Prior childhood sexual abuse in mothers of sexually abused children

OBJECTIVE: To study extensively the therapeutic approach of gastroesophageal reflux disease in intellectually disabled children. DESIGN: We studied the effect of omeprazole sodium on healing and symptom relief in 52 institutionalized intellectually disabled children (male-female, 21:31; mean age, 15.4 years; range, 4-19 years). INTERVENTION: Endoscopically proven esophagitis (grades I-IV, Savary-Miller classification) was treated with omeprazole sodium, 40 mg/d (20 mg/d for children weighing <20 kg) as healing dose for 3 months, and 20 mg/d (10 mg/d for children weighing <20 kg) as maintenance dose for another 3 months. After 3 and 6 months, results of treatment were evaluated using symptom scoring and/or endoscopy. For patients with relapse, the dose was increased. RESULTS: At first endoscopy, 19 patients (36%) of 52 showed grade I esophagitis; 20 (38%), grade II; 6 (12%), grade III; and 7 (13%), grade IV. In 44 (86%) of 51 patients, treatment was effective in healing esophagitis and keeping patients in remission, independent of the severity of esophagitis. In 7 patients (14%), a symptomatic relapse was observed after decreasing the dose. However, these patients became symptom free again after increasing the dose and showed healing on endoscopy at the end of the study. One child did not finish the study for reasons not related to therapy. Marked improvement of persistent vomiting, regurgitation, food refusal, iron deficiency anemia, and signs of depression was seen at the end. CONCLUSIONS: Omeprazole is highly effective for all grades of esophagitis in intellectually disabled children, without adverse effects. The dose needed to maintain the remission can be titrated according to the reflux symptoms. One disadvantage of medical therapy is that it is open ended, in contrast to operation, but surgery in this population has high mortality and complication rates.     

Course of psychological symptoms in sexually abused young children.

Assessed 8 sexually abused (SA) children (aged 3–7 yrs) repeatedly with the Child Behavior Checklist during a 10–18 mo period to explore the course of psychological symptoms that emerged in response to the abuse. Their individual courses were linked to whether treatment was provided and pathology in the parents. In some Ss, symptoms reflected a similar pattern of resolution. Symptomatology included depression and somatic complaints, aggressiveness, and the emergence of sexualized behavior. Parent–child interactions and the impact of therapy are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Play therapy behaviors of sexually abused children.

Examined the question of whether there are specific play therapy behaviors associated with children who have been sexually abused, and whether these behaviors differ by sex and age of the children. A survey instrument was developed which listed 140 play therapy behaviors. 21 play therapists participated in a field test to establish external validity. 249 play therapists were also surveyed to identify professionals who provide play therapy. Analysis identified highly interrelated play therapy behaviors of sexually abused girls and boys from ages 3–10 yrs. Suggested use of the play therapy behaviors include assessments to detect sexual abuse and recommendations for child placement and/or court testimony. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of sexually abused children and adolescents.

The authors review research demonstrating the variable effects of childhood sexual abuse, the need for intervention, and the effectiveness of available treatment models. The well-controlled treatment-outcome studies reviewed do not focus on sensationalistic fringe treatments that treat sexually abused children as a special class of patients. Instead, studies demonstrate empirical evidence for extending and modifying treatment models from mainstream clinical child psychology to sexually abused children. The authors propose a continuum of interventions to meet the needs of this heterogeneous group. Interventions range from psychoeducation, prevention, and screening, to short-term, abuse focused cognitive-behavioral therapy with family involvement, to more comprehensive long-term plans for multiproblem cases. Last discussed are gaps in the research and suggestions for future research to address the pressing dilemmas faced by clinicians and policymakers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological functioning and behavior of sexually abused girls.

The psychological functioning and behavior of 46 sexually abused girls (ages 6–14) was compared with that of 46 nonabused girls who were matched on age, race, family income, and family constellation. Sexually abused children demonstrated heightened sexual preoccupation and behavior problems, lower cognitive abilities and school achievement, and more stressful past histories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression, developmental level and disclosure in sexually abused children

OBJECTIVE: To investigate the relationship between sexual abuse disclosure, developmental level and psychopathology in children. DESIGN: A retrospective analysis of case records, using chi-square and t-tests for statistical significance. SETTING: Child and Adolescent Unit, Midlands Hospital, Pietermaritzburg. SUBJECTS: One hundred children consecutively admitted for all types of mental health problems. OUTCOME MEASURES: Diagnostic evaluations were made using the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (3rd edition, revised). RESULTS: Forty of the 100 children had been sexually abused, but 14 (35%) of the abused children did not disclose their abuse until after admission. The post-admission disclosure group had a significantly higher mean age (13.71 years) than the pre-admission disclosure group (10.96 years). Also, significantly more post-admission disclosure children received a diagnosis of major depressive disorder than their pre-admission disclosure counterparts. CONCLUSION: The study highlights the issue of sexual abuse disclosure and its relationship to depression and developmental level. Internal psychological and developmental mechanisms appear to influence the disclosure/non-disclosure of sexual abuse.     

Presenting problems of sexually abused girls receiving psychiatric services.

Twenty-three behaviors among those suggested in the literature to be associated with sexual abuse were studied in 195 girls, ages 2–18 years, who were consecutive admissions to three Midwestern mental health agencies. Results indicated that sexually inappropriate behaviors, sleep disturbance, depressed mood, and delinquent behavior occurred more frequently in young abuse victims than in clinic comparisons. Sexually inappropriate behaviors and running away appeared more often in older sexually abused girls, than they appeared in older clinic comparisons. These comparisons of the presenting problems of sexually abused and nonabused girls suggest there are few behavioral "markers' of sexual abuse in clinical samples and that sexual abuse may not be a unique contributing factor in the ontogeny of childhood psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attribution-based treatment of self-blame and helplessness in sexually abused children.

Reviews a number of attributional distinctions within the concepts of self-blame and helplessness that can be utilized in treatment planning for sexually abused children to make possible simultaneous reduction of guilt and powerlessness. Adaptive and maladaptive subtypes of self-blame and helplessness are separated, often based on their implications for past vs future control. Recommendations are presented for phrasing attributional interventions in language understandable to young children. The formulation is also applied to work on children's ambivalent feelings toward perpetrators and non-offending parents. The role of client education as a therapeutic technique is emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Filial therapy with nonoffending parents of children who have been sexually abused.

Examined the effectiveness of a 10 wk filial therapy training model as a method of intervention for nonoffending parents (24–56 yrs old) and their children (4–10 yrs old) who have experienced sexual abuse. Ss were assigned to either an experimental or control group and were given pretraining sessions and assessments. The parents in the experimental group then conducted weekly 30 min special play sessions with their children, as recommended by Landreth (1991). One session was videotaped. The parents received constructive feedback and support from the facilitator and group members during meetings. A posttest battery of instruments was administered to parents and children following the training sessions. Analyses of covariance revealed that the nonoffending parents in the experimental group significantly increased their level of empathy in their interactions with their children, significantly increased their attitude of acceptance toward their children, and significantly reduced their level of stress. Measures of the children's behavior, anxiety, emotional adjustment, and self-concept indicated positive trends. The authors maintain that this study supports filial therapy as an effective intervention for nonoffending parents and their children who have experienced sexual abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with fathers' caregiving activities and sensitivity with young children.

A multifactorial model was used to identify child, sociodemographic, paternal, and maternal characteristics associated with 2 aspects of fathers' parenting. Fathers were interviewed about their caregiving responsibilities at 6, 15, 24, and 36 months, and a subset was videotaped during father-child play at 6 and 36 months. Caregiving activities and sensitivity during play interactions were predicted by different factors. Fathers were more involved in caregiving when fathers worked fewer hours and mothers worked more hours, when fathers and mothers were younger, when fathers had more positive personalities, when mothers reported greater marital intimacy, and when children were boys. Fathers who had less traditional child-rearing beliefs, were older, and reported more marital intimacy were more sensitive during play. These findings are consistent with a multifactorial and multidimensional view of fathering. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of sexual behavior and self-esteem in young adult females with positive and negative tests for sexually transmitted diseases

Contracting sexually transmitted diseases is a serious health problem faced by young women, in part, because they may routinely engage in risky sexual behaviors. This study describes the sexual behaviors of eighty-one young adult females who had positive and negative tests for STDs. The STD-negative group consisted of forty-nine African American females and the STD-positive group was thirty African American and two Caucasian females. The women completed the Safe Sex Behavior Questionnaire and the Rosenberg Self Esteem Scale. Demographic factors were also examined. The findings revealed that STD-negative females had higher self esteem and practiced safe sex more frequently. Also, women with higher education and incomes above $10,000 a year, plus a higher self-esteem level scored higher on the SSBQ, indicating the practice of safer sex. Age was not related to self esteem or the practice of safe sexual behavior. Implications for nurse practitioner practice are discussed.     

Randomized trial of treatment for children with sexual behavior problems: Ten-year follow-up.

This study prospectively follows 135 children 5-12 years of age with sexual behavior problems from a randomized trial comparing a 12-session group cognitive-behavioral therapy (CBT) with group play therapy and follows 156 general clinic children with nonsexual behavior problems. Ten-year follow-up data on future juvenile and adult arrests and child welfare perpetration reports were collected. The CBT group had significantly fewer future sex offenses than the play therapy group (2% vs. 10%) and did not differ from the general clinic comparison (3%), supporting the use of short-term CBT. There were no group differences in nonsexual offenses (21%). The findings do not support assumptions about persistent or difficult to modify risk and raise questions about policies and practices founded on this assumption. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anatomic puppets. (An aid in examinations of sexually abused children)

The 1970s and 1980s were decades of rapid growth in health care services and expenditures in Canada. Numerous government sponsored reports laid our principles for restructured health services delivery. These principles included directions such as community orientation, continuity of care and health promotion. The principles were similar, and so were the results: throughout Canada there has been limited action on these principles.     

A comparison of group treatments of women sexually abused as children.

We randomly assigned 65 women who had been sexually abused by a father, stepfather, or other close relative to 1 of 3 treatment conditions: a 10-week interpersonal transaction (IT) group, a 10-week process group, or a wait list condition. Subjects were evaluated at pretreatment, posttreatment, and (if assigned to a group) a 6-month follow-up on measures of social adjustment, depression, fearfulness, and general distress. Results suggested that both the IT and process group formats were more effective than the wait list condition in reducing depression and in alleviating distress; changes were maintained at follow-up. Subjects in the process group format exhibited improvement in social adjustment, whereas subjects in the wait list condition actually deteriorated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Considerations in the psychoanalytic treatment of men who were sexually abused as children.

Examines the literature on sexually abused men and illustrates with clinical examples from individual and group psychoanalytic practice the themes that emerge in working with them. Sexual abuse situations with boys are considered in 3 groups: those involving penetration, those involving inappropriate tactile contact, and those involving noncontact seduction and excitation. The boundary violation inherent in all of these situations is crucial in the treatment of the man who has been abused, as is the familial context of the abuse. Sexual orientation and gender identity, abuse in a familial context, love and sexuality, and transference and countertransference are discussed. For the analyst treating men who were sexually abused, there may be feelings of being overwhelmed by the seductive energy in the analytic relationship and also wishes to reel back and deny the horror of the material being discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal study assessing trauma symptoms in sexually abused children engaged in play therapy.

Children who have been sexually abused exhibit a variety of emotional, sexual, behavioral, and psychological problems. A great deal of interest has been generated in the use of play therapy as a clinical approach to intervention with sexually abused children. This study explores the effect of play therapy as a primary treatment modality with sexually abused children. The impact of specific traumatic symptoms and overall treatment is examined. Findings indicate that, overall, trauma symptom severity in children decreased after 6 months of play therapy. In addition, anxiety, depression, post-traumatic stress, and sexual distress scores indicated a significant decrease. Additional research is recommended to develop evaluative and systematic guidelines that will further validate the use of play therapy as an empirically supported assessment and treatment tool. (PsycINFO Database Record (c) 2010 APA, all rights reserved)