Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their nonoffending mothers.

The differential efficacies of supportive and cognitive behavioral group therapy models designed for young children (ages 2 to 8) who have experienced sexual abuse and their nonoffending mothers were compared. Forty-four mothers and their respective children participated in either supportive or cognitive behavioral therapy groups with the group format being randomly determined. Repeated measures MANOVAs indicated that compared to mothers who participated in the support groups, the mothers who participated in cognitive behavioral groups reported greater reductions at posttest in (a) their intrusive thoughts and (b) their negative parental emotional reactions regarding the sexual abuse. The children treated with cognitive behavioral therapy demonstrated greater improvement in their knowledge regarding body safety skills at posttest than did the children who received supportive therapy.

The importance of culture in treating abused and neglected children: an empirical review.

There is growing evidence that cultural factors may influence symptom development and treatment referral patterns among abused and neglected children. To date, few treatment outcome studies have specifically examined the impact of race, culture, or ethnicity on treatment response among maltreated children. Those that have attempted to include these factors have typically suffered from lack of clarity of the meaning of these terms. This article reviews the available empirical evidence that addresses the influence of culture on symptom formation, treatment-seeking behaviors, treatment preference, and response following child maltreatment. Hypotheses regarding these findings are addressed, and implications for practice, research, and public policy are discussed.

Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering post-traumatic stress symptoms.

OBJECTIVE: The present study sought to determine whether the 12-session pre- to posttest therapeutic gains that had been found by Deblinger, Lippmann. and Steer (1996) for an initial sample of 100 sexually abused children suffering posttraumatic stress disorder (PTSD) symptoms would be sustained 2 years after treatment. METHOD: These sexually abused children, along with their nonoffending mothers, had been randomly assigned to one of three cognitive-behavioral treatment conditions, child only, mother only, or mother and child, or a community comparison condition, and were followed for 3 months, 6 months, 1 year, and 2 years after treatment. RESULTS: A series of repeated MANCOVAs, controlling for the pre-test scores, indicated that for the three measures of psychopathology that had significantly decreased in the original study (i.e., externalizing behavior problems, depression, and PTSD symptoms), these measures at 3 months, 6 months, 1 year, and 2 years were comparable to the posttest scores. CONCLUSIONS: These findings suggest that the pre- to post-treatment improvements held across the 2-year follow-up period. The clinical and research implications of these findings are discussed.

Problems in differentiating sexually from nonsexually abused adolescent psychiatric inpatients by self-reported anxiety, depression, internalization, and externalization.

To ascertain whether self-reported psychopathology differentiated sexually and nonsexually abused adolescents, the Beck Depression Inventory, Beck Anxiety Inventory, and the Achenbach Youth Self-Report were administered to 111 psychiatric inpatients between 13 and 17 years of age who were diagnosed with various psychiatric disorders. Data about 14 background and clinical characteristics that were purported to be associated with sexual abuse were also collected. Forty (67%) of the 60 girls reported sexually abusive experiences, whereas six (12%) of the 51 boys reported such experiences. None of the scales were correlated with sexual abuse in either sex, and a history of physical abuse was the only characteristic that was significantly correlated with sexual abuse for both sexes. Furthermore, none of the scales was correlated with identity of sexual abuser, age of first abuse, age of last abuse, number of abuses, days of abuse, penile insertion, and the reporting of the abuse to the authorities in the sexually abused girls.

Sexually abused children at high risk for post-traumatic stress disorder.

Ninety-two sexually abused children were studied using structured interviews and standardized instruments to determine the frequency of post-traumatic stress disorder (PTSD) and associated symptoms. Of these sexually abused children, 43.9% met DSM-III-R PTSD criteria; 53.8% of children abused by fathers, 42.4% abused by trusted adults, and 10% of those abused by strangers met criteria as opposed to none of the children abused by an older child. No relationship was observed between the time lapsed since last abusive episode and the presence of PTSD. Many children not meeting full criteria exhibited partial PTSD symptoms. Only one standardized instrument (Child Behavior Checklist) detected group differences with PTSD children exhibiting more symptoms. This study replicates an earlier pilot study and underscores the need for further PTSD research.

Cognitive behavioral treatment for sexually abused children suffering post-traumatic stress: preliminary findings.

The present investigation examined the effectiveness of a cognitive behavioral treatment program designed for sexually abused children suffering post-traumatic stress disorder. Nineteen girls who suffered contact sexual abuse and met DSM-III-R criteria for post-traumatic stress disorder were included in the study. Subjects ranged in age from 3 to 16 years old. Structured interviews were conducted to assess the presence or absence of post-traumatic stress disorder symptoms before, during, and following the abuse. Additionally, parents completed the Child Behavior Checklist, and subjects at least 6 years of age were administered the Child Depression Inventory and the Spielberger State-Trait Anxiety Inventory at the initial evaluation and again approximately 2 to 3 weeks later before the initiation of treatment. The baseline data collected at these two points were compared, and no significant changes were found over time. The above measures were readministered following 12 treatment sessions. The results revealed significant improvements at post-treatment on all measures.

Post-traumatic stress in sexually abused, physically abused, and nonabused children.

This investigation compared the rates of post-traumatic stress disorder symptoms across sexually abused, physically abused, and nonabused psychiatrically hospitalized children matched for age, sex, and socioeconomic status. Among the sexually abused children, 20.7% met diagnostic criteria for post-traumatic stress disorder compared with 6.9% of the physically abused and 10.3% of the nonabused children. Although these overall rates were not significantly different across groups, they were significantly high to reinforce the need for further study of post-traumatic stress in childhood. Further, significant symptom rate differences across groups were found with respect to specific post-traumatic stress symptoms. Specifically, sexually abused children exhibited significantly higher rates of inappropriate sexual behaviors than either the physically abused or nonabused children. In addition, both the sexually abused and physically abused groups showed a tendency to exhibit more avoidant/dissociative symptoms as compared to the nonabused children. Results are discussed in terms of their clinical and research implications.

Daily versus major life events as predictors of symptom frequency: a replication study.

Predictions of physical symptomatology by daily life events and by major life events were compared, replicating and expanding work reported by DeLongis, Coyne, Dakof, Folkman, & Lazarus (1982). Analyses of daily, prospective data collected on 79 married men for 90 days demonstrated that daily, undesirable events were better predictors of symptom frequencies than either past, major life events or daily, desirable events. These results, similar to those found by DeLongis et al. (1982), were further explored by examining "healthy" subjects versus subjects with prior medical conditions. Undesirable daily events were a much stronger predictor of physical symptoms in the healthy group than in the prior medical conditions group.