Factors associated with delayed disclosure of child sexual abuse: A focus on the victim's having been led to perform sexual acts on the perpetrator.

BACKGROUND: Contextual variables associated with children's willingness to disclose sexual abuse have been identified in previous studies, but further investigation is needed to better understand delayed disclosure of child sexual abuse (CSA). OBJECTIVES: This study aimed to examine the factors associated with the risk of delayed disclosure of CSA. More specifically, it focused on a factor that has rarely, if ever, been looked into: the fact that some victims are led to perform sexual acts on the perpetrator. PARTICIPANTS AND SETTING: A content analysis was performed on 68 transcripts of investigative interviews with CSA victims aged 4 to 12 years old. METHODS: Based on our content analysis, the time between the first abuse and the first disclosure was determined for each victim. The age and gender of the victim, the victim's relationship with the perpetrator, the age of the perpetrator, the frequency and severity of the abuse, and whether or not the victim mentioned having performed sexual acts on the perpetrator were also coded. RESULTS: Chi-square analyses showed that the risk of delayed disclosure was associated with the victim's having performed, or not performed, sexual acts on the perpetrator (χ2 = 16.327, p < 0.001), the victim's relationship with the perpetrator (χ2 = 10.013, p = 0.002), and the frequency of the abuse (χ2 = 11.617, p < 0.001). CONCLUSION: Our study is the first to demonstrate that having been led to sexually touch the perpetrator is associated with delayed disclosure of CSA.

A Longitudinal Study of Suicidal Ideation in Sexually Abused Adolescent Girls: Depressive Symptoms and Affect Dysregulation as Predictors.

Child sexual abuse (CSA) is associated with many repercussions on adolescents' mental health, including suicidal ideation. Yet, the mechanisms linking CSA to adverse outcomes have rarely been investigated within a longitudinal design. The current study aimed to examine the role of affect dysregulation in the association between depressive symptoms and suicidal ideation 1year after the first assessment in a sample of 119 sexually abused adolescent girls. An integrative mediational model was conceptualized to examine the explicatory role of affect dysregulation (Time 2) in the association between depressive symptoms (Time 1) and suicidal ideation (Time 3). Approximately 31% of the girls reported suicidal ideation at Time 3. Path analysis with logistic regressions revealed that the association between depressive symptoms and suicidal ideation presence was partly explained by affect dysregulation, which increased the risk of suicidal ideation presence by 18.4%, OR = 1.18, 95% CI [1.07, 1.33]. The integrative model explained 21.5% of the variance in suicidal ideation. These findings identify potential predictors of suicidal ideation among sexually abused adolescent girls. This present study highlights the role of affect dysregulation in the presence of suicidal ideation and provides potential targets for intervention practices when working with adolescent girl victims of CSA. As such, interventions for this vulnerable population should aim to decrease depressive symptoms and affect dysregulation to reduce suicidal risk.

Correlates and Predictors of Mothers' Adaptation and Trauma Symptoms Following the Unveiling of the Sexual Abuse of Their Child.

Child sexual abuse (CSA) can severely affect the mental health of children and their parents. While correlates of recovery have been documented in children, factors exacerbating parents' adaptation to their child's unveiling of CSA deserves further attention. Parents' history of abuse has been inconsistently identified as a predictor of their distress in reaction to their child's abuse disclosure. This study proposes a mediation model that explores various processes underlying mother's psychological distress (posttraumatic stress disorder [PTSD], dissociation, and their comorbidity) following their children's unveiling of CSA. It investigates the influence of mother's own CSA, as well as of her exposure to additional forms of past and current victimization, on her reaction to the child's CSA disclosure, while considering coping mechanisms as mediators (avoidance, problem solving, search for social support, and feeling of guilt). Data were collected through self-report measures completed by 298 mothers of children who had recently disclosed CSA. Path analyses revealed that mother's exposure to interparental violence as a child acted as a primary predictor of dissociation and of its comorbidity with PTSD, while a history of CSA was directly and exclusively linked to dissociation. Being exposed to recent partner violence was indirectly related to trauma symptoms, with coping mechanisms acting as mediators. This study outlines the relationship between mother's psychological distress and her cumulative, past, and current exposure to various forms of victimization. Exposure to interparental violence as a child represents a particularly important factor for identifying mothers most in need of support, as it is a significant predictor of dissociation and of its comorbidity with PTSD.

Self-Blame, Shame, Avoidance, and Suicidal Ideation in Sexually Abused Adolescent Girls: A Longitudinal Study.

Depressive symptoms, posttraumatic stress disorder, and suicidal ideation are among the most prevalent problems associated with sexual abuse. Based on the Traumagenic dynamic of stigmatization model, the aim of this study was to investigate whether self-blame, shame, and maladaptive coping strategies predicted posttraumatic stress disorder, depressive symptoms, and suicidal ideation among sexually abused adolescent girls using a longitudinal design. A total of 100 adolescent girls completed a series of questionnaires at the initial visit at the intervention center (T1) and 6 months later (T2). Path analysis reveals shame at T1 predicted posttraumatic stress disorder symptoms at T2 whereas self-blame at T1 predicted depressive symptoms at T2. Furthermore, avoidance coping at T1 and depressive symptoms at T2 predicted suicidal ideation at T2 and accounted for 54% of the variance. These findings suggest that interventions designed for sexually abused adolescent girls should target shame, self-blame, and avoidance coping to foster recovery in this vulnerable population.

Paternal support for child sexual abuse victims: A qualitative study.

BACKGROUND: The current state of knowledge regarding the role of non-offending fathers in supporting their sexually abused children is very scarce. OBJECTIVE: The objective of this study is to further our understanding of fathers' roles following disclosure of their children's sexual abuse (SA) by evaluating fathers' perceptions of the impact of disclosure on their involvement and support of their children. PARTICIPANTS AND METHOD: This qualitative study relies on individual semi-structured interviews conducted with 17 fathers of allegedly abused children. RESULTS: Inductive thematic analysis first highlighted that some reported a period of disengagement from the child during which they put into question their role and attitudes, followed by a period of re-involvement. This period of difficulties experienced by some fathers in regard to their involvement towards their children was due to either their own important psychological distress, their ambivalence towards their child or even because of feelings of uneasiness experienced during physical contact with them. Despite this, findings indicate the presence of thoughts and attitudes that suggest children are a source of concern for fathers. The four forms of abuse-specific support previously observed among mothers (believing the child, seeking out professional services, protecting him/her from the offender, supporting him/her emotionally) were also observed among fathers. In accordance with the activation theory, a form of support specific to fathers, namely, encouraging the child to open up to and explore the world outside the family, thereby, fostering the child's self-esteem development, was observed and constitutes a relevant finding. CONCLUSION: Clinical and empirical implications are discussed.

Maternal Emotional Support following the Disclosure of Child Sexual Abuse: A Qualitative Study.

Non-offending maternal (NOM) support is considered one of the most important protective factors in facilitating better victim adjustment following the disclosure of child sexual abuse (CSA). However, recent findings have led authors to conclude that NOM support has yet to be properly conceptualized and operationalized within the CSA literature. Emotional support is one dimension that has consistently emerged in studies attempting to reconceptualize NOM support but is a concept which also requires further theoretical investigation. Researchers interviewed 22 mothers of children aged 6-12 years about their experience and provision of emotional support following their child's disclosure of CSA. Data were analyzed using a method inspired by grounded theory. Mothers reported feeling initially overwhelmed and lost about how to emotionally support their child but described an improvement in their support capabilities following conjoint therapy. Furthermore, three overarching categories emerged outlining maternal emotional support strategies, each serving a specific emotional function: (a) elaborating, encouraged children to talk about their CSA experience; (b) soothing, attempted to comfort children's distress; and (c) orienting, attempted to guide children's recovery process. Authors discuss implications for offering improved and more rapid clinical services following the disclosure of CSA, and considerations for the operationalization of NOM emotional support.

An analysis of avoidant and approach coping as mediators of the relationship between paternal and maternal attachment security and outcomes in child victims of sexual abuse.

OBJECTIVE: Prior studies have documented the potential role of nonoffending parent support in promoting recovery of adult survivors following sexual abuse (SA). However, few studies have distinguished the maternal and paternal role and the mechanisms by which quality of the parent-child relationship might foster more positive outcomes in child victims. The purpose of this study was to examine coping strategies as mediators of the link between mother-child and father-child relationship and outcomes following child SA. METHOD: A sample of 505 children (339 girls and 166 boys) ages 6-13 years completed measures evaluating perceived attachment security to mother and father (Kerns Security Scale; Kerns, Klepac, & Cole, 1996), as well as coping strategies related to the SA experienced (Self-Reported Coping Scale; Causey & Dubow, 1992). Outcomes evaluated were posttraumatic stress symptoms (PSS; Children's Impact of Traumatic Events Scale-II [CITES-II]; Wolfe, 2002) and self-esteem (Harter, 1985). RESULTS: Results indicated that, in girls, both attachment security to the mother and to the father are associated with lower PSS symptoms and higher self-esteem through a lesser use of avoidant coping. Avoidance coping mediated the link between attachment security to the mother and outcomes in boys. In addition, security in the relationship with the same-sex parent was associated with approach coping, which in turn was associated with both outcomes for girls and with PSS for boys. CONCLUSION: Findings highlight the importance of involving both parents in interventions for sexually abused children as mothers and fathers appear to play different, yet complementary roles in sustaining children's recovery. (PsycINFO Database Record

Posttraumatic Stress Disorder and Suicidal Ideation Among Sexually Abused Adolescent Girls: The Mediating Role of Shame.

Sexual abuse is associated with a host of negative repercussions in adolescence. Yet the possible mechanisms linking sexual abuse and negative outcomes are understudied. The purpose of this study was to investigate the relationships among self-blame, shame, coping strategies, posttraumatic stress disorder, depressive symptoms, and suicidal ideation. The sample included 147 sexually abused adolescent girls between 14 and 18 years of age. A total of 66% of girls reached clinical score for posttraumatic stress disorder, and 53% reached clinical score for depressive symptoms. Close to half (46%) reported suicidal thoughts in the past 3 months. Shame was found to partially mediate the relationship between self-blame and posttraumatic stress disorder. Shame and depressive symptoms were also found to partially mediate the relationship between self-blame and suicidal ideation. Results suggest that shame is a crucial target in interventions designed for sexually abused adolescent girls.

Sexual abuse and preschoolers: Forensic details in regard of question types.

The present study looks into the association between the types of questions used by interviewers and the number of details obtained among preschoolers during an investigative interview. An innovative aspect of this study concerns the analysis of question subtypes (eg. open-ended directive and closed-ended). Analysis of variance were carried out on 55 NICHD interview protocols conducted among children aged three to five years old who disclosed an episode of sexual abuse. Findings reveal that interviewers' style is in accordance with best practices in conducting investigative interviews with children allegedly victims of sexual abuse. As expected, there are more details in answers: 1) provided by older children compared to younger counterparts; 2) following invitations compared to all other question types. However, the analysis of question subtypes has shown that answers given to an open-ended question using cues (cued invitations or directive open-ended) obtained more details concerning the incident compared to the absence of cues (general invitations). These findings support the fact that children as young as three years old are able to produce informative responses when questioned appropriately about the CSA incident and propose reconsidering the types of question that should mainly be used with them. Findings suggest that the use of open-ended questions, using a cue previously mentioned in the testimony of the child, helps provide a detailed account during an investigative interview conducted among preschoolers allegedly victims of sexual abuse.

Psychological and Physical Health of Nonoffending Parents After Disclosure of Sexual Abuse of Their Child.

Disclosure of child sexual abuse can be traumatic for nonoffending parents. Research has shown its impact on mothers' mental health, which includes heightened psychological distress, depression, and post-traumatic stress disorder. Very little is known, however, about its impact on their physical health or on fathers' health. The self-perceived mental and physical health of nonoffending parents after child sexual abuse disclosure was compared to determine gender-related differences in this regard. Interviews were conducted with 109 mothers and 43 fathers of 6- to 13-year-old sexually abused children. Bivariate analyses revealed that a fair proportion of parents reported psychological and physical problems after disclosure. However, proportionally more mothers than fathers reported psychological distress, depression, and use of professional services. Fathers were more likely to resort to health services instead of social services and to use medication for depression. Study findings provide leads for health and social service providers for the development of intervention protocols and referral procedures sensitive to gender issues, and they shed new light on specific needs of nonoffending parents.

Impact of interviewers' supportive comments and children's reluctance to cooperate during sexual abuse disclosure.

In the field of child sexual abuse (CSA) disclosure, many studies have been conducted on the impact of interviewers' questioning style, but few have examined the impact of interviewers' supportive comments on children's cooperative and reluctant disclosure of substantive details. This field study used a sample of children ranging from 4 to 13 years of age who have all disclosed CSA. The first objective was to examine if the interviewer's and the child's comments during CSA interviews would vary as a function of the use of the National Institute of Child Health and Human Development (NICHD) Protocol. The second objective was to identify the strongest correlates of the proportion of details disclosed by the children during forensic interviews. A total of 90 matched NICHD Protocol and non-Protocol interviews done by the same interviewers were audio-taped, transcribed, and coded using verbal subscales. The goal was to explore if differences exist between the interviewers' supportive and non-supportive comments as well as children's cooperative and reluctant statements during investigative interviews conducted prior to or after the NICHD Protocol training. Results of a MANCOVA showed that the use of the NICHD Protocol had no influence on interviewers' and children's demeanors. A hierarchical multiple regression analysis controlling for relevant variables (e.g., child's age and NICHD Protocol) showed that children's reluctance and interviewers' non-support were associated with a lesser proportion of details. Overall, these results indicate that in order to promote detailed disclosure of CSA, interviewers should decrease their non-supportive comments and learn to deal more effectively with children's reluctance during forensic interviews. As such, protocols and training should encourage investigative interviewers to devote more time identifying early signs of children's verbal reluctance and to understand the negative impact of non-supportive comments on the disclosure of substantive details.

Support and profiles of nonoffending mothers of sexually abused children.

Maternal support offered to sexually abused children following disclosure may be a crucial factor in children's recovery. A person-centered approach was used to examine how profiles of nonoffending mothers could better describe their ability to support their children after disclosure. Cluster analyses based on a total of 226 nonoffending mothers recruited from child protective services yielded four distinctive groups of mothers: resilient, avoidant-coping, traumatized, and anger-oriented reaction. These profiles differed on measures of support, parenting, and variables related to attitude following disclosure. The discussion underscores the relevance of adopting a tailored approach to intervention with mothers of sexually abused children.

Maternal Lifetime Depressive/Anxiety Disorders and Children's Internalizing Symptoms: The Importance of Family Context.

OBJECTIVES: This study investigated the interaction effects between mothers' lifetime depressive/anxiety disorders and other psychosocial correlates of 6 to 11 year-old children's self-reported internalizing symptoms in the Quebec Child Mental Health Survey. METHOD: A representative subsample of 1,490 Quebec children aged 6 to 11 years was selected from the original sample. Multiple linear regression analyses were performed using children's internalizing symptoms and child, family and socioeconomic characteristics. RESULTS: Four variables interacted significantly with mothers' lifetime depressive/anxiety disorders to predict 6 to 11 year-old children's internalizing symptoms: child age (t=2.415, P=0.016), mother's caring behaviours (t=2.950, P=0.003), mother's punitive behaviours (t=2.629, P=0.009) and parental social support (t=2.272, P=0.023). CONCLUSION: Results highlight the important contribution of the family context to the intergenerational transmission of internalizing symptoms and the relevance of taking into account children's developmental period. They support the importance of early screening of children's self-reported internalizing symptoms, among children of depressed/anxious parents. It is suggested to develop preventive intervention programs oriented towards children of depressed/anxious parents and exposed to relational difficulties.

Prevalence of childhood sexual abuse and timing of disclosure in a representative sample of adults from Quebec.

OBJECTIVE: Our study sought to explore patterns of disclosure of child sexual abuse (CSA) in a sample of adult men and women. METHOD: A telephone survey conducted with a representative sample of adults (n = 804) from Quebec assessed the prevalence of CSA and disclosure patterns. Analyses were carried out to determine whether disclosure groups differed in terms of psychological distress and symptoms of posttraumatic stress, and a logistic regression was used to examine factors associated with prompt disclosure. RESULTS: Prevalence of CSA was 22.1% for women and 9.7% for men. About 1 survivor out of 5 had never disclosed the abuse, with men more likely not to have told anyone, than women. Only 21.2% of adults reported prompt disclosure (within a month of the first abusive event), while 57.5% delayed disclosure (more than 5 years after the first episode). CSA victims who never disclosed the abuse and those who delayed disclosure were more likely to obtain scores of psychological distress and posttraumatic stress achieving clinical levels, compared with adults without a history of CSA. In the multivariate analysis, experiencing CSA involving a perpetrator outside the immediate family and being female were factors independently associated with prompt disclosure. CONCLUSION: A significant number of adult women and men reported experiencing CSA, and most victims attested to either not disclosing or significantly delaying abuse disclosure.

Assessing the effectiveness of the NICHD investigative interview protocol when interviewing French-speaking alleged victims of child sexual abuse in Quebec.

OBJECTIVES: The study was designed to assess the effectiveness of the flexibly structured NICHD Investigative Interview Protocol for child sexual abuse (CSA) investigative interviews by police officers and mental health workers in Quebec. The NICHD Protocol was designed to operationalize "best practice" guidelines and to help forensic interviewers use open-ended prompts to facilitate free recall by alleged victims. METHOD: A total of 83 interviews with 3- to 13-year-old alleged victims were matched with 83 interviews conducted by the same interviewers before they were trained to use the Protocol. Interviews were matched with respect to the children's ages, children-perpetrator relationships, and the types and frequency of abuse. Coders categorized each of the prompts used to elicit information about the abuse and tabulated the numbers of new forensically relevant details provided in each response. RESULTS: Interviewers used three times as many open-ended prompts in Protocol interviews than in non-Protocol interviews, whereas use of all other types of questions was halved, and the total number of questions asked decreased by 25%. Protocol-guided interviews yielded more details than comparison interviews. The mean number of details per prompt increased from 3 to 5 details when the Protocol was used. Even with young children, interviewers using the Protocol employed more invitations to elicit forensically relevant details. CONCLUSIONS: French-speaking investigators using the NICHD Protocol used open-ended prompts rather than focused questions when interviewing alleged victims. In addition, these interviewers needed fewer questions to get relevant information when using the Protocol. PRACTICAL IMPLICATIONS: A French version of the NICHD Protocol is now available to police officers and social workers who investigate the alleged sexual abuse of young children in French-speaking countries. This French version allowed trained interviewers to increase the use of invitations and reduce the use of more focused and risky questions. When the number of questions was controlled, more central details and more details in total were obtained in Protocol interviews, because the average prompt elicited more detailed answers in Protocol interviews. However, learning to use the NICHD Protocol required extended training and continued feedback sessions to maintain the high quality of interviewing.

The use of the NICHD protocol to enhance the quantity of details obtained from children with low verbal abilities in investigative interviews: a pilot study.

This study explored the impact of the NICHD protocol to enhance the quantity and content of details reported by children with low verbal abilities. Thirty-four children aged from 6 to 14 were interviewed following their experience of sexual abuse. Half the interviews were conducted using the NICHD protocol. Results indicate that NICHD interviews contained more open-ended prompts and more details overall. Open-ended invitations yielded significantly more detailed responses than did closed-ended questions for both children with low and average verbal abilities. Although children with low verbal abilities provided fewer details than children with average verbal abilities, the NICHD protocol helped them provide detailed responses containing the core elements of the sexual abuse.

Prevalence and co-occurrence of violence against children in the Quebec population.

OBJECTIVE: A literature review on the incidence of different forms of child maltreatment revealed that rates in Australia and Quebec (Canada) were similar. This study sought to determine the prevalence and co-occurrence of various forms of violence (physical, sexual and psychological) and explore gender and age difference. METHODS: A telephone inquiry was conducted with a representative sample of 1,002 adults from the province of Quebec. RESULTS: More than one in three adults (37%) reported having experienced at least one of three forms of violence in childhood. Twelve per cent (12%) of the adults experienced two forms of violence while 4% of the respondents reported having experienced all three forms of violence in childhood. Psychological violence (22%) was the form most frequently reported, followed by physical violence (19%) and sexual violence (16%). The different prevalence rates did not vary as a function of age. However, regarding gender, women were more likely to report having been sexually victimised (rape and fondling) and less likely to report having experienced physical violence. A lower percentage of women reported having sustained no form of childhood victimisation and a higher percentage of women reported have experienced both sexual and psychological violence compared to men. CONCLUSION: These results, including both the global rates and those particular to each gender, are comparable to findings in similar North American studies. The co-occurrence rates noted are salient enough to necessitate particular attention to diverse clinical clientele and need to be considered in future research exploring the risk factors of violence and its subsequent repercussions.

Factors linked to distress in mothers of children disclosing sexual abuse.

The aim of the present study is to investigate the variability in clinical level of psychological distress experienced by mothers of sexually abused children by exploring the role of (a) abuse-related variables (length, severity, and identity of perpetrator), (b) a history of childhood sexual abuse and partner violence experienced in the past year, and (c) mothers' coping and feelings of empowerment. Data were collected through self-report measures completed by 149 French-speaking mothers of girls aged 4 to 12 years disclosing sexual abuse. Results revealed that more than half of the mothers reported clinical levels of psychological distress and experienced child sexual abuse, and 1 of 4 mothers experienced physical partner violence. Logistic regression analysis revealed that mother's sexual abuse and partner violence as well as avoidance coping and empowerment contributed to scores reaching clinical levels of psychological distress. In addition, mothers of child victims of intrafamilial sexual abuse are more likely to report clinical levels of distress. Results underscore the importance of evaluating for trauma history and taking coping strategies and empowerment into account in treatment interventions.

Intrusion errors in explicit memory: their differential relationship with clinical and social outcome in chronic schizophrenia.

INTRODUCTION: Memory deficits might account for clinical and adaptive differences between groups of patients with chronic schizophrenia. We investigated the qualitative factors of memory that influence clinical and social status. METHODS: Psychosocial functioning, clinical symptoms, and memory function were assessed in 99 patients at four time points over a 16-month period using recall scores for semantically related words, unrelated words, paired associated learning, and word span. An initial cluster analysis using symptom assessment data from all four time points divided the sample into three groups: patients with low symptoms ratings that remained stable throughout the study period (low symptom-stable group - LSSG; N=51); patients with initially high symptoms ratings that subsequently improved (high symptom-improved group - HSIG; N=32); and patients with initially high symptoms ratings that deteriorated during the follow-up (high symptom-deteriorated group - HSDG; N=16). RESULTS: Memory was better preserved in LSSG compared to HSIG and HSDG patients. Recall performance was generally better for semantically related words than for unrelated words but the difference between LSSG and the two other groups was more constant over time for semantically related words. Extra-list errors variable was positively correlated with three PANSS measures (r=.25-.47). Also, the extra-list errors scores were correlated with the Magical Ideation Scale (r=.34-.39). Memory scores (global explicit, unrelated, related) were significantly and positively correlated with independent living skills (r=.26-.55) and the extra-list errors were negatively correlated with both social support and independent living skills (r=-.29 and r=-.46, respectively). All groups showed a reduction in extraneous false recognition errors/intrusions (FRIs) over time with the HSIG showing the greater change. HSIG and HSDG patients committed slightly more FRIs in recall tasks (extraneous information) than LSSG patients. CONCLUSION: Memory performance is better in patients presenting with less severe symptomatology. The extent to which FRIs reduce over time in patients with schizophrenia is a novel finding.

[The influence of cognitive abilities, age and characteristics of their sexual abuse experience on the statement of the presumed victims]. / L'influence des habiletés cognitives, de l'âge et des caractéristiques de l'agression sexuelle sur la déclaration des présumées victimes.

OBJECTIVE: The goal of the present study was to examine the effects of children's age, cognitive abilities and the characteristics of their sexual abuse experience on the quantity of details revealed about the sexual abuse in an investigative interview as a function of the type of questions asked. METHOD VERSION: Transcripts of 37 investigative interviews conducted with children between 6 and 12 years of age were analyzed according to the type of interviewer questions used and the quantity of details given by the child. The children's cognitive abilities were measured using the vocabulary, information and block design subtests of the WISC-III. RESULTS: Results of multiple regression analyses indicate that children's age and verbal abilities as well as their relationship with the perpetrator explain 50% of the variance of the mean number of details obtained from the child following open-ended interviewer questions. CONCLUSION: The results of this study suggest that the quantity of details obtained during an investigative interview is influenced not only by children's age but also by their verbal skills and the child-perpetrator relationship.