Mary Fran Flood

Understanding Child Sexual Behavior Problems: A Developmental Psychopathology Framework

Children exhibiting sexual behavior have increasingly gained the attention of child welfare and mental health systems, as well as the scientific community. While a heterogeneous group, children with sexual behavior problems consistently demonstrate a number of problems related to adjustment and overall development. In order to appropriately intervene with these children, a comprehensive understanding of etiology is imperative. The overarching goal of the present paper is to review the extant research on mechanisms associated with the development of problematic sexual behavior in childhood within a developmental psychopathology framework. What is known about normative and nonnormative sexual behavior in childhood is reviewed, highlighting definitional challenges and age-related developmental differences. Further, the relationship between child sexual abuse and child sexual behavior problems is discussed, drawing attention to factors impacting this relationship. Risk factors for child sexual behavior problems, beyond that of sexual abuse, are also reviewed utilizing a transactional-ecological framework. Finally, we conclude with a discussion of implications of a developmental psychopathology perspective on problematic child sexual behaviors to inform future research and intervention efforts. Such implications include the need for attention to normative childhood sexual behavior, developmental sensitivity, and examinations of ecological domain in concert.

Early Childhood Intervention Programs: Opportunities and Challenges for Preventing Child Maltreatment

Due to the destructive impact of child maltreatment and limited available funding to address its consequences, the value of preventive measures is evident. Early Childhood Intervention Programs (ECIPs) provide excellent opportunities to prevent and identify cases of child maltreatment, among other varied objectives. These programs are typically targeted at high-risk families with children under age 5 and address risk factors across various levels of intervention (child, parent, immediate context, and broader context). A sample of ECIPs within home, school, clinic, and community settings were selected for description in this paper if they include services that address common child maltreatment risk factors, demonstrated reductions in risk factors through outcome research, and provide valuable lessons for preventing child maltreatment. Challenges to preventing child maltreatment through ECIPs are discussed, including unreliable identification of high-risk families, lack of involvement of low-income and minority parents, and barriers to effective dissemination and implementation of programs. Recommendations for future research and improving child maltreatment prevention through ECIPs are provided.

Weekly Problems Scales: Instruments for Sexually Abused Youth and Their Nonoffending Parents in Treatment

This studys purpose was to determine if efficient measures could be created to assess multiple problematic behaviors identified in youth who were sexually abused and in treatment. Because of the lack of easily administered brief instruments that assess multiple domains of interest in this population, complementary parent and child assessment measures were developed. The Weekly Problems Scale–Child Version (WPSC) and the Weekly Problems Scale–Parent Version (WPS-P) were created to monitor the weekly progress of the child and family in treatment and focus specifically on common areas of difficulties in this population. Exploratory factor analysis was conducted to assist in identifying the number of underlying dimensions in the scales. Results indicate that the WPS-C and WPS-P demonstrate adequate internal consistency, temporal stability, and construct validity. The WPS-C and WPSP display significant promise as research and clinical assessment tools for use with youth who are sexually abused and their nonoffending parents in treatment.

Child advocacy center based group treatment for child sexual abuse.

The present study examines initial symptom presentation among participants, outcomes, and social validity for a group treatment for child sexual abuse delivered at a child advocacy center. Participants were 97 children and their nonoffending caregivers who were referred to Project SAFE (Sexual Abuse Family Education), a standardized, 12-week cognitive-behavioral group treatment for families who have experienced child sexual abuse. Sixty-four percent of children presented with clinically significant symptoms on at least one measure with established clinical cutoffs. Caregivers of children who presented with clinically significant symptoms reported more distress about their competence as caregivers. Children who presented as subclinical were more likely to have experienced intrafamilial sexual abuse. Posttreatment results indicated significant improvements in functioning for all children who participated in treatment, with greater improvements reported for children who initially presented with clinically significant symptoms. Overall, the program was rated favorably on the posttreatment evaluation of social validity.

Social Skills Interventions

The term “social skills” encompasses an array of learned behaviors that share the common goal of maintaining or increasing reinforcement within a social context. Deficits in social skills can occur at any developmental period and are not likely to improve spontaneously because impaired social skills impede interactions with other people. In turn, unsatisfying or disruptive interactions exacerbate social skill deficits by preventing the refinement of existing skills and limiting the acquisition of new ones (Hansen, Giacoletti, & Nangle, 1995; Kelly, 1982). Given the importance of functioning effectively within a social context, the amelioration of social skills deficits is sometimes an independent treatment goal. More often, the improvement of social skills is one component of the treatment plan for a variety of psychological disorders (see Campbell, Hansen, & Nangle, this volume).

Epidemiology of Child and Adolescent Sexual Abuse

Child welfare professionals from clinical science and legal disciplines have worked to improve knowledge about the scope of child sexual abuse since its recognition as a widespread societal problem. Research over the past few decades provides insight into the incidence of child sexual abuse, as well as a starting point for understanding risk factors and abuse sequelae. There are still major issues preventing an accurate epidemiological understanding of the issue, however. The current chapter reviews definitions of child sexual abuse generated by legal entities, researchers, and clinicians, and considers the implications of differences among them for an accurate epidemiology. National and international reports offer estimates of the incidence and prevalence of child sexual abuse and are used to outline victim and abuse characteristics. The chapter notes issues raised by delayed and avoided disclosure, and briefly addresses information about false allegations. Finally, outcomes associated with the experience of child sexual abuse are summarized.

Sexually and Physically Abused Children

Child physical abuse (CPA) and child sexual abuse (CSA), although not psychiatric disorders, are prevalent and stressful life events that often result in the need for mental health interviewing services. The US Department of Health and Human Services (2008) recorded 142,041 cases of CPA and 78,120 cases of CSA reported to Child Protective Services (CPS) in the United States in 2006. These data are probably an underestimation, as many incidents of child abuse are not reported. Multiple factors, including the child’s developmental level, race, ethnicity, abuse severity, and relationship with the perpetrator influence whether the abuse is disclosed (Hanson et al., 2003; Paine & Hansen, 2002). However, disclosure does not necessarily mean that the abuse is reported. For example, a national survey of adolescents found that 65% of physical abuse cases and 86% of sexual abuse cases experienced by the adolescents surveyed were never reported to authorities (Kilpatrick, Saunders, & Smith, 2003).

Cognitive-Behavioral Group Treatment for a Sexually Abused Child and a Nonoffending Caregiver: Case Study and Discussion

This study presents the case of 11-year-old Amanda and her mother (Ms. Jones) who completed Project SAFE (Sexual Abuse Family Education), a manualized group treatment for sexually abused children and their nonoffending caregivers. Amanda experienced sexual abuse by her stepfather on multiple occasions over a 4-year period. Prior to treatment, Amanda reported symptoms of anxiety, posttraumatic stress, and fear related to victimization. Ms. Jones also reported clinically significant internalizing problems for Amanda. Ms. Jones presented with stress related to parenting, as well as depression and anxiety. Both Amanda and Ms. Jones completed the entire 12-session protocol. Amanda and Ms. Jones’s progress throughout treatment are described, along with implications of the case and recommendations for clinicians and students. Results support the efficacy of the group modality, the importance of including nonoffending caregivers, and the necessity of broad treatment strategies when treating children who have experienced sexual abuse.

Psychological Distress and Revictimization Risk in Youth Victims of Sexual Abuse

Psychological distress, including depression and anxiety, has been associated with increased risk for sexual revictimization in youth who have experienced child sexual abuse. The present study utilized assessment information from treatment seeking youth with histories of sexual abuse to explore specific risk indicators for revictimization—risk taking, social problems, maladaptive cognitions, and posttraumatic stress—that may be indicated by self-reported distress. The relationship between initial levels of distress and change in symptoms over a 12-week course of treatment was also explored. Participants were 101 youth referred to a child-focused therapeutic group for victims of sexual abuse, 65 youth referred to an adolescent-focused group, and their non-offending caregivers. Results revealed that when combined into a distress score, depression and anxiety were associated with delinquent behaviors, interpersonal difficulties, maladaptive cognitions, and posttraumatic stress symptoms for child and adolescent group participants at presentation to treatment. Children exhibited improvement on measures of interpersonal difficulties, maladaptive cognitions, and self-reported posttraumatic stress disorder (PTSD) symptoms. Adolescents exhibited less change over time, with significant improvement on self-reported social problems and PTSD only. Higher psychological distress was associated with less improvement in regard to negative expectations of abuse impact for child group participants. The findings suggest that distress indicates the presence of specific revictimization risk indicators, helping to identify targetable symptoms for intervention. Therefore, screening for psychological distress after discovery of sexual abuse may help detect youth at higher risk for revictimization and guide treatment.

A protective service system

Abstract This article presents the results of a small scale study of the protective service caseload of a mid-western metropolitan area. The basic characteristics of the caseload match the national picture presented by the American Humane Associations National Study on Child Abuse and Neglect. The present study focused on the degree to which “systematic” vs. “random” forces appear to be at work in the progress of cases through the system. The overall picture is of some systematic efforts to conduct the process of referrals to community agencies but of a great deal of “randomness” in the bureaucratic closing of cases. This is a major area of concern.