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Aviad M, Klebanov B, Katz C. Unveiling the shadows: Parental perceptions and familial impact of daycare abuse of preschool children. CHILD ABUSE & NEGLECT 2024; 151:106755. [PMID: 38513428 DOI: 10.1016/j.chiabu.2024.106755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 03/08/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Preschoolers are at an increased risk of experiencing abuse, especially from caregivers. Early child abuse has adverse continuances on children's short and long-term development. The majority of previous studies were conducted in the 1990s in the United States, focusing primarily on sexual abuse. Despite the recently increasing public awareness of daycare abuse (DA), empirical studies on this topic have not yet been conducted in Israel. OBJECTIVE The current study was designed to examine parents' perceptions regarding the DA of their preschool children. METHOD The data were collected through semi-structured, in-depth interviews with 14 parents of children who underwent DA. Qualitative analysis was performed on the narratives of the participants. FINDINGS Three main themes were identified: 1) parental shock, 2) community echoes, and 3) ripples of trauma. The study revealed the dramatic consequences of DA on children and their families. The families dealt with the consequences of the traumatic DA event, which destabilized almost every part of their lives. The study found that parents felt alone and without assistance from the authorities while facing the consequences of the DA. CONCLUSIONS In examining the parents' perspectives, the current study's findings presented essential empirical knowledge regarding the DA phenomenon and encouraged future studies in this area. This study has the potential to serve as a basis for the creation of professional training programs.
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Affiliation(s)
- Michal Aviad
- Paul Baerwald School of Social Work and Social Welfare at the Hebrew University of Jerusalem, Israel
| | - Bella Klebanov
- Bob Shapell School of Social Work at Tel Aviv University, Israel
| | - Carmit Katz
- Bob Shapell School of Social Work at Tel Aviv University, Israel.
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2
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Talmon A, Ditzer J, Talmon A, Tsur N. Maltreatment in Daycare Settings: A Review of Empirical Studies in the Field. TRAUMA, VIOLENCE & ABUSE 2024; 25:512-525. [PMID: 36869785 PMCID: PMC10666466 DOI: 10.1177/15248380231155528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Daycare maltreatment refers to abusive and/or neglectful acts perpetrated by teachers, directors, non-professionals or volunteers, family members of staff, and peers in a daycare setting. Despite growing evidence of its occurrence, the prevalence and consequences of daycare maltreatment for the child, the parent(s), and their dyad are largely unknown. This qualitative systematic literature review was conducted to synthesize the existing literature referring to daycare maltreatment, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In order to be included in the analysis, the manuscripts needed to report empirical findings regarding maltreatment in daycare settings, be written in English, be published in a peer-reviewed journal or a dissertation, and be accessible by our research team. In all, 25 manuscripts met the above criteria and were included in the review. Our results indicate that reports of daycare maltreatment are characterized by early age of abused children, inferring mainly to sexual, physical, and emotional abuse. The majority of these manuscripts reported caregivers' and teachers' abuse, while peer victimization was reported much less. In addition, the findings demonstrated a higher representation of female perpetrators compared to abuse in other scenarios. Although some indications of long-term implications are reported in the manuscripts, a well-validated measure for assessment of daycare maltreatment seems to be lacking. These findings contribute to a more nuanced understanding of the complex experience and ramifications of daycare maltreatment, providing insight into its multi-faceted implications.
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Affiliation(s)
- Anat Talmon
- The Hebrew University of Jerusalem, Israel
- Stanford University, Palo Alto, CA, USA
| | - Julia Ditzer
- Stanford University, Palo Alto, CA, USA
- Leipzig University, Germany
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3
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Quayle E, Schwannauer M, Varese F, Cartwright K, Hewins W, Chan C, Newton A, Chitsabesan P, Richards C, Bucci S. The experiences of practitioners working with young people exposed to online sexual abuse. Front Psychiatry 2023; 14:1089888. [PMID: 36993927 PMCID: PMC10042324 DOI: 10.3389/fpsyt.2023.1089888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/17/2023] [Indexed: 03/16/2023] Open
Abstract
IntroductionThis qualitative study explored healthcare professionals' current understanding of, and clinical practices related to, Online Child Sexual Abuse (OCSA).MethodsData were collected across two UK sites (Manchester and Edinburgh). Interviews and one focus group were held with 25 practitioners working in services offering clinical support to young people who have experienced OCSA. Thematic analysis of the data identified three overarching themes and 10 subthemes related to the research questions: (1) the breadth of the problem; (2) working with OCSA; and (3) the emotionally charged nature of OCSA.ResultsWhile practitioners recognized OCSA as problematic, they differed in how they conceptualized it. There was a heightened awareness of the role that sexual images played in OCSA and concerns about first-person-produced imagery by Children and Young People (CYP). Practitioners described a generational gap related to their technology use and that of the young people they worked with. Practitioners also described a paucity of referral pathways and concerns that there was no training available to them. Organizational barriers meant that questions about technology use were not routinely included in assessments and often there was reliance on young people making disclosures.DiscussionNovel findings from this study were the psychological impacts that such cases had on practitioners, which may indicate a need for organizational support for staff as well as further training needs. Existing frameworks that help conceptualize and assess the role of technology as part of the ecology of the child may have great utility for practitioners.
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Affiliation(s)
- Ethel Quayle
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthias Schwannauer
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
- NHS Lothian, University of Edinburgh, Edinburgh, United Kingdom
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Kim Cartwright
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - William Hewins
- NHS Lothian, University of Edinburgh, Edinburgh, United Kingdom
| | - Cindy Chan
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Alice Newton
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | | | - Cathy Richards
- NHS Lothian, University of Edinburgh, Edinburgh, United Kingdom
| | - Sandra Bucci
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Division of Psychology and Mental Health, The University of Manchester, Manchester, United Kingdom
- *Correspondence: Sandra Bucci
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4
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van Duin EM, Verlinden E, Tsang VMW, Verhoeff AP, Brilleslijper-Kater SN, Voskes Y, Widdershoven GAM, Lindauer RJL. 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. CHILD ABUSE & NEGLECT 2022; 125:105460. [PMID: 35065473 DOI: 10.1016/j.chiabu.2021.105460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/12/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Esther M van Duin
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, the Netherlands; Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands.
| | - Eva Verlinden
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Epidemiology, Health Promotion & Healthcare Innovation, Amsterdam Public Health Service, Amsterdam, the Netherlands.
| | - Vionna M W Tsang
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Arnoud P Verhoeff
- Department of Sociology, University of Amsterdam, Amsterdam, the Netherlands.
| | - Sonja N Brilleslijper-Kater
- Department of Social Pediatrics, Child Abuse and Neglect Team, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Yolande Voskes
- Department of Ethics, Law and Humanities, Amsterdam UMC, location VUMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Guy A M Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam UMC, location VUMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, the Netherlands; Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands.
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5
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Tsang VMW, Verlinden E, van Duin EM, Twisk JWR, Brilleslijper-Kater SN, Gigengack MR, Verhoeff AP, Lindauer RJL. The Amsterdam Sexual Abuse Case: What Scars did it Leave? Long-Term Course of Psychological Problems for Children Who have been Sexually Abused at a Very Young Age, and their Parents. Child Psychiatry Hum Dev 2021; 52:891-902. [PMID: 33011833 PMCID: PMC8405499 DOI: 10.1007/s10578-020-01067-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 11/30/2022]
Abstract
Longitudinal research of CSA in infancy and early childhood is scarce. The current study examined the long-term course of psychological outcomes (PTSD, dissociation and internalizing and externalizing behavioral problems) in children who were sexually abused in the early childhood. Additionally, we looked into the outcomes for their parents by assessing PTSD symptoms and negative emotional reactions towards the sexual abuse of their child. We examined the outcomes for five consecutive years in a sample of children (n = 45) who were sexually abused at a very young age (0-3) and their parents (n = 42), included in the Amsterdam Sexual Abuse Case-study. We found that outcomes following CSA in early childhood go beyond PTSD symptoms and can manifest in atypical symptoms such as behavioral problems. Parents experienced persistent PTSD in the years following CSA disclosure. CSA in very young children warrants long-term monitoring, as negative outcomes still present 8 years later.
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Affiliation(s)
- Vionna M. W. Tsang
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eva Verlinden
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands ,Department of Epidemiology, Health Promotion & Healthcare Innovation, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
| | - Esther M. van Duin
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jos W. R. Twisk
- Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Sonja N. Brilleslijper-Kater
- Department of Social Pediatrics, Child Abuse and Neglect Team, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maj R. Gigengack
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnoud P. Verhoeff
- Department of Epidemiology, Health Promotion & Healthcare Innovation, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands ,Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Ramón J. L. Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands ,De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
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6
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van Ham K, Brilleslijper-Kater S, van der Lee H, van Rijn R, van Goudoever H, Teeuw R. Validation of the Sexual Knowledge Picture Instrument as a diagnostic instrument for child sexual abuse: study protocol. BMJ Paediatr Open 2020; 4:e000799. [PMID: 33083573 PMCID: PMC7526291 DOI: 10.1136/bmjpo-2020-000799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The consequences of child sexual abuse (CSA) can be significant and can affect short-term and long-term mental, sexual and physical health. In order to offer timely and appropriate care for the child, early recognition of CSA is necessary. The lack of specific physical and psychological signs and barriers to abuse disclosure that these young victims face makes it difficult for medical and psychological professionals to recognise and confirm CSA signs. We aimed to validate the Sexual Knowledge Picture Instrument (SKPI) as a diagnostic instrument for CSA. METHODS AND ANALYSIS An observational study to quantify the intraobserver and interobserver reliability and diagnostic accuracy of the SKPI will be performed. A total of 250 subjects from three groups will be included in the study: (1) a group of suspected CSA victims, recruited from three academic paediatric hospitals; (2) a case group of (proven) victims of CSA, recruited in cooperation with the Dutch Police Vice Squad; and (3) a control group of children, recruited from preschools and primary schools. All children will be interviewed using the SKPI, and to investigate reliability, video recordings will be assessed and reassessed by the same and a different blinded rater, respectively. Within 1 year, the results of the SKPI will be compared with the conclusions from the independent child protective services or police reports. If necessary, the SKPI will be modified to improve its reliability and accuracy. ETHICS AND DISSEMINATION This validation study of the SKPI is necessary for obtaining a reliable diagnostic tool, which will enable medical and psychological professionals to detect CSA in young victims at an early age and start intervention/treatment. TRIAL REGISTRATION NUMBER NL 50903.018.15.
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Affiliation(s)
- Kirsten van Ham
- Paediatrics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | | - Hanneke van der Lee
- Epidemiology, Kennisinstituut van Medisch Specialisten, Utrecht, The Netherlands
| | - Rick van Rijn
- Paediatric Radiology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | | - Rian Teeuw
- Paediatrics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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7
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Vrolijk-Bosschaart TF, Brilleslijper-Kater SN, Verlinden E, Widdershoven GAM, Teeuw AH, Voskes Y, van Duin EM, Verhoeff AP, de Leeuw M, Roskam MJ, Benninga MA, Lindauer RJL. A Descriptive Mixed-Methods Analysis of Sexual Behavior and Knowledge in Very Young Children Assessed for Sexual Abuse: The ASAC Study. Front Psychol 2019; 9:2716. [PMID: 30687174 PMCID: PMC6333700 DOI: 10.3389/fpsyg.2018.02716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/17/2018] [Indexed: 12/30/2022] Open
Abstract
Child sexual abuse (CSA) is a worldwide problem with serious consequences. We hypothesized that worrisome sexual behavior and knowledge would frequently be reported in children assessed after CSA. We therefore investigated (A) what types of sexual behaviors and knowledge were reported by parents of young children assessed for CSA; (B) in what cases such behaviors and knowledge were worrisome; and (C) how such children responded verbally and non-verbally during child interviews. We conducted a mixed-methods study, including qualitative inductive content analysis and quantitative analysis. It included 125 children (76 boys, 60.8%; median age 3.3 years, age range 0–11), all involved in the Amsterdam sexual abuse case (ASAC) and examined for highly suspected (n = 71) or confirmed CSA (n = 54). We identified themes from (1) the parent reports: sexual behavior (e.g., self-stimulation, touching others, imitation of sexual acts), fears and anxiety with regard to sexuality, and sexual utterances (sexual slang, references to sexual acts); and (2) the child interviews: behavioral reactions (avoidance, distractive behaviors), emotional reactions (anger, aggression), and verbal reactions (conspicuous utterances, refusal to talk about specific subjects). In 37% of the children the sexual behavior was deemed worrisome or very worrisome. Clinicians who assess children for CSA are advised to focus in particular on sexual behavior problems and inappropriate sexual knowledge.
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Affiliation(s)
- T F Vrolijk-Bosschaart
- Department of Social Pediatrics, Child Abuse and Neglect Team, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - S N Brilleslijper-Kater
- Department of Social Pediatrics, Child Abuse and Neglect Team, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - E Verlinden
- Department of Epidemiology, Health Promotion and Healthcare Innovation, Public Health Service, Amsterdam, Netherlands
| | - G A M Widdershoven
- Department of Medical Humanities, VU University Medical Center, Amsterdam, Netherlands
| | - A H Teeuw
- Department of Social Pediatrics, Child Abuse and Neglect Team, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - Y Voskes
- Department of Medical Humanities, VU University Medical Center, Amsterdam, Netherlands
| | - E M van Duin
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, Netherlands
| | - A P Verhoeff
- Department of Epidemiology, Health Promotion and Healthcare Innovation, Public Health Service, Amsterdam, Netherlands
| | - M de Leeuw
- Former Medical Student, University of Amsterdam, Amsterdam, Netherlands
| | - M J Roskam
- Former Medical Student, University of Amsterdam, Amsterdam, Netherlands
| | - M A Benninga
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - R J L Lindauer
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, Netherlands.,De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, Netherlands
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8
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van Duin EM, Verlinden E, Vrolijk-Bosschaart TF, Diehle J, Verhoeff AP, Brilleslijper-Kater SN, Lindauer RJL. Sexual abuse in very young children: a psychological assessment in the Amsterdam Sexual Abuse Case study. Eur J Psychotraumatol 2018; 9:1503524. [PMID: 30206471 PMCID: PMC6129781 DOI: 10.1080/20008198.2018.1503524] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Esther M van Duin
- Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eva Verlinden
- Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Epidemiology, Health Promotion & Healthcare Innovation, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Thekla F Vrolijk-Bosschaart
- Department of Social Pediatrics, Child Abuse and Neglect Team, Academic Medical Center, Amsterdam, The Netherlands
| | - Julia Diehle
- Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnoud P Verhoeff
- Department of Epidemiology, Health Promotion & Healthcare Innovation, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Sonja N Brilleslijper-Kater
- Department of Social Pediatrics, Child Abuse and Neglect Team, Academic Medical Center, Amsterdam, The Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
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9
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Vrolijk-Bosschaart TF, Brilleslijper-Kater SN, Widdershoven GAM, Teeuw AH, Verlinden E, Voskes Y, van Duin EM, Verhoeff AP, de Leeuw M, Roskam MJ, Benninga MA, Lindauer RJL. Psychosocial symptoms in very young children assessed for sexual abuse: A qualitative analysis from the ASAC study. CHILD ABUSE & NEGLECT 2017; 73:8-23. [PMID: 28942057 DOI: 10.1016/j.chiabu.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/25/2017] [Accepted: 09/03/2017] [Indexed: 06/07/2023]
Abstract
Child sexual abuse (CSA) is a worldwide problem with serious consequences. No recognizable symptom pattern for suspected CSA has yet been identified in very young children. We aim to investigate psychosocial symptoms in a sample of children with confirmed or strongly suspected CSA and the interpretations given to such symptoms by independent clinical experts. Secondly we examined whether experts were able to identify confirmed victims of severe CSA. A qualitative study including inductive content analysis of medical files and focus group discussions with independent experts on the interpretation of psychosocial symptoms was conducted. We included 125 children (76 boys, 60.8%, and 49 girls, 39.2%; median age 3.3 years; age range 0-11) who were involved in the Amsterdam sexual abuse case (ASAC) and had been examined for strongly suspected CSA. We identified four themes among the psychosocial symptoms: problems concerning emotions, behavior, toilet training, and development, whether or not associated with the daycare center or the perpetrator. Clinical experts identified signs of posttraumatic stress disorder (PTSD), regression in continence skills (not otherwise explained), and problems triggered by exposure to the perpetrator or the abuse location as concerning symptoms for CSA. Less concerning symptoms were designated as worrisome if they were numerous and there was no clear explanation for these symptoms. A clear symptom pattern was lacking and about half of the confirmed severe victims of CSA did not display any psychosocial problems. Therefore, it is difficult for experts to identify confirmed CSA victims. Thus, the assessment of suspected CSA should be over time and multidisciplinary.
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Affiliation(s)
- T F Vrolijk-Bosschaart
- Department of Social Pediatrics, Child Abuse and Neglect Team, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands.
| | - S N Brilleslijper-Kater
- Department of Social Pediatrics, Child Abuse and Neglect Team, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - G A M Widdershoven
- Department of Medical Humanities, VU University Medical Center, Amsterdam, Netherlands
| | - A H Teeuw
- Department of Social Pediatrics, Child Abuse and Neglect Team, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - E Verlinden
- Department of Epidemiology, Health Promotion and Healthcare Innovation, Amsterdam, Netherlands
| | - Y Voskes
- Department of Medical Humanities, VU University Medical Center, Amsterdam, Netherlands
| | - E M van Duin
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, Netherlands
| | - A P Verhoeff
- Department of Epidemiology, Health Promotion and Healthcare Innovation, Amsterdam, Netherlands
| | - M de Leeuw
- Former Medical Student, University of Amsterdam, Netherlands
| | - M J Roskam
- Former Medical Student, University of Amsterdam, Netherlands
| | - M A Benninga
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - R J L Lindauer
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, Netherlands; De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, Netherlands
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10
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Vrolijk-Bosschaart TF, Brilleslijper-Kater SN, Widdershoven GA, Teeuw A(RH, Verlinden E, Voskes Y, van Duin EM, Verhoeff AP, Benninga MA, Lindauer RJL. Physical symptoms in very young children assessed for sexual abuse: a mixed method analysis from the ASAC study. Eur J Pediatr 2017; 176:1365-1374. [PMID: 28844100 PMCID: PMC5607905 DOI: 10.1007/s00431-017-2996-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 08/10/2017] [Accepted: 08/13/2017] [Indexed: 12/16/2022]
Abstract
UNLABELLED So far, a recognizable pattern of clinical symptoms for child sexual abuse (CSA), especially in young male children, is lacking. To improve early recognition of CSA, we reviewed physical complaints, physical examination, and tests on sexually transmitted infections (STIs) in confirmed victims (predominantly preschool boys) of CSA from the Amsterdam sexual abuse case (ASAC). We retrospectively analyzed the outcomes of the primary assessment using mixed methods: descriptive analysis of physical complaints, physical exams, and STI tests from medical files and a qualitative analysis on expert's interpretations of physical complaints and children's behavior during physical examination. We included 54 confirmed CSA victims, median age 3.2 (0-6) years, 43 boys (80%), and 11 girls (20%). Physical complaints were reported in 50%, of which gastrointestinal and anogenital complaints were most common. None of the children showed CSA-specific genital signs at physical examination. Most prominent finding during physical examination was a deviant behavioral response (anxiety, withdrawal, too outgoing) in 15 children (28%), especially in children who experienced anal/vaginal penetration. Testing for STIs was negative. CONCLUSION Physical complaints and physical signs at examinations were non-specific for CSA. Deviant behavioral reactions during physical examination were the most prominent finding. Precise observation of a child's behavior during physical examination is needed. What is known • Child sexual abuse (CSA) affects many children on both the short and the long term but remains unrecognized in most cases. • So far, there is a lack of studies on symptom patterns of CSA in male, preschool children. What is new • None of the children showed CSA-specific findings at physical and anogenital examination; STIs were not found in the confirmed victims of CSA. • The most prominent finding was the deviant behavioral response of the children examined, especially in children who experienced anal/vaginal penetration; therefore, precise observation of a child's behavior during physical examination is a crucial part of the evaluation of suspected CSA.
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Affiliation(s)
- Thekla F. Vrolijk-Bosschaart
- 0000000404654431grid.5650.6Department of Social Pediatrics, Child Abuse and Neglect Team, Emma Children’s Hospital, Academic Medical Center Amsterdam, AMC, Meibergdreef 9 (h7-288), 1105 AZ Amsterdam, the Netherlands
| | - Sonja N. Brilleslijper-Kater
- 0000000404654431grid.5650.6Department of Social Pediatrics, Child Abuse and Neglect Team, Emma Children’s Hospital, Academic Medical Center Amsterdam, AMC, Meibergdreef 9 (h7-288), 1105 AZ Amsterdam, the Netherlands
| | - Guy A. Widdershoven
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Medical Humanities, VU University Medical Center, Amsterdam, the Netherlands
| | - Arianne (Rian) H. Teeuw
- 0000000404654431grid.5650.6Department of Social Pediatrics, Child Abuse and Neglect Team, Emma Children’s Hospital, Academic Medical Center Amsterdam, AMC, Meibergdreef 9 (h7-288), 1105 AZ Amsterdam, the Netherlands
| | - Eva Verlinden
- Department of Epidemiology, Health Promotion and Healthcare Innovation, Public Health Services, Amsterdam, the Netherlands
| | - Yolande Voskes
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Medical Humanities, VU University Medical Center, Amsterdam, the Netherlands
| | - Esther M. van Duin
- 0000000404654431grid.5650.6Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | - Arnoud P. Verhoeff
- Department of Epidemiology, Health Promotion and Healthcare Innovation, Public Health Services, Amsterdam, the Netherlands ,0000000084992262grid.7177.6Department of Sociology, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc A. Benninga
- 0000000404654431grid.5650.6Department of Pediatric Gastroenterology, Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - Ramón J. L. Lindauer
- 0000000404654431grid.5650.6Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, the Netherlands ,De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands
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