DESNUTRICION:

A brief summary o f the major content areas covered by the interview is presented in the following table (Table 6.vi). As the interview was over 80 pages long, it is not reproduced in full in this thesis. Appendix 6 contains a full description of major content areas. Interviews are available from the author.

Interview Topic Items

Demographic Age; family tree; marital status; educational and occupational history; social class data; cultural group and religion.

Individual history Criminal history; drug, alcohol and palliative use; medical and psychiatric history; social support network. Target boy history Pregnancy and childbirth; early

development; descriptions of boy as young child and currently; reactions to discovery of abuse/perpetration, or to misdemeanours for antisocial group. Ratings of expressed warmth, criticism and hostility were made following this section.

Family of origin Family demography; early loss and separation; early experience of abuse and neglect, including child sexual abuse. Adult abuse Experiences of adult physical and sexual

abuse.

Table 6.vi; Content area of maternal semi-structured interview.

Modifications were made to the interview for the mothers of comparison group boys, however these mothers were also asked about any sexual abuse experiences in their son's lives ('As far as you know has your son ever been a victim of any unwanted sexual experiences?', 'As far as you know has your son ever been accused o f touching or interfering with another child?'). This situation did not arise in the present study, all comparison group mothers reported that, to their knowledge, their sons had not been victims or perpetrators of sexual abuse. One mother reported that her son may have been tickled inappropriately by a priest during an outing, however the team decided that this did not fulfil the criteria for sexual abuse and he remained in the comparison group.

Ratings o f expressed criticism, hostility and warmth:

Three expressed emotion variables (based on Brown and Rutter, 1966) were rated during the interviews with mothers (see Appendix 7 for rating criteria). Expressed criticism, hostility and warmth towards the index boy were rated by the author after the interview,while subjects were completing self-report questionnaires. No reliability study was undertaken, however the author had limited previous experience of these ratings in the context of working with families of chronic psychiatric patients at the District Services Centre, Maudsley Hospital, London from October to December,

1987.

Family o f origin data:

This section focussed on quality of parental care in childhood which was based on the Measure of "Lack of Care" in Childhood (Andrews, Brown and Creasey, 1986). Four measures o f early experience were derived (composite variables) on the basis of questions at interview, i) Parental control; coded as 1 (high control) to 3 (lax control). This refers to the level of supervision of the child and rules and discipline enforced by parents; ii) Parental discord; coded as 1 (marked discord) to 4 (little or no discord). This refers to the subject's perception of the amount of arguing and domestic violence in the house, and the marital history o f the subjects parents;

iii) Parental functioning; coded from 1 (markedly poor functioning) to 4 (little or no poor functioning). This was based on subject's description of parental alcohol use, mental illness and general functioning in social and family life; iv) Parental

antipathy; coded from 1 (marked antipathy) to 4 (little or no antipathy). This rating was based on the degree of dislike, hostility or disapproval by parents towards the subject as a child, (see Appendix 7 for further details)

Maternal sexual abuse experiences:

The questions used to ask about sexual abuse in both childhood and adulthood at interview were asked towards the end of the interview period. Mothers were asked whether they had ever been sexually approached against their wishes. If they said no, they were asked again following further clarification of the question. If the answer was no a second time then the interviewer proceeded to end the interview (see Appendix 8) and administered the questionnaires.

Subjects who reported that they had been approached against their wishes were then asked to give details of each abuse episode by answering the following questions: (i) how old were you when that happened? (ii) was it someone in your original family? (iii) can you tell me who it was? (iv) did it involve touching? (v) did it involve

intercourse? (vi) could I ask you to look at this page and tell me which ones applied to you? (see Appendix 9) (vii) did anybody else know that it happened? (viii) what did they do? (ix) is this the first time you have told anyone about what happened to you?

Other questions were asked where appropriate in order to ascertain that a detailed account was obtained of the type of abuse, age of victim, relationship to perpetrator, tactics used by the perpetrator, and whether the abuse was reported on and how the victim was treated (see Appendix 10).

A prevalence study based on a community sample of women by Anderson, Martin, Mullen, Romans and Herbison (1993) included criteria for rating sexual abuse. These criteria were used in the present study to determine whether sexual abuse had taken place and was categorised by six types of sexual abuse (see p. 913, Anderson et al., 1993).

i) Non-contact sexual abuse: This category includes spying, indecent suggestions, and pornography.

ii) Non-genital contact: Touching o f non-genital areas including breasts/buttocks, kissing, sexual 'attacks' which were stopped.

iii) Genital contact/ being touched: Being touched or fondled in the genital area. iv) Genital contact/ touching perpetrator: Forcing or persuading child to touch perpetrator's genital area or oral-genital abuse.

v) Attempted intercourse: Includes physical contact and degree of force. vi) Sexual intercourse: Actual vaginal and/or anal penetration.

Oral-genital contact was the only form of abuse not specified in the Anderson et al., (1993) definition, and it was included under category iv).

This definition or classification of child sexual abuse is similar to others used in the literature (e.g., Peters, Wyatt and Finkelhor, 1986), and is comprehensive. Clearly it also provides an indication of severity of sexual abuse experiences which is important given that abuse experiences including intercourse usually have a more deleterious effect on adult outcomes than sexual abuse which does not include intercourse (e.g., Mullen, Martin, Anderson, Romans and Herbison, 1993).

Similar criteria were used to establish adult sexual abuse. Slightly more stringent criteria were applied to adult experiences. For example in the second category, non­ genital contact, a clearly defined sexual 'attack' was included, but an unwanted kiss, if it involved no physical coercion was not included. Coercion was an important factor in assessing adult sexual abuse and included verbal pressure, threats of harm, use of weapon, physical restraint and actual physical harm (see Sorenson, Stein, Siegel, Golding and Bumam, 1987).

Definitions of child physical abuse were taken from that used in research projects reported on by Brown and his colleagues (e.g., Andrews, Brown and Creasey, 1990; Bifijlco, Brown and Harris; 1994). This definition is comparable to that used in the Severe Violence index of the widely used Conflict Tactics Scale (CTS; Straus, 1979; Straus and Gelles, 1980) and includes any incidence of violence towards a child by an adult, usually parents. Physical abuse covers beatings, kicking, burning, hitting with objects, being threatened with knives or other weapons.

Adult physical abuse was defined in a similar way, with reference to the Conflict Tactics Scale which operationalises the concept of violence or physical aggression. Violent acts include throwing an object, pushing or shoving, kicking, biting, punching and use or threat o f weapons (guns, knives). The abuse is defined by the violent act rather than the extent of the injury, although more severe violence usually causes injuries which were also asked about (cuts, bruises, broken bones and hospitalisation). As in the case of sexual abuse, this is an extremely sensitive area of enquiry during interviews. A card was provided for mothers (see Appendix 11) in order for them to identify which experiences they had, without having to actually describe the abuse if this was too distressing.

Piloting:

During the early stage o f this study, it became increasingly clear that despite

canvassing all social service departments in the South East of England, the number of referrals was less than expected. Therefore, a formal pilot study was not carried out and it was decided that when mothers of boys of the correct age group were referred, they would be approached to take part in the actual study.

For this reason, the interview could not be piloted fully, but was based on well- established interview schedules which have been used for interviewing mothers o f a

similar clinical group regarding sensitive areas such as sexual abuse and early

experiences. One mother was seen who had a son outside the eligible age range (16 years 9 months), and was interviewed as a pilot subject.

The Attributional Style Questionnaire (ASQ, Seligman et al., 1979) was completed for the first 10 subjects and the 'pilot' mother but had to be abandoned when it became clear that subjects were unable and unwilling to proceed with the questionnaire. The ASQ involves asking subjects to 'vividly imagine' situations (see Section 4.4.1), which were clearly out of these women's experience (such as dating or getting a pay rise). Furthermore, the task of rating causes of events was not clearly understood, thus making the results unreliable.