Personal and Interpersonal Characteristics Related to Resilient Developmental Pathways of Sexually Abused Adolescents

doi:10.1016/j.chc.2006.11.002

Child and Adolescent Psychiatric Clinics of North America

Volume 16, Issue 2, April 2007, Pages 415-434

https://doi.org/10.1016/j.chc.2006.11.002 Get rights and content

Childhood sexual abuse is a prevalent and important social problem. In this article the authors' main objective is the exploration of resilience among sexually abused adolescents under child protection services care in Quebec, Canada. The introduction provides an overview of the impact of childhood sexual abuse and conceptualizations of trauma, resilience, recovery, and factors linked to resilience profiles. The remainder of the article discusses a study of resilience and factors predicting resilience over a 5-month period for a sample of 86 teenage girls under child protection services care.

Section snippets

The impact of childhood sexual abuse

A number of studies have assessed SA adolescents' functioning, revealing the presence of diverse sequelae in many spheres. The empirical literature has identified a host of outcomes after childhood SA, such as depression, anxiety, post-traumatic stress, dissociation, low self-esteem, somatization, behavior problems, delinquency, substance abuse, sexual promiscuity, prostitution, aggressivity, and relational problems [3], [4], [5], [6], [7], [8], [9], [10].

These sequelae are not all evident in

Conceptualization of trauma from childhood sexual abuse

Childhood SA trauma theories have attempted to explain this symptomatic diversity [15]. This broad range of potential symptoms seems best conceptualized by the Complex Post Traumatic Stress Disorder (CPTSD), also known as Disorder of Extreme Stress not Otherwise Specified [1] or Type II PTSD [16], [17]. This relatively new concept includes as diagnostic criteria a more complex elaboration of classic PTSD (or Type I PTSD as proposed by Terr [16]) that considers the impact on various areas of

Conceptualization of recovery from childhood sexual abuse

This diagnostic and theoretical formulation of CPTSD is part of a larger conceptualization of the impact of interpersonal traumas in general and of the recovery that ensues [28]. Thus, based on the syndrome of CPTSD described previously as a diagnostic category, Herman and colleagues [28], [29] have proposed an ecologic model of recovery for prolonged interpersonal trauma that involves integrating affects and cognitions related to the trauma within a coherent and continuous sense of self. This

Conceptualization of resilience

Resilience is a concept that is gaining increased interest in scientific circles and in popular culture [41], [42]. A paradigm shift seems to be taking place toward a greater emphasis on positive adaptation of individuals facing trauma and strengths-based research, which bear a sense of hopefulness and confidence in the human spirit when compared with research on risk and vulnerability processes [43]. This theoretical, empirical, and clinical orientation is also associated with the increased

Procedures and participants

All participants were recruited between September 1998 and December 2005 at one CPS center and two centers offering group intervention to SA teenagers. Eligible girls were between 11 and 17 years of age (mean, 14.6 years of age; standard deviation [SD], 1.4). All subjects spoke and read French. All reports of SA were investigated and confirmed by CPS. Participants signed a written consent form, and a trained research assistant performed the interview, which lasted approximately 90 minutes, at

Resilient pathways

According to the definition used in the present study, 34% of participating adolescents were considered resilient at T1 and T2 (Fig. 1). Findings demonstrate that 38% of participants were classified as nonresilient at both assessments, whereas 5% were resilient at first but then exhibited symptoms that moved them away from a resilient pathway (deteriorated). Twenty-three percent of the participants were not resilient at T1 but moved toward a resilient or “recovered” pathway at T2. Pearson's χ²

Discussion

This research was mainly concerned with developmental pathways after the trauma of SA and with identifying factors that may buffer the impact of such events and foster resilient outcomes. CPTSD, a measure of resilience specific to the outcomes associated with the risk under study was derived, and personal and interpersonal factors were used to predict resilient profiles over an average 5-month period.

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Citation Excerpt :
Additionally, non-offending caregivers and siblings may have increased symptomology after disclosure as well, and treatment could increase their ability to care for themselves and in turn their abused child (Schreier et al., 2017; Tavkar & Hansen, 2011). Also, youth empowerment as well as trusting relationships are related to increased resilience in survivors of CSA, which is a protective factor within itself (Daigneault et al., 2007). Although mental health care may decrease long-term mental health concerns and reduce risk for revictimization for youth who have experienced CSA, access to mental health services is a significant issue.
Child sexual abuse (CSA) is a significant public health concern and is associated with a multitude of negative health outcomes. A substantial body of research has shown that experiences of CSA increase risk for short-term and long-term negative sequelae across psychological, behavioral, physical, and biological domains. Mental health treatments have been effective at decreasing children's mental health symptomology after CSA and preventing future negative outcomes. Child Advocacy Centers (CACs) are a common entry point for children following disclosure of CSA and are intended to streamline services, promote collaboration, and increase accessibility of mental health services. CACs rely on the blending and braiding of multiple funding sources to provide mental health services. Yet, traditional funding mechanisms are insufficient to meet the mental health needs of this population. Specific barriers related to the current funding system and the community context of mental health service provision are discussed. The CAC model provides a unique opportunity to increase access to mental health services through innovative funding mechanisms. Recommendations for strengthening the CAC model through policy research and advocacy are provided.
Recovery from child sexual abuse (CSA) in India: A relational framework for practice
2017, Children and Youth Services Review
CSA is prevalent internationally and its negative impact can continue in adulthood. India has a high prevalence of child maltreatment. The present study recorded the ‘recovering’ experiences of adult survivors of child sexual abuse (CSA) in India and developed a clinically applicable framework of recovery. Qualitative semi-structured individual interviews were conducted. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA) to identify recurrent themes. A total 20 adult survivors were interviewed. Results identified four core stages/processes of ‘moving on from CSA’ based on the descriptions provided by participants in India: The Affected Self - Keeping the Self Together; Accurate Symbolisation; Activation of the Recovering Self; Re-connection, Integration and Growth. We have developed the first survivor-centred relational growth – based model of recovery from CSA in India and potentially internationally. The findings support relational approaches to treatment and service delivery. A clear recovery process within and outwith services has been identified, thus emphasising the need for psychosocial support for facilitating personally meaningful recovery within the community through consistent practice. The findings have implications for continuing professional development (CPD), training, supervision, social reform, service delivery and policy as well as self-recovery of adult survivors. It is recommended to include relational approaches in working with survivors in India and internationally.
The role of strengths in anger and conduct problems in maltreated adolescents
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Overall, parent functioning can influence child adjustment, which can be examined via proxies such as internalizing and externalizing problems. Sexually abused adolescent females, who had fewer conflicts with their mothers, reported greater interpersonal trust in relationships, more active coping, and less drug use (Daigneault, Hébert, & Tourigny, 2007). In addition, maltreated adolescents who perceived greater emotional support from their caregivers reported lower levels of depression and better self-esteem one year after sexual abuse discovery (Rosenthal, Feiring, & Taska, 2003).
Despite multi-type maltreatment, some individuals demonstrate positive adaptation and continue to develop in a healthy way. A multitude of strength factors have been linked to adaptive functioning and resilience, but this has not been adequately examined in maltreated adolescent’s psychosocial functioning. This study sought to examine the role of strengths such as having talents/interests, family relationships, educational support, the role of the recognition and application of these strengths, and the role of multi-type maltreatment on anger control and conduct problems. One hundred and thirty participants (61 males; 69 females) aged 13–19 years old were rated using the Singapore version of Child and Adolescent Needs and Strengths (CANS) tool. The results revealed that certain strengths were associated with anger and conduct problems, but the recognition and application of strengths emerged as a consistently significant predictor for both outcomes. Hence, to understand and apply one’s strengths may be equally as important as merely possessing those strengths. This study extends current understanding of the importance of strengths with a group of maltreated adolescents in an Asian context. Adopting a person-centered and strength-based approach will further enhance the effectiveness of interventions and improve outcomes for maltreated adolescents living in residential care.
A prospective study of the impact of child maltreatment and friend support on psychological distress trajectory: From adolescence to emerging adulthood
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Transition into adulthood is a critical developmental period that may be influenced by adverse life events as well as by protective factors. This study aimed at investigating the effect of different forms of child maltreatment experienced prior to age 14 (i.e., sexual abuse, physical abuse and exposure to intimate partner violence), and of friend support at age 14 on the psychological distress trajectory from age 14 to 24.
Participants were 605 adolescents from the general population involved in a 10-year longitudinal study. Psychological distress was evaluated at ages 14, 16, 18 and 24. Child maltreatment prior to 14 years was retrospectively assessed at 14 and 24 years while perception of support from friends was evaluated at age 14.
Multilevel growth modeling indicated that psychological distress followed a significant decreasing curvilinear trajectory, with participants reporting fewer distressing psychological symptoms after 18 years. All three forms of child maltreatment, as well as their cumulative effect, predicted more psychological distress over 10 years above and beyond the protective effect of support from friends. Higher support from friends at age 14 was related to lower distress at baseline andover 10 years, beyond the effect of child maltreatment.
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Pre-treatment profiles of adolescent girls as predictors of the strength of their working alliances with practitioners in residential care settings
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These girls' stronger propensity to cooperate with and try to please other people means that practitioners may want to start building the working alliance from the very outset. With girls who match this profile, practitioners may also want to adopt methods recommended for working with clients who have experienced various kinds of abuse, in particular, methods for creating a secure environment in which they can feel safe, feel empowered, and improve their ability to trust other people (Daigneault, Hébert, & Tourigny, 2007). With these girls, it seems especially important to employ strategies that get them to participate in setting their treatment objectives and that accommodate their need to work in terms that make sense to them (Safran & Muran, 2000), as well as not to insist on discussing particularly sensitive content until they are ready to do so (Chu et al., 2010).
Given the importance of the working alliance to achieve positive outcomes in various types of treatment, it is important to better understand the factors that contribute to a good alliance. The present study aimed to determine which configuration of pre-treatment characteristics predicted a higher or weaker working alliance between 175 adolescent girls in residential care and their practitioners. Girls' self-reported pre-treatment characteristics (behavior problems, trauma-related symptoms, interpersonal problems and attitudes toward change) were assessed soon after admission in treatment and the working alliance was assessed three months later by both girls and their designated practitioner. Latent class analysis revealed three different profiles of girls at admission: “fewer problems”, “distressed” and “more/externalizing problems”. Findings indicated that girls with “more/externalizing problems” were 7.9 times more likely than girls from the “distressed” group to report a weaker working alliance. However, girls' pre-treatment profiles did not predict practitioners' assessment of the quality of their working alliance. Implications for research and practice are discussed.
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Research investigating the use of group therapy treatment for sexually abused children is limited. This paper aims to review the current state of the science of group therapy and its outcomes with children and adolescents under age 18 who have experienced sexual abuse. A literature review was conducted which located eight articles meeting the inclusion criteria of this paper. These outcome studies utilized a wide array of theoretical orientations and intervention delivery, as well as an assortment of outcomes measurement. While the studies lacked consistency, there is some support that group therapy formats to treat sexually abused children and adolescents may be effective across a range of symptoms. Implications for practice, policy, and future research are discussed.

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: This research was supported by grants from the Centre de Recherche Interdisciplinaire sur les Problèmes Conjugaux et les Agressions Sexuelles (CRIPCAS) and the Fonds québécois de la recherche sur la société et la culture (FQRSC) and by an FQRSC postdoctoral fellowship awarded to the first author. The authors thank the teenagers who participated in the study and the practitioners for their collaboration in this project.

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Personal and Interpersonal Characteristics Related to Resilient Developmental Pathways of Sexually Abused Adolescents

Section snippets

The impact of childhood sexual abuse

Conceptualization of trauma from childhood sexual abuse

Conceptualization of recovery from childhood sexual abuse

Conceptualization of resilience

Procedures and participants

Resilient pathways

Discussion

J Am Acad Child Adolesc Psychiatry

Child Abuse Negl

Child Abuse Negl

Child Abuse Negl

Child Abuse Negl

J Am Acad Child Adolesc Psychiatry

Clin Psychol Rev

Child Abuse Negl

Child Abuse Negl

Child Abuse Negl

Child Abuse Negl

Child Abuse Negl

J Am Acad Child Adolesc Psychiatry

Child Abuse Negl

Les soins aux jeunes en difficulté - QC-411-Volet 1. Portrait des jeunes inscrits à la prise en charge des centres jeunesse du Québec et descriptions des services reçus au cours des premiers mois. Montréal: GRISE

Description of trauma and resilience in sexually abused adolescents: an integrated assessment

Journal of Trauma Practice

Sexual and physical abuse among adolescent girls with disruptive behavior problems

J Child Fam Stud

Psychological and behavioral functioning in adolescent psychiatric inpatients who report histories of childhood abuse

Am J Psychiatry

Impact of sexual abuse on children: a review and synthesis of recent empirical studies

Psychol Bull

The relationship of sexual abuse to symptom levels in emotionally disturbed girls

Child Adolesc Social Work J

Self-destructive and delinquent behaviors of adolescent female victims of child sexual abuse: rates and covariates in clinical and nonclinical samples

Violence Vict

Immediate and long-term impacts of child sexual abuse

Future Child

A structural model examining the relationship between physical child abuse, sexual victimization, and marijuana/hashish use in delinquent youth: a longitudinal study

Violence Vict

Childhood origins of self-destructive behavior

Am J Psychiatry

Stress, appraisal, and coping in child sexual abuse: a theoretical and empirical review

Psychol Bull

Childhood traumas: an outline and overview

Am J Psychiatry

The psychological sequelae of child sexual abuse

Advances in Clinical Child Psychology

Complex PTSD: a syndrome in survivors of prolonged and repeated trauma

J Trauma Stress

Development of a criteria set and a structured interview for disorders of extreme stress (SIDES)

J Trauma Stress

Complex posttraumatic stress disorder in women from a psychometric perspective

J Pers Assess

The development of a 90-day residential program for the treatment of complex posttraumatic stress disorder

Journal of Aggression, Maltreatment & Trauma

DESNOS in three postconflict settings: assessing cross-cultural construct equivalence

J Trauma Stress

Complex PTSD: a review of current issues

Int J Emerg Ment Health

Preliminary evidence of efficacy for EMDR resource development and installation in the stabilization phase of treatment of complex posttraumatic stress disorder

J Clin Psychol

Complex PTSD in victims exposed to sexual and physical abuse: results from the DSM-IV field trials for posttraumatic stress disorder

J Trauma Stress

“Complex” posttraumatic stress disorder/disorders of extreme stress (CP/DES) in sexually abused children: an exploratory study

J Child Sex Abus

Type I and type II posttraumatic stress disorder in sexually abused children

J Child Sex Abus

Trauma and recovery

A stage-by-dimension model of recovery from sexual trauma

J Interpers Violence

Les huits étapes de l'homme. Enfance et Société

Helping early adolescents tell: a guided exercise for trauma-focused sexual abuse treatment groups

Child Welfare

Group issues and activities for female teen survivor of sexual abuse

Child Adolesc Social Work J

Treating traumatized children: a research review and synthesis

Trauma Violence Abuse

Child abuse trauma: theory and treatment of the lasting effects

Treating abused adolescents