Risk factors for child maltreatment recurrence: An updated systematic review.

OBJECTIVES: Children who have been maltreated are at increased risk of further maltreatment. Identification of those at highest risk of further maltreatment is a priority for professionals working in child protection services. The current study is intended to consolidate and expand on previous work on recurrence of child maltreatment. It has sought to identify risk factors for maltreatment recurrence in the recent literature in the expectation that this may help in the practical identification of children at risk. METHODS: We conducted a systematic review of cohort studies published between 2003 and 2009, identifying factors associated with maltreatment recurrence in children. Studies included demonstrated differing levels of substantiation of maltreatment. RESULTS: Fifteen studies met inclusion criteria but showed significant heterogeneity, varying in setting, recruitment of subjects, types of maltreatment considered and length of follow-up. Previous findings were replicated and expanded in the current study in relation to a range of factors, including rates of maltreatment recurrence, maltreatment types, frequency of previous episodes of maltreatment, child and family considerations, home environment and service provision. Factors were identified irrespective of level of maltreatment substantiation. CONCLUSION: This study provides further systematic evidence of the existence of a number of factors associated with child maltreatment recurrence. It points to the possibility of practical application of its findings within the wider context of decision making in child protection services, with the ultimate aim of reducing recurrence of maltreatment in individual cases.

Why children tell: a model of children's disclosure of sexual abuse.

OBJECTIVE: The present study investigated variables associated with delay of disclosure of child sexual abuse and tested a model of time to disclosure. METHOD: Data were obtained for 218 alleged child sexual abuse victims whose cases had been referred to District Attorneys' Offices. Five variables were posited to influence the delay between an abusive event and children's disclosure of that event to a reporting adult: child's age, gender, type of abuse experienced (intrafamilial or extrafamilial), perceived responsibility for the abuse, and fear of negative consequences of disclosure. These variables were used to create a model of factors influencing children's disclosure of sexual abuse. RESULTS: Results indicated that age, type of abuse, fear of negative consequences, and perceived responsibility all contributed to predicting time to disclosure. There was significant support for the model, suggesting that children who were older, came from incestuous families, felt greater responsibility for the abuse, and feared negative consequences of disclosure took longer to disclose. CONCLUSIONS: Children's cognitive appraisal of others' tolerance of disclosure of child sexual abuse, and their own perceptions of responsibility for the abuse, are crucial to the decision to disclose. When evaluating children for possible sexual abuse, developmental, cognitive, and socio-emotional factors need to be taken into consideration.

Intergenerational transmission of health beliefs in somatoform disorders: exploratory study.

Children of parents with a range of psychiatric disorders are at increased risk of developing psychological disturbance themselves. There is growing evidence that this includes children who have parents with a chronic somatoform disorder. The health beliefs of children with a parent with a somatoform disorder were compared with those of children with a parent with an organic physical disorder. Children of parents with somatoform disorder scored higher on bodily preoccupation and disease phobia scales and their health beliefs showed similarities to the beliefs of their parents.

What can subjective forgetting tell us about memory for childhood trauma?

In the present study, we examined the prevalence and predictors of subjective forgetting (i.e., self-reported amnesia) of child sexual abuse (CSA). Adults who, as children, were involved as victims in legal prosecutions were questioned about their CSA experiences, which had been documented in the 1980s, and about lost and recovered memory of those experiences. Males and individuals who experienced more severe abuse were more likely to report forgetting. The majority of individuals attributed their forgetting to active attempts to avoid thinking about the abuse. In contrast, when predictors of subjective forgetting were used to predict objective memory of abuse, more severe abuse and more extended legal involvement were associated with fewer memory errors. The differences between subjective and objective memory underscore the risks of using subjective measures to assess lost memory of abuse.

Traumatic impact predicts long-term memory for documented child sexual abuse.

Prospective studies of adults' memories of documented child sexual abuse (CSA) reveal that the majority of individuals remember their victimization. However, the accuracy of these memories has rarely been investigated scientifically. The present study examined predictors of memory accuracy and errors 12 to 21 years after abuse ended for individuals with legal experiences resulting from documented CSA. Severity of posttraumatic stress disorder (PTSD) symptomatology was positively associated with memory accuracy. However, individuals nominating CSA as their most traumatic life event exhibited relatively accurate memory regardless of indicators of PTSD. Predictors of memory errors were also identified (e.g., less maternal support). These results indicate that, in addition to understanding the role of traditional cognitive factors, understanding an event's traumatic impact is important for predicting the accuracy of long-term memory for reported CSA.

Childhood sexual assault victims: long-term outcomes after testifying in criminal court.

We report a longitudinal study of long-term outcomes of participating in criminal cases following child sexual abuse (CSA). In the 1980s, 218 child victim/witnesses took part in a study of short-term sequelae of legal involvement. Approximately 12 years later, 174 of them, as well as a comparison group of 41 matched individuals with no CSA history, were interviewed about their mental health and legal attitudes. Being young when the legal case started was associated with poorer later adjustment. Additionally, even when controlling for psychological problems at the start of the legal case and other familial, CSA, and life stressors, testifying repeatedly in childhood predicted poorer current functioning. These associations were often moderated by the severity of both the CSA and the perpetrator's sentence: Testifying repeatedly in cases involving severe abuse, and not testifying when the perpetrator received a light sentence, predicted poorer current mental health. In partial contrast to the mental health results, being older when the case began and the perpetrator receiving a lenient sentence predicted more negative feelings about the legal system. In addition, not having testified when the perpetrator received a light sentence predicted more negative legal attitudes. Individuals' emotional reactions while waiting to testify and while actually testifying were also associated with their current mental health and attitudes toward the legal system: Greater distress predicted poorer adjustment, especially in individuals who were adolescents when they went to court. Greater distress also predicted more negative attitudes. Finally, when the former CSA victim/witnesses were compared with individuals with no CSA history, the former reported poorer adjustment and more negative feelings about the legal system. Results have implications for multilevel-transactional models of development, for understanding developmental sequelae of legal involvement following childhood trauma, and for social policy concerning the treatment of child victim/witnesses.

Treating psychological symptoms in sexually abused children: from research findings to service provision.

BACKGROUND: The experience of having been sexually abused is associated with a wide range of psychiatric symptoms and difficulties, and these problems can persist over years. The psychological treatment of children who have experienced sexual abuse has only recently begun to be systematically investigated. An increasing number of robust studies have been conducted. AIMS: To review systematically the available evidence from randomised controlled trials of psychological treatments for children who have been sexually abused, and to consider the place of these treatments in a multi-disciplinary service. METHOD: A systematic search of the available research was undertaken. Included trials were critically appraised and the results considered. RESULTS: Twelve studies were included in the review. The best evidence of efficacy for improving psychological symptoms in these children was found for cognitive-behavioural therapy, particularly for young children. CONCLUSIONS: Efficacious treatments existto improve psychological symptoms in children who have experienced sexual abuse. Consideration is given to the place of these treatments within the response of a multi-disciplinary service.

A prospective study of memory for child sexual abuse: new findings relevant to the repressed-memory controversy.

Previous research indicates that many adults (nearly 40%) fail to report their own documented child sexual abuse (CSA) when asked about their childhood experiences. These controversial results could reflect lack of consciously accessible recollection, thus bolstering claims that traumatic memories may be repressed. In the present study, 175 individuals with documented CSA histories were interviewed regarding their childhood trauma. Unlike in previous studies, the majority of participants (81%) in our study reported the documented abuse. Older age when the abuse ended, maternal support following disclosure of the abuse, and more severe abuse were associated with an increased likelihood of disclosure. Ethnicity and dissociation also played a role. Failure to report CSA should not necessarily be interpreted as evidence that the abuse is inaccessible to memory, although inaccessibility or forgetting cannot be ruled out in a subset of cases.