Behavior, family function, school performance, and predictors of persistent disturbance in sexually abused children

Although sexual abuse is widely considered to have severe sequelae, most studies of children's status after sexual abuse have had major limitations, including retrospective design, small sample sizes, selective enrollment of subjects, no comparison groups, and lack of information about potentially confounding characteristics of studied children. The aim of this study was to clarify the impact of sexual abuse on children's psychological well-being.

We prospectively studied 154 children who were brought to urban, university-affiliated hospitals for assessment of recently disclosed sexual abuse and compared them with a control group of 53 demographically similar children not known to have been sexually abused.

In comparison with the control children, fewer of the sexually abused children had health insurance and more had received psychiatric care unrelated to the sexual abuse. Most initial ratings of behavior, maternal psychiatric status, family function, and school performance were less favorable among the sexually abused than among the control children (P < .05). At follow-up 6 months later, the psychiatric status of the mothers of the abused children apparently improved, but the children's difficulties largely persisted. Baseline characteristics of the abused children significantly or suggestively associated with persisting problematic behavior were older age (P = .04), lower maternal educational attainment (P = .06), poorer maternal psychiatric status (P = .04) and lower family integration (P < .001). These four factors accounted for 31% of the variance in the children's behavior at 6-month follow-up (P < .001). Unexpectedly, characteristics of the children's sexual abuse experiences did not predict their later behavioral status.

These findings suggest that preexisting, long-standing adverse psychosocial circumstances may contribute importantly to persistently problematic behavior and school performance among sexually abused children. The findings also suggest that it is children's preexisting psychosocial circumstances, rather than the abuse, that determine, at least in part, the nature of their functional outcomes.