Type and timing of mothers' victimization: effects on mothers and children.

OBJECTIVES: There is mounting concern about how mothers' own victimization experiences affect their children. This study examines the effects of mothers' victimization on their own mental health and parenting and on their children's behavior, development, and health. The effects of both timing and type of victimization are assessed. A related objective was to determine if there was a cumulative risk effect produced by victimization during both childhood and adulthood, or both physical and sexual. SETTING: Urban families in an eastern state and urban and rural families in a southern state. PARTICIPANTS: A total of 419 mothers and their children 6 to 7 years old were identified from 2 sites. The eastern sample was recruited in the first 2 years of life from 3 pediatric clinics: 1 for children at high risk for human immunodeficiency virus disease, 1 for children with failure to thrive, and a third providing pediatric primary care. The southern sample was derived from a cohort of children at risk for adverse health or developmental outcomes, plus a systematic sampling of controls, recruited from area hospitals. At age 4, a random sample of children from the original cohort who had been maltreated along with a matched comparison group of nonmaltreated children were selected. RESULTS: In general, mothers victimized during both childhood and adulthood had poorer outcomes than mothers victimized during either childhood/adolescence or adulthood who in turn had worse outcomes than mothers with no history of victimization. This manifested as more maternal depressive symptoms, harsher parenting, and more externalizing and internalizing behavior problems in their children. There were no significant differences in maternal functioning or child outcomes between those abused in childhood and those abused in adulthood. These findings were similar for type of victimization. Mothers' depression and harsh parenting were directly associated with their children's internalizing and externalizing behavior problems. CONCLUSIONS: Maternal victimization appears to be a highly prevalent problem in high-risk samples and is associated with harmful implications for mental health and parenting, as well as for the offspring. Pediatricians need to consider past and current victimization of mothers. Routine screening for these problems, followed by appropriate evaluation and intervention may reduce maternal depression, improve parenting, and reduce the incidence of behavior problems in children.

Investigative interviews of alleged sexual abuse victims with and without anatomical dolls.

Verbal and nonverbal responses by alleged victims of child sexual abuse were coded for length, amount of information, and the manner in which they were elicited by the interviewer. In 16 of the interviews, anatomical dolls were employed for the purposes of demonstration, whereas they were not used in another eight cases matched with respect to other characteristics of the children and the alleged events. Children interviewed with dolls provided an equivalent number of details and spoke as many words in the substantive portion of the interview as did children interviewed without dolls, and interviewers in the two groups used similar probes to elicit information. However, the average responses by the children were significantly longer and more detailed when dolls were not used. Children gave longer and more detailed responses to open-ended invitations when dolls were not used. Caution is necessary when interpreting these findings.

The Intervention Stressors Inventory: a measure of the stress of intervention for sexually abused children.

This paper describes the development and initial validation of the Intervention Stressors Inventory (ISI), a new scale designed to measure the level of stress sexually abused children experience as a result of societal intervention. Estimates of the relative stress level of various interventions were obtained from 98 professionals; a police interview was the designated anchor with a score of 50 points. Resulting scores from the survey included 35 points for social worker interview, 100 points for placement in foster care, and 111 points for testimony in criminal court. Factors that could potentially modify the stress of any given event were also considered. Interviews with 254 sexually abused children and their parents, 9 months after their cases were reported, provided an opportunity to examine the validity of the instrument. Weighted scores for each child were generated based on their experiences. Validity was supported by higher scores for older children, varying patterns of scores in different jurisdictions and a decline in scores over the one-year period in which jurisdictions were actively seeking to reduce the intrusiveness of intervention. Early results suggest that the ISI is useful as a research tool and as a guide in our efforts to reduce the trauma of intervention.

Putting the anatomical doll controversy in perspective: an examination of the major uses and criticisms of the dolls in child sexual abuse evaluations.

Through an extensive review of guidelines and protocols on the use of anatomical dolls in sexual abuse evaluations, seven functional uses of the dolls were identified: Comforter, Icebreaker, Anatomical Model, Demonstration Aid, Memory Stimulus, Diagnostic Screen, and Diagnostic Test. These functional uses are discussed in light of several criticisms that have been raised about the use of anatomical dolls in sexual abuse evaluations. The relevancy of these criticisms is shown to vary greatly by doll use. As a result, the authors argue that any critique of anatomical dolls must consider the specific function the dolls serve in the evaluation. Although there seem to be widespread perceptions in both lay and professional circles that young children's behavior with the dolls is commonly used to make definitive diagnoses of sexual abuse (Diagnostic Test Use), such a use of the dolls was not endorsed by any of the guidelines reviewed and is open to significant criticism. The most common criticisms of the dolls, that they are overly suggestive to young, sexually naive children, is not supported by available research. Finally, the continued, informed use of anatomical dolls in sexual abuse evaluations of young children is strongly supported.

Exploration of anatomical dolls by nonreferred preschool-aged children: comparisons by age, gender, race, and socioeconomic status.

The contributions of age, gender, race, and socioeconomic status (SES) to differences in nonreferred (i.e., presumably nonabused) preschool-aged children's interactions with anatomical dolls were explored. Significant age findings included a decrease with age in manual exploration, an increase in showing doll-to-doll kissing and an increase in demonstrating suggestive intercourse between the dolls. Although 2-year-olds were active in undressing the dolls and exploring the genitals, anus, and breasts, no 2-year-old displayed any sexualized behaviors with the dolls. Six percent (6%) of the children demonstrated clear intercourse positioning. Only low SES black males, ages 4 and 5, demonstrated clear intercourse positioning when the interviewer was present in the room. However, such demonstrations were seen across gender and race and SES when the children were left alone with the dolls. The implications of the findings for evaluators who interview children using anatomical dolls are discussed.

Sexualized doll play among young children: implications for the use of anatomical dolls in sexual abuse evaluations.

The use of anatomical dolls in sexual abuse evaluations remains controversial because of concerns that the dolls induce normal, nonabused children to act out in sexual ways that are likely to be misinterpreted as evidence of sexual abuse. This study examines the incidence of explicit sexual doll play in a large, demographically diverse sample of 2- to 5-year-olds. The 6% incidence of demonstrations of apparent sexual intercourse found in this sample compared favorably with the rate of less than 2% across prior studies of anatomical doll play among presumably nonabused children. However, higher rates of explicit sexual play were associated with being older, poor, black, and somewhat with being male, with over 20% of some subgroups of children displaying such behavior. These results are interpreted as evidence that anatomical dolls are not overly suggestive to young, sexually naive children, but are useful in assessing sexual knowledge and exposure to sexual intercourse.

Determinants of placement for sexually abused children.

While conducting a prospective study of 100 sexually abused children, we found a much higher rate of out-of-home placement than has been previously described for child maltreatment. This study was designed to determine which factors were most influential in predicting the placement experiences of this cohort. The children, ages 6-17 years, were recently substantiated victims of intrafamilial sexual abuse whose parents or guardians permitted study involvement. We examined child and family demographics, abuse characteristics, and family response as possible determinants of immediate and later placement. At the initial assessment, within a few weeks of the disclosure, 50% of the children had already been removed. A follow-up assessment of 83 children two years later revealed that 73% had been removed from the abusing home. In a multivariate regression model, only maternal support of the child emerged as a significant predictor of immediate placement and placement over time. The offender's status as a resident in the child's home was an important predictor of immediate placement but was not significant as a predictor of all placements at any time. As maternal support is an important predictor of the need for placement, workers are encouraged to seek ways of enhancing maternal support as a means of reducing placement.

Maternal support following disclosure of incest.

The level of maternal support to incest victims following disclosure was found to be more closely related to perpetrator than to child characteristics. Lack of maternal support was significantly associated with foster placement and higher psychopathology scores in a clinical interview. Evidence is presented challenging the validity of maternal behavioral reports in assessments of incest victims.

False allegations of sexual abuse by children and adolescents.

The frequency of false allegations of sexual abuse by children and adolescents is of significant legal and clinical importance. The rate of false allegations of sexual abuse is examined in a large sample of Child Protective Services (CPS) cases. The criteria used by CPS workers in judging the validity of allegations are considered, and the relationship between substantiation rates and attitudes about the trustworthiness of child reports of abuse is explored. Many professionals in the field of child sexual abuse are more skeptical of child and adolescent claims of sexual abuse than available research suggests is warranted.

Impact of legal intervention on sexually abused children.

OBJECTIVE: Examining the psychologic risks of court and related interventions on child sexual abuse victims. DESIGN: A prospective cohort study with follow-up at 5 months. SETTING: Eleven county social service departments in central North Carolina. SUBJECTS: 100 sexually abused children, ages 6 to 17 years, were recruited from consecutive referrals by social service departments; 75 completed the study. MEASUREMENTS AND RESULTS: Using a structured psychiatric inventory, the Child Assessment Schedule, we found a high degree of distress at referral. The level of distress fell by 26% over the next 5 months (p less than 0.001). The 33 children not involved in criminal proceedings improved 30%, in comparison with a 17% improvement in the 22 children waiting for the proceedings (p = 0.042). The 12 children who had testified in juvenile court improved 42% on the Anxiety subscale, in comparison with a 17% improvement in all other subjects (p less than 0.01). With mathematical modeling that controlled for the factors of vaginal or anal penetration, the relationship to the perpetrator, an estimate of verbal IQ, duration of abuse, and whether counseling was received, it was estimated that children waiting for court proceedings at the follow-up examination were only one twelfth as likely to have improved by one standard deviation on the Depression subscale (p less than 0.05). A second model revealed that children who testified in juvenile court were 20.11 times more likely to improve by one standard deviation on the CAS Anxiety subscale (p less than 0.05). CONCLUSIONS: Testimony in juvenile court may be beneficial for the child, whereas protracted criminal proceedings may have an adverse effect on the mental health of the victim.

Interviewing young children with anatomical dolls.

Although children under six constitute a large number of sexual abuse victims, their immature intellectual and emotional development can severely hinder efforts to validate reported or suspected abuse. Interviewing with anatomical dolls offers a potential avenue of communication if interviewers are trained to use the dolls with care and an understanding of both their value and misuse. This article provides a full set of guidelines.

Use of anatomical dolls among professionals in sexual abuse evaluations.

A total of 295 child protection workers, law enforcement officers, mental health practitioners, and physicians were surveyed to ascertain their uses of the anatomical dolls in child sexual abuse evaluations and their interpretations of young children's interactions with the dolls. The dolls enjoy fairly wide use among all four professional groups although most professionals employing the dolls have had little specific training in their use. Law enforcement officers were significantly less likely than the other professionals to view children's demonstrations of sexual acts with the dolls as convincing evidence of sexual abuse. There was no behavior (e.g., undressing the dolls, touching the dolls' genitals) which all professional groups unanimously agreed would be normal play behavior by young children ages 2-5, who had not been sexually abused. Results highlight the need for training resources and normative research.

Conflicting needs and interests of researchers and service providers in child sexual abuse cases.

A child sexual abuse research project was designed which was dependent on referrals from local departments of social services. Significant differences in needs and goals existed between the referral sources and the research team. Modifications of project designs were necessary in the areas of subject recruitment, allocation of project resources, design and measurement, and analysis and reporting. These modifications resulted in a beneficial blend of service and research and produced a useful service in the setting of competent research.