R. Kim Oates

Stability and Change in Outcomes for Sexually Abused Children

OBJECTIVE To evaluate sexually abused children and their families at intake and 18 months later, in comparison with a control group. METHODS Eighty-four sexually abused children aged 5 to 15 years were assessed at intake, with 64 being able to be reassessed at 18 months, the assessment using measures of self-esteem relevant to their age; the Childrens Depression Inventory, and the Achenbach Child Behavior Checklist. Parents were assessed with the McMaster Family Assessment Device and the General Health Questionnaire. Control children and families were similarly assessed. Additional measures at follow-up were a structured interview with the parents, the Indices of Coping Responses, and the Newcastle Child and Family Life Events Schedule. Therapists were contacted to obtain information on type and duration of therapy. RESULTS While the control childrens self-esteem, depression, and behavior scores showed little change over time, the abused childrens scores were more likely to move toward the normal range although 56% remained in the dysfunctional range for self-esteem, 48% for behavior, and 35% for depression. Improvement in child behavior was related to improvement in family function. While there was no direct relationship between child outcome and the relationship of the abuser to the child, family dysfunction, which was related to child outcome, did correlate with the closeness of the abuser to the child. Sixty-five percent of abused children had received therapy for an average of 9 months. No relationship was found between therapy and outcome. CONCLUSIONS The major variable relating to improvement in sexually abused children appears to be adequacy of family functioning. There is a need for increased emphasis on the evaluation of treatment.

Five Years After Child Sexual Abuse: Persisting Dysfunction and Problems of Prediction

OBJECTIVE To assess change in behavior, depression, and self-esteem in sexually abused children after 5 years and to determine which factors predict later functioning. METHOD Sixty-eight of 84 children and their nonoffending parents were reassessed after 5 years for depression, self-esteem, and behavior problems in the children; parental mental health; and family functioning. RESULTS There were no significant changes in depression, self-esteem, or behavior over 5 years. Forty-three percent of the children were now sad or depressed, 43% had low self-esteem, and 46% had behavioral dysfunction. While some children improved, a nearly equal number deteriorated, with no clear pattern of change. The only abuse-related variables associated with 5-year functioning were further contact with the abuser, which was significantly associated with depression and self-esteem, and sexual abuse prior to intake, which was related to an increased incidence of behavior problems. Older children showed more depression and lower self-esteem but less behavioral dysfunction. Poor family functioning at 5 years was associated with low self-esteem and behavior problems. Treatment had no effect on depression, self-esteem, or behavior. Multivariate analysis showed that depression and self-esteem at intake were prognostic indicators of 5-year outcome. CONCLUSION Many sexually abused children have continuing problems with behavior, self-esteem, and depression. Family and abuse-related variables do not appear to be good predictors of outcome, although sexually abused children who are sad or depressed and have low self-esteem at intake are likely to have continuing problems in these areas.

What have we learned about treating child physical abuse? A literature review of the last decade

A literature review of articles on treatment of physically abused children and treatment of physically abused parents was undertaken. Only articles that had more than five subjects in the sample, at least 15% of the children in the sample having been physically abused and either pretest, posttest; comparison group; or randomization between different treatments used in the design were selected. Twelve papers meeting these criteria for abusive parents and 13 for treatment of abused children were found. Treatment duration ranged from 4 weeks to 12 months for parents and 4 weeks to 24 months for children. A wide range of treatments were used, the most popular for children being therapeutic daycare, with emphasis on improving developmental skills. While most programs showed some improvement with treatment, many had no, or very short, follow-up to see if improvement was sustained. More emphasis needs to be placed on rigorous evaluation and longer-term follow-up of children in physical abuse treatment programs.

Suicide Risk Following Child Sexual Abuse

OBJECTIVE To determine the suicide rate and prevalence of suicide attempts and suicidal ideation in 183 young people who had experienced child sexual abuse and to examine variables related to the abuse, which may correlate with suicide attempts or suicidal ideation. METHODS Adolescents and young adults who had experienced child sexual abuse and individuals from a nonabused comparison group were asked about suicide attempts and suicidal ideation 5 and 9 years after intake to the study. Nine years after the abuse, a national death search was carried out to ascertain the number and causes of death in the 2 groups. Logistic regression was used to assess information on demographic and family functioning variables, the sexual abuse, notifications for other child abuse, criminal convictions, and out-of-home placements that were related to the outcome variables. RESULTS Young people who had experienced child sexual abuse had a suicide rate that was 10.7 to 13.0 times the national Australian rates. There were no suicides in the control group. Thirty-two percent of the abused children had attempted suicide, and 43% had thought about suicide since they were sexually abused. CONCLUSIONS Little information seems to be available to clinicians at the time of investigations for child sexual abuse in children that may identify those who are at increased risk of suicide. Abuse by an acquaintance, parental denial, or being angry with the child and not the abuser may predispose to suicide attempts but not necessarily to a completed suicide.

Subdural Hematomas in Children under 2 Years. Accidental or Inflicted? A 10-Year Experience.

OBJECTIVE The aim of this study was to determine the relative frequency of child abuse, accidents and disease as a cause of subdural hematomas in children under 2 years of age, and to determine the main clinical features at presentation, that may help to distinguish these groups of patients. METHOD A retrospective review was undertaken of the medical records of all children under 2 years of age admitted to the Royal Alexandra Hospital for Children with the diagnosis of subdural hematoma in the 10-year period January 1987 to December 1996. RESULTS Thirty eight children were identified with subdural hematomas during the study period. The commonest cause was nonaccidental injury in 55% of cases, accidents in 39% and nontraumatic causes (6%) made up the remainder. The nonaccidental injury cases were significantly younger than the accidentally injured children. The most important clinical features were the significantly higher incidence of retinal hemorrhages and associated long bone and rib fractures in the abuse group. Delay in presentation for medical evaluation was also more commonly seen in the abused children. CONCLUSION Nonaccidental injury is the commonest cause of subdural hematomas in children under 2 years of age. The presence of retinal hemorrhages, bone and rib fractures, delay in presentation and the young age of the infants, suggests child abuse is the most likely cause of these injuries.

The Process of Attrition in Child Sexual Assault Cases: A Case Flow Analysis of Criminal Investigations and Prosecutions

Abstract As part of a prospective study which tracked 183 child sexual abuse cases referred to two Child Protection Units in Sydney, NSW, a search of court records was conducted to obtain criminal justice outcomes. Of the 183 cases, there were 117 cases where the name of the offender was known. Forty-five cases reached trial. Thirty-two cases resulted in a conviction. A sub-cohort of 84 of the children and their families was interviewed in detail to determine reasons why many cases did not proceed down the track of criminal investigation and prosecution and why other cases dropped out of the criminal justice system. Among this sub-cohort of 84 children, there were 67 cases where the offender was identifiable and could have been charged. There were 25 convictions. Reasons for not proceeding to trial included: the offence was not reported to police; parents wished to protect children, the perpetrator or other family members; evidence was not strong enough to warrant proceeding; the child was too young; the offender threatened the family; or the child was too distressed. The implications for criminal prosecution as a child protection strategy are considered in the light of this evidence of attrition.

Child Sexual Abuse in the Anglican Church of Australia

This article reports on a retrospective study of cases of child sexual abuse complaints made against clergy, other employed pastoral staff, and volunteers in the Anglican Church of Australia between 1990 and 2008. There were 191 allegations of sexual abuse made by 180 complainants against 135 individuals. Twenty-seven of those 135 had more than one complaint made against them. Three-quarters of all complainants were male. The most likely explanation for the large proportion of abused males is that the church gives many more opportunities for abusers to be alone with boys than with girls. Prevention strategies need to focus on reducing the opportunities for abuse to occur as well strategies concerning the recruitment of professional staff and volunteers.

Teaching children about skin cancer prevention: why wait for adolescence?

Abstract: The baseline knowledge about skin cancer prevention of 983 children aged 8 to 12 years was assessed by a pretest questionnaire. After the pretest, half were given a formal presentation about skin cancer prevention. The other half participated in an informal, question–and–answer session, which covered all material from the formal presentation. Two weeks later, all students completed an identical post–test. The students had a high baseline level of knowledge about skin cancer prevention. Knowledge increased for most items in the post–test questionnaire. In all age groups there was no difference in results between the formal and interactive teaching sessions, except among eight–year–olds, for whom the formal presentation was more effective. As much solar skin damage occurs before adolescence, the younger age group is the important target for skin cancer prevention programs. (Aust N Z J Public Health 1997; 21: 602–5)

Sport and recreation activities and opportunities for children with spina bifida and cystic fibrosis.

A survey, completed by 69 parents whose children have cystic fibrosis and 97 parents of children with spina bifida, showed that opportunities for participation in sport and recreation activities were significantly greater for children with cystic fibrosis than for children with spina bifida. Parents from both groups felt that there was not enough variety available, that there was difficulty finding suitable activities which involved the whole family and that they had found barriers to their child participating in sport and recreation activities. The stresses of having a child with a significant disability and trying to balance the needs of these children with those of other non-affected family members was reflected by the finding that both groups of parents had double the rate of psychological health problems that would be expected in the population.

Nonsex Offences Committed by Child Molesters: Findings From a Longitudinal Study

This study, which used a prospective as well as a retrospective methodology, examined the criminal records of 30 child molesters prior to, and up to 10 years after an index event of sexual abuse for which they were convicted: 73% had convictions for other offences, 60% had convictions for offences other than sex offences, 50% had convictions for property offences, 27% had convictions for offences involving violence, and 23% had convictions for drug offences. Offending levels for nonsex offences were significantly higher than the general adult male population. Any theory concerning the dynamics of sex offending against children needs to account for the level of nonsex offences committed by child molesters.