Stability and change in outcomes for sexually abused children

To evaluate sexually abused children and their families at intake and 18 months later, in comparison with a control group.

Eighty-four sexually abused children aged 5 to 15 years were assessed at intake, with 64 being able to be reassessed at 18 months, the assessment using measures of self-esteem relevant to their age; the Children's Depression Inventory, and the Achenbach Child Behavior Checklist. Parents were assessed with the McMaster Family Assessment Device and the General Health Questionnaire. Control children and families were similarly assessed. Additional measures at follow-up were a structured interview with the parents, the Indices of Coping Responses, and the Newcastle Child and Family Life Events Schedule. Therapists were contacted to obtain information on type and duration of therapy.

While the control children's self-esteem, depression, and behavior scores showed little change over time, the abused children's scores were more likely to move toward the normal range although 56% remained in the dysfunctional range for self-esteem, 48% for behavior, and 35% for depression. Improvement in child behavior was related to improvement in family function. While there was no direct relationship between child outcome and the relationship of the abuser to the child, family dysfunction, which was related to child outcome, did correlate with the closeness of the abuser to the child. Sixty-five percent of abused children had received therapy for an average of 9 months. No relationship was found between therapy and outcome.

The major variable relating to improvement in sexually abused children appears to be adequacy of family functioning. There is a need for increased emphasis on the evaluation of treatment.