A meta-analysis of the prevalence of child sexual abuse disclosure in forensic settings

Differences Between Girls and Boys in the Disclosure of Sexual Violence

This article addresses the differences between girls and boys in the disclosure of sexual violence. The dataset combines data from the Finnish Child Victim Survey (FCVS) of 2008 (N = 13,459) and 2013 (N = 11,364), focusing on victims of sexual violence, ages 11 to 17 years, from the perspectives of disclosure and gender. Frequency and percentage analysis, cross tabulation, and a Chi-square test were used in the analysis. In the FCVS for both years, around 85% of the victims were girls. In almost two-thirds of the cases, the offender was a relative, friend, or some other known person, while in more than one-third of the cases, the offender was unknown to the victim. The second most common case was that the victim knew the offender, who was not, however, a friend. Sexual violence was found to be, in many ways, gendered. Most of the victims were girls, and most of the offenders were men. There was also a gender difference in the disclosure of experiences. Twenty-one percent of the girls and 45% of the boys reported that they had not told anyone about their experiences. Irrespective of the type of offender, the victims most often (63%) told a peer about their experiences, while 23% told parents, and only 10% told authorities. Moreover, victims reported shame and fear, distrust toward adults, and disbelief that disclosure would be helpful as reasons for not disclosing their experiences. To address this problem, raising awareness of the phenomenon, promoting an atmosphere that supports disclosing experiences of sexual violence, and improving readiness to address them are required.

An examination of questioning methods and the influence of child maltreatment on paediatric pain assessments: Perspectives of healthcare providers

AIMS AND OBJECTIVES

Children with a history of maltreatment have underestimated and undertreated pain; however, it is unknown if healthcare providers consider maltreatment when assessing children's pain. The current study aimed to address this issue by investigating healthcare providers' pain assessment practices, and specifically, their consideration of child maltreatment.

METHOD

Healthcare providers (N = 100) completed a survey, asking them to reflect upon their pediatric pain assessment practices (e.g., methods and questions used to assess pain) through self-report and case vignette questions.

RESULTS

Participants who received continuing education about child maltreatment were more likely to consider maltreatment in several areas of their pediatric pain assessment practice, whereas participants who received continuing education about pediatric pain, were not. Participants were also more likely to report that they would consider maltreatment in vignette responses than in questions regarding their daily practice.

CONCLUSION

Findings indicate healthcare providers use multidimensional methods when assessing children's pain, although it is unclear when or how they use open-ended vs. option posing questions. Healthcare providers also tended to consider the effects of child maltreatment on children's ability to communicate their pain more so when the history of maltreatment was known to them.

Adaptation of the Child sexual abuse myth scale to Turkish culture: A reliability and validity study

This study aims to analyze the reliability and validity of the Child Sexual Abuse Myth Scale (CSAMS) in Turkish society. This methodological and cross-sectional study was conducted with 334 individuals between the ages 19 to 65. Data were collected through the Personal Information Form and the Child Sexual Abuse Myth Scale. Content Validity Ratio values of the scale items in the study ranged between 0.500 and 1.00, and the Content Validity Index was found to be 0.68. Exploratory Factor Analysis was appropriate based on Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO = 0.809) and Barlett's Test of Sphericity (X2 = 1269, p < 0.001). Factor Analysis resulted in 4 sub-scales (Accusation, Causality, Normalization, and Sexist Approach). Item factor loads of the scale were found to range between 0.501 and 0.839, and the total explained variance was 59.4 %. Pearson correlation coefficients of all the items ranged between 0.32 and 0.60, and Cronbach's alpha coefficient was 0.81. Accusation, Normalization, and Sexist Approach sub-scale scores were found to increase with age. Sub-scale scores were found to demonstrate significant differences by gender, marital status, education level, working or not, income level, family type, number of siblings, and number of children (p < 0.05). The findings of this study show that the CSAMS is valid and reliable for Turkish culture in its 14-item and 4 sub-scale form.

Factors related to delayed disclosure among victims of child sexual abuse in Singapore

BACKGROUND

Delayed disclosure is a prevalent and serious issue among victims of child sexual abuse (CSA). Identifying the factors associated with delayed disclosure can identify the profile of children who are at risk of delaying disclosures and inform measures to facilitate timely disclosure.

OBJECTIVE

The current study represented a pioneering effort to investigate factors that are related to disclosure of CSA in Singapore. It examined the influence of various victim and abuse characteristics on the time taken for a victim to disclose CSA.

PARTICIPANTS AND SETTING

A total of 252 CSA cases that were referred to the psychology department of Singapore's Ministry of Social and Family Development (MSF) from 2017 to 2021 were analyzed.

METHODS

Cases were coded for the study variables and multivariate Cox regression was conducted to analyze the impact of each variable of interest on the time taken to disclose the abuse.

RESULTS

It was found that the following sub-populations of CSA victims were associated with delayed disclosure: younger victims, female victims (as compared to male victims), victims with higher severity of sexual abuse (e.g., forced intercourse), and victims who were abused by in-home caregivers (as compared to acquaintances).

CONCLUSIONS

The findings from the study generated practical implications to help reduce the time victims take to disclose CSA in the Singaporean context.

Stereotypical Victims: Visibility of #MeToo Disclosures on Twitter

The #MeToo movement has brought greater visibility to the topic of sexual assault in public discourse. We analyzed a dataset of 1,070 Twitter #MeToo self-disclosures to examine the relationship between online visibility (retweets and favorites) and the content of victim-survivors' self-disclosures such as victim's gender, relationship to the perpetrator, and the emotions expressed in the tweet. The visibility of sexual assault self-disclosures was shaped by the extent to which they align with stereotypical misconceptions of victimization. These findings carry significant implications for understanding patterns of victimization, and for identifying whose voices are being amplified or not on Twitter.

A systematic review of factors associated with disclosure of child sexual abuse

BACKGROUND AND OBJECTIVE

Disclosure of CSA is key to victims having access to support and protection, but the current understanding of what factors play a key role is still limited. The present review aims to understand a range of socio-ecological factors that can either facilitate or obstruct the disclosure of CSA.

METHODS AND RESULTS

Through a systematic review of 27 quantitative studies published from 2000 to 2022, the current review identified 17 significant predictors of CSA disclosure. Facilitators of disclosure included older age, being female, higher IQ, recent abuse, resistance during abuse, clergy perpetrator, non-offending caregiver support, and acculturation. Barriers to disclosure included intellectual disability, avoidant coping, romantic relationships with the perpetrator, family criminality, domestic violence, adherence to traditional Asian values, and ethnic minority identity. The findings also suggested that the relationship between predictors and disclosure tends to be mixed, contradictory, or indirect/interactional, emphasizing the importance of situating the findings in specific social-ecological contexts.

CONCLUSIONS

The findings can inform future research and practice by providing a comprehensive understanding of the predictors of CSA disclosure and highlighting the importance of considering the socio-ecological context when interpreting findings. Moreover, the review provides a valuable resource for professionals who work with victims of CSA, helping them better identify factors that may facilitate or hinder disclosure and allowing for tailored interventions.

Factors associated with delayed disclosure of child sexual abuse: A focus on the victim's having been led to perform sexual acts on the perpetrator

BACKGROUND

Contextual variables associated with children's willingness to disclose sexual abuse have been identified in previous studies, but further investigation is needed to better understand delayed disclosure of child sexual abuse (CSA).

OBJECTIVES

This study aimed to examine the factors associated with the risk of delayed disclosure of CSA. More specifically, it focused on a factor that has rarely, if ever, been looked into: the fact that some victims are led to perform sexual acts on the perpetrator.

PARTICIPANTS AND SETTING

A content analysis was performed on 68 transcripts of investigative interviews with CSA victims aged 4 to 12 years old.

METHODS

Based on our content analysis, the time between the first abuse and the first disclosure was determined for each victim. The age and gender of the victim, the victim's relationship with the perpetrator, the age of the perpetrator, the frequency and severity of the abuse, and whether or not the victim mentioned having performed sexual acts on the perpetrator were also coded.

RESULTS

Chi-square analyses showed that the risk of delayed disclosure was associated with the victim's having performed, or not performed, sexual acts on the perpetrator (χ2 = 16.327, p < 0.001), the victim's relationship with the perpetrator (χ2 = 10.013, p = 0.002), and the frequency of the abuse (χ2 = 11.617, p < 0.001).

CONCLUSION

Our study is the first to demonstrate that having been led to sexually touch the perpetrator is associated with delayed disclosure of CSA.

The Association Between Child Abuse and Aggressive Behavior: A Three-Level Meta-Analysis

Child abuse is considered to be an essential factor in the development of aggressive behavior. The intensity of the positive relations between child abuse and aggressive behavior differed considerably among researches despite the fact that abundant studies have observed this relation. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, a three-level meta-analysis was employed to obtain reliable estimates for the sizes of effects and investigate some potential moderators of the relation between child abuse and aggressive behavior. The present study obtained 51 studies (30,566 participants; 680 effect sizes) through performing the detailed literature search. It was found that child abuse was positively associated with aggressive behavior in the current study. In addition, the present meta-analysis observed significant moderating effects for type of child abuse, culture, measurement of child abuse, and publication year in the association between child abuse and aggressive behavior. This study suggests that child abuse is a predictor for the development of aggressive behavior in humans. Moreover, child abuse is an important aspect for consideration in efforts toward strengthening of interventions targeting individuals' aggressive behavior.

When Disclosure Fails to Substantiate Abuse: Child and Perpetrator Race Predict Child Sexual Abuse Substantiation

We examined the effects of child race, perpetrator race, and abuse disclosure status (within the context of a formal forensic interview) on abuse substantiation outcomes. Specifically, we coded child sexual abuse disclosure, abuse substantiation, and race of 315 children (80% girls, M age = 10, age range = 2-17; 75% White, 9% Black, 12% Biracial, 3% Hispanic, 1% Asian) who underwent a child forensic interview in a Midwestern child advocacy center. Supporting hypotheses, abuse substantiation was more likely in cases involving (a) abuse disclosure (vs. no disclosure), (b) White children (vs. children of color), and (c) perpetrators of color (vs. White perpetrators). Also supporting hypotheses, the effect of abuse disclosure on increased abuse substantiation was greater for White children than for children of color. This research suggests that even when children of color disclose their experiences of sexual abuse, they nonetheless face barriers to abuse substantiation.

Psychological symptoms of adolescent survivors of sexual abuse and characteristics of survivors displaying suicidal and/or self-harming behaviors

We examine the psychological symptoms and suicide attempts and/or self-injury behaviors of survivors of childhood sexual abuse (CSA) according to individual and familial characteristics. The participants of this study included 80 adolescents aged 14-17 years. We show that high psychological symptom scores may indicate that the perpetrator was a family member and that penetration occurred. In addition, most of the participating survivors have experienced numerous problems, largely related to psychological symptoms. Considering the results regarding survivors who had previously attempted suicide, we demonstrate that the perpetrators in these cases were mostly reliable/loved people, while these survivors generally hid the events and were exposed to penetration more often. We conclude that survivors exposed to CSA by a reliable/loved person, blaming themselves, having low social support, and displaying certain symptoms should be followed closely and necessary psychosocial interventions for suicide should be applied.

Successful Criminal Prosecutions of Sex Trafficking and Sexual Abuse of Minors: A Comparative Analysis

Despite increased awareness of sex trafficking of minors in the U.S., prosecution of traffickers remains difficult, in part because of victim uncooperativeness. There are questions about how that uncooperativeness is expressed, whether it is evident in successfully prosecuted cases, and whether it is unique to trafficked minors or it emerges in similar age victims of sexual abuse. To provide insight relevant to these questions, we compared appellate opinions in two types of successfully prosecuted criminal cases: sex trafficking and sexual abuse of adolescent victims. In the trafficking opinions, victims were rarely described as disclosing on their own or as knowing their trafficker before the victimization. The opinions also often alluded to the trafficking victims' uncooperativeness and delinquency history, and frequently mentioned electronic evidence and prosecution experts. The sexual abuse opinions, in contrast, tended to suggest that victims' own disclosures initiated the case, perpetrators were known and trusted adults, and caregiver support during the case was common. Finally, the sexual abuse opinions never explicitly mentioned victim uncooperativeness or electronic evidence and rarely mentioned expert testimony or delinquency. The different characterizations of the two case types highlight the need for improved education concerning effective prosecution of sex crimes against minors.

Childhood Sexual Abuse: A Longitudinal Study of Disclosures and Denials

In legal cases regarding child sexual abuse (CSA), children have various options, such as to disclose or deny maltreatment. When interviewed in adulthood, their accounts may be consistent with their childhood responses. Alternatively, denial in childhood could be followed in adulthood by disclosure ("deferred disclosure"), confirming previous suspicions. Or the adults could possibly recant. We conducted a longitudinal study of CSA disclosures and denials (N = 99; Time 1 [T1], 3- to 16-year-olds). T1 CSA disclosures and denials at a forensic unit were compared to the individuals' responses 20 years later (Time 2 [T2]. 22- to 37-years-old). We found that consistent disclosure was associated with being older at T1 and female. Deferred disclosure was significantly associated with greater T2 trauma-related symptoms. Corroboration and higher CSA severity predicted T2 recantation. Consistent denial was related to less severe CSA. Our findings add to knowledge about CSA disclosures, which affect legal pathways available to child victims.

Attorneys' Questions and Children's Responses Referring to the Nature of Sexual Touch in Child Sexual Abuse Trials

Eliciting clear descriptions of sexual body parts and abusive touch in child sexual abuse trials is challenging because of children's immaturity and embarrassment. This study examined references to sexual body part knowledge and sexual touch in attorneys' questions and 5- to 10-year-old children's responses (N = 2,247) in 113 child sexual abuse trials. Regardless of children's age, attorneys and children primarily used unclear colloquialisms to refer to sexual body parts. Questions asking children to name sexual body parts elicited more uninformative responses than questions about the function of sexual body parts. In turn, questions about the function of sexual body parts were more likely to increase the specificity of body part identifications than questions about the location of sexual body parts. Attorneys predominantly used option-posing (yes-no and forced choice) questions to ask about sexual body part knowledge, the location of touch, the method or manner of touching, skin-to-skin contact, penetration, and how the touching felt. Generally, wh- questions were no more likely than option-posing questions to elicit uninformative responses, and consistently elicited more child-generated information. The results question the legal assumption that children's uninformative responses when testifying about sexual abuse should be overcome by asking option-posing questions.

A Meta-Analysis of the Effects of Childhood Maltreatment on Elderly Depression

Background: The present study aimed to synthesize the effects of five types of child maltreatment (physical abuse, emotional abuse, sexual abuse, physical neglect and emotional neglect) on late-life depression.Method: Four English-language databases (Web of Science, PsycINFO and PsycARTICLES, PubMed, and Cochrane Library) and three Chinese databases (China National Knowledge Infrastructure, Wanfang Database, and Weipu Database) were systematically reviewed, and data related to the association between child maltreatment and late-life depression were extracted. Ten studies involving 30,308 older adults were included, and the effect sizes were pooled using random-effect models.Findings: Except for sexual abuse, four types of child maltreatment were found to be positively associated with late-life depression. Physical abuse, emotional abuse and physical neglect were associated with elderly depression (PA: OR = 1.73, 95% CI = 1.55-1.95, p < .001; EA: OR = 1.92, 95% CI = 1.73-2.12, p < .001; PN: OR = 2.05, 95% CI = 1.15-3.67, p < .01) at a small level, and emotional neglect was associated with elderly depression (OR = 3.25, 95% CI = 1.43-7.39, p < .001) at an approximately moderate level. Gender moderated the relationship between physical neglect, emotional neglect, and late-life depression.Conclusion: Our findings highlight the significance of child maltreatment in the development of late-life depression, and underscore the need for future research and practice to explore potential ways to address late-life depression among older adults who suffered child maltreatment.

Long-term mental health consequences of female- versus male-perpetrated child sexual abuse

BACKGROUND

Research on child sexual abuse increasingly focuses on sexually offending females; however, there is a lack of research that focuses on the individuals being affected. Studies have suggested that the consequences for those affected by sexually offending males and females are comparable.

OBJECTIVE

The aim is to compare mental health consequences of sexual abuse perpetrated by women versus men in quantity and type.

PARTICIPANTS AND SETTING

Data was anonymously retrieved from the German-wide contact point "help line sexual abuse" from 2016 to 2021. Details of abuse cases, gender of the offending individuals, and reported mental disorders of the person affected were analyzed. The sample consisted of N = 3351 callers with experiences of child sexual abuse.

METHOD

The relationship between gender of the perpetrating person and mental disorders of the victimized person was computed using logistic regression models. To account for rare events data, Firth's logistics regression model was used.

RESULTS

The consequences were similar in quantity, albeit different in type. Callers with experiences of female-perpetrated abuse were more likely to report suicidality, non-suicidal self-injury behavior, personality disorders, dissociative identity disorders, alcohol/ drug addiction, and schizophrenia, while people with experiences of male-perpetrated abuse rather reported post-traumatic stress disorder, affective disorders, anxiety disorders, dissociative disorders, eating disorders, externalized disorders, and psychosomatic disorders.

CONCLUSIONS

The differences may be due to stigmatization leading to dysfunctional coping mechanisms. Societal gender stereotypes must be reduced, especially within the professional helping system to ensure support for people who have experienced sexual abuse, regardless of gender.

Novel Forms of Reluctance Among Suspected Child Sexual Abuse Victims in Adolescence

Adolescents tend to be neglected in research examining child sexual abuse (CSA) interviews, yet are often said to be particularly reluctant. This study examined reluctance among 119 10- to 17-year-old females questioned about suspected CSA (n = 25,942 responses), utilizing a scheme identifying previously overlooked types of reluctance in commercially sexually exploited (CSE) youth. In contrast to the CSE youth in a prior study, in which 26% of responses were reluctant, only 8% of CSA victims' responses expressed reluctance. Reluctance was unrelated to age, abuse characteristics, and don't know (IDK) responding. Greater reluctance (but not IDK responding) was related to disclosure of fewer characteristics of abuse. Virtually all youth (93%) had disclosed prior to the interview, in contrast to previous studies examining reluctance among adolescent victims of internet-initiated sexual abuse and CSE. The way in which abuse is discovered may better explain reluctance than the age of the alleged victims.

A Vignettes-Based Exploration of Attitudes of Parents Toward Reporting of Child Sexual Abuse in Ghana

Reporting child sexual abuse (CSA) to law enforcement institutions is the ideal child protection imperative. The role of parents in this process is unquestionably profound. Yet, there is limited evidence on parental perspectives on reporting CSA to law enforcement agencies in developing country contexts. We apply vignettes to describe the views of parents about reporting CSA perpetrated by "family members, schoolteachers, and strangers." Data was collected from 89 parents from four culturally diverse regions of Ghana. A systematic inductive approach was used to determine patterns and similarities in participants' attitudes toward reporting. We note that the attitudes of participants about reporting CSA varied considerably; these are influenced by the nature of social relationships between the victim and perpetrator. In a seeming order of severity, CSA perpetrated by a family member was viewed less seriously compared to victimization by a teacher or a stranger. The desire to preserve familial/kin ties and reputation and keeping to the cultural heritage of resolving "disputes and disagreements" amicably were primary norms against reporting CSA. However, attitudes toward reporting CSA by teachers were influenced by expectation of higher moral standards, which made reporting CSA by a teacher a reasonable cause of action. Positive attitudes toward reporting CSA by "strangers" were prevalent. Child protection programs must recognzse the segmented attitudes toward CSA and tackle the deep-seated cultural and social norms through social and behavioral change communication (SBCC).

"It was Really Hard for Me to Tell": The Gap between the Child's Difficulty in Disclosing Sexual Abuse, and their Perception of the Disclosure Recipient's Response

Disclosure of child sexual abuse (CSA) is essential to its mitigation and the protection of children. Previous studies have greatly contributed to the understanding of disclosure rates both in childhood and adulthood, in addition to delayed disclosure and disclosure barriers. In acknowledging the relevancy of the ecological framework, researchers have illustrated how the various systems in the children's lives have a role in their decision to disclose the abuse. The current study was designed to delve into the disclosure stories shared by children during their forensic interviews. Fifty children, 30 girls and 20 boys, from diverse communities in the Jewish society in Israel (15 secular, 15 Orthodox and 20 ultra-Orthodox) were forensically interviewed for the first time following CSA. Thematic analysis was carried out on their narratives, focusing on two main themes. The first was the children's descriptions of their difficulties to disclose, which were embedded in their own perceptions and experiences, their fear of the disclosure recipient's response, and their dynamic with the perpetrator. The second theme provided a glance into the children's descriptions of the disclosure recipients' responses, which highlighted the children's central experience of loneliness in the context of the abuse. Theoretical and practical ramifications pertaining to these crucial gaps will be discussed. In addition, specific religious-cultural elements raised in relation to the disclosure will be highlighted. Limitations of the study as well as further recommendations and implications will be introduced.

Patterns of disclosure and perceived societal responses after child sexual abuse

BACKGROUND

Disclosure of child sexual abuse (CSA) is key for abused children to access help and to protect them and other children.

OBJECTIVE

The aim of this study was to investigate patterns of disclosure of child sexual abuse and how children perceived responses from people they disclosed to.

PARTICIPANTS AND SETTING

Data were collected online in classrooms and during home studies in a national probability-based sample of 3282 third-year students in Swedish high schools in 2020-2021 (the age of the students varied between 16 and 23 years (M = 18,2)).

METHODS

Results are presented with frequencies (n) and percentages (%). Pearson's chi-squared test was used for comparisons between groups.

RESULTS

First, a substantial share of abused girls and most abused boys had not yet told anyone about the abuse, leaving them unable to access protection or rehabilitation. Second, participants who had disclosed sexual abuse had most often turned to a peer, more rarely to an adult, and seldom to a professional or volunteer. Third, although the societal responses that the participants perceived were mixed, more severe abuse was associated with more negative societal responses. Fourth, most participants stated that they did not need any professional support. Fifth, among the minority who had sought help, half were satisfied and a third dissatisfied.

CONCLUSIONS

Results showed that most children with experience of CSA did not have access to the protection, support, and rehabilitation that they have a right to. Preventive measures need to target children and young people, while societal responses after CSA, especially severe CSA, need to be improved.

Mock Jurors' Perceptions of Child Sexual Abuse Cases: Investigating the Role of Delayed Disclosure and Relationship to the Perpetrator

Child sexual abuse (CSA) claims brought forward weeks, months, or years after the alleged events are commonplace, yet the trial-level ramifications of delayed disclosure remain unclear. In the present study, we investigated the influence of length of delayed disclosure (1 day, 1 month, 10 months) as a function of the victim-perpetrator relationship (next-door neighbor, stepfather) on mock jurors' perceptions of a CSA case. Jury-eligible participants (N = 328) read a mock trial summary describing an alleged incident of CSA between an adult male defendant and a seven-year-old female victim. Participants then rendered various case judgments. When length of delay was 10 months versus 1 day, mock jurors rendered fewer guilty verdicts and lower ratings of victim trustworthiness, believability, memory strength, and memory accuracy. Effects of length of delay varied as a function of the victim-perpetrator relationship, but only when the perpetrator was the victim's next-door neighbor versus stepfather. When the perpetrator was the victim's next-door neighbor, participants rated the likelihood of abuse as higher and the victim's memory as stronger with shorter versus longer lengths of delay. Delay did not vary as a function of the victim-perpetrator relationship when the perpetrator was the victim's stepfather. Findings have implications for trial-level safeguards (e.g., expert testimony) in CSA cases involving delayed disclosure.

Do children unintentionally report maltreatment? Comparison of disclosures of neglect versus sexual abuse

BACKGROUND AND AIMS

Children's initial reports often play a key role in the identification of maltreatment, and a sizeable amount of scientific research has examined how children disclose sexual and physical abuse. Although neglect constitutes a large proportion of maltreatment experiences, relatively little attention has been directed toward understanding whether and how children disclose neglect. The overarching aim of the present study was to document this process by comparing disclosure patterns in cases of neglect to those in cases of sexual abuse.

METHOD

Redacted jurisdiction reports (N = 136) of substantiated dependency cases of neglect (n = 71) and sexual abuse (n = 65) in 4- to 17-year-olds were coded for why maltreatment was suspected, and for children's perceived awareness and disclosure of the maltreatment.

RESULTS

Neglect was most often initially suspected via contact with emergency services (e.g., police, emergency medical services), whereas sexual abuse was most often initially suspected as a result of children's statements. Children evidenced greater perceived awareness of sexual abuse than neglect and were more likely to disclose the former in their first investigative interview. Perceived awareness was further associated with a higher likelihood of children's statements initiating discovery of maltreatment and disclosing in the first investigative interview.

CONCLUSIONS

Children may benefit from greater knowledge about their needs for safety, supervision, and provision in the home, which could increase the likelihood they would disclose neglect. Such, in turn, could lead to earlier interventions for children and families.

How Chronological Age, Theory of Mind, and Yield are Interrelated to Memory and Suggestion in Young Children

We investigated the interrelations between chronological age, theory of mind (ToM), Yield (as a measure of individual suggestibility), memory and acceptance of experimental suggestion in a sample of children between 3 and 7 years old (N = 106). One week after participants interacted with 'a Teacher', they were asked to recall activities carried out with the Teacher (direct experience) and the contents of a story read to them by the Teacher (indirect experience). Data were examined with an analysis of developmental trajectories, which allows establishing the predictor value of socio-cognitive developmental factors regardless of participants' chronological age. It also estimates predictor values in interaction with the age and determines whether age is the best predictor for performance. As in previous research, results showed that chronological age was the main predictor of memory performance, both for direct experience (i.e., activities performed) and indirect experience (i.e., contents of the story). However, ToM and Yield, together with participants' ages, modulated their acceptance of the external suggestions received (presented only once, one week after the event). A turning point was observed at age 4.6. Below this age, the greater the mentalist skills (higher ToM), the lower was the vulnerability to external suggestion. Still, children below this age characterized individually as being suggestible (Yield medium or high) were more vulnerable to suggestion the younger they were. Thus, developmental socio-cognitive factors might modulate young children's vulnerability to external suggestions, even if received only once.

Multidisciplinary Approach to Emergent Sexual Abuse in a Pediatric Emergency Department: A Simulated Child Advocacy Center Model of Care

INTRODUCTION

The purpose of this study was to compare child sexual abuse interview disclosures and judicial outcomes for cases of child and adolescent sexual abuse/assault seen in a pediatric emergency department (PED) before and after the implementation of a simulated child advocacy center (CAC) multidisciplinary model of care.

METHOD

A retrospective chart and legal records review was conducted from both the PED model of care group and the simulated CAC multidisciplinary model of care for judicial outcomes, child sexual abuse interview disclosures, and sexual abuse case characteristics.

RESULTS

The simulated CAC multidisciplinary model of care did not result in increased indictments, pleas, trials, or disclosure of sexual abuse in the sexual abuse interview when compared with the PED model of care. The simulated CAC multidisciplinary model of care did result in a significantly higher rate of sexual abuse interview completion.

DISCUSSION

Demographic risk factors for sexual abuse victimization as well as perpetration have been identified in the literature and were supported by this study. Law enforcement and child protective services were more frequently present in the PED under the simulated CAC multidisciplinary model allowing for improved protection of children.

Magnitude of Child Sexual Abuse and Its Associated Factors Among Children Treated in Public Hospitals of Addis Ababa Ethiopia

Background

Methods

Results

Conclusion and Recommendations

Children’s needs during disclosures of abuse

A Narrative Literature Review was conducted providing a comprehensive overview of children’s barriers to disclose during investigations of child abuse. Patterns in the literature were categorized as themes and include: rapport and relationship with the interviewer, feeling in control and prepared, communication, physical abilities, mental health, environment, family dynamics, culture and individual uniqueness. Using a combination of a critical analyses approach and drawing from personal background experiences and knowledge in working with children during disclosures, the themes are expanded upon as a discussion that explores what children may therapeutically need during their disclosures of abuse within the forensic interview. Some practice implications are incorporated with the intent to generate further thinking about addressing children’s needs during investigations of child abuse. Working with multidisciplinary teams in Child and Youth Advocacy Centres is discussed and may be a resource for understanding children’s needs during disclosures of abuse.

The role of multiple attachments in intergenerational transmission of child sexual abuse among male victims

BACKGROUND

According to Finkelhor (1984), difficulties child sexual abusers have in establishing adaptive adult relationships are a consequence of attachment problems with parents. Research shows that insecure attachment is associated with both the experience of child sexual abuse (CSA) as a victim and perpetration of CSA as an adult. Attachment may thus be a key factor in intergenerational transmission (IT) of CSA.

OBJECTIVE

The study aims to examine the direct, interactive, and mediated effects linking attachment in different relationships (mother, father, romantic partner) to IT of CSA among male victims.

PARTICIPANTS AND SETTING

Thirty-two abusing and 27 non-abusing male CSA survivors were recruited, respectively, in a prison and via networks of former foster children or CSA victims.

METHOD

All participants completed the Attachment Multiple Model Interview to assess attachment along four dimensions (security, deactivation, hyperactivation, and disorganization) in the relationship with mother, father, and partner.

RESULTS

Partial least square modeling suggests that the partner carries forward (mediates) the increased risk of committing sexual abuse associated with insecure/disorganized attachment with the father. A significant partner-mother interaction also suggests that the deleterious effects of attachment to the mother in terms of committing CSA are countered by more secure/organized attachment to the partner.

CONCLUSIONS

Findings highlight the pivotal role of the romantic partner in IT of CSA. Beyond early intervention, therapy in adulthood aimed at fostering adaptive ways of finding emotional security in the relationship with an adult could thus be encouraged.

Reactions to the disclosure of intrafamilial childhood sexual abuse: Findings from the National Sexual Assault Online Hotline

INTRODUCTION

For child sexual abuse (CSA) victims, disclosure can be helpful or harmful depending on how recipients respond. Despite a growing body of literature examining reactions to disclosure, little is known about the experiences of current CSA victims, particularly those abused by family.

OBJECTIVE

We aimed to describe and explore the initial disclosure experiences of intrafamilial CSA victims, and whether reactions varied based on the type of disclosure recipient.

PARTICIPANTS AND SETTING

This study utilized anonymous, archival data from the US-based National Sexual Assault Online Hotline (NSAOH), and focused on a sample of 224 intrafamilial CSA victims who had previously disclosed to one type of recipient.

METHODS

NSAOH staff summarized children's disclosure experiences via an open-ended survey field. Data were independently coded using the Social Reactions Questionnaire.

RESULTS

Nearly three-fourths (73%) of children described receiving a negative reaction to disclosure. Negative reactions included distracting or dismissing the victim (33%), not believing the victim (29%), or retaliating or responding violently following disclosure (10%). Children most frequently disclosed abuse to non-offending family (66%), friends (17%), and formal support providers (12%). Relative to friends and intimate partners, victims were more likely to discuss negative reactions from family (49% v 87%, respectively, Cramer's V = 0.33, p < 0.001).

CONCLUSIONS

Disclosing to non-offending family may be unproductive and potentially harmful for some children. This study has implications for disclosure-related planning protocols on anonymous hotlines. Findings underscore the importance of educating the public, and parents in particular, about how to respond to CSA disclosures.

Children's Disclosures of Physical Abuse in a Population-Based Sample

Few studies have explored the disclosure of child physical abuse although child sexual abuse disclosure has been widely studied and debated for years. The present study explores the characteristics of child physical abuse disclosures and compares them to previously published findings on child sexual abuse disclosure from the same data. The data consist of a representative sample of 11,364 sixth and ninth graders. Participants responded to a wide variety of questions concerning experiences of violence, including child physical abuse and child sexual abuse, in the Finnish Child Victim Survey conducted in 2013. Within this sample, the prevalence of child physical abuse was 4.1%. Children reporting abuse experiences also responded to questions regarding disclosure, reactions encountered during disclosure, and potential reasons for nondisclosure. Findings show that most of the children who disclosed physical violence had disclosed to their mother. The overall disclosure rate of child physical abuse was 74%. However, only 42% had disclosed to adults, and even fewer had reported their experiences to authorities (12%). The most common reason for nondisclosure was that the youth did not consider the experience sufficiently serious to report (53%). These findings were largely in line with the child sexual abuse disclosure rates in our previous study. Analyses of variables associated with disclosing to an adult indicate that the strongest factors predicting disclosure to an adult are younger age, female gender, no previous experiences of child physical abuse, and parents knowing who their child spends her or his spare time with. Implications for further research and practice are discussed.

How Plausible are the Accounts of Child Victims of Sexual Abuse? A Study of Bizarre and Unusual Scripts Reported by Children

Child sexual abuse is a serious social problem. In reports of sexually abused children, victims' narratives often contain elements that suggest the abuse was recorded to create images for child pornography with sadistic, bizarre, or perverted details. The presence of unusual or bizarre elements in the accounts of abused children affects their credibility. The purpose of this paper is to assess the presence and prevalence of these elements in the reports of children with suspected sexual abuse and to examine their consistency with verified cases of child abuse. We conducted two studies. In Study 1, we developed a list of 16 categories of unusual and bizarre scripts reported by children in reports of sexual abuse. In Study 2, we validated the list by examining the presence of the identified scripts in the actual experiences of both individuals convicted of crimes related to child pornography and Italian police officers who were involved with child pornography as part of their official duties. Our findings suggest that children's accounts of sexual abuse should be considered credible even if they contain unusual or bizarre elements that also occur in child pornography and therefore may reflect events actually experienced rather than merely the child's fantasy or imagination.

Introduction to the Special IssueThe Use of Creative Art Therapies in the Prevention, Screening, and Treatment of Child Sexual Abuse

The significant gap between the prevalence of child sexual abuse and disclosure underscores the need for new, innovative, and creative screening tools to identify victims to end the abuse and provide these victims with appropriate treatment. This article presents the cumulative efforts of a series of innovative studies dealing with sexually abused survivors and offenders that concentrates on preventing, assessing, screening, and treating Child Sexual Abuse (CSA). We start by describing the need and rationale for using the arts for purposes of identification and treatment. We discuss how these arts help bypass censorship and dissociation mechanisms involving the body as a critical factor during the assessment and the treatment. Each of the articles is then presented. The introduction is organized to show how non-verbal techniques for the prevention, screening, assessment and treatment of sexual abuse in chidren can move beyond verbal techniques that are known to be limited in their effectiveness.

Predictors of Skeptical Responses to Disclosures of Childhood Sexual Abuse

Victims of Childhood Sexual Abuse (CSA) may be met with skeptical responses when they disclose their experience. The fear of such a response means that most victims delay telling anyone about the abuse. The aim of this study was to explore how contextual factors of abuse such as victim gender and age, perpetrator gender, and victim-perpetrator relationship affect a response to CSA. Further, we explored what personality traits may predict a skeptical response. An online questionnaire with 357 undergraduate students asked participants to read a vignette describing CSA, and to indicate the extent to which they believed the vignette, whether they blamed the victim or perpetrator, and what punishment they would recommend for the perpetrator. Results indicated that older victims were less likely to be believed and more likely to be blamed than younger victims. Further, we found more blame was placed on a perpetrator of intrafamilial abuse compared with extrafamilial abuse, but only if the perpetrator was male. Female perpetrators were punished less harshly than male perpetrators, but female intrafamilal perpetrators received harsher punishment than female extrafamilial perpetrators. No such effect was found for male perpetrators. Openness to Experience was associated with a more supportive response to CSA, as was Agreeableness. Implications and future directions are discussed.

Predicting disclosure latency in substantiated cases of child sexual abuse

OBJECTIVE

Children who experience sexual abuse (CSA) often delay disclosure, thus impeding early interventions. This study explores predictors of disclosure latency in a sample of forensically substantiated cases.

METHODS

Court files were analyzed for a total of 124 cases of CSA. The ground truth of the alleged victims' statements had been substantiated by at least one inclusion criterion-an evaluation of the alleged victims' statement as credible by psychological experts applying Statement Validity Assessment (SVA), or the conviction of the suspected offender by the court. Six possible predictors of disclosure latency were tested individually and in a joint negative binomial regression model.

RESULTS

Younger age of the child at abuse onset and intrafamilial (vs. extrafamilial) child-perpetrator relationships (including stepparents) were associated with prolonged disclosure latency. No predictive evidence was found for the child's gender, severity of abuse, or offender's usage of violent or nonphysical strategies to prevent disclosure.

CONCLUSION

This study contributes to understanding the processes of disclosure by reassessing formerly identified predictors of disclosure latency in a sample of forensically substantiated cases. Results are in line with suggestions to further develop effective prevention programs for younger children (e.g., for elementary school) and to explicitly discuss the issue of intrafamilial abuse.

Disclosures of Sexual and Physical Abuse across Repeated Interviews

This study examined the recorded interviews of 132 children between 3 and 16-years of age who were involved in a forensic investigation evaluating allegations of sexual and/or physical abuse. As part of this investigation, two interviews were conducted over a 5-day period. The interviews were analyzed to examine how frequently these children disclosed substantiated allegations of abuse when asked directly about these experiences in one or both interviews. Results revealed that 39.2% of children with substantiated sexual abuse and 55.6% of those with substantiated physical abuse denied these experiences in one or both interviews. The denial rate was highest among school aged children (6- to-10-year- olds), as over a third of the girls and more than half of the boys in this age group denied the substantiated allegations in one or both interviews. Recantations were also relatively common, as 24% of the children who disclosed sexual and/or physical abuse prior to the assessment denied the allegations in one or both interviews. The youngest children (3- to 5-year-olds) were most likely to be inconsistent in their denials/disclosures across interviews. Custody status and relation to the perpetrator also predicted denials/disclosures of sexual, but not physical abuse. Overall, the data suggest that denials of both sexual and physical abuse are quite common and higher than rates found in most archival file reviews.

Descriptive Analysis of the Characteristics of Proven Cases of Sexual Abuse in Victims With Intellectual Disabilities and Children With Typical Development in Spain

Children and people with intellectual disability (ID) are considered to be highly vulnerable and in need of special protection against sexual abuse (SA). The objective of this work was to analyze the characteristics of cases of SA in children with typical development and in people with ID in Spain. To do so, 25 cases of each type that had been investigated by specialized groups of the Judicial Police of the Spanish Civil Guard and that had been classified as proven and confirmed by police and forensic-medical evidence were analyzed. The results allowed the establishment of the typical minor victim profile as Spanish female (76%), with an average age of 8.64 years. Typical victim with ID was characterized as being of Spanish, aged 20.28 years on average, without prior sexual experience, and similar percentages of males (40%) and females (60%). In both cases, the aggressor usually acted alone, was known to the victim, had an average age of 42 years, and without a history of sexual offenses. The most common child sexual crime was SA with penetration, practiced repeatedly, using strategies such as the use of force, authority, rewards, or secrecy. Victims with ID suffered sexual abuse with penetration, using force, authority, threats or blackmail. Finally, 36% of minors not disclose the events by only 8% of victims with ID. Spontaneity was found in the 40% first disclosure in both victims, with greater police evidence and greater recognition of guilt on behalf of the aggressors against victims without disabilities. Minors took an average of 26.26 days to report the facts, and victims with ID of 64.94. It is necessary to know more about these types of offenses to design appropriate prevention and detection programs.

Avaliação do dano psíquico associado ao depoimento especial

O Depoimento Especial de crianças e adolescentes vítimas de violência sexual vem sendo realizado por psicólogos judiciários. O objetivo deste artigo é discutir um modelo de avaliação psicológica prévia ao depoimento, voltada à ocorrência de danos psíquicos ou revitimização a ele associados. Para tanto, apresenta-se síntese reflexiva da experiência profissional dos autores em processos criminais envolvendo violência contra crianças e adolescentes, debatida à luz da literatura especializada nas áreas da Avaliação Psicológica e Psicologia Forense. Na dimensão intrapsíquica do dano, sugere-se a avaliação de fantasias, ansiedades e mecanismos de defesa da criança associados ao depor. Na dimensão intersubjetiva, aprecia-se seu nível de desenvolvimento cognitivo, raciocínio moral e vinculação ao entrevistador. Observou-se a aplicabilidade das técnicas projetivas temáticas – CAT-A, TAT e Procedimento de Desenhos-Estórias – para avaliar tais constructos, utilizando-se vinhetas clínico-forenses para ilustrar o raciocínio avaliativo. Conclui-se que proteger a criança do processo penal é proteger o próprio processo penal.

Psychometric Properties of the Dominic Interactive in a Sample of French Canadian Sexually Abused Children

There are few computerized questionnaires assessing mental health in children. Although the psychometric properties of the Dominic Interactive have been verified for clinical and nonclinical populations, no study has specifically targeted sexually abused children. This study aimed to explore the reliability and validity of the Dominic Interactive with a sample of sexually abused children. The sample consisted of 687 children aged from 6 to 11 recruited in specialized intervention centers in Quebec. We conducted confirmatory factor analysis to assess the factorial structure of the questionnaire and assessed the internal consistency of the subscales with Cronbach alphas and McDonalds omegas. Subscales of the Dominic Interactive showed good fit with the factorial structure and met the prescribed criteria, except for Specific Phobias and Separation Anxiety subscales that showed high interitem correlations. After accounting for intercorrelation errors, all model fit indices showed good adjustment to the factorial structure and met the fit indices criteria. The different subscales of the DI were found to be significantly correlated (r ranging from .13 to .30) with their equivalent parent-reported assessments. The results extend previous findings and suggest that the Dominic Interactive is a valid tool to quickly diagnose various behavioural problems in sexually abused children.

Sexual abuse disclosure among incarcerated female adolescents and young adults

BACKGROUND

Childhood sexual abuse (CSA) is over-represented among incarcerated girls and women. In order to inform effective methods of response, they represent a critical group for better understanding disclosure processes.

OBJECTIVE

The purpose of the current study was to assess the CSA and CSA disclosure experiences of incarcerated female adolescents and young adults.

PARTICIPANTS AND SETTING

Participants were 94 serious female offenders, ages 15-24 (M = 18.72, SD = 1.94), incarcerated in a secure juvenile facility.

METHOD

In one-on-one interviews, participants answered questions about abuse characteristics, whether they had previously disclosed, to whom they had disclosed and after how long, and reasons for prior disclosure or nondisclosure.

RESULTS

Over half of the sample (51.8%,n = 44) reported experiencing CSA. Most individuals who reported a CSA history had previously disclosed (79.5%, n = 35), with approximately equal proportions claiming to disclose within one week (40%) and after a year or years (45.8%). However, 20.5% (n = 9) claimed that our study interview was their first disclosure. Several reasons for their disclosure patterns were endorsed: Most commonly feelings of shame or embarrassment prevented disclosure (56%) and no longer wanting to keep the abuse a secret motivated disclosure (44%).

CONCLUSIONS

Although many incarcerated girls and women share a history of CSA, our results indicate that the abuse and disclosure experiences of incarcerated females are diverse. Understanding their disclosure patterns can inform mental health services, rehabilitation, and professional interviewing strategies that may facilitate disclosure (e.g., forensic interviews, facility intake interviews).

Comparison of Sexual Dysfunction in Women Who Were or Were Not Victims of Sexual Violence

The victims of sexual violence may develop FSD. This retrospective study examined the characteristics of women victims of sexual abuse who had FSD who attended a tertiary hospital from 2004 to 2017. Patients were divided in two groups: women who were victims of sexual violence and women who were not victims (controls). One thousand and ten women (60.4%) presented with FSD and 610 of them were eligible for inclusion, 134 (21.97%) reported they were victims of sexual violence, and the abuser was mostly someone close to the victim (92.31%). Depression was more prevalent in the women who were victims (32.1% vs. 18.3%; p<0.05), 74.0% vs. 59.8% had hypoactive sexual desire disorder (HSDD) (p<0.05), 20.3% of victims vs. 7.19% of controls (p<0.05) had primary anorgasmia, and 51.15% of the victims and 39.61% of controls reported anorgasmia. The victims reported a lower sex drive (39.6% vs. 52.3%), and reduced arousal (48.8% vs. 61.3%; all p<0.05). More of the victims than controls reported that their partners had engaged in an extramarital relationship (19.0% vs. 9.25%, p<0.05).

The Need to Act: Incest as a Crime Given Low Priority—A View with India as an Example

Background: Incest is a form of sexual activity that occurs within family or kinship systems. It is prohibited by religion and law in most countries as well as by social mores or taboos. Data from various parts of the world indicate, however, that it appears to be a relatively common event, although there is reason to believe that the actual frequency is unknown. Most available data focus upon children as victims, although we note that incest also occurs between adult family members. Methods: A systematic review was performed using PRISMA guidelines. With a focus upon India, the search tools of Academic Search Complete, Google Scholar and PUBMED were used to identify articles that legally defined incest; frequency; barriers to disclosure; the dynamics of incest and social norms. Results: The available data were very limited, making a systematic review unachievable within the narrow confines of incest. Conclusions: The literature is sparse. This led to a discussion of definitional issues; barriers to disclosure; and challenges with measuring the problem of incest and the impact of social norms. Questions of law and efforts at reform were also considered. The article considers what steps might be appropriate.

Dental care of patients exposed to sexual abuse: Need for alliance between staff and patients

The aim was to explore the experiences of sexually abused individuals as dental patients. Purposively selected were 13 informants (11 women) aged 19-56. All had experienced sexual abuse as children or adults and memories of this abuse had been triggered and expressed during a dental appointment. They were encouraged to relate in their own words their experiences of the dental appointment. The interviews were recorded digitally, transcribed verbatim, and analysed according to Qualitative Content Analysis. The overall theme illustrating the latent content was The dental appointment - a volatile base requiring predictability and a secure working alliance. The first category covering the manifest content was The dental care provider "assumes responsibility," with two subcategories: (i) contradictory disclosure, and (ii) alliance formation - a levelling of power. The second category was The patient is "in focus," with two subcategories: (i) alertness to signs of discomfort, and (ii) attention to obvious but subtle expressions of needs. On an understanding that the patient has been sexually abused, an individually tailored, patient-centered approach to treatment is suggested. Dental care providers may also need to be aware of and reflect on their position of power, in relation to the patient and its possible chairside implications.

Interventions that address institutional child maltreatment: An evidence and gap map

Background

Child maltreatment has serious short and long-term negative impacts for those experiencing it. Child maltreatment occurring in institutional settings has recently received substantial attention. However, evidence about the effectiveness of interventions that prevent, disclose, respond to, or treat maltreatment that has occurred in these environments is fragmented and can be difficult to access. This evidence and gap map (EGM) collates this research evidence. It was developed as a resource for stakeholders operating in the child health, welfare and protection sectors, including practitioners, organisational leaders, policy developers and researchers, wanting to access high quality evidence on interventions addressing institutional child maltreatment.

Objectives

The objectives of this EGM were twofold: (a) To provide a structured and accessible collection of existing evidence from finalised and ongoing overviews of systematic reviews, systematic reviews and effectiveness studies of interventions addressing institutional child maltreatment-for those who work to fund, develop, implement and evaluate interventions aimed at ensuring children's safety in institutional settings; (b) to identify gaps in the available evidence on interventions addressing institutional child maltreatment-thereby helping to inform the research agendas of funders and other organisations.

Search Methods

A comprehensive search strategy identified relevant studies from published and grey literature, comprising: (1) 10 electronic academic databases; (2) five trial and systematic review registries; (3) nine organisational websites; (4) websites and reference lists of inquiry reports associated with seven international inquiries into child abuse and (4) the lists of included studies within systematic reviews identified by the search strategy. Members of this EGM's Subject Matter Experts group were also invited to forward relevant unpublished studies or grey literature.

Selection Criteria

The selection criteria were developed to identify finalised and ongoing overviews of reviews, systematic reviews and primary studies that reported on the effectiveness of interventions addressing child maltreatment (including sexual abuse, physical abuse, neglect and emotional abuse) within institutional settings. Eligible effectiveness study designs included: randomised controlled trials (RCTs), nonrandomised trials, controlled before-and-after studies and quasi-experimental studies. Reviews were eligible if they reported a systematic literature search strategy.

Data Collection and Analysis

All screening, data extraction, coding and critical appraisals were undertaken by two or more reviewers working independently, with discrepancies resolved via consensus or by a third reviewer. The titles and abstracts of studies identified by the search strategy were screened, and each full text of potentially relevant studies was further assessed for inclusion. Key data were extracted from all included studies and reviews. This included information about: publication details (e.g., year, author, country), inclusion/exclusion criteria (for reviews), study design, institutional setting, target population, type of maltreatment, intervention type and outcomes. Critical appraisal of included systematic reviews was achieved using the AMSTAR 2 tool, and completed RCTs were assessed using the updated Cochrane Risk of Bias 2.0 tool.

Main Results

Number of studies The electronic database search yielded 6318 citations, and a further 2375 records were identified from additional sources. Following deduplication and title/abstract screening, 256 studies remained for full text review. A total of 73 eligible studies (reported across 84 publications) met the inclusion criteria, including: 11 systematic reviews (plus, one update); 62 primary studies (including, three protocols for primary studies). Study characteristics The studies were conducted across 18 countries, however more than half (52%) were undertaken in the United States. Overall, most studies evaluated curriculum-based interventions delivered in educational settings, primarily aimed at the prevention of sexual abuse. Institutional setting: Most studies evaluated interventions in school or early learning environments (n = 8 systematic reviews; n = 58 primary studies). Far fewer studies examined other organisational settings. Out of home care (including foster care, residential care and orphanages), and social service organisations servicing children were minimally represented. No studies were identified where the primary setting was sports clubs, churches/religious organisations, summer/vacation camps, detention centres/juvenile justice settings, or primary/secondary health care facilities. Target population: Most interventions targeted children rather than adults (n = 7 systematic reviews; n = 47 primary studies) from the general population. Fewer studies included populations known to be at an increased risk, or those already exposed to maltreatment. Just over a third of the primary studies conducted an analysis to ascertain differences in the effect of an intervention between the genders. Intervention type: Prevention interventions were the most studied (n = 5 systematic reviews; n = 57 primary studies), with additional studies including prevention approaches alongside other intervention types. Fewer studies evaluated interventions targeting disclosure, institutional responses, or treatment interventions. Type of maltreatment: The vast majority of the studies assessed interventions solely addressing the sexual abuse of children (n = 8 systematic reviews; n = 45 primary studies). The remaining studies addressed other forms of maltreatment, including physical and emotional abuse, or neglect, either in combination or as a sole focus. Outcomes: Primary reported outcomes reflected the bias toward child targeted interventions. Outcome measures captured child wellbeing and knowledge outcomes, including measures of mental health, children's knowledge retention and/or self-protective skills. Measures of maltreatment disclosure or maltreatment occurrence/reoccurrence were less common, and all other outcome categories included in the EGM were minimally or not reported. A third of studies reported on some measure of implementation. Study quality The overall quality of the studies was low to moderate. Most systematic reviews were low-quality (n = 10), with only one high quality review (and update) identified. Most completed RCTs had some concerns relating to the risk of bias (n = 30), and the remainder were considered to be at a high risk of bias (n = 19).

Authors' Conclusions

This EGM has highlighted a substantial need for more high quality studies that evaluate interventions across a broader range of institutional contexts and maltreatment types. The current evidence base does not represent countries with large populations and the greatest incidence of child maltreatment. Few studies focussed on perpetrators or the organisational environment. Further evidence gaps were identified for interventions relating to disclosure, organisational responses and treatment, and few studies assessed interventions targeting perpetrators' maltreatment behaviours, recidivism or desistence. Future studies should also include measure of programme implementation.

Meta-analysis of the effects of two interviewing practices on children's disclosures of sensitive information: Rapport practices and question type

BACKGROUND & OBJECTIVE

The forensic interview is an important part of the investigative process with child witnesses, and ensuring evidence-based practices is crucial to its success. This meta-analysis examined the overall effect of rapport practices and question type on children's disclosures during forensic interviews to determine (a) how large of an influence existing practices have on children's tendency to disclose information, and (b) how consistent the effect sizes of interviewing practices are across studies, given that inconsistent results have been found.

METHOD

A systematic review of child interviewing practices was conducted, and 35 studies met the inclusion criteria. Articles were categorized thematically according to interviewing practice. Two practices were predominantly represented in the literature and were selected for review and meta-analysis: rapport techniques, including interviewer support, (n = 9), and question type (n = 25 samples, 23 studies). Random-effects meta-analytic models were computed separately for rapport practices and question type, and moderator analyses were conducted to test for differences according to age and interviewing protocol.

RESULTS

Rapport techniques had a medium overall effect on children's disclosures (d = 0.55, p < .001), and was moderated by the interviewing protocol used, but not children's age. Open-ended questions compared to closed-ended questions had a medium overall effect on children's descriptions of sensitive events (d = 0.52, p < .001), and was not moderated by age or interviewing protocol.

CONCLUSIONS

These findings provide overarching support for the use of rapport and support, and the use of open-ended questions in forensic interviews with child witnesses.

Understanding expert testimony on child sexual abuse denial after New Jersey v. J.L.G.: Ground truth, disclosure suspicion bias, and disclosure substantiation bias

The New Jersey Supreme Court held in New Jersey v. J.L.G. (2018) that experts can no longer explain to juries why sexually abused children might deny abuse. The court was influenced by expert testimony that "methodologically superior" studies find lower rates of denial. Examining the studies in detail, we argue that the expert testimony was flawed due to three problems with using child disclosure studies to estimate the likelihood that abused children are reluctant to disclose abuse: the ground truth problem, disclosure suspicion bias, and disclosure substantiation bias. Research identifying groups of children whose abuse can be proven without reliance on disclosure reveals that denial of sexual abuse is common among abused children.

Analyzing the scientific foundation of Child Sexual Abuse Accommodation Syndrome: A reply to Lyon et al

The issue before the New Jersey Supreme Court in the Frye hearing New Jersey v. J.L.G. (2018) was whether the scientific community agreed that Summit's (1983) Child Sexual Abuse Accommodation Syndrome rested on a firm scientific foundation. Lyon et al. (this issue) critique our approach to describing child sexual abuse disclosure, which involved extrapolating rates from children who came to the attention of authorities. Lyon et al. claim that our conclusions are marred by sampling biases resulting from what they term the ground truth problem, suspicion bias and substantiation bias. The points Lyon et al. claim we "fell victim to" were the very points we acknowledge are inherent difficulties in estimating the extent to which children will come forward to tell others about sexual maltreatment. Lyon et al. offer an alternative solution to the inherent difficulties in studying a difficult-to-identify population, relying in large part on 21 papers published mostly in the 1960s and 1970s. We argue that the method they propose has more flaws than the one it is intended to replace. Points of agreement and disagreement, along with suggestions for future research, are discussed. Moving forward, we argue that studies are needed that embrace both validity and generalizability in order to foster data-driven theories rather than invoking the intuitive suppositions of Summit's (1983) syndromal evidence.

Detecting children's true and false denials of wrongdoing: Effects of question type and base rate knowledge

One common and unfortunately overlooked obstacle to the detection of sexual abuse is non-disclosure by children. Non-disclosure in forensic interviews may be expressed via concealment in response to recall questions or via active denials in response to recognition (e.g., yes/no) questions. In two studies, we evaluated whether adults' ability to discern true and false denials of wrongdoing by children varied as a function of the types of interview question the children were asked. Results suggest that adults are not good at detecting deceptive denials of wrongdoing by children, even when the adults view children narrate their experiences in response to recall questions rather than provide one word answers to recognition questions. In Study 1, adults exhibited a consistent "truth bias," leading them toward believing children, regardless of whether the children's denials were true or false. In Study 2, adults were given base-rate information about the occurrence of true and false denials (50% of each). The information eliminated the adults' truth bias but did not improve their overall detection accuracy, which still hovered near chance. Adults did, however, perceive children's denials as slightly more credible when they emerged in response to recall rather than recognition questions, especially when children were honestly denying wrongdoing. Results suggest the need for caution when evaluating adults' judgments of children's veracity when the children fail to disclose abuse.

Early identification of youth with problematic sexual behavior: A qualitative study

BACKGROUND

Early intervention efforts designed for youth with problematic sexual behavior (PSB) have strong promise. Prompt identification of youth with PSB is critical to ensuring early intervention and effective response.

OBJECTIVE

The current study explored the complexities of how PSB of youth is identified in the community.

SETTING

A qualitative semi-structured interview approach was utilized to explore the perceptions and experiences of community members involved in cases of youth with PSB.

PARTICIPANTS

Participants included 100 community members from eight geographically diverse locations in the United States.

METHOD

Themes involving identification of PSB were classified by qualitative analyses, beginning with thematic analysis followed by focused coding.

RESULTS

Results indicated multiple pathways for the identification of youth with PSB involving a variety of professionals and agencies. Victim disclosure and witnessing the PSB were the most common identification pathways, with caregivers and school personnel the most common initial identifiers. Once identified, cases were reported to child welfare, law enforcement, and/or behavioral health agencies. Complications due to unclear response pathways and fears held by caregivers were notable.

CONCLUSIONS

Developmentally appropriate, evidence-informed policies and procedures for the identification of and response to PSB in youth within and across professions would facilitate a public health response to for prevention and early responses to PSB of youth.