Children's Responses to Maltreatment: Key Conclusions From a Systematic Literature Review

The impact of parental acceptance and childhood maltreatment on mental health and physical pain in Burundian survivors of childhood sexual abuse

BACKGROUND

Parental support has been suggested to mitigate mental and physical consequences following childhood sexual abuse (CSA). However, many CSA survivors experience parental rejection post-CSA.

OBJECTIVE

We aimed to understand the impact of abuse-specific parental acceptance on post-traumatic stress disorder (PTSD) and physical pain in Burundian CSA-survivors. We further assessed the significance of parental acceptance among known risk factors for predicting PTSD.

METHODS, PARTICIPANTS, AND SETTINGS

Participants (N = 131, 80.9 % female, mean age 16.21 years) were recruited via primary health care centers for survivors of sexual violence which survivors approached post-CSA. Survivors reported on PTSD symptoms, daytime/nighttime pain, and adverse childhood experiences in semi-structured interviews. Parental acceptance levels were categorized (acceptance, no acceptance, no contact) for mothers and fathers separately. Kruskal-Wallis tests assessed group differences. Conditional random forests (CRF) evaluated the significance of parental acceptance in predicting PTSD symptom severity.

RESULTS

No significant differences regarding PTSD symptoms and physical pain between levels of maternal acceptance were obtained. Pairwise comparisons revealed significant differences in PTSD symptom severity between paternal acceptance and no acceptance (d = 1.04) and paternal acceptance and no contact (d = 0.81). The CRF identified paternal acceptance as important variable for the prediction of PTSD symptom severity. Even though results were less conclusive, medium effect sizes hint at less pain perception within the paternal acceptance group.

CONCLUSIONS

The results highlight paternal acceptance as a potential risk or protective factor regarding psychological and possibly physical well-being in the aftermath of CSA, even in the context of other known risk factors.

"Many bad things had been happening to me": Children's perceptions and experiences of polyvictimization in the context of child physical abuse

BACKGROUND

The association between child maltreatment and polyvictimization has received growing attention since being identified by Finkelhor and colleagues in 2005.

OBJECTIVE

The current study was designed to explore the experiences and perceptions of children who reported polyvictimization during forensic interviews.

METHODS

This mixed-methods study sample comprised 117 children aged 5-14, referred for the first time to forensic interviews following suspected physical abuse by a parent. More than one-third of the children reported polyvictimization. A thematic analysis was carried out to spotlight these children's experiences.

RESULTS

The analysis identified three main themes: the way children comprehend the polyvictimization, the consequences of the polyvictimization regarding the children's negative self-attribution, and the way the polyvictimization was constructed through the dynamic with the forensic interviewers.

CONCLUSIONS

The findings pointed to the importance of the forensic interview platform in assessing children's maltreatment burden. The current study also provided a glance into the possible involvement of the mechanics of self-blame among maltreated children. These findings have the potential to enhance our understanding of the excessive psychological toll taken on polyvictimized children.

Child Maltreatment During COVID-19: Key Conclusions and Future Directions Based on a Systematic Literature Review

The COVID-19 pandemic has had a far-ranging impact. As societies struggled to minimize infection, questions arose regarding the consequences for children. Initial research reported the urgent need for child protective services worldwide to adapt existing policies and practices to protect children from maltreatment during this time, which is the rationale for the current systematic literature review. This review examined studies published in peer-reviewed journals from March 2020 to October 2020 on child maltreatment (CM) in the context of COVID-19. Twenty-five manuscripts met the inclusion criteria and were predominantly from the United States, with three international studies. The majority of the studies included CM reports during COVID-19 based on official data. The results clearly demonstrated an increased risk for children alongside a worrisome international decrease in CM reports. Only two studies addressed interventions during the pandemic. The current review highlights that, along with the obligation of scholars to advance the protection of children during COVID-19, there is much that is unknown. Future studies should examine the impact of the pandemic on children and their surrounding systems as well as child protective services' responses, which face enormous challenges during a pandemic. An additional conclusion is that, since children were not identified as a health risk group during the pandemic, their protection rights may have been jeopardized. Furthermore, the variance identified in the policies of different countries pinpoints the urgent need to establish an international protocol for protecting children from maltreatment during COVID-19, a protocol that will hopefully be a basis for policymakers worldwide.

Children's Peritraumatic Responses During Sexual Abuse Incidents: Exploring the Narratives of Children From Different Ethnoreligious Groups in Israel

The peritraumatic response of children during incidents of child sexual abuse (CSA) is a neglected construct in the literature. Despite the widespread use of the fight-flight-freeze model, recent studies have shown that in the unique context of child abuse, additional peritraumatic responses could be relevant. The current mixed-methods study examined children's peritraumatic responses to CSA. The sample consisted of 249 forensic interviews with children aged from 4 to 13 years. An initial qualitative analysis resulted in identifying various ways in which the children responded to the abuse, the children's decision-making around these responses, as well their perceptions of their response. This analysis was followed by quantitative analyses, which explored the frequency of these peritraumatic responses and their correlation with the characteristics of the children and abuse. Six peritraumatic response categories were identified, the most common being fight, flight, and fear. Only ethnoreligious identity was significantly correlated with the fight-or-flight response, with a significantly lower frequency among Muslim and ultra-Orthodox Jewish children. Frequency of abuse and perpetrator familiarity were correlated with the frequency of the fight-or-flight response, indicating that the latter was less relevant in reoccurring incidents of abuse and with perpetrators who were family members. The findings promote the conceptualization of children's peritraumatic responses during incidents of abuse and the realization of the crucial role of children's ecological systems in their peritraumatic responses to incidents of abuse.

Peritraumatic Pain in Child Sexual Abuse: Children's Descriptions of Pain as Conveyed in Their Testimonies Following Child Sexual Abuse

The literature on child sexual abuse (CSA) has contributed significantly to the understanding of its characteristics, epidemiology, and consequences. Considerably less attention has been dedicated, however, to the subjective experiences of the abused children, and more specifically to their experiences of pain. The current study explored the way children perceive and describe pain during and shortly following incidents of sexual abuse. The sample was comprised of 35 transcripts of forensic interviews following alleged CSA. Thematic analysis of the children's narratives identified three themes: (a) pain during the abusive incidents, described using words indicating its intensity and quality; (b) pain shortly after the abusive incidents, including weeks later, and (c) pain as embedded within the complex dynamic with perpetrator. The children struggled to localize the pain, mainly using words such as "inside" and "deep." Moreover, they testified that in the course of the abusive incidents, they were often silenced when trying to communicate their pain to the perpetrators. The children's narratives provided us with a unique opportunity to learn about the pain not only during the abusive incidents but also following it. Additionally, children described suffering from pain in areas that were not directly injured during the CSA incidents, mainly referring to the head, abdomen and legs. The discussion addresses the potential intervening factors in peritraumatic CSA pain, as well as its potential links with chronic post-traumatic physical and mental morbidity. This study illuminates the necessity to address the complicated links between short- and long-term physical, emotional, cognitive, and interpersonal manifestations of CSA.

"If Only I Could Have Stopped It": Reflections of Adult Child Sexual Abuse Survivors on Their Responses During the Abuse

Child sexual abuse (CSA) has received much research attention in recent years, leading to the considerable development of services provided for children worldwide. The literature in the field of trauma studies recognizes that responses to trauma are of central importance and mainly discusses the fight-flight-freeze model of automatic responses to traumatic events. For a variety of reasons, research on this specific subject in the field of CSA is sparse. The current study was designed to spotlight the way adults perceive their responses during incidents of CSA. Semistructured interviews were carried out with 20 survivors who described their responses. The results pointed to the irrelevance of "fight or flight" responses in the context of CSA and emphasized compliance, avoidance, and simply surviving the abuse. In addition, the survivors shared the thoughts they had had during the abusive incidents. Specifically, while they understood that what was being done to them was wrong, they also realized that there was little they could do other than try to survive. The survivors' reflections on how their responses to CSA affected their negative self-attributions and on the way they contend with difficult incidents in adulthood suggest the central role played by CSA responses. The findings point to the multifaceted nature of responses to CSA and to the urgent need to further examine them by exploring other relevant contexts and perceptions to develop a theoretical model that will address responses to child abuse and inform both prevention and intervention efforts.

Beyond fight, flight, and freeze: Towards a new conceptualization of peritraumatic responses to child sexual abuse based on retrospective accounts of adult survivors

BACKGROUND

Child sexual abuse (CSA) studies have greatly contributed to theory, policy, and practice worldwide. Surprisingly, although trauma studies in particular have highlighted the importance of peritraumatic responses to trauma, this aspect is underdeveloped in the context of child abuse studies.

OBJECTIVE

The current study profiles the peritraumatic responses of children to abuse, based on adults' retrospective accounts of their childhood experiences.

PARTICIPANTS & METHODS

180 adults who retrospectively reported having been sexually abused in childhood completed a questionnaire that included four categories of common peritraumatic responses to CSA: automatic, behavioral, cognitive and affective.

RESULTS

Latent class analysis revealed a number of classes in each of the questionnaire's four categories. Within each, classes were identified and the relationships within and between them, as well as with abuse characteristics were explored.

CONCLUSIONS

Existing theory with respect to peritraumatic responses to trauma, and to CSA in particular, should be reconsidered based on the multifaceted model proposed in the current study. The findings point to a previously unrecognized peritraumatic response to trauma: numbness and seeking ways to survive ongoing abuse. Finally, recommendations are provided for incorporating the current model in both prevention and intervention efforts in the CSA field.