were asymptomatic. In parents, we found feelings of guilt, shame, and anger about the abuse of their child; 19% showed PTSD symptoms and 3% showed avoidant and 8% anxious attachment problems in their intimate relationship. Parental symptomatology was related to child symptomatology, except for child sexual behaviour problems. One-quarter of confirmed child victims and 45% of parents had received psychological treatment. Conclusions: Three years after disclosure, extrafamilial CSA in very young children was associated with sexual and non-sexual behaviour problems and attachment insecurity, but rarely with PTSD or dissociation. For parents it was associated with PTSD symptoms and emotional reactions. Assessments and interventions should focus on the wide spectrum of problems that follow CSA, as well as on parental psychopathology and the parent-child relationship. Future follow-up assessments in our longitudinal study should provide insights into longer-term outcomes.

Change in Parental Depressive Symptoms in Trauma-Focused Cognitive-Behavioral Therapy: Results from a Randomized Controlled Trial

OBJECTIVES

Depressive symptoms are frequently described in parents whose children have been exposed to traumatic events. Hence, including nonoffending parents in trauma-focused cognitive-behavioral therapy (TF-CBT) for children and adolescents may help both children and their parents to cope with the trauma. Up to now, three randomized controlled trials have investigated parental depressive symptoms after TF-CBT. Given the ambiguous results, further effectiveness trials are needed to investigate parental benefit from TF-CBT. The aim of this study is to determine whether TF-CBT is superior to waitlist (WL) regarding change in parental depressive symptoms.

METHODS

Parents, N = 84, whose children (age 6-17 years) were randomly assigned to either 12 sessions of TF-CBT (n = 40) or to WL condition (n = 44) completed the Beck Depression Inventory-Second Edition (BDI-II) for pre-post comparison. The group difference was tested through repeated-measures analyses of variance (ANOVA). The change in parental depressive symptoms was additionally categorized using the reliable change index.

RESULTS

Repeated-measures ANOVA indicated a significant time effect F(1, 82) = 2.55, p = 0.02, and no significant time-group interaction F(1, 82) = 1.09, p = 0.30, suggesting a similar reduction in parental depressive symptoms in both groups. Across both conditions, most of the parents remained unchanged (n = 62), some of them improved (n = 17), and a few deteriorated (n = 5). There was no significant difference between the conditions (χ²(2) = 1.74; p = 0.42).

CONCLUSION

Contrary to findings of several previous studies, our results suggest no superiority of TF-CBT in comparison with WL regarding change in depressive symptoms in parents. This might be due to different types of the child's trauma. Parental benefit from TF-CBT was found in samples of sexually abused, but not in children and adolescents exposed to diverse trauma types.

Posttraumatic symptoms and cognitions in parents of children and adolescents with PTSD

Parents may develop symptoms of distress and dysfunctional cognitions in response to their child's exposure to traumatic events. Additionally, they may also be affected by their own traumatic experiences. This study investigated the frequency of traumatic experiences and of symptoms of posttraumatic stress and depression in a sample of parents of children and adolescents with posttraumatic stress disorder (PTSD). Furthermore, we explored the association of parental symptoms with their dysfunctional cognitions related to their child's trauma. Parents (N = 113) of children and adolescents with PTSD completed the Posttraumatic Diagnostic Scale (PDS), the Beck depression inventory (BDI-II), the State-Trait Anxiety Inventory, and the Posttraumatic Cognitions Inventory. Correlations between symptom measures and dysfunctional cognitions were calculated. The majority (78.8 %) of the parents reported their own potentially traumatic experiences. Furthermore, 33.6 % evaluated their child's trauma as the worst event, 34.5 % rated their own experiences as their worst event, and 26.5 % indicated that their own worst traumatic event was the same type as their child's trauma. The frequency of clinically elevated parental symptoms on the PDS was 48.6 %, and on the BDI-II 32.7 %. Parental symptoms were independent of the reference person of the parental traumatic index event. However, they did correlate significantly with their dysfunctional cognitions (between r = 0.44 and 0.69, p < 0.01). Many parents report their own traumatic experiences and a significant proportion has its own clinically relevant symptoms of distress. Parental psychological symptoms are moderately associated with their dysfunctional cognitions. The results emphasize the need to consider parental distress when treating pediatric PTSD.