Journal of the American Academy of Child & Adolescent Psychiatry
RESEARCH UPDATE REVIEWTen-Year Research Update Review: Child Sexual Abuse
Section snippets
EPIDEMIOLOGY OF CSA
Before the late 1970s, CSA was regarded as rare. In the following decades, the incidence—based on official statistics—increased dramatically (Finkelhor, 1984;U.S. Department of Health and Human Services, 1998). Although much of this apparent increase probably reflected a growing awareness among the public and professionals, some studies suggest that the overall incidence of child abuse and neglect increased. Using as official observers a variety of professionals who routinely came in contact
RISK FACTORS FOR CSA
CSA occurs across all socioeconomic and ethnic groups (Finkelhor, 1993). A number of factors, however, have been identified that increase risk for CSA.
INTERGENERATIONAL TRANSMISSION OF CSA
The observation that child abusive behavior occurs across generations more often than would be expected by chance has led to a number of theories ranging from the postulation of large sociopolitical and cultural cycles (Buchanan, 1996) to maladaptive family processes (Ney, 1992) to psychodynamic models based on identification with the aggressor, low self-esteem, and related constructs (Steele, 1997). The actual rates of intergenerational occurrence of child abuse are lower than is often
OUTCOMES ASSOCIATED WITH CHILDHOOD SEXUAL ABUSE
A variety of adult psychiatric conditions have been clinically associated with CSA. These include the DSM disorders of major depression, borderline personality disorder, somatization disorder, substance abuse disorders, posttraumatic stress disorder (PTSD), dissociative identity disorder, and bulimia nervosa. Initially the evidence for these associations was based primarily on findings of high rates of retrospectively reported CSA in clinical samples with these diagnoses. Increasingly these
PRINCIPLES OF PSYCHOPATHOLOGY IN CSA
The array of disorders and dysfunctional behaviors associated with CSA has been difficult to account for with a simple cause-and-effect model. This apparent diversity can be explained in part by the heterogeneity of CSA experiences, the complexity of the confounds among abuse severity variables, and a host of moderating and mediating constitutional and environmental variables together with important individual differences in coping strategies that may come into play at different points in
EFFECTS OF DISCLOSURE AND STABILITY OF SELF-REPORTS OF CSA OVER TIME
Unfortunately, disclosure by the child of abuse does not always result in the termination of the abuse or end the child's distress (Palmer et al., 1999). A follow-up comparison of children who had accidental disclosures of CSA (i.e., their abuse was discovered by an adult) versus children who deliberately disclosed, revealed that the former were doing significantly better at 1 year (Nagel et al., 1996). Children who voluntarily disclosed their abuse received less treatment and support, which
Asymptomatic Children
Not all sexually abused children have serious psychiatric sequelae. When evaluated with standard instruments, up to 40% of sexually abused children may present with few or no symptoms (Finkelhor and Berliner, 1995). A number of reasons have been offered including the possibility that asymptomatic children had minor abuse, that they are more resilient, or that they have a coping style that masks their distress. The limited longitudinal data available, however, suggest that 10% to 20% of
Child Education Programs
There is considerable debate within the field as to the best approach to CSA prevention. School-based education programs directed at teaching children to identify potential abuse situations, to respond in a self-protective fashion, and to tell a trusted adult are popular. A meta-analysis of 16 evaluation studies of school-based child education programs found that such programs are generally successful at teaching children CSA concepts and self-protection skills (Rispens et al., 1997). In most
FUTURE DIRECTIONS
Research on CSA shares most of the methodological limitations and thorny dilemmas associated with child abuse and neglect research in general. These include determining what constitutes representative samples, uniformity of definitions, classification of multiple forms of maltreatment, understanding self-selection biases for research participation, detecting false negatives, and determination of appropriate comparison groups (Briere, 1992;Ferguson, 1997). The existence of sleeper effects,
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From Children's Hospital Medical Center, Cincinnati.