Elemento subjetivo

The strengths of this study were that it was long-term, prospective, involved substantiated sexual abuse, included a comparison cohort, took into account mediating factors, utilised multiple data sources, relied on standardised measures and had a high follow-up rate. It has been the only study to date which has followed up sexually abused young people for five years from the official disclosure of the abuse and where the sexual abuse was limited to that involving physical contact and which was substantiated by clinicians and extensively documented.

The study was well designed in that the abused group was compared to a group of nonabused young people which was similar in gender and age, from a non-clinical population and drawn from stratified random sampling from the community. The method of analysis took into account differences between the abused and nonabused young people via multivariate regression modelling. Furthermore, the data were comprehensive in that they were collected from the young people themselves as well as parents, teachers and official records. Measures were valid, reliable and widely used, allowing results to be easily compared to other work. The follow-up rates were quite acceptable, 81% for the abused group and 89% for the nonabused group.

Chapter 6 - Summary and Conclusions 6.6 Suggestions for future research

This study focused on a follow-up five years after presentation for sexual abuse.

Young people were aged between nine and twenty-two years at this time. It may be that this time period was insufficient to allow certain effects of the abuse to manifest themselves. This “sleeper effect” has been discussed in the literature (Kendall-Tackett, 1993) and requires further examination via longer-term prospective studies. While initially appearing to have been resolved, trauma may resurface later in life when triggered by major life events such as marriage, divorce, the birth of a child, death of a family member, illness or retirement (Herman, 1997). It would also have been of interest to document whether repeat victimisation occurs with regard to other types of crimes.

Gender is an important variable which requires more comprehensive study. Ideally predictors of the different outcomes would be examined separately for each gender.

Owing to the small number of males in this study, this was not possible. Gender is strongly related to another area which begs further research, that of the cultural implications of sexual abuse. The importance of virginity within some cultures should not be under-estimated. The impact of sexual abuse on young people in certain cultures can have severe ramifications for the treatment they receive from their immediate and extended families, their status in their community and eligibility for marriage. These factors, in turn, can heighten the experience of self-blame and shame by a child and their family, thereby reducing the likelihood that they will seek access to treatment and support. In this study, for example, one father was adamant that his daughter was not affected by the sexual abuse because her hymen was intact. Another child did not participate in the study and did not return for follow-up treatment after presenting to the Child Protection Unit because her mother did not want the child’s father to find out about the sexual abuse. This mother feared that if the abuse became known, the father would react violently towards the child and that they would be ostracised by their extended family and community.

Other areas requiring further study are the effects of a child’s sexual abuse upon their non-offending siblings and fathers. While mothers’ child sexual abuse was examined here, it would also have been of interest to explore non-offending fathers’ experiences

Chapter 6 - Summary and Conclusions

of child sexual abuse. The effectiveness of specific types of treatment within certain populations of sexually abused children would also be of interest. Ideally, a large, multi-centred follow-up of children with documented sexual abuse would be conducted and young people would be followed up into their 30s and 40s to examine emotional and behavioural trajectories (including criminal activity and sexual functioning) throughout adolescence, young adulthood and adulthood, including their own parenting practices and the influences of other life events and treatment would also be explored.

The key finding that attributional style was associated with depression, self-esteem and anxiety was only able to be described with certainty in the younger study participants.

Ideally, in future work, an appropriate form of the Children’s Attributional Style Questionnaire would be administered to older participants.

6.7 Conclusions

The effects of child sexual abuse continue to be manifest for some years afterwards.

Five years after presentation for child sexual abuse, striking differences emerged between sexually abused young people and a group of their non-abused peers. Even when variations in age and gender, follow-up lag, socio-economic status, number of parent changes, family functioning, mother's mental health and number of negative life events were taken into account, differences in the behaviour and psychological functioning of abused and nonabused young people remained significant. Sexually abused young people were significantly more dysfunctional than their nonabused peers in terms of their behaviour and psychological states.

Variables which predicted the young people’s behavioural and psychological outcomes were the number of negative life events that they had experienced, attributional style, mother’s mental health, parental drug and alcohol history, family functioning at intake, parent-figure changes, history of parental discord and the child’s history of other notifications for abuse and/or neglect. Logically, young people’s psychological states were also predictive of their behaviour. Behaviour scores at intake contributed to predicting behaviour scores at five year review.

Chapter 6 - Summary and Conclusions 6.8 Implications

Given the significant differences between the abused and nonabused groups, and the types of variables which were significant predictors of outcome, these predictor variables may have mediated outcome in the sexual abuse group.

There are six implications of these findings:

1. Difficulties associated with child sexual abuse continue for some years after the abuse event.

2. Child sexual abuse needs to be considered as a possible antecedent of behaviour and psychological difficulties in young people.

3. Treatment and monitoring should continue for some years after the abuse.

4. Treatment may need to be directed more towards young people’s psychological states rather than focus specifically on the sexual abuse. For example, generic modes of treatment such as rehearsal and catharsis may not be as effective as those which address specific sequelae of child sexual abuse, for example, depression.

5. Family and parent functioning may need to be addressed early in order to prevent some of the behavioural and psychological difficulties associated with the long-term outcome of child sexual abuse. Early treatment of parents’ drug and alcohol problems may also contribute to preventing some of the long-term associations of sexual abuse in their children. Stability of young people’s living situations may need to be addressed.

6. Early intervention with regard to young people’s attributional styles may also enhance psychological adjustment by improving levels of sadness/depression, self-esteem and anxiety. There may also need to be ongoing support for these young people in order for them to better withstand the impact of negative life events.

Appendix 1

Appendices