Elsevier

Child Abuse & Neglect

Volume 27, Issue 6, June 2003, Pages 641-661
Child Abuse & Neglect

Emotional support and adjustment over a year’s time following sexual abuse discovery

https://doi.org/10.1016/S0145-2134(03)00104-2Get rights and content

Abstract

Objective: This study investigated age and gender differences in perceived emotional support in children and adolescents who experienced sexual abuse from the time of discovery to 1 year later. Also examined were the relations among sources of support and adjustment and whether support explained resilience, defined as better adjustment over a year’s time.

Method: One hundred and forty-seven sexually abused youth were interviewed at the time of discovery (T1) and 1 year later (T2). Information gathered included severity of the sexual abuse, satisfaction with support from caregivers, same-sex and other-sex friends, feelings of shame about the abuse, and attributional style. Youth adjustment was measured using reports from the youth themselves, caregivers, and teachers.

Results: Children reported the most satisfaction with support from caregivers followed by friends whereas adolescents reported similar levels of support from friends and caregivers. Satisfaction with support was differentially related to adjustment. Youth who reported more satisfaction with caregiver support at T1, reported less depression, better self-esteem but more sexual anxiety 1 year later. More satisfaction with support from friends predicted lower self-esteem but less sexual anxiety. More satisfaction with initial caregiver support at T1 predicted better parent- and teacher-rated adjustment 1 year later, after controlling for initial adjustment.

Conclusions: In general, initial caregiver emotional support at the time of abuse discovery predicted resilience in child and adolescent victims of sexual abuse. Findings suggested that treatment should include a focus on helping caregivers provide appropriate emotional support.

Résumé

Objectif: Cette recherche a voulu étudier comment le sexe et de l’âge influencent la façon dont les enfants et les adolescents perçoivent les appuis émotionnels suite à des agressions sexuelles. L’étude portait sur une période d’un an suivant l’agression. On a aussi examiné les liens entre les diverses sources d’appuis et la capacité des victimes de s’adapter à leur épreuve, et si ces appuis pouvaient expliquer leur capacité de résister à l’épreuve durant une période d’un an.

Méthode: On a interviewé 147 jeunes victimes d’agressions sexuelles, au moment de l’agression, puis un an plus tard. Les données recueillies comprennent: la gravité de l’agression, le degré de satisfaction par rapport aux appuis fournis par les parents, les amis du même sexe ou du sexe opposé, les sentiments de honte face à l’agression et le mode d’attribution du blâme. L’ajustement des jeunes a été mesuré au moyen de leurs témoignages et de ceux des parents et des enseignants.

Résultats: Ce sont les appuis de leurs parents ou autres personnes chargées de leur garde qui donnent aux enfants le plus de satisfaction. Pour les adolescents, ce sont les amis, puis les parents ou leurs substituts. Plus les enfants sont satisfaits des appuis reçus, plus leur ajustement est considérable. Parmi les jeunes qui se disent plus satisfaits des appuis de leurs parents ou autres personnes chargées de leur bien-être, on note moins de dépression, une meilleure estime de soi, mais un plus haut niveau d’angoisse sexuelle durant l’année qui suit. Par contre, une plus grande satisfaction vis-à-vis de l’appui reçu des amis prédit une estime de soi inférieure, mais moins d’angoisse sexuelle. Une plus grande satisfaction pour les appuis reçus des parents au moment de l’agression prédit une meilleure adaptation au bout d’une année, selon les rapports recueillis auprès des parents et des enseignements, et ceci ayant contrôlé pour l’ajustement initial qui suit immédiatement l’agression.

Conclusions: Dans l’ensemble, les appuis émotionnels des parents ou substituts au moment où l’agression est déclarée prédit une capacité de surmonter l’épreuve de la part des enfants et des adolescents. Étant donné ces constats, le traitement des victimes devrait prendre en considération l’importance des parents ou substituts en tant que source d’appui émotionnel.

Resumen

Objetivo: Este estudio investigó las diferencias de edad y de género en el apoyo emocional percibido por niños/as y adolescentes que experimentaron abuso sexual desde el momento de la revelación hasta un año más tarde. También se examinaron las relaciones entre las distintas fuentes de apoyo y el ajuste personal y si el apoyo social explicaba la resiliencia, siendo ésta definida como el mejor ajuste personal a lo largo de un perı́odo de un año.

Método: Se entrevistó a 147 jóvenes abusados sexualmente en el momento de la revelación (T1) y un año más tarde (T2). Se recogió información que incluı́a la gravedad del abuso sexual, la satisfacción con el apoyo prestado por los cuidadores, por amigos del mismo y diferente sexo, los sentimientos de culpa acerca del abuso, y el estilo atribucional. El ajuste del joven fue medido utilizando informes de los propios jóvenes, de sus cuidadores y de sus profesores.

Resultados: Los niños/as notificaron el mayor grado de satisfacción sobre el apoyo prestado por los cuidadores, seguido el apoyo recibido por parte de los amigos; mientras que los adolescentes notificaron niveles similares de apoyo prestado tanto por amigos como por cuidadores. La satisfacción con el apoyo estaba relacionada de manera diferente con el ajuste. Aquellos jóvenes que notificaron mayor satisfacción con el apoyo prestado por el cuidador en T1, notificaron menos depresión y mejor autoestima, pero mayor ansiedad sexual al año de la revelación. La mayor satisfacción con el apoyo prestado por los amigos predijo una menor autoestima pero una menor ansiedad sexual. Mayor satisfacción con el apoyo inicial prestado por el cuidador en T1 predijo un mejor ajuste personal, según las puntuaciones de los padres y los profesores, un año más tarde, después de haber controlado el ajuste inicial.

Conclusiones: En general, el apoyo emocional prestado por el cuidador en el momento de la revelación del abuso predijo la resiliencia de niños/as y jóvenes vı́ctimas de abuso sexual. Los resultados sugieren que el tratamiento deberı́a tener en cuenta como foco de intervención el ayudar a los cuidadores a proporcionar a los menores un apoyo emocional adecuado.

Introduction

Children and adolescents who have been sexually abused are at increased risk for the development of a number of psychosocial problems including depressive symptoms, post-traumatic stress disorder (PTSD), poor self-esteem, inappropriate sexual behavior, and substance abuse (e.g., Ackerman, Newton, McPherson, Jones, & Dykman, 1998; Boney-McCoy & Finkelhor, 1995; Kendall-Tackett, Williams, & Finkelhor, 1993; Silverman, Reinherz, & Giaconia, 1996; Widom, 1999). Although most victims of sexual abuse experience some acute psychosocial problems, not all display long-term psychological distress (Ackerman et al., 1998; Feiring et al., 1998, Feiring et al., 2002; Finkelhor, 1990, Kendall-Tackett et al., 1993). Some children appear resilient to the chronic negative effects of abuse and are able to develop healthy concepts of self and social relationships. Resilience is conceptualized as a process whereby individuals who experience traumatic events cope or adjust in ways that are better than expected (Luthar, Cicchetti, & Becker, 2000).

Most studies examining effects of child sexual abuse (CSA) employ cross-sectional or retrospective designs. Moreover, adjustment is not typically examined across more than one domain (e.g., emotional vs. school functioning). In order to understand the heterogeneity in adaptation after traumatic events, it is necessary to examine a range of factors that might contribute to resilience as well as multiple domains of functioning (Luthar et al., 2000). This paper examines how characteristics of the social support network help explain variations in children’s and adolescents’ adjustment. It examines persistence over a year’s time in patterns of support in a sample first seen at the time of abuse discovery (Feiring et al., 1998). Of interest were the ways in which social support from caregivers and peers promotes resilience under the adverse conditions of having been the victim of sexual abuse. This study examines adjustment in terms of stigmatization, symptoms of psychological and behavioral disorders, self-esteem, and school functioning. Four major questions are addressed: (1) Are there age differences in children’s perceptions of emotional support over time? (2) Are there gender differences in perceptions of emotional support over time? (3) Does the relation between support and adjustment vary as a function of the source of support? (4) Does more emotional support at the time of discovery promote resilience by decreasing negative and increasing positive adjustment over time?

A developmental perspective must be adopted to understand the impact of victimization on children as well as the operation of protective factors (Finkelhor, 1995). It is reasonable to expect children and adolescents to differ in how they process and respond to victimization, yet most of the literature on CSA has not examined age differences in patterns of support provision and adjustment (Kendall-Tackett et al., 1993). Similarly, there is limited knowledge about how developmental period is related to the response of victims’ support network and there is almost no research concerning patterns of support over time. From a normative perspective children would be expected to rely more on their parents for emotional support than on same-sex or other-sex friends (Furman & Buhrmester, 1992). In contrast adolescents are striving for greater autonomy from parents and thus may experience greater conflict concerning relying on parents for emotional support and protection (Steinberg, 1990). We expected victims of CSA to show the normative pattern, with children compared to adolescents reporting relatively more support from parents than friends. Such a pattern was expected to place adolescents at a disadvantage for seeking the kind of support needed during times of extreme stress (Salt, Myer, Coleman, & Sauzier, 1990). Adolescents compared to children may also receive less support from caregivers because they are seen as more responsible for their victimization (Collings & Payne, 1991, Elliot & Carnes, 2001, Salt et al., 1990).

Some studies suggest that gender plays a role in the kind of abuse experienced and the outcomes of abuse. Research indicates girls may experience more severe CSA and higher levels of PTSD and depression (Feiring et al., 2002; Wolfe, Sas, & Wekerle, 1994). It also is reasonable to consider the impact of gender on the relations among the CSA experience, social support, and adjustment. Some studies find that mothers are more protective of sons than daughters whereas others show no differences by gender in this type of maternal support (Heriot, 1996, Pintello & Zuravin, 2001, Salt et al., 1990). Although existing literature examining the relation between victim’s gender and the response of the victim’s support network is inconsistent, the developmental literature suggests that girls and boys networks differ (Feiring & Lewis, 1991, Youniss & Smollar, 1985). Girls may be better at seeking support from others when they feel stressed (Belle, 1989, Cross & Madson, 1997). Based on the literature with normative samples we expected that girls would be more effective than boys at seeking support as reflected in higher satisfaction.

Whereas the provision of emotional support is related to more optimal adjustment, it remains unclear whether the identity of the support provider also plays a role. Different providers of supportive relationships (e.g., parents vs. friends) might differentially impact adjustment following sexual abuse. For the most part, only caregiver support has been examined in the CSA literature (Elliot & Carnes, 2001). In the study of perceived social support, the provider model stipulates that specific sources of support, that is specific support relationships, are the central determinant of the effects of support (Scholte, Lieshout, & van Aken, 2001). Parental support is associated with fewer symptoms of psychological distress and a greater level of social competence in the short-term and is thought to be vital for later adjustment (e.g., Elliot & Carnes, 2001; Everson, Hunter, Runyon, Edelsohn, & Coulter, 1989; Feiring et al., 1998; Hazzard et al., 1995, Leifer et al., 1993; Spaccarelli & Kim, 1995). In contrast, results from this study at the time of abuse discovery showed emotional support from friends was associated with more negative self-esteem and more PTSD symptoms (Feiring et al., 1998). This report examines whether the positive relation of caregiver support and the negative relation of peer support to adjustment persisted over a year’s time from abuse discovery. Given the major stress surrounding abuse discovery and its aftermath, reliance on and availability of caregiver compared to friends support was expected to be more important and positively predictive of better adjustment in both children and adolescents (Spaccarelli & Fuchs, 1997). We expected that support from parents may be particularly important to help victims feel safer and less stigmatized, making them less likely to develop symptoms.

The protective value of support might vary based on when it is offered both in relation to the abuse experience and to the developmental stage of the victim. Most studies finding beneficial effects of emotional support are focused on the time directly following disclosure of CSA. However, it is not known whether effects of early support endure over time or whether current functioning engenders biased recollections of past support (e.g., Mannarino & Cohen, 1996). The literature is limited by retrospective data, concurrent or short-term studies and small samples (Mannarino & Cohen, 1996, Spaccarelli & Kim, 1995). For this study, we expected that emotional support at the time of abuse discovery from the primary adult caregiver (typically the mother), would be particularly important for promoting resilience over time.

Section snippets

Sample selection and characteristics

Participants were recruited from urban and suburban populations in the eastern United States. They were confirmed cases of sexual abuse by at least one of the following criteria: specific medical findings, confession by the offender, abuse validated by an expert such as child protective services (CPS), or conviction of the offender in family or criminal court. About half of the sample came directly from CPS and the remainder came from other referral sources (e.g., medical clinics) and were not

Results

The majority of the sample came from single parent families (71%) and were poor (70% with an income of $25,000 or less). The ethnicity of the sample was self described as: African-American (40%), White (34%), Hispanic (18%), and other (8%, including Asian and Native Americans). Based on the most serious form of contact abuse reported by this sample, 67% experienced genital penetration. Thirty-four percent of perpetrators were parents or parent-figures. Almost half of the sample (43%) lived with

Discussion

It is generally assumed that emotional support promotes resilience and protects against the development of psychosocial problems in children and adolescents who were sexually abused. However, knowledge is limited about individual differences in emotional support or the impact of support on resilience among victims of CSA. In this study, resilience was defined in terms of positive functioning after childhood sexual abuse; less depression, PTSD and behavior problems as well as better self-esteem.

Acknowledgements

We gratefully acknowledge the efforts of Patricia Lynch and Patricia Myers in data collection and the children, adolescents, and families for their participation.

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    The preparation of this paper was made possible by a grant from the National Institute of Mental Health—MH49885.

    1

    Present address: The College of New Jersey, Center for Youth Relationship Development, PO Box 7718, 2000 Pennington Rd., Ewing, New Jersey 08628-0718, USA.

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