Many children suffer emotional and behavioural difficulties following trauma, however, children are not at equal risk for developing such difficulties following abuse (e.g., Kendell-Tackett, Williams, & Finkelhor, 1993). A detailed review of the literature indicated the need for an empirical investigation into the occurrence of Post Traumatic Stress Symptoms (PTSS) and other psychopathology in children and adolescents following Child Sexual Abuse (CSA).
This project investigated the occurrence of psychopathology in children who experienced CSA. In particular, it examined the degree to which children and adolescents experience PTSS following CSA. Further, the study endeavoured to identify caregiver-related variables, abuse details, parenting behaviour, family functioning, and child coping strategies which predicted maladjustment following CSA.
The first study (Chapter 4) involved 175 children aged
between 8 and 16 years, and their primary caregivers. The purpose of this study was to develop and assess the psychometric properties of a measure of parenting behaviour that could be used in subsequent studies. As parenting behaviour has been linked with the development of psychopathology in children, an economical, reliable and valid measure of the dimensions of parenting behaviour of interest (parental support and overcontrol) was required.
Based on existing measures of parenting behaviour, the Parent Support-Control Questionnaire (PSCQ) was developed. It was hypothesised that two central dimensions, namely parental warmth/support and overcontrol/protection, would be supported by factor analysis. The results of this study supported this hypothesis: a two-factor solution offered the most parsimonious explanation. Adequate internal and test-retest reliability, and convergent and discriminant validity were identified.
The second study
(Chapter 5) was conducted with 92 children (19 boys; 73 girls) aged 6 - 15 years who were referred and accepted into an early intervention program following the experience of sexual abuse. Children were accepted for the program if they had experienced sexual abuse within the previous three years, if the abuse had been formally substantiated, and if they had a primary caregiver willing to participate in the program. Children were excluded from the study if they continued to have regular contact with the perpetrator, had an IQ less than 70, or had a diagnosis of psychosis or pervasive developmental disorder.
Assessment of children's emotional and behavioural adjustment as reported by children and their caregivers revealed that a significant majority of children experienced difficulties in the clinical range following CSA. Recent literature and findings in the current thesis indicate that there is considerable variability in symptom expression after CSA. A range
of behaviours in the clinical range, including anxiety, depression, dissociation and post traumatic stress symptoms, were reported by caregivers and children. Despite previous reports that approximately 30% of children present as symptom free at the time of first assessment (e.g., Finkelhor & Berliner, 1995), only 2.2% of children in this sample were asymptomatic at initial presentation. In addition to general psychopathology, 31.4% of the sample reported PTSS indicative of a DSM-IV diagnosis of Post Traumatic Stress Disorder (PTSD).
The three symptom clusters in the DSM-IV diagnostic criteria for PTSD (i.e., re-experiencing, avoidance, and hypervigilance) were not supported in preliminary analyses. Instead, it is suggested that PTSD can best be conceptualised as existing on a continuum for children following sexual abuse, with children showing elevations across the full spectrum of PTSD symptoms. This finding is more consistent with a
single-dimension conceptualisation of PTSD. A discussion is offered about the developmental trajectory after trauma. Controversy surrounding the DSM-IV diagnostic criteria for PTSD is discussed, and modification of these criteria for use with children is recommended.
A transactional model, based on the work of Spaccarelli (1994) was outlined in the third study (Chapter 7), as a basis for understanding differences in the occurrence of psychopathology following CSA. Specifically, it was hypothesised that poor adjustment following CSA is associated with abuse of high severity, a caregiver who has a history of abuse in her own childhood and high levels of psychopathology, a family environment with high levels of dysfunction, parenting behaviour characterised by low levels of support and high levels of control, and the child's reliance on avoidant coping strategies.
The results of the current investigation provide some support for the
model. Caregiver-reported anxiety and family dysfunction were significantly associated with child adjustment. Further, family functioning mediated the influence of caregiver anxiety on child adjustment. Contrary to prediction, parenting behaviour characterised by low support and high control was not significantly related to poor adjustment. Child-reported adjustment data revealed that an avoidant coping style was significantly associated with poor outcome following sexual abuse. Interestingly, the nature of the abuse was not related to child or parent report of difficulties following CSA.
The results indicate that, following the experience of CSA, a high proportion of children experience psychopathology in the clinical range. Since affected children can continue to experience difficulties in adolescence and adulthood, early intervention is paramount. Of great clinical relevance is the finding that the factors significantly associated with poor adjustment, are
those factors that are more amendable to change (e.g., coping style) rather than the characteristics of the abuse itself (e.g., frequency and duration of abuse).
Findings are discussed in terms of identification of risk factors for poor adjustment following CSA, and presented as a guide clinicians could use in the selection of treatment goals for a particular case and in designing an individualised treatment program. Limitations associated with the present program of research are discussed. Recommendations are made for future research.