ASSESSMENT AND TREATMENT OF SEXUALLY ABUSED CHILDREN AND ADOLESCENTS

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ASSESSMENT AND TREATMENTOF SEXUALLY ABUSED
CHILDREN AND ADOLESCENTS

• Barbara L. Bonner, Ph.D.
• Center on Child Abuse and Neglect
• University of Oklahoma Health Sciences Center

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EFFECTS OF CHILD MALTREATMENT

• Effects range from mild to severe
• Effects differ across forms of abuse
• Most research on effects in childhood and
  adulthood
• Effects differ at different developmental stages
  of infancy (I), childhood (C), adolescents (A)

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SEXUAL ABUSEEffects at Different Developmental
Stages

• Infancy
• No empirical research conducted
• Possibly overly sexually stimulated
• Can have major medical trauma

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SEXUAL ABUSE Effects at Different Development
StagesChildhood

• Sleep disturbances
• PTSD, impaired concentration
• Anxiety, fearfulness

• Inappropriate, aggressive
• sexual behavior
• Aggressive behavior
• Somatic complaints

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SEXUAL ABUSE Effects at Different Development
StagesAdolescence

• Depression
• Suicidal gestures, acts
• School problems

• Social isolation
• Drug or alcohol abuse
• Frequent, indiscriminate
• sexual activity

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ISSUES IN TREATMENT

• Has the investigation been completed?
• Safety of the child
• Who is the client?
• Child having multiple placements/reunification
• Involve siblings?
• Role of the therapist
• Confidentiality

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ASSESSMENT QUESTIONS

• Is treatment needed?
• What is the appropriate setting?
• What symptoms need to be focused on first?
• What are his/her strengths?
• What are family factors that will effect
  treatment outcome?
• Who will be the agent of change?

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AREAS TO ASSESS

• Emotional Adjustment
• Behavior Problems
• Attributions and Coping Skills
• Social Adjustment
• Family Relationships

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PSYCHOLOGICAL ASSESSMENT

• Child/Adolescent Evaluation
• Objective Tests and Interview
• Anxiety, Depression, and Self Concept
• Abuse/Trauma Related Instruments
• Caregiver Interview Behavioral Adjustment
• Observations

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GOALS OF TREATMENT

• Decrease symptoms
• Return child to normal developmental activities
• Increase strengths
• Prevent reabuse

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FOCUS AREAS IN TREATMENT

• Decrease oppositional, aggressive behavior
• Increase coping strategies and problem-solving
  abilities
• Reduce symptoms of PTSD
• Increase appropriate sexual behavior
• Address prevention of further abuse

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MAJOR TREATMENT ISSUES

• Resolving feelings about abuse
• Reducing acting-out behavior
• Decreasing fears, nightmares
• Increasing self-esteem

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OTHER TREATMENT ISSUES

• Decreasing family problems
• Decreasing enuresis, encopresis
• Resolving sexual acting-out
• Resolving physical problems
• Decreasing regressive or pseudomature behavior

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ESTABLISHING RAPPORT AND DECREASING RESISTANCE

• Discuss confidentiality
• Normalize treatment problems with school,
  family, friends, feelings, sexual behavior,
  substance abuse, general behavior
• Take a positive attitude
• Depathologize symptoms

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PREDICTORS OF POSITIVE OUTCOME IN CSA CASES

• Childs abuse related attributions
• and perceptions
• Parental support of the child
• Cohen Mannarino (2000)

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COPING STRATEGIES FOR FEAR AND ANXIETY

• Relaxation/controlled breathing
• Thought stopping
• Pleasant imagery
• Reassuring self statements
• Recognizing triggers/reminders
• Anticipate/practice for anxiety producing
  situation
• Environmental support

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CURRENT RESEARCH FINDINGS

• Cognitive-behavioral therapy more effective than
  non-directive approaches
• Parental support major factor in positive outcome
• Sexual behavior problems more resistant to change
• Protocol driven treatment shows effectiveness

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CONCLUSION

• Effects of sexual abuse range from mild to severe
• Important to involve caregivers in treatment
• CBT approach effective
• Additional research