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PubMed1983

Vaginal inspection as it relates to child sexual abuse in girls under thirteen.

Inclusion of vaginal inspection in all physical examinations resulted in doubling identification of cases of child sexual abuse. Forty-five of 247 girls under 13 years of age were admitted because sexual abuse had been reported. Of the 202 girls not suspected, 45 additional cases of sexual abuse were discovered by suspicious findings on vaginal inspection. The horizontal diameter of the vaginal opening exceeding 4 mm correlated in three of four instances with a confirming history for past sexual abuse. It is recommended that physical examination of young girls routinely include inspection of the vaginal opening. Pediatric caregivers need to teach themselves the parameters of the normal to protect those children who are suffering sexual abuse in their environment.

Adolescent↗
PubMed1983

The child sexual abuse accommodation syndrome.

Child victims of sexual abuse face secondary trauma in the crisis of discovery. Their attempts to reconcile their private experiences with the realities of the outer world are assaulted by the disbelief, blame and rejection they experience from adults. The normal coping behavior of the child contradicts the entrenched beliefs and expectations typically held by adults, stigmatizing the child with charges of lying, manipulating or imagining from parents, courts and clinicians. Such abandonment by the very adults most crucial to the child's protection and recovery drives the child deeper into self-blame, self-hate, alienation and revictimization. In contrast, the advocacy of an empathic clinician within a supportive treatment network can provide vital credibility and endorsement for the child. Evaluation of the responses of normal children to sexual assault provides clear evidence that societal definitions of "normal" victim behavior are inappropriate and procrustean, serving adults as mythic insulators against the child's pain. Within this climate of prejudice, the sequential survival options available to the victim further alienate the child from any hope of outside credibility or acceptance. Ironically, the child's inevitable choice of the "wrong" options reinforces and perpetuates the prejudicial myths. The most typical reactions of children are classified in this paper as the child sexual abuse accommodation syndrome. The syndrome is composed of five categories, of which two define basic childhood vulnerability and three are sequentially contingent on sexual assault: (1) secrecy, (2) helplessness, (3) entrapment and accommodation, (4) delayed, unconvincing disclosure, and (5) retraction. The accommodation syndrome is proposed as a simple and logical model for use by clinicians to improve understanding and acceptance of the child's position in the complex and controversial dynamics of sexual victimization. Application of the syndrome tends to challenge entrenched myths and prejudice, providing credibility and advocacy for the child within the home, the courts, and throughout the treatment process. The paper also provides discussion of the child's coping strategies as analogs for subsequent behavioral and psychological problems, including implications for specific modalities of treatment.

Adaptation, Psychological↗
PubMed1983

Removing the child--prosecuting the offender in cases of sexual abuse: evidence from the national reporting system for child abuse and neglect.

Sexual abuse has come to public attention so rapidly and is such a difficult problem to deal with that many observers are concerned that the quality of child protective intervention in these cases has been haphazard and indiscriminate. This article analyzes data on all 6,096 cases of child sexual abuse which were "officially reported" in 1978 to see what kinds of intervention were made. The data show that foster placement occurred in more cases of sexual abuse than physical abuse, and was concentrated among cases of older children who reported their own victimization. Criminal action was taken almost five times more often in cases of sexual abuse than in cases of physical abuse, and occurred more often among cases which were directly reported to police and involved offenders with prior criminal records. Black families and poorer families did not seem to be the objects of obvious discrimination in the disposition of these cases.

Child↗
PubMed1983

School programs to prevent intrafamilial child sexual abuse.

The incidence of child sexual abuse would argue for the schools assuming a larger role in the development of preventive and educational programs. Because of the public school system's consistent and longitudinal contact with children and families it is perhaps the most promising institution for the delivery of preventive efforts. This article presents specific suggestions for school-based programs directed toward the prevention of intrafamilial child sexual abuse. Further, it is argued that for maximum effectiveness, the support of local parent-teacher organizations be elicited; that educational programs be presented separately for parents and children; and that a variety of programs in concert with the developmental level of participants be presented on topics related to child sexual abuse. Topics regarded as important for prevention efforts are factual information on sexual abuse, appropriate and inappropriate touch, the respective role responsibilities and rights of parents and children, and a sex education approach that stresses the values of nonexploitation and discrimination in the choice of whether to engage in sexual behavior and the choice of partners.

Child↗
PubMed1984

The prevalence and seriousness of incestuous abuse: stepfathers vs. biological fathers.

Analysis of interviews obtained from a random sample of 930 adult women in San Francisco revealed that 17% or one out of approximately every six women who had a stepfather as a principal figure in her childhood years, was sexually abused by him. The comparable figures for biological fathers were 2% or one out of approximately 40 women. In addition, when a distinction was made between Very Serious Sexual Abuse (including experiences ranging from forced penile-vaginal penetration to non-forceful attempted fellatio, cunnilingus , and anal intercourse) and other less serious forms, 47% of the cases of sexual abuse by stepfathers were at the Very Serious level of violation compared with 26% by biological fathers. Possible explanations for these starting discrepancies are discussed, and some of the implications for remarriage are considered.

Adolescent↗
PubMed1984

Sexual abuse in the National Incidence Study of Child Abuse and Neglect: an appraisal.

The National Incidence Study of Child Abuse and Neglect was a major, government sponsored effort to collect data on reported and unreported child abuse. It used a systematic representative sample methodology and very precisely developed definitions of child abuse. This paper review some of the main limitations of the study in regard to findings on sexual abuse. First, there is probably less "new" data in the study on sexual abuse than on other forms of abuse, since so many of the study cases of sexual abuse were "officially reported' cases. In addition, the study limited its definition of sexual abuse only to cases where a caretaker was the perpetrator , a definition that is much more restrictive than what is used in many treatment programs. Finally, the data on perpetrators has a number of problems that stem from the study's definitions of sexual abuse. The paper makes suggestions for future incidence type studies of sexual abuse.

Adolescent↗
PubMed1984

Law enforcement officers as investigators and therapists in child sexual abuse: a training model.

Law enforcement officers, often the first professionals to come in contact with a victim of child sexual abuse, can either increase or decrease the traumatic impact on the child and the family at the time of disclosure. The model for a training program for police officers in handling cases of child sexual abuse outlined in this paper is divided into three sections. The first part is directed towards theoretical issues involved in this problem, including an explanation of the history and background of sexual abuse of children by adults and of the difference in the dynamics of extra- and intrafamilial sexual abuse. The second part consists of a detailed explanation of different types of sex offenses and of standard physical examinations of sexual abuse victims. Graded slides of physical trauma geared towards wound identification are paired with relaxation exercises. The third section focuses on special considerations when interviewing sexually abused children. The difference between interviewing and interrogation, specific questioning techniques, and the use of videotape is explained. Each part of this training procedure is followed by a question and answer period and small group discussions for the purpose of encouraging disclosure and better understanding of the officers' personal reactions to cases of child sexual abuse.

Attitude↗
PubMed1985

The sexually abused child: a comparison of male and female victims.

Although the amount of research dealing with child sexual abuse is rapidly increasing, there have been very few attempts to identify and compare variables that characterize differences between female and male victims. To address this void, 25 substantiated cases of sexual abuse involving male children were compared with 180 substantiated cases of sexual abuse of female children. Significant differences between female and male victims were observed in the following areas: family composition, the perpetrator of the abuse, variables contributing to the continuation of the abusive situation, and the type of services provided to the sexually abused child and family. Implications for treatment are offered.

Adult↗
PubMed1985

Child sexual abuse: a study of prevalence in Great Britain.

Of 2019 men and women (aged 15 years and over) interviewed as part of a MORI Survey of a nationally representative sample of Great Britain, 10% reported that they had been sexually abused before the age of 16 (12% of females; 8% of males). There was no increased risk associated with specific social class categories or area of residence. For all types of sexual abuse, the mean age of victims when first abused was significantly lower for females. Subjective reports of the effects of sexual abuse indicated that the majority (51%) felt harmed by the experience, while only 4% reported that it had improved the quality of their life. We estimate that there are over 4.5 million adults in Great Britain who were sexually abused as children, and that a potential 1,117,000 children will be sexually abused before they are 15 years of age. At least 143,000 of these will be abused within the family. The social and mental health implications are enormous, and the authors suggest that an effective intervention and prevention policy is urgently required.

Adolescent↗
PubMed1985

The sexual abuse of Afro-American and white-American women in childhood.

This study examined the prevalence of child sexual abuse in a multi-stage stratified probability sample of Afro-American and white-American women, 18 to 36 years of age, in Los Angeles County. The sample ranged in demographic characteristics by age, marital status, education and the presence of children. Of the total sample of 248 women, 154 (62%) reported at least one incident of sexual abuse prior to age 18, with 57% of Afro-American women and 67% of white-American women having been abused. Sexual abuse before the age of 18 appears to be of equal concern for both ethnic groups, although similarities and differences in the circumstances under which abuse incidents occurred were subtle and deserve attention. The need for identifying contemporary factors that contribute to the prevalence of abuse over the past 40 years is stressed.

Adolescent↗
PubMed1986

Childhood histories of women imprisoned for fatal child maltreatment.

A history of childhood maltreatment is the most consistently reported characteristic of abusive parents. Retrospective research with nine women imprisoned for fatal child abuse revealed childhood histories of maltreatment. Detailed life histories indicated that the meaning of the abuse to the individual had an important impact on later abusive parenting. The types of childhood abuse varied. Childhood abuse was one in a set of factors contributing to abusive parenting. Retrospective studies underline the need for prospective research on long-term outcomes of childhood abuse.

Adult↗
PubMed1986

Individual psychotherapy for the sexually abused child.

This paper describes one Center's experience using individual psychotherapy to help the sexually abused child. The approach described rests upon a five-part conceptualization of the traumatic experience: trauma, threat to ontogeny, neglect and emotional unavailability by the caregiver, child's feeling of exploitation, and the child's adaptation. The process of treatment is divided into three phases: starting, middle and closing. Some common issues which occur are guilt, loss and anger, as well as alterations in the child's sexual feelings. The psychotherapeutic approach to these and other issues is coordinated with other therapies. If the child is to appear in court, the experience of testifying provides a reality-based focus for treatment and is not a divisive problem for the therapist. At times, therapists experience feelings of anger, hopelessness and a desire to rescue their patients. The therapists meeting in a supervision group provided a means of understanding and working through the therapists' experiences. Future study of the therapy process with long term follow-up could reveal the issues necessary for an abused child to negotiate in order to achieve full recovery. Further research could establish which treatment modality is primarily suited to a particular type of sexually abused child taking into account differences in age, duration and severity of abuse, family dynamics and psychological impact.

Adaptation, Psychological↗
PubMed1986

Runaway youths and sexual victimization: gender differences in an adolescent runaway population.

Running away from home has often been viewed as one of the sequelae to sexual abuse. Our study of 144 adolescent runaways finds that 38% of male runaways (n = 89) and 73% of female runaways (n = 55) report having been sexually abused. The impact of abuse is examined by studying, within each gender group, its relationship to the subject's perceptions of sexual activity, relationships with peers and adults, involvement with delinquent/criminal activities, and physical and emotional complaints. The results of assessing the differences between abused and nonabused adolescents show that both the victimized males and females are more likely to report anxiety and suicidal feelings than are their nonabused counterparts. Male victims of sexual abuse are more likely to report physical symptomatology and fear of adult men. Female victims of sexual abuse are more likely to be confused about sex and to engage in delinquent/criminal activities. Discussion focuses on gender differences and runaway behaviors in relation to sexual victimization with the suggestion that differences in the degree of abuse and the sex of the abuser may explain study findings.

Adolescent↗
PubMed1986

A clinical-demographic study of sexually abused children.

Forty-five children who had been sexually abused were psychologically evaluated. Parents or guardians of the children completed symptom checklists. Results indicated that the majority of children (71%) were abused 4 or fewer times. In addition, genital manipulation and/or fondling was the most common form of abuse. In 82% of the cases, there were no marital separations or family breakups of any kind within six months before or six months after the abuse. Many children (69%) displayed psychological symptoms. The most frequent were nightmares, bedwetting, clinging behavior, inappropriate sexual behavior, anxiety and sadness. Results of this study are largely inconsistent with popular notions about the nature of child sexual abuse. The major methodological shortcoming of the investigation was the lack of a systematic control group.

Adolescent↗
PubMed1986

Child abuse and multiple personality disorder: review of the literature and suggestions for treatment.

The syndrome of multiple personality is associated with a high incidence of physical and/or sexual abuse in childhood. Occasionally those with multiple personality abuse their own children. Multiple personality is difficult to diagnose both because of the nature of the syndrome and because of professional reluctance. Although multiple personality is most difficult to diagnose during childhood because of the subtlety of the syndrome, the much higher morbidity found in adult cases makes it imperative that it be diagnosed and treated early in order to avoid further abuse and greater morbidity and to shorten treatment time. This review describes the history, clinical features and treatment of multiple personality, particularly in children, in addition to exploring the professional reluctance to make the diagnosis.

Child↗