Carl Göran Svedin

Child sexual abuse is largely hidden from the adult society An epidemiological study of adolescents' disclosures.

OBJECTIVES The aim of this study was to investigate disclosure rates and disclosure patterns and to examine predictors of non-disclosure in a sample of male and female adolescents with self-reported experiences of sexual abuse. METHOD A sample of 4,339 high school seniors (2,324 girls, 2,015 boys) was examined with a questionnaire concerning sexual experiences in this study with a focus on disclosure of sexual abuse (non-contact, contact or penetrating abuse, and including peer abuse). RESULTS Of the sample, 1,505 girls (65%) and 457 boys (23%) reported experience of sexual abuse. The disclosure rate was 81% (girls) and 69% (boys). Girls and boys disclosed most often to a friend of their own age. Few had disclosed to professionals. Even fewer said that the incident had been reported to the authorities. Logistic regression showed that it was less likely for girls to disclose if they had experienced contact sexual abuse with or without penetration, abuse by a family member, only a single abuse occasion or if they had perceived their parents as non-caring. Boys were less likely to disclose if they studied a vocational program, lived with both parents or had perceived their parents as either caring and overprotective or non-caring and not overprotective. CONCLUSIONS Disclosing sexual abuse is a complex process. Much is hidden from the adult society, especially from professionals and the legal system. Since peers are the most common receivers of abuse information, programs for supporting peers ought to be developed. Differences in disclosure patterns for girls and boys indicate that a gender perspective is helpful when developing guidelines for professionals. PRACTICE IMPLICATIONS Professionals, especially in the school system, need to be more aware of the finding that few sexually abused children seek help from professionals or other adults and that support offers should be directly addressed not only to the vulnerable young persons themselves but also to peers who wish to help a friend.

Child physical abuse and concurrence of other types of child abuse in Sweden—Associations with health and risk behaviors

OBJECTIVE To examine the associations between child physical abuse executed by a parent or caretaker and self-rated health problems/risk-taking behaviors among teenagers. Further to evaluate concurrence of other types of abuse and how these alone and in addition to child physical abuse were associated with bad health status and risk-taking behaviors. METHODS A population-based survey was carried out in 2008 among all the pupils in 2 different grades (15 respectively 17 years old) in Södermanland County, Sweden (n=7,262). The response rate was 81.8%. The pupils were asked among other things about their exposure to child physical abuse, exposure to parental intimate violence, bullying, and exposure to being forced to engage in sexual acts. Adjusted analyses were conducted to estimate associations between exposure and ill-health/risk-taking behaviors. RESULTS Child physical abuse was associated with poor health and risk-taking behaviors with adjusted odds ratios (OR) ranging from 1.6 to 6.2. The associations were stronger when the pupils reported repeated abuse with OR ranging from 2.0 to 13.2. Also experiencing parental intimate partner violence, bullying and being forced to engage in sexual acts was associated with poor health and risk-taking behaviors with the same graded relationship to repeated abuse. Finally there was a cumulative effect of multiple abuse in the form of being exposed to child physical abuse plus other types of abuse and the associations increased with the number of concurrent abuse. CONCLUSIONS This study provides strong indications that child abuse is a serious public health problem based on the clear links seen between abuse and poor health and behavioral problems. Consistent with other studies showing a graded relationship between experiences of abuse and poor health/risk-taking behaviors our study shows poorer outcomes for repeated and multiple abuse. Thus, our study calls for improvement of methods of comprehensive assessments, interventions and treatment in all settings where professionals meet young people.

Prevalence and characteristics of child physical abuse in Sweden - findings from a population-based youth survey.

Aim:  To examine prevalence rates of child physical abuse perpetrated by a parent/caretaker, abuse characteristics and the extent of disclosures.

The psychometric properties of the Trauma Symptom Checklist For Children (TSCC) in a sample of Swedish children

OBJECTIVE To evaluate the psychometric properties of the Swedish version of the Trauma Symptom Checklist for Children (TSCC) and to study traumatic symptoms in a normative group of Swedish children and adolescents. METHOD A normative group of 728 children and adolescents age 10-17 and a clinical group of 91 children and adolescents known to have experienced sexual abuse participated in the study. A test-retest procedure was conducted with 79 participants from the normative group. RESULTS Good reliability such as internal consistency (Cronbachs alpha) for the total scale .94 (ranging in the clinical scales .78-.83) and test-retest for the total scale r=.81 (ranging in the clinical scales .67-.81) were found. The confirmatory 6-factor analysis explained 50.7% of the variance. Other validity measures such as concurrent validity and criterion related validity were also shown to be satisfactory. The normative sample of Swedish children and adolescents showed lower means on the subscales than has been reported in previous studies from a number of other countries. CONCLUSION The Swedish version of TSCC has been shown to be a screening instrument with satisfactory psychometric qualities that is capable to identify trauma symptoms among children and adolescents who have themselves self-reported experiencing trauma or for whom clinicians have identified traumatic experiences.

Sexually Coercive Behavior in Male Youth: Population Survey of General and Specific Risk Factors

Little is known about risk/protective factors for sexually coercive behavior in general population youth. We used a Swedish school-based population survey of sexual attitudes and experiences (response rate 77%) and investigated literature-based variables across sexually coercive (SEX), non-sexual conduct problem (CP), and normal control (NC) participants to identify general and specific risk/protective factors for sexual coercion. Among 1,933 male youth, 101 (5.2%) reported sexual coercion (ever talked or forced somebody into genital, oral, or anal sex) (SEX), 132 (6.8%) were classified as CP, and the remaining 1,700 (87.9%) as NC. Of 29 tested variables, 25 were more common in both SEX and CP compared to NC youth, including minority ethnicity, separated parents, vocational study program, risk-taking, aggressiveness, depressive symptoms, substance abuse, sexual victimization, extensive sexual experiences, and sexual preoccupation. When compared to CP youth only, SEX youth more often followed academic study programs, used less drugs and were less risk-taking. Further, SEX more frequently than CP youth reported gender stereotypic and pro-rape attitudes, sexual preoccupation, prostitution, and friends using violent porn. Finally, in a multivariate logistic regression, academic study program, pro-rape attitudes, sexual preoccupation, and less risk-taking independently remained more strongly associated with SEX compared to CP offending. In conclusion, several sociodemographic, family, and individual risk/protective factors were common to non-sexual and sexually coercive antisocial behavior in late adolescence. However, pro-rape cognitions, and sexual preoccupation, were sexuality-related, specific risk factors. The findings could inform preventive efforts and the assessment and treatment of sexually coercive male youth.

Sexual Coercion Experience and Sexually Coercive Behavior: A Population Study of Swedish and Norwegian Male Youth

The authors tested the hypothesis that experiencing sexual coercion and engaging in sexually coercive behavior are positively associated in a representative sample totaling almost 4,000 Swedish or Norwegian male high school students (estimated response rate 80%). In both surveys, youths who had experienced sexual coercion were approximately three times more likely to engage in sexually coercive behavior than those without such experience (10%—12% vs. 4%). The association between sexual coercion experience and sexually coercive behavior was attenuated but remained significant and moderately strong in both surveys when controlling for nonsexual antisocial behavior, substance use, and noncoercive sexual behavior in multivariate logistic regression models. The population attributable fraction (proportion of sexually coercive behavior that can be explained by sexual coercion experience) was 18%—25%. The findings support a robust link between having been sexually coerced and engaging in coercive sexual behavior in the general population.

Social Anxiety Disorder and Victimization in a Community Sample of Adolescents.

Despite high prevalence rates of social anxiety disorder (SAD) and high rates of victimization in adolescents, studies on the relationship between these phenomena are missing. In the present study we report associations between SAD and multiple victimization experiences in a community sample of adolescents. A cross-sectional study was conducted on 3211 Swedish high-school students. The prevalence rate of self-reported SAD was 10.6% (n=340). Significantly higher rates of lifetime victimization was found in subjects with self-reported SAD compared to non-cases, on the total score on the Juvenile Victimization Questionnaire, and on the subscales maltreatment, sexual victimization and victimization from peer/siblings. Different results emerged due to gender. In females, maltreatment and peer/sibling victimization was associated with an increased risk of SAD and, in males peer/sibling victimization increased the risk of reporting SAD. Further studies are needed to elaborate developmental models on SAD and to add to modification of prevention- and treatment interventions.

Differences and similarities in sexual behaviour among pre-schoolers in Sweden and USA

Studies of childhood sexual behaviour in a cross-cultural perspective are important in that they increase our knowledge of normative behaviour in general and enhance our understanding of cultural influences on child sexual development. Two studies, one from Sweden (n=185) and one from Minnesota, USA (n=467) of 3-6 year old children, were assessed with a 25-item scale derived from the Child Sexual Behaviour Inventory. Both studies were screened for the absence of sexual abuse. The Swedish parents completed the questionnaire about their childs behaviour at home and the US parents typically completed the questionnaire in the waiting room of a paediatric clinic. Pre-school children in Sweden exhibited more sexual behaviour than American children of the same age according to parental reports. These differences were most pronounced in boys. In both studies exhibitionistic or voyeuristic behaviour and touching behaviour was most frequent. Both intrusive and sexually explicit behaviour was very unusual. The results reflect how cultural context influences which behaviour is permitted in young children, and consequently what adults think constitutes normal and problematic childhood sexual behaviour.

Prevalence, Characteristics, and Associations of Sexual Abuse with Sociodemographics and Consensual Sex in a Population-Based Sample of Swedish Adolescents

The purpose of this study was to investigate lifetime prevalence and characteristics of self-reported child sexual abuse and associations between child sexual abuse, gender, sociodemographic data, and consensual sexual experiences. A questionnaire was completed by 4,339 Swedish high school seniors. Three categories of child sexual abuse were studied: noncontact, contact without penetration, and penetrating child sexual abuse. Penetrating child sexual abuse was correlated with the most severe abuse characteristics. Students reporting child sexual abuse, especially penetrating child sexual abuse, were more likely to not be living with both parents, to have parents with lower socioeconomic status, and to have their first consensual intercourse at a young age. The study showed that distinct categories of child sexual abuse must be employed since each category shows a specific pattern concerning abuse characteristics, sociodemographics, and consensual sex.

The strengths and difficulties questionnaire as a screening instrument in a community sample of high school seniors in Sweden

The Strengths and Difficulties Questionnaire (SDQ) has been used among Swedish children since 1996, usually the parent or the teacher version. The self-report version was originally developed for children aged 11–16 years. The aim of this study was to investigate the application of the Swedish self-report version to a representative sample of 1015 senior high school students aged 17–19 years. Girls reported more emotional symptoms and scored higher on prosocial items than boys. Boys on the other hand scored higher on both conduct and peer problems. The means were similar to means in two Nordic studies that have included subjects of this age group. A confirmatory five-factor analyses explained 44.5% of the variance with a good fit for all subjects and boys but somewhat weaker for girls. The item-subscale correlation (ISC) ranged from moderate to high (r=0.47–0.76) and the Cronbachs alpha was 0.74 (ranging in the five subscales 0.50–0.70). The SDQ seems to be useful even in this older age group. The psychometric qualities were acceptable but can probably be improved by changing the oppositely worded questions and by considering development of different questionnaires for boys and girls at least in late adolescence.