Lucy Berliner

Child Sexual Behavior Inventory: normative, psychiatric, and sexual abuse comparisons

A normative sample of 1,114 children was contrasted with a sample of 620 sexually abused children and 577 psychiatric outpatients on the Child Sexual Behavior Inventory (CSBI), a 38-item behavior checklist assessing sexual behavior in children 2 to 12 years old. The CSBI total score and each individual item differed significantly between the three groups after controlling for age, sex, maternal education, and family income. Sexually abused children exhibited a greater frequency of sexual behaviors than either the normative or psychiatric outpatient samples. Test-retest reliability and interitem correlation were satisfactory. Sexual behavior problems were related to other generic behavior problems. This contributed to the reduced discrimination between psychiatric outpatients and sexually abused children when compared to the normative/sexually abused discrimination.

Treatment for 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 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.

Trauma-Focused Cognitive Behavioral Therapy for Children and Adolescents An Empirical Update

This article reviews the four major components of trauma-focused cognitive behavioral therapy (CBT) for children and adolescents: exposure, cognitive processing and reframing, stress management, and parental treatment. For each component, background, description, and the current empirical support for including each of these components in the treatment of traumatized children is presented. Although there is growing empirical support for the efficacy of traumafocused CBT in decreasing psychological symptomatology, there are inadequate data to indicate the relative contribution of the individual CBT components. Suggestions for future clinical and research directions are also discussed.

The Effects of Disclosure and Intervention on Sexually Abused Children.

There has been concern that disclosure and intervention might negatively impact victims of sexual abuse. In this retrospective study, 82 children and their families were interviewed about their experiences with disclosure and intervention an average of 3.5 years later. The children and parents completed a measure of distress developed for the study which discriminated between abused and non-abused children. The children reported primarily favorable experiences and provided clinically helpful descriptions of the positive and negative aspects of intervention. More contacts with intervention professionals was associated with increased distress, placement, offender removal and testifying were not. Based on the childrens comments, suggestions for improving the intervention process are made.

The process of victimization: the victims' perspective

Twenty-three child victims (aged 10-18 years) of childhood sexual abuse were interviewed about the victimization process, the person who abused them, and how abuse might have been prevented. Specific questions obtained information about the quality of the relationship between victim and offender, the offenders pre-abuse behavior, the explanation for the behavior given by the offender, and the childs understanding of the behavior. Results suggest that the victimization process involves three overlapping processes: sexualization of the relationship, justification of the sexual contact, and maintenance of the childs cooperation.

Report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems:

Although the term attachment disorder is ambiguous, attachment therapies are increasingly used with children who are maltreated, particularly those in foster care or adoptive homes. Some children described as having attachment disorders show extreme disturbances. The needs of these children and their caretakers are real. How to meet their needs is less clear. A number of attachment-based treatment and parenting approaches purport to help children described as attachment disordered. Attachment therapy is a young and diverse field, and the benefits and risks of many treatments remain scientifically undetermined. Controversies have arisen about potentially harmful attachment therapy techniques used by a subset of attachment therapists. In this report, the Task Force reviews the controversy and makes recommendations for assessment, treatment, and practices. The report reflects American Professional Society on the Abuse of Childrens (APSAC) position and also was endorsed by the American Psychological Associations Division 37 and the Division 37 Section on Child Maltreatment.

Treating Fear and Anxiety in Sexually Abused Children: Results of a Controlled 2-Year Follow-Up Study

Fear and anxiety are the most commonly reported symptoms in sexually abused children. The purpose of this study was to determine whether the addition of specific interventions designed to reduce fear and anxiety to a standard group treatment program for sexually abused children would result in greater reductions in these symptoms. In this study, 80 children ages 4 to 13 were randomly assigned to 10-week index or comparison treatment groups. Both treatment groups included common elements of conventional sexual abuse treatment, and the index group included stress inoculation training (SIT) and gradual exposure treatment procedures. Children and parents were assessed before treatment, immediately after treatment, and 1 year and 2 years after treatment. As had been hypothesized, both treatment groups improved significantly over time on most outcome measures. However, no differences were found between the groups in improvement on fear and anxiety symptoms. Possible explanations for these results and implications for practice and research are discussed.

Sexual abuse evaluations: Conceptual and empirical obstacles

Evaluating children for possible sexual abuse is widely regarded as a difficult clinical endeavor. Practitioners are concerned with both the basis for professional opinions and the accuracy of their ultimate judgments. Current approaches are critically analyzed for conceptual integrity and empirical support. The authors conclude that improvements in practice will be more productive than efforts to devise a procedure for classification of cases. Implications of this approach and recommendations for further research are discussed.

Report of the ATSA Task Force on Children With Sexual Behavior Problems

The Association for the Treatment of Sexual Abusers (ATSA) Task Force on Children With Sexual Behavior Problems was formed by the ATSA Board of Directors as part of ATSA’s overall mission of promoting effective intervention and management practices for individuals who have engaged in abusive sexual behavior. The task force was charged to produce a report intended to guide professional practices with children, ages 12 and younger. Specifically, the task force was asked to address how assessment should be linked to intervention activities, what intervention models or components are most effective, and the role of family involvement in Report of the ATSA Task Force on Children With Sexual Behavior Problems

Treating the Effects of Sexual Abuse on Children

Effects of child sexual abuse are conceptualized as the result of conditioned anxiety and as socially learned responses to the victimization experience. This conceptualization is used to link existing psychological theory and research to therapeutic interventions. Strategies are proposed to alleviate anxiety, modify maladaptive beliefs and cognitions, restore or instate expectations of self-efficacy, and mitigate disturbed sexual attitudes or behaviors.