Psychological testing in evaluation of child sexual abuse

In order to assess the utility of psychological testing in evaluating allegations of child sexual abuse, the empirical literature is reviewed in an attempt to answer two questions. First, are there systematic and significant differences on psychological tests between sexually abused and nonabused children? Second, are these differences on psychological testing a direct result of sexual abuse, or are they a result of other coexisting factors that might cause psychological distress? Cognitive measures, personality inventories, symptomatology checklists, and projective tests with sexually abused children are reviewed. While a variety of standardized instruments have been administered to sexually abused children, relatively few have been utilized in empirical studies. Findings have been mixed, with stronger differences between sexually abused and nonabused children generally found on measures completed by parents than on measures administered directly to children. Sexually abused children often fall between nonabused and psychiatric groups. Use of measures specific to sexual abuse is advocated. While psychological tests may currently have limited use in validating suspected sexual abuse, they may be extremely useful in the clinical treatment of the child.     

Sexual abuse and bulimia: response to inpatient treatment and preliminary outcome

The purpose of this study was to explore the clinical impact of child sex abuse on bulimic patients. Specifically, differences in treatment response and preliminary treatment outcome between hospitalized bulimic patients with and without a reported history of sexual abuse were examined. The patients were evaluated for past history of alleged sexual abuse by investigator-based interview and ratings of severity of sexual abuse were made. Assessments of mood, eating disordered-related attitudes, and eating behaviors were conducted at the start of treatment, weekly during treatment, and three months post discharge. Sixty-one per cent (45) of the 74 patients enrolled in the study reported a history of child sexual abuse. The majority of such events constituted serious and very serious abuse by this study's criteria. The abused subjects exhibited higher levels of depression, anxiety, and eating disordered attitudes at each assessment point relative to nonabused subjects. In addition, abused subjects were more likely to be re-hospitalized in the 3 month post-discharge period. Significant differences in the extent of actual bulimic behaviors were not detected. Both the abused and nonabused bulimic patients demonstrated significant reductions in psychiatric symptomatology from pretreatment to posttreatment, and from posttreatment to follow-up. Contrary to prediction, differences in symptomatology between the very serious, serious, and least serious abused groups were not detected. Results suggest that bulimic patients with reported histories of sexual abuse can be effectively engaged in a conventional eating disorder treatment program, but that such abuse may place patients at a disadvantage owing to higher levels of pretreatment symptom severity. Findings suggest that extended and/or more specific intervention may be warranted for the abused bulimic patient.     

Assessing suicidality in adults: Integrating childhood trauma as a major risk factor.

Can knowing whether an adult client was abused as a child assist psychologists when assessing suicidality? Reviewing the files of 200 outpatients revealed, in keeping with previous studies, that child abuse was related not only to previous psychiatric admissions and younger age at first treatment and first admission, but also to past and present suicidality. Current suicidality was predicted better by child sexual abuse (experienced on average 20 years previously) than by a current diagnosis of depression. Evidence that abuse histories are not routinely taken, and recommendations for why, and how, taking abuse histories should be integrated into suicide assessment and treatment, are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of domestic violence on children's behavior problems and depression.

The Children's Depression Inventory, Child Behavior Checklist, and Youth Self-Report were completed by mothers, fathers, and their 8–12 yr old children to assess the effects of various types of domestic violence on children's behavior problems and depression. 110 Israeli children from lower-class families were identified through social service records. 33 of the children had been physically abused by their parents within the last 6 mo, 16 had witnessed spouse abuse, 30 had been both victims and witnesses of domestic violence, and 31 had experienced no known domestic violence. Overall, domestic violence had effects on child development that varied in magnitude and nature depending on the type of domestic violence and who reported the information about the child's adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral comparisons of children from abusive and distressed families.

Investigated the problem behaviors of 35 physically abused 6–16 yr olds in comparison with 36 nonabused children from a child welfare agency and 35 nonabused children in the community. Parental report of behavioral strengths and weaknesses was examined by administering the Child Behavior Profile. Results concur with those of previous reports that abused children display a significantly greater number of behavior problems and fewer social competencies than normals. The behavior patterns of abused Ss closely resembled the range of behavior problems shown by Ss from distressed families in which abuse was not present. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Energy level and sleep quality following bone marrow transplantation

Hypothalamic-pituitary-adrenal (HPA) axis disturbances in depressed children with a history of abuse were examined. Thirteen depressed abused, 13 depressed nonabused, and 13 normal control children were given 1.0 microgram/kg of human corticotropin-releasing hormone (CRH) intravenously. Blood samples for corticotropin (ACTH) and cortisol were obtained at nine intervals. When compared to depressed nonabused and normal control children, depressed abused children had significantly greater peak, total, and net ACTH secretion post-CRH. Increased ACTH secretion was only observed in depressed abused children experiencing ongoing chronic adversity (marital violence, emotional abuse, poverty, lack of supports). The pattern of findings of the depressed abused children experiencing ongoing adversity parallels the pattern of HPA axis dysregulation reported in animal studies of chronic stress. They add to a growing body of literature suggesting measures of past trauma and current adversity are important sources of variability in psychobiological correlates of major depression.     

Randomized controlled trial of a family cognitive-behavioral preventive intervention for children of depressed parents.

A family cognitive-behavioral preventive intervention for parents with a history of depression and their 9–15-year-old children was compared with a self-study written information condition in a randomized clinical trial (n = 111 families). Outcomes were assessed at postintervention (2 months), after completion of 4 monthly booster sessions (6 months), and at 12-month follow-up. Children were assessed by child reports on depressive symptoms, internalizing problems, and externalizing problems; by parent reports on internalizing and externalizing problems; and by child and parent reports on a standardized diagnostic interview. Parent depressive symptoms and parent episodes of major depression also were assessed. Evidence emerged for significant differences favoring the family group intervention on both child and parent outcomes; strongest effects for child outcomes were found at the 12-month assessment with medium effect sizes on most measures. Implications for the prevention of adverse outcomes in children of depressed parents are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Variations in the reported age of a patient: A source of bias in the diagnosis of depression and dementia.

The presence of bias in assessing organic vs depressive pathology in the elderly psychiatric population has been clinically observed in the apparent tendency to overattribute cognitive deficits to senile dementia. In the present study, 21 male and 15 female 26–49 yr old clinical psychologists were presented with a taped interview in which the age of a 64-yr-old male with depressive pseudodementia was varied (either 55 or 75 yrs). It was assumed that the ambiguity involved in determining the etiology of the patient's cognitive deficits would elicit a social or diagnostic bias related to his age. Results show the presence of a bias, with a greater attribution of organic symptoms reflective of senile dementia and fewer judgments of depression when the patient was described as elderly rather than middle-aged. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Impact of sexual abuse on children: A review and synthesis of recent empirical studies.

A review of 45 studies clearly demonstrates that sexually abused children have more symptoms than nonabused children, with abuse accounting for 15–45% of the variance. Fears, posttraumatic stress disorder (PTSD), behavior problems, sexualized behaviors, and poor self-esteem occurred most frequently among a long list of symptoms noted, but no one symptom characterized a majority of sexually abused children. Some symptoms were specific to certain ages, and approximately one-third of victims had no symptoms. Penetration, the duration and frequency of the abuse, force, the relationship of the perpetrator to the child, and maternal support affected the degree of symptomatology. About two-thirds of the victimized children showed recovery during the 1st 12–28 mo. The findings suggest the absence of any specific syndrome in children who have been sexually abused and no single traumatizing process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive reactions and unemployment.

Investigated correlates of situation-specific depressive affect associated with unemployment and correlates of more general depressive symptoms assessed by the Beck Depression Inventory (BDI) for 116 15–32 yr old unemployed Ss. Consistent with a frustrated work-motivation pattern, depressive affect was associated with concern about being unemployed and with stronger endorsement of external causes of unemployment. Consistent with a self-blame view of depression, BDI scores were related to stronger endorsement of internal causes for unemployment, to low self-esteem, and to feelings of helplessness. Stronger endorsement of internal causes was found among those Ss with a longer history of unemployment. Multiple regression analyses showed, however, that the attributional variables accounted for a relatively low proportion of the variance in the depression measures. Results question the adequacy of attributional accounts of depression. (44 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pathways from child sexual abuse to adult depression: The role of parental socialization of emotions and alexithymia.

Objective: Depression is common among adult survivors of child sexual abuse (CSA), but the intervening processes responsible for this outcome have not yet been fully delineated. The present study investigated the mediating role of perceived parental emotion socialization and alexithymia (difficulties identifying and describing feelings) in explaining the link between CSA and adult depressive symptoms in female veterans. Method: Cross-sectional data were collected from 110 female veterans who completed self-report questionnaires measuring demographics, sexual victimization history, perceived parental emotion socialization, and current symptoms of alexithymia and depression. Results: Linear regression analyses showed that CSA predicted greater depression, which was partly accounted for by alexithymia. Less positive socialization practices by both parents fully mediated the relationship between CSA and alexithymia. When these factors were examined together in a path model, greater CSA severity predicted perceptions of fewer positive socialization practices by mothers, which, in turn, was associated with greater alexithymia and depression. Conclusions: Perceptions of early positive emotion socialization and current alexithymia may contribute to experience of depression among sexually victimized female veterans. Interventions aimed at targeting emotion regulation skills and perceptions associated with other salient childhood experiences such as emotion socialization by parents could help reduce adult depression among CSA survivors. Furthermore, encouraging positive parenting practices for caregivers of abused children could allay subsequent affective symptoms. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Sex differences in the longitudinal relations among family risk factors and childhood externalizing symptoms.

Despite potential sex differences in base rates, predictors, and maintaining processes for children's externalizing behaviors, little prospective research has examined sex differences in the relations between concurrent, proximal family risk factors and children's externalizing behaviors. The current study examined the relations among maternal depressive symptoms, maternal parenting behaviors (i.e., negativity and low warmth), and child externalizing symptoms at 24 months and first grade in a community-based sample of 1,364 children enrolled in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Structural equation modeling revealed that maternal depression and negative parental behaviors were associated with concurrent externalizing behaviors, though maternal depression may be differentially linked to boys' and girls' externalizing problems. The relation between depression and boys' externalizing symptoms was more pronounced at 24 months, and over time, the relation between maternal depression and boys' externalizing symptoms decreased in magnitude, whereas this relation increased among girls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic liability, environment, and the development of fussiness in toddlers: The roles of maternal depression and parental responsiveness.

Using a longitudinal, prospective adoption design, the authors of this study examined the effects of the environment (adoptive parents' depressive symptoms and responsiveness) and genetic liability of maternal depression (inferred by birth mothers' major depressive disorder [MDD]) on the development of fussiness in adopted children between 9 and 18 months old. The sample included 281 families linked through adoption, with each family including 4 individuals (i.e., adopted child, birth mother, adoptive father and mother). Results showed that adoptive mothers' depressive symptoms when their child was 9 months old were positively associated with child fussiness at 18 months. A significant interaction between birth mothers' MDD and adoptive mothers' responsiveness indicated that children of birth mothers with MDD showed higher levels of fussiness at 18 months when adoptive mothers had been less responsive to the children at 9 months. However, in the context of high levels of adoptive mothers' responsiveness, children of birth mothers with MDD did not show elevated fussiness at 18 months. Findings are discussed in terms of gene–environment interactions in the intergenerational risk transmission of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal punitiveness as affected by situational stress: An experimental analogue of child abuse.

To test hypothesized variables involved in punishment and child abuse, 2 techniques were used to increase child-dependent and child-independent situational demands placed on mothers in a controlled laboratory situation while they monitored their children's performances. 10 23–29 yr old mothers and their 4–8 yr old children participated in concurrent tasks. Whether these stressors were directly related to their children's behaviors or independent of them, heightened stress resulted in increases in punitiveness toward the children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of current psychiatric disorder to functional disability and distress in patients with inflammatory bowel disease

Although prior theories about psychiatric disorders causing inflammatory bowel disease (IBD) have largely been discredited, these same disorders have at times been associated with functional gastrointestinal symptoms such as those found in irritable bowel syndrome. Since functional gastrointestinal symptoms can also occur in patients with organic pathology, we hypothesized that a current psychiatric disorder might amplify or produce additional gastrointestinal symptoms in patients with organic gastrointestinal diseases such as IBD, leading to additive functional disability and decreased quality of life. This pilot study evaluated a sequential sample of 40 IBD patients using the NIMH Diagnostic Interview Schedule, structured interviews for functional gastrointestinal symptoms, and prior episodes of emotional, physical, and sexual abuse as well as self-report measures of personality and disability. We compared IBD patients with and without a current psychiatric disorder while controlling for disease severity. Eight patients with major depression were treated with antidepressants. Patients with a current psychiatric disorder had significantly higher 1) mean number of lifetime psychiatric diagnoses, 2) prevalence rates of prior sexual and physical victimization, and, 3) mean numbers of both gastrointestinal and other medically unexplained symptoms despite no differences in severity of IBD. Significant and trend level differences were apparent on several measures of functional disability. A regression analysis showed that number of psychiatric diagnoses, number of functional gastrointestinal symptoms, and dissociation scale scores significantly discriminated the groups. Treatment of current major depression decreased functional disability despite no objective changes in gastrointestinal disease severity. It was concluded that the presence of a current psychiatric disorder appears to alter the perception of disease severity in patients with IBD. Nonrecognition of the psychiatric disorder may lead to unnecessary and aggressive interventions for IBD patients such as medication changes, invasive testing, or surgery. The presence of a current psychiatric illness also appears to be associated with increased functional disability. Psychiatric evaluation and treatment, therefore, have an important role in the ongoing management of IBD patients with distressing gastrointestinal symptoms not directly attributable to their IBD.     

Early and long-term effects of child sexual abuse: An update.

New research on the impact of child sexual abuse generally confirms the conclusions of an earlier review article by A. Browne and D. Finkelhor (see record 1986-14683-001) and extends findings into a few new areas. For example, more studies are now available concerning the impact of abuse on boys, but they have not found consistent gender differences. Some longitudinal studies have also been completed; they show a decline in symptomatology in the months following disclosure. Two areas of controversy are also prominent. One concerns how to explain the relatively substantial percentages of sexually abused children in most studies who have no symptoms on current diagnostic measures. The second concerns whether posttraumatic stress disorder is a useful conceptual framework for understanding the findings on the impact of sexual abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of attention problems on depression: Developmental, academic, and cognitive pathways.

The present study investigated developmental pathways between inattention and depression, particularly the roles of school maladjustment and child cognitions. Additionally, a measure of conduct problems was included in all analyses to test competing theories about the emergence of depressive symptoms. Results supported the hypothesized path models from inattention to depression for younger and older children. Consistent with developmental theories, only an environmental variable, school maladjustment, was needed to explain the relationship between inattention and depression for the younger group (under 8 years old). For children in the middle group (8-9 years old), school maladjustment continued to uniquely account for part of the path to child depressive symptoms, but a cognitive variable, control-related beliefs, emerged as a significant mediator as well. For older children (10 years and older), control-related beliefs fully mediated the effects of school maladjustment on depressive symptoms. The hypothesized paths from conduct problems to depression, however, were not supported. Implications for designing interventions and prevention strategies for children with inattention and conduct problems are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interactional correlates of treatment outcome in behavioral parent training.

52 21–38 yr old mothers and their 2–11 yr old children took part in a behavioral parent-training program to modify aggressive and oppositional child behavior. Several measures of mother–child interaction were obtained for each dyad at baseline, treatment, and follow-up. Measures included sociodemographic variables and home observations. After 1-yr follow-up, measures were compared between dyads who succeeded in the program and dyads who did not. Results show that: (1) unsuccessful mothers were more aversive and indiscriminate in their use of aversive behavior toward their children than successful mothers in all phases; (2) unsuccessful children were more aversive than successful children, but only in treatment and follow-up; and (3) all children evidenced some degree of indiscriminate aversive responding. The majority of unsuccessful dyads scored high on several measures of socioeconomic disadvantage, suggesting that such interactional differences might provide a link to account in part for the impact of adverse socioeconomic factors on mother–child interaction. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of parental maltreatment on children's conceptions of interpersonal relationships.

39 maltreated and 60 nonmaltreated Black 6–14 yr olds from lower income families told stories about kind or unkind initiatives from child to child, adult to child, or child to adult and then told what the recipient would do next. In contrast to their nonmaltreated counterparts, maltreated 6–8 yr olds told more stories in which children reciprocated the kind acts of adults and fewer stories in which adults or peers reciprocated the kind acts of children. Maltreated Ss of all ages justified their parents' unkind acts on the basis of their own bad behavior. Developmental trends in story content and story context measures differed for maltreated boys and girls; boys showed less development toward mature interpersonal peer relations. Findings suggest that the modes of adaptation used by abused and neglected children may be cognitively and emotionally similar. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)