Child sex rings.

Details of 11 child sex rings identified in one working class community were obtained by interviewing investigating police officers and examining health and social services records. The rings contained 14 adult male perpetrators and 175 children aged 6-15 years. Most perpetrators used child ringleaders to recruit victims; others became a "family friend" or obtained a position of authority over children. Secrecy was encouraged and bribery, threats, and peer pressure used to induce participation in sexual activities. Offences reported included fondling, masturbation, pornography, and oral, vaginal, and anal intercourse. Eleven perpetrators were successfully prosecuted; all but one received a sentence of three years or less. Behavioural problems were common among those children who had participated for a long time. Child sex rings are difficult to detect and may be common. Many children are seriously abused as a consequence of them.     

Family violence: guidelines for recognition and management

Chronic and intermittent abuse of one family member by another is common. Victims may be children who are sexually or physically abused, wives or live-in partners, or older relatives. Physicians are often the first points of contact for patients who have been abused, but the abuse is frequently concealed by the victims. Physicians should be alert to signs of battering such as bruises in various stages of healing, unusual behaviour in children and interpersonal difficulties in the family. There are a number of options in prevention and treatment, including referral to social service and legal authorities, calling on other resources in the family and helping the individual develop coping skills. This review also lists a large number of social agencies in Canada that are willing to help victims of abuse.     

Les violences sexuelles

The penal code severely represses all forms of sexual violence. It distinguishes between sexual aggressions and sexual attacks —The exploitation of 275 psychodynamic assessments of perpetrators of sexual violences jointly carried out by two experts led to the following data: The perpetrators were between 12 and 68 years old, 108 were between 12 and 25, 109 between 26 and 40. The parents had left a void in the infantile history of the perpetrators of aggressions. The aggressors came mostly from large families. The conclusions of the assessment make possible to assert that, 50% of the perpetrators were immature, 90 suffered from psychic troubles, i.e. referring to a form of trouble of the psychiatric nosography. The assessments revealed the existence of a neurotic structure in 20 cases, a perverse structure in 16 cases and a psychotic structure in 9 cases. Studies on the psychopathology of sexual aggressor, in particular Claude Balier’s work, reveal the basic anxiety, the personality split, the early trauma (most sexual aggressors have themselves been aggressed in their childhood), the counter-organization to face anxiety. Bernard Cordier’s work on pedophilia makes possible to outline a clinical approach. Pedophiles can be divided into three groups: primary or chronic pedophiles, pedophiles with a mental anomaly, reactive or transitory pedophiles. The exploitation of 222 assessments of victims (195 women, 33 men) carried out by us brings forth the following elements:

- the large majority of those victims consisted of under 18s, from 3 to 18 years old (72%), out of which 109 were less than 15 years old (47%).

- 106 among the vicitms had an inadequate father, which amounts to 45%, close to the 50% of inadequate fathers among the aggressors.

- 24% of the fathers were described as violent.

- 40.8% of the mothers had died, divorced or separated, which is high for a population of rather young victims.

- 6.5% of the mothers were described as violent.

- More than 40% had ben brought up in a children’s home or fostered.

- 17.6% had bad memories or no memories at all of their childhood, 10% had suffered from maltreatment.

- 36% had had psychic troubles. Those figures show the victims structural fragility, their deficiencies facilitating their aggressors’hold on them.

The conclusions of the assessment assert that in 71% of the cases the aggression had consequences directly linked with it. The 17/06/98 law on the prevention and repression of sexual attacks, and on the protection of under 18s, sets up on the one hand a socio-judicial follow-up for sexual delinquents, on the other hand a real «status» for the child victim of sexual abuse. If the notion of treatment has made real progress with regard to the victims, absent for too long in the judicial process, the treatment of aggressors, even though the texts sem to be firm about it, is still to be established.     

Risk factors for development of sexually abusive behaviour in sexually victimised adolescent boys: cross sectional study

Objective: To identify factors that may increase the risk of a sexually victimised adolescent boy developing sexually abusive behaviour. Design: Sexually victimised boys who had sexually abused other children were compared with sexually victimised boys who had not done so. Setting: Social services departments in south east England were invited to refer sexually abused and sexually abusing boys to a London postgraduate teaching hospital. Subjects: 25 adolescent boys aged between 11 years and 15 years and 11 months. Main outcome measures: Adjusted odds ratios estimated from unconditional logistic regression. Results: Unadjusted odds rations for witnessing (8.1) as well as experiencing (18.0) intrafamilial violence and discontinuity of care (7.2) discriminated boys who had sexually abused from others who were solely victims of sexual abuse. Only the adjusted odds ratios for witnessing intrafamilial violence (39.7) discriminated the two groups. Conclusions: The risk of adolescent boys who have been victims of sexual abuse engaging in sexually abusive behaviour towards other children is increased by life circumstances which may be unrelated directly to the original abusive experience, in particular exposure to a climate of intrafamilial violence. Our findings have implications for the management of boys found to have been sexually abused and raise important questions about the possibility of secondary prevention of subsequent abusive behaviour in those at greatest risk.

Key messages

• The risk of sexually abused boys in early adolescence abusing other children may be associated with experiences in early life that are independent of sexual victimisation
• Exposure to persistent violence within the family may be a particularly important risk factor
• Management of sexually abused boys should take into account the impact of early life experiences that may be associated with increased risk with a view to the secondary prevention of sexually abusive behaviour

     

Testing the Validity and Reliability of the Shame Questionnaire among Sexually Abused Girls in Zambia

Purpose

The aim of the current study is to test the validity and reliability of the Shame Questionnaire among traumatized girls in Lusaka, Zambia.

Methods

The Shame Questionnaire was validated through both classical test and item response theory methods. Internal reliability, criterion validity and construct validity were examined among a sample of 325 female children living in Zambia. Sub-analyses were conducted to examine differences in construct validity among girls who reported sexual abuse and girls who did not.

Results

All girls in the sample were sexually abused, but only 61.5% endorsed or reported that sexual abuse had occurred. Internal consistency was very good among the sample with alpha = .87. Criterion validity was demonstrated through a significant difference of mean Shame Questionnaire scores between girls who experienced 0–1 trauma events and more than one traumatic event, with higher mean Shame Questionnaire scores among girls who had more than one traumatic event (p = .004 for 0–1 compared to 2 and 3 events and p = .016 for 0–1 compared to 4+ events). Girls who reported a history of witnessing or experiencing physical abuse had a significantly higher mean Shame Questionnaire score than girls who did not report a history of witnessing or experiencing physical abuse (p<.0001). There was no significant difference in mean Shame Questionnaire score between girls who reported a sexual abuse history and girls who did not. Exploratory factor analysis indicated a two-factor model of the Shame Questionnaire, with an experience of shame dimension and an active outcomes of shame dimension. Item response theory analysis indicated adequate overall item fit. Results also indicate potential differences in construct validity between girls who did and did not endorse sexual abuse.

Conclusions

This study suggests the general utility of the Shame Questionnaire among Zambian girls and demonstrates the need for more psychometric studies in low and middle income countries.     

Survivors of sexual abuse: clinical,lifestyle and reproductive consequences

BACKGROUND: In recent years, an increase in the prevalence of sexual abuse of women has been reported in Canada and elsewhere. However, there are few empirical data on the extent of the problem in Canadian aboriginal populations. The authors investigated the presence of a reported history of sexual abuse and other health determinants in a sample of women attending a community health centre with a substantial aboriginal population. This allowed determination of whether reported sexual abuse and its associated demographic and health-related effects were different for aboriginal and non-aboriginal women. METHODS: A sample of 1696 women was selected from women attending a community health centre in a predominantly low-income inner-city area of Winnipeg for a cross-sectional survey designed to study the association between sexual behavior and cervical infections. The survey was conducted between November 1992 and March 1995 and involved a clinical examination, laboratory tests and an interviewer-administered questionnaire. A substudy was conducted among 1003 women who were asked 2 questions about sexual abuse. RESULTS: The overall response rate for the main study was 87%. Of the 1003 women who were asked the questions about sexual abuse, 843 (84.0%) responded. Among the respondents, 368 (43.6%) were aboriginal. Overall, 308 (36.5%) of the respondents reported having been sexually abused, 74.0% of the incidents having occurred during childhood. The prevalence was higher among aboriginal women than among non-aboriginal women (44.8% v. 30.1%, p < 0.001). Women who had been sexually abused were younger when they first had sexual intercourse, they had multiple partners, and they had a history of sexually transmitted diseases. In addition, non-aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have had abnormal Papanicolaou smears. The proportion of smokers was higher among the abused women than among the non-abused women in both ethnic groups. INTERPRETATION: A history of sexual abuse was associated with other clinical, lifestyle and reproductive factors. This suggests that sexual abuse may be associated with subsequent health behaviors, beyond specific physical and psychosocial disorders. Aboriginal and non-aboriginal women who have suffered sexual abuse showed substantial differences in their subsequent health and health-related behaviours.     

Family background characteristics and relationship satisfaction in a native community in Canada

Abstract

Using data collected from a Native Canadian community by Embree (1993), we examine the influence of personal and family background characteristics on satisfaction with spousal relationships, both legal marriages and cohabitations. Of special interest are the quality of relationships with parents while growing up, alcohol abuse by the parent(s), and the experience of sexual abuse during childhood. Personal traits such as age, sex, and gender role attitudes and the respondent's own drinking behavior are also considered. Path analytic techniques model both the direct effects of independent variables on relationship satisfaction as well as the role of personal consumption of alcohol as an intervening variable in level of satisfaction with a relationship. The results of the analysis indicate that personal consumption of alcohol and the experience of sexual abuse during childhood are the best direct predictors of level of satisfaction with the current relationship, with higher alcohol consumption and experience of sexual abuse related to lower satisfaction. Age also has a significant direct, though smaller, positive influence on relationship satisfaction. Sexual abuse and the respondent's sex are also linked to level of satisfaction through personal alcohol consumption. With personal alcohol use, both the respondent's sex and the experience of sexual abuse during childhood have a significant effect, with males and those sexually abused as children reporting higher levels of alcohol consumption. The socialization explanation of the intergenerational consequences of parental behavior argues that parental role models are primary to the future family formation behavior of children. Consistent with this hypothesis, the findings concerning sexual abuse, in particular, as a predictor of both personal alcohol use and relationship satisfaction seem to underscore the importance of antecedent family characteristics in influencing later adjustment to adult roles and responsibilities.     

Blood,solidarity, status,and honor: The sexual balance of power and spousal abuse in Sonora,Mexico

Independent samples of 128 women and 106 men were interviewed in a study site in Hermosillo, Sonora, Mexico. Respondents were screened for involvement in a committed sexual relationship during the past year, but not with each other. Questions pertained to family structure, support, and conflict; females reported on victimization by spousal aggression and males on perpetration. Previously documented effects of their partner's mate quality (“sex”) and socioeconomic status (“money”) were cross-culturally replicated. The following family structure parameters were also measured: (1) the local density of female kin, (2) the local density of male kin, (3) the social support provided by local kin, (4) the socioeconomic status of close kin, and (5) the “culture of honor” revenge ideology of the respondents. The same interactions of local density of male kin that protected women from spousal abuse also empowered men to perpetrate it. The risk of spousal abuse was mitigated by the “sexual balance of power” between the family structures of potential victims and potential perpetrators. Evidence was also found partially supporting several alternative hypotheses tested regarding local cultural and ideological mechanisms (culture of honor and patriarchal beliefs), major dimensions of psychopathology (anxiety and depression) and substance abuse (alcohol), and indicators of general criminality (permissive and risk-taking attitudes).     

A 30‐year Follow‐up of the Effects of Child Abuse and Neglect on Obesity in Adulthood

Childhood maltreatment has been implicated as a risk factor for adult obesity. We describe the first prospective assessment of adult obesity in individuals with documented histories of childhood physical and sexual abuse and neglect and a matched comparison group in a 30‐year follow‐up. Using a prospective cohort design, children with court substantiated cases of physical and sexual abuse and neglect (ages 0–11 years) from a Midwest county during 1967–1971 (n = 410) were matched with children without histories of abuse or neglect on age, sex, race/ethnicity and approximate family social class (n = 303) and followed up and assessed at mean age 41. Outcome measures include BMI and obesity assessed in 2003–2004 as part of a medical status examination and interview. Childhood physical abuse predicted significantly higher BMI scores in adulthood (β = 0.14, P < 0.05), even controlling for demographic characteristics, cigarette smoking, and alcohol consumption (β = 0.16, P < 0.01). Childhood sexual abuse (β = 0.07, not significant) and neglect (β = 0.02, not significant) were not significant predictors of adult BMI scores. These results demonstrate the long‐term impact of childhood physical abuse on weight into adulthood and suggest that physically abused children may be at risk for other adverse health outcomes associated with increased weight. Health professionals need to understand this risk for physically abused children and researchers should identify and evaluate strategies for effective interventions.     

Differential parental investment in families with both adopted and genetic children

Stepchildren are abused, neglected and murdered at higher rates than those who live with two genetically related parents. Daly and Wilson used kin selection theory to explain this finding and labeled the phenomenon “discriminative parental solicitude.” I examined discriminative parental solicitude in American households composed of both genetic and unrelated adopted children. In these families, kin selection predicts parents should favor their genetic children over adoptees. Rather than looking at cases of abuse, neglect, homicide and other antisocial behavior, I focused on the positive investments parents made in their children as well as the outcomes of each child. The results show that parents invested more in adopted children than in genetically related ones, especially in educational and personal areas. At the same time, adoptees experienced more negative outcomes. They were more likely to have been arrested, to have been on public assistance and to require treatment for drug, alcohol or mental health issues. They also completed fewer years of schooling and were more likely to divorce. In adoptive families, it appears that “the squeaky wheel gets the grease.” Parents invest more in adoptees not because they favor them, but because they are more likely than genetic children to need the help. I conclude that discriminative parental solicitude differs in adoptive and step households because adoptive families generally result from prolonged parenting effort, not mating effort like stepfamilies.     

Cérémonie du pardon dans la thérapie des familles maltraitantes

The author’s experience is based on interdisciplinary consultations on maltreatment within the family with a team of physicians, psychologists, and educators who employ systematic strategies (family therapy, couple therapy, group therapy, individual therapy, and network therapy). The author mainly describes the strategy of acknowledgment and forgiveness within families after various kinds of abuse (sexual, physical, and psychological) and neglect. The need to heal family relationships damaged by abuse requires patient efforts and a number of different settings, sometimes individual and sometimes collective involving confrontation with other family members. It follows a logical construction centered on the perpetrator/ victim/third-party triangle. This paper discusses the principles and technical rules of this pyramidal approach, illustrating them with several clinical examples. It is necessary to preserve the influence and position of parents driven to acknowledge misdeeds, even when asking for forgiveness from victims, in order to restore family ties without damaging the natural hierarchy (in the best interest of each child and family).     

Domestic violence. Risk factors and outcomes.

Domestic violence is a pervasive and frequently unrecognized cause of injury among women. We reviewed data from standardized interviews with 218 women who presented to an emergency department with injuries due to domestic violence. Victims ranged in age from 16 to 66 years and constituted a wide range of socioeconomic and ethnic backgrounds. Domestic violence often resulted in severe injury; 28% of the women interviewed required admission to hospital for injuries, and 13% required major surgical treatment. The typical presentation was injuries to the face, skull, eyes, extremities, and upper torso. A third of the cases involved a weapon, such as a knife, club, or gun. In all, 10% of the victims were pregnant at the time of abuse, and 10% reported that their children had also been abused by the batterer. Most victims (86%) had suffered at least one previous incident of abuse, and about 40% had previously required medical care for abuse. Victim recognition and referral to appropriate agencies could be improved if primary care physicians were more aware of the prevalence, severity, frequency of occurrence, and typical presentation of domestic violence.     

Early childhood sexual abuse increases suicidal intent

Childhood sexual abuse has been consistently associated with suicidal behavior. We studied suicide attempt features in depressed individuals sexually abused as children. On average, sexual abuse started before age 9. It frequently coexisted with physical abuse. Suicide attempters more often had personality disorders and had endured abuse for longer, but did not differ in terms of other clinical characteristics from non‐attempters. Earlier onset of sexual abuse and its duration were associated with more suicide attempts. However, when personality disorders were included in the regression model, only these disorders predicted number of attempts. The severity of sexual abuse and the coexistence of physical abuse were correlated with age at first suicide attempt. However, only severity of sexual abuse was marginally associated with age at first suicide attempt in the regression model. Finally, the earlier the age of onset of sexual abuse, the higher the intent, even after controlling for age, sex and personality disorders. This suggests that the characteristics of childhood sexual abuse, especially age of onset, should be considered when studying the risk for suicidal behavior in abused populations.     

Development of Overweight in Children in Relation to Parental Weight and Socioeconomic Status

The purpose of the study was to test the hypothesis that socioeconomic status (SES) moderates the association between parental weight and changes in BMI from childhood to early adolescence. Participants included 428 twin children from 100 families with obese parents (“obese families”) and 114 sociodemographically matched families with normal‐weight parents (“lean families”) who were assessed in their homes (age = 4.4). Follow‐up study was conducted 7 years later (age = 11.2) on 346 children (81%). Complete data were available for 333 children. Family SES was indexed with maternal education. Children's weights and heights were measured to calculate BMI s.d. scores based on 1990 British norms. Overweight was defined as >91st BMI centile. In children with obese parents, BMI s.d. scores increased from 0.51 at age 4 to 1.06 at age 11. In children with lean parents, BMI s.d. scores decreased from 0.11 to 0.05. Prevalence of overweight remained stable from age 4 to 11 in children with lean parents (8% to 9%), but it more than doubled in children with obese parents (17% to 45%). There was a significant interaction between parental weight and family SES (P < 0.01), so that in children with lean parents there was no SES difference in the BMI status from age 4 to 11; however, in children with obese parents, the increase in adiposity was significantly greater in lower SES families. These results suggest that parental leanness confers significant protection against development of overweight in children regardless of family SES, while parental obesity is an adverse prognostic sign, especially in lower SES families.     

Selective battering of the family pet

Abstract

We examined the attitudes, perceptions and behaviors of both pet-abusing and non-pet-abusing perpetrators of family violence. Using data collected from victims residing at domestic violence shelters, results indicated that relative to their non-pet-abusing counterparts, pet-abusing batterers tend to less often show affection toward their pets, more often communicate with their pets only through commands and threats, more often view companion animals as property, are more likely to scapegoat their pets, and are more likely to have unrealistic expectations about their pets, more frequently punish their pets, and are more sensitive to stressful life events—particularly those perceived to be caused by the pet. We also queried respondents about batterers' past history with pets, the frequency and type of abuse inflicted on animals, the number of batterers who hunt, the frequency with which children witnessed abuse of the family pet, the impact of animal guardianship on decisions to remain with or return to the batterer, and where companion animals ended up when victims fled the batterer.     

Going to the dogs: A quasi-experimental assessment of animal assisted therapy for children who have experienced abuse

Experience of childhood sexual abuse (CSA) is a risk factor for the development of maladaptive outcomes across the lifespan. CSA victims have been found to have a significantly higher risk of developing Post Traumatic Stress Disorder (PTSD) than children who experience non-CSA trauma. While cognitive behavioral therapy approaches have been found to effectively treat PTSD, reviews suggest that children who have experienced CSA commonly disengage from this type of therapy. Engaging children who have been sexually abused may therefore require both innovation and creativity. One approach that is gaining recognition as effectively addressing barriers associated with engagement and retention is animal assisted therapy (AAT). The current article presents a quasi-experimental assessment of an AAT program working with children who present with clinical symptoms of PTSD following CSA. The efficacy of the program is discussed along with implications of the rising interest in AAT initiatives.     

Reliability of video taped interviews with children suspected of being sexually abused.

OBJECTIVE--To determine the reliability of judgments about the likelihood of child sexual abuse based only on video recorded interviews. DESIGN--Blinded rating of likelihood of abuse by seven professional groups and comparison with consensus rating. SETTING--Child and adolescent psychiatry centre. SUBJECTS--Four people from each of seven professional disciplines: specialist psychiatrists, general psychiatrists, experimental psychologists, trainee social workers, trainee clinical psychologists, lawyers, and police. MAIN OUTCOME MEASURE--Rating of 12 recorded interviews. RESULTS--Agreement between the consensus panel and professional groups was 83% (151/183) for high likelihood cases (seven cases) and 89% (118/132) for low likelihood cases (five). Specialist psychiatrists and the police were better able to identify high likelihood cases than were other groups with less experience of interviewing sexually abused children (91% (48/53) v 79% (102/129); p = 0.05). CONCLUSIONS--Raters could accurately distinguish children with low likelihood of abuse on interview evidence alone, but those with more experience of dealing with sexual abuse were better at identifying high likelihood cases.     

Reexamining Obesigenic Families: Parents’ Obesity‐related Behaviors Predict Girls’ Change in BMI

Objective: It has been shown that girls from families in which mothers and fathers had high dietary intake and low physical activity (i.e., obesigenic families) were at increased risk of obesity from ages 5 to 7 years. This follow‐up study uses additional data collected when girls were 9 and 11 years old to examine whether girls from obesigenic families continued to show greater increases in BMI over time and reported unhealthy dietary and activity patterns. Research Methods and Procedures: Families from the original cohort were reexamined when girls were 9 and 11 years of age. Parents’ and girls’ BMI, dietary intake, and physical activity and girls’ percentage body fat and television viewing were assessed. Results: In comparison with girls from non‐obesigenic families, girls from obesigenic families showed greater increases in BMI and BMI z score from ages 5 to 7 years that were maintained across ages 7 to 11 years. Furthermore, girls from obesigenic families had higher percentage body fat at ages 9 and 11 years. These results were independent of parents’ BMI. Additional findings showed that girls from obesigenic families had diets higher in percentage fat and had higher levels of television viewing than girls from non‐obesigenic families. Discussion: The environment that parents create, by way of their own dietary and physical activity behaviors, may have a lasting negative effect on children's weight trajectories and their emerging obesity risk behaviors, such as their dietary patterns. These findings further highlight the importance of the family in establishing children's obesity risk and the necessity of targeting parents of young children in obesity prevention efforts.     

The pediatric walk-in clinic: competition for the private practitioner.

In an affluent city with many pediatricians a 20% increase in patients seen in a hospital-based walk-in clinic in 1982 prompted a study to determine the characteristics of clinic users and their reasons for using the clinic. It was found that users of the clinic were middle-class, that they had a higher employment rate than the average for the region, and that in 54% of the families both parents worked outside the home. The children of 85% of the families were patients of pediatricians in private practice; most of the others were patients of a family physician in private practice. Most of the children seen at the clinic had had symptoms for more than 24 hours, but few parents had attempted to contact their own physicians. In the previous 12 months 95% of the children had been seen at the clinic, 43% in the month preceding the study. They came to the clinic for two main reasons: the broad range of services offered --laboratory, radiology and pharmacy as well as medical--and the convenient hours, with 71% coming outside of their physicians'' office hours. Given the reality of social trends pediatricians will either have to share their patients with facilities that offer services outside of regular office hours or devise another system for the treatment of their patients.