Children with sexual behavior problems: Ties to child maltreatment, family functioning, and help-seeking.

Although the literature on children's sexual behavior problems (SBPs) has indicated that maltreatment and family dysfunction are linked to SBPs, several facets of these factors have remained unexamined. Prior research has largely focused on SBPs more broadly, though interpersonal SBPs (ISBPs) are likely a distinct, more severe SBP subtype. The aim of the current study was to examine potentially relevant, unexplored factors, including the number of types of and total allegations of maltreatment as well as familial characteristics (i.e., parenting attitudes and behaviors, discipline methods, family functioning, and help-seeking) in relation to SBPs and ISBPs. The present study included 8-year-old children (N = 1,011, 51.1% female, 53.8% Black) and their caregivers from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) study. In the model for SBPs, externalizing symptoms, the number of types of maltreatment allegations, maladaptive discipline methods, and help-seeking were associated with SBPs, whereas child's gender, race/ethnicity, internalizing symptoms, total maltreatment allegations, income, family functioning, and parenting attitudes were unrelated, r2 = .23. When ISBPs were examined, only child's gender and externalizing symptoms were tied to ISBPs, r2 = .09. However, child's race/ethnicity and internalizing symptoms, as well as maltreatment experiences, family factors, and help-seeking, were not associated with ISBPs. These findings highlight the importance of broader externalizing symptoms for both SBPs and ISBPs as well as the role of multiple types of maltreatment, parenting behavior, and help-seeking in the context of general SBPs.

Factors associated with caregiver help seeking behavior among at-risk children.

BACKGROUND: Few at-risk school-age children receive needed psychological help, and our understanding of predictors of service use in this population is limited. Many broader contextual factors have received little attention including caregiver's trauma history and social support, father involvement, family functioning, and neighborhood satisfaction. The links between types of and cumulative maltreatment have also been inconsistent, and prior work has not always accounted for children's symptoms. OBJECTIVE: The current study examined child, caregiver, family, neighborhood, and maltreatment factors in relation to past-year mental health service use among at-risk eight-year-old children. Cumulative and types of maltreatment were both investigated to help elucidate the role of these experiences. PARTICIPANTS/SETTING/METHOD: Eight hundred and forty-five eight-year-old at-risk children (48.3 % male; 59.5 % Black) from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) were included. RESULTS: A small portion of children (12.4 %) received psychological help in the previous year. Children's externalizing symptoms, residing with a non-biological caregiver, cumulative maltreatment and sexual and emotional abuse were associated with seeking psychological services, whereas physical abuse, neglect, and domestic violence exposure were not. Other caregiver factors, and family and neighborhood factors were also unrelated. CONCLUSIONS: Non-biological caregivers as well as caregivers of children with higher levels of externalizing symptoms may be more inclined to seek out mental health services, along with greater, and specific, maltreatment experiences. These findings indicate that child factors may be key in understanding help seeking, however, it is important to further consider other broader contextual factors in future work.

Correlates of caregiver's help seeking behavior among young maltreated children.

BACKGROUND: Relatively few maltreated children receive mental health services, despite the importance of treatment in combating the deleterious impact of maltreatment. Characteristics of the child, caregiver, and family have been investigated in relation to caregiver's help seeking behavior for children's psychological difficulties; yet, these associations have been inconsistent, and are very understudied among younger maltreated children. Other aspects of the child's environment, such as father involvement, negative life events, and neighborhood risk and satisfaction have not been examined. It is also uncertain how cumulative maltreatment and the specific forms of maltreatment - sexual, physical, and emotional abuse, neglect, and domestic violence, are associated with mental health consultation. OBJECTIVE: The aim of the current study was to utilize an ecological model that included child, caregiver, family, neighborhood, and maltreatment factors to better understand caregiver's help seeking behavior. PARTICIPANTS/SETTING/METHOD: The study relied upon 448 six-year-old maltreated children (47.5% male; 48.7% Black) from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) study. RESULTS: Several factors, including child's gender and externalizing symptoms, and caregiver educational attainment and depression and were associated with mental health consultation. Cumulative maltreatment, however, was unrelated. When the specific forms of maltreatment were included, none of the individual maltreatment types were tied to help seeking behavior. CONCLUSIONS: Child and caregiver factors, such as child's level of behavioral challenges as caregiver's level of education and depression, may contribute to decisions regarding seeking services for young, maltreated children. However, neither cumulative nor the forms of maltreatment may correspond with help seeking among young, maltreated children.

Maternal support and caregiver-child symptom concordance among sexually abused children.

Caregivers and children often diverge in their reports of children's trauma-related symptoms, and this discordance has been linked with children's behavioral difficulties and poorer treatment outcomes. Knowledge regarding what factors may be related to discordance is limited, and maternal support in relation to trauma-related symptom agreement has yet to be investigated. The aim of the present study was to examine the associations between discordance and both maternal emotional support and blame/doubt in caregivers' and children's reports of trauma-related symptoms in sexually abused children. Participants were treatment-seeking, sexually abused children (N = 122) aged 8-12 years (M = 9.45 years, SD = 1.09; 70.5% female, 57.4% White) and their nonoffending caregivers. Low intraclass correlation coefficients (ICCs) indicated the presence of significant discordance across symptom types, with caregivers reporting higher levels of trauma-related difficulties, ICCs = -.21-.22. Older children were more likely to disclose higher levels of anger and sexual concerns than younger children, ßs = .18-.33. Children's gender, race, and relationship to their caregiver were not related to symptom discordance. Further, maternal emotional support and blame/doubt were not associated with caregiver-child concordance for any examined difficulties. Assessment of both caregivers' and children's perceptions of trauma-related symptoms is vital given the likelihood of discordance in child and caregiver reports of symptom levels. Although maternal emotional support and blame/doubt may not be linked to concordance with regard to trauma-related difficulties, child age should further be considered as a potentially important factor in understanding caregiver-child symptom concordance.

Sexual Behavior Problems Among Sexually Abused Children: Associations With Co-Occurring Symptoms.

Sexual behavior problems (SBPs) and interpersonal SBPs (ISBPs) among sexually abused children often occur alongside a variety of other clinical difficulties, such as externalizing problems, attentional difficulties, social concerns, and posttraumatic stress symptoms (PTSS). Yet, as few studies have examined these links in a multivariate manner, it is unclear which symptoms are most strongly related to SBPs and ISBPs. Research regarding children's reports of their difficulties and SBPs and ISBPs is also very limited. The current study investigated the relations between both caregiver- and child-reported trauma-related symptoms and SBPs and ISBPs among 248 treatment-seeking sexually abused children (ages 6-12; M = 8.06, SD = 2.52; 64.5% female; 55.6% white). Children's caregiver-reported trauma-related sexual concerns and anger were associated with SBPs. For ISBPs, only caregiver-reported sexual concerns were related to ISBPs. Surprisingly, none of the child-reported symptoms were associated with either SBPs or ISBPs. Trauma-related sexual concerns and anger may be tied to SBPs, whereas other clinical difficulties may be less strongly implicated. Trauma-related sexual concerns may be most important in understanding interpersonally focused SBPs. Children's self-reported difficulties may be unrelated to caregiver-reported SBPs, or these results may be a function of a low degree of caregiver and child symptom concordance.

Children's Coping and Perceptions of Coping Efficacy After Sexual Abuse: Links to Trauma Symptoms.

Despite an emphasis on coping following childhood sexual abuse (CSA) to reduce trauma-related symptoms, very few studies have researched the associations between sexually abused children's coping and trauma-related difficulties, and perceived coping efficacy has been largely overlooked. The current study investigated whether children's use and perceived efficacy of avoidant, internalized, angry, and active/social coping strategies were associated with caregiver- and child-reported posttraumatic stress symptoms (PTSS), and caregiver-reported internalizing and externalizing symptoms among 202 sexually abused children (8-12 years; M = 10.47 years, SD = 1.70 years). Children reported using approximately eight types of coping strategies (M = 8.29, SD =2.50). Regression models indicated that internalized and angry coping were associated with child-reported PTSS. In contrast to expectations, none of the types of coping strategies were linked with caregiver's reports of PTSS or internalizing and externalizing symptoms. Interestingly, perceived efficacy of coping was largely unrelated to symptoms, with only perceived efficacy of avoidant coping inversely related to child-reported PTSS. Perceived efficacy was not tied to caregiver's reports of children's symptoms. Coping strategies may be associated with children's, but not caregiver's, reports of children's trauma-related difficulties. Furthermore, perceived efficacy of coping strategies may also be largely unrelated to children's symptoms, or children may have limited insight regarding the efficacy of their coping strategies. To further inform trauma-focused interventions that support effective long-term coping, future research should investigate which coping strategies children perceive to be efficacious, as well as potential reasons why.

Factors Associated With Caregiver-Child Symptom Concordance Among Trauma-Exposed Children.

Concordance in caregivers' and children's reports of children's trauma-related symptoms is often low, and symptom discrepancies are associated with negative clinical implications. The aim of the current study was to examine the degree of concordance between children's and caregivers' reports of trauma-related difficulties and determine whether any child or family characteristics were associated with symptom agreement. Three hundred thirteen trauma-exposed children (M = 9.55, SD = 1.77; 65.2% girls, 51.3% Black) and their nonoffending caregivers seeking treatment were included in the study. Children's and caregivers' reports of trauma-related difficulties were related, but low intraclass correlation coefficients indicated poor concordance across symptoms. Child's gender was associated with levels of concordance for several trauma-related difficulties (e.g., anxiety, depression, anger, dissociation, and sexual concerns), with lower symptom agreement for girls. Child's age, minority status, and relationship to caregiver emerged as factors related to levels of concordance for certain trauma-related symptoms. Child's gender, age, minority status, and relationship to caregiver may predict symptom discordance for select trauma-related difficulties, whereas other family factors such as caregiver marital status and income may be unrelated. Given the importance of caregiver-child concordance in treatment success, additional research should investigate other factors that may influence trauma-related symptom agreement.

Does Maternal Support Mediate or Moderate the Relationship between Sexual Abuse Severity and Children's PTSD Symptoms?

Maternal support and abuse severity are often considered to be vital factors in predicting children's functioning following childhood sexual abuse (CSA); however, much of the prior research has examined support and abuse severity as main effects, without consideration of how these factors may interrelate to predict children's post-CSA functioning. Further, even though mediators and moderators are conceptually distinct, maternal support has been theorized to be both a mediator and a moderator of symptoms, and it is unclear if support acts as either among sexually abused children. The aim of the present study was to investigate whether caregiver-reported maternal support mediates or moderates the relationships between sexual abuse severity and children's trauma-related symptoms. The study included 235 treatment-seeking children ages 3-16 (M = 8.85, SD = 3.77) and their non-offending mothers. Contrary to expectations, caregiver-rated maternal support did not mediate nor moderate the relationship between abuse severity and children's symptoms (range r2 =.002 -.03). Caregiver-rated maternal support may play a small role in mitigating sexually abused children's trauma symptoms. Irrespective of abuse severity, children with less supportive mothers may not be at heightened risk for experiencing higher levels of trauma-related difficulties.

Predictors of parenting attitudes in an at-risk sample: Results from the LONGSCAN study.

BACKGROUND: Associations between parenting attitudes and behavior and children's adjustment are well-established, including links between negative parenting beliefs and increased risk for child maltreatment and poorer child functioning. Considerably less is known regarding what factors may correspond with parenting attitudes, particularly among at-risk samples. In line with theoretical models of the determinants of parenting, the aim of the study was to investigate correlates of parenting attitudes among child, caregiver, family, and neighborhood factors. PARTICIPANTS AND SETTINGS/METHODS: The study included 1071 4-year-old children (48.8 % female; 55.7 % Black) and their caregivers from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) study. RESULTS: Numerous factors were consistently related to more positive parenting attitudes (i.e., more appropriate parenting expectations, greater empathy, and valuing non-physical punishment), including greater educational attainment, caregiver history of child sexual and physical abuse, lower levels of children's internalizing symptoms, greater family income, and lower levels of psychological aggression. Lower levels of caregiver depressive symptoms, greater number of maltreatment allegations, use of nonviolent discipline, and less severity of stressful life events were tied to more adaptive parenting attitudes in one or two domains. CONCLUSIONS: Caregiver, child, familial, and environmental factors, as well as child maltreatment, may be important in determining parenting attitudes. Identification of the drivers of parenting attitudes may aid identification and intervention efforts with high-risk samples of caregivers to help improve parenting outcomes.

Childhood sexual abuse characteristics, abuse stress, and PTSS: Ties to sexual behavior problems.

BACKGROUND: Sexual behavior problems (SBPs) are present in a subset of sexually abused children and are associated with more severe childhood sexual abuse (CSA) experiences; however, few studies have investigated abuse characteristics and SBPs. Children's reports of abuse stressors have not been previously examined and may provide novel information. Posttraumatic stress symptoms (PTSS) have also been linked with SBPs but have not been consistently accounted for in prior studies, which may obscure the true relationships between abuse characteristics and stressors with SBPs. Moreover, the term SBP consists of a range of behaviors, including interpersonally-focused SBPs (ISBPs), and the relationships between abuse characteristics and stressors may differ in the context of ISBPs. OBJECTIVE: The present study determined whether caregiver-reported abuse characteristics, child-reported abuse stressors, and PTSS, were associated with both SBPs and ISBPs. PARTICIPANTS AND SETTING: Two-hundred and fifty-four sexually abused children (ages 2-12; M = 7.69, SD = 2.67; 58.7 % female; 52.8 % white) participated in the study. RESULTS: Child- and caregiver-reported level of PTSS were related to SBPs, and trends were noted for greater caregiver-reported abuse severity and child-reported abuse-related stressors. When ISBPs were examined, boys, younger children, greater CSA severity, and higher levels of PTSS were associated with higher levels of ISBPs. CONCLUSIONS: Level of PTSS may be important in identifying children at risk for SBPs and ISBPs, and CSA severity may be more relevant in the development or maintenance of ISBPs specifically.

Children's sexual behavior problems: An ecological model using the LONGSCAN data.

BACKGROUND: Although prior research has indicated that sexual behavior problems (SBPs) are present among maltreated and non-maltreated children, risk factors for SBPs remain understudied. Further, few studies have examined multiple forms of trauma such as exposure to community violence and several likely important familial and environmental factors have yet to be investigated in the context of SBPs. The use of a more comprehensive ecological model of child, trauma-related, family, and environmental risk factors may help to further delineate the factors that contribute to the development of SBPs. OBJECTIVE: The aim of the current study was to build upon previous research by utilizing an ecological model that includes child, trauma-related, caregiver and familial, and environmental factors as potential predictors of SBPs. PARTICIPANTS AND SETTING: The present study was conducted with 1,112 8-year-old children (51.6% female; 48.9% Black) and their primary caregivers from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) study. RESULTS: Several child, caregiver, and familial factors, as well as sexual and physical abuse demonstrated bivariate associations with SBPs. A number of these factors remained significant in a regression model, such as child's living arrangement, child's aggressive behaviors and posttraumatic stress symptoms (PTSS), sexual and physical abuse, caregiver's psychological difficulties, and children's perceptions of family health. CONCLUSIONS: The findings highlight the role of select child, trauma-related, caregiver and familial, and environmental factors in the context of SBPs and also demonstrate the need to examine multiple levels of children's environments when investigating SBPs.

Maternal Support as a Predictor of Children's Sexualized Behaviors Following Childhood Sexual Abuse.

Although previous studies have concluded that maternal support following children's sexual abuse disclosures is an important predictor of children's symptoms, the empirical data to support this is limited. Much of the small prior literature has used measures of maternal support without adequately reported psychometric properties, which may obscure the true relationship between support and children's sexual behaviors. Further, it is unclear whether maternal support is related to children's sexual acting out in the context of known predictors of sexual behaviors. The purposes of the current study were to (1) examine the relationships between support and children's sexual behaviors and (2) determine whether support is related to sexual behaviors after controlling for known predictors among 161 treatment-seeking children (6-12 years old; M = 8.70, SD = 2.69) and their nonoffending mothers. In the bivariate analyses, emotional support was negatively related to children's sexual behaviors, whereas maternal blame/doubt was positively correlated with sexual behaviors. Nonetheless, after controlling for other predictors, emotional support predicted developmentally related sexual behaviors but not sexual abuse-specific sexual behaviors. Levels of emotional support and blame/doubt predicted children's total sexual behaviors, after accounting for identified predictors, suggesting that support may play a small role in understanding children's sexual behaviors.