Original article
Contribution of attachment security to the prediction of internalizing and externalizing behavior problems in preschoolers victims of sexual abuseAdaptation psychosociale des enfants d’âge préscolaire agressés sexuellement : contribution de la sécurité d’attachement

https://doi.org/10.1016/j.erap.2012.12.001Get rights and content

Abstract

Objectives

This study pursued three objectives: provide a descriptive behavioral profile of preschool-aged children having disclosed sexual abuse (SA); assess their attachment representations; and explore whether SA characteristics and child attachment security can predict children's symptomatology, while controlling for parental psychological distress.

Method

Parents consulting a specialized medical clinic in Montreal following the child's disclosure of sexual abuse (n = 116) completed measures regarding parental psychological distress (Échelle de Détresse Psychologique de l’Enquête de Santé Québec; Préville, Boyer, Potvin, Perrault, & Légaré, 1992) and behavioral and psychological problems concerning their preschool-aged children (3 to 6 years) (Child Behavior Checklist for Ages 11/2–5 (CBCL) (Achenbach & Rescorla, 2000a). Children responded to a semi-structured interview assessing their attachment representations (Attachment Story Completion Task; Bretherton, Oppenheim, Buchsbaum, & Emde, 1990). Data concerning SA characteristics were provided by medical records (History of Victimization Form; Wolfe, Gentile, & Boudreau, 1987).

Results

Secure attachment was observed in 58.6% of the children evaluated, and 73.3% of the children had experienced a very severe SA. Parental psychological distress, the intra-familial nature of the sexual abuse experienced, and disorganised/disoriented child attachment were found to predict clinical levels of internalizing behavior problems. Clinical levels of externalizing behavior problems were predicted by child age, avoidant attachment and disorganized/disoriented attachment.

Conclusions

Disorganised/disoriented attachment brings a unique contribution to the prediction of sexually abused preschoolers’ clinical internalizing and externalizing difficulties, beyond SA characteristics (type and severity) and parental psychological distress. This underscores the importance of attachment representations in the prediction of emotional and behavioural difficulties in sexually abused children. Practice implications: clinical intervention for sexually abused preschoolers should focus on personal and familial variables, namely attachment security and the quality of parent–child relationships.

Résumé

Objectifs

La présente étude tente de répondre à trois objectifs : fournir un profil descriptif de la symptomatologie observée auprès d’enfants d’âge préscolaire ayant dévoilé une agression sexuelle (AS) ; étudier leurs représentations d’attachement ; et évaluer l’apport prédictif des caractéristiques de l’AS vécue (sévérité et type) et de la sécurité d’attachement de l’enfant sur sa symptomatologie. Afin de répondre à ce dernier objectif, la détresse psychologique du parent répondant, une variable confondante, sera contrôlée.

Méthode

Les parents consultant la clinique de pédiatrie socio-juridique du CHU Mère-Enfant Sainte-Justine de Montréal (n = 116) ont complété des instruments de mesure évaluant leur santé psychologique (Échelle de Détresse Psychologique de l’Enquête de Santé Québec ; Préville, Boyer, Potvin, Perrault, & Légaré, 1992) et la qualité de l’adaptation de leur enfant d’âge préscolaire (trois à six ans) ayant dévoilé une AS (Liste de Vérification du Comportement des Enfants de 1,5 à cinq ans ; Achenbach & Rescorla, 2000a). L’enfant a participé à une entrevue semi-structurée afin d’évaluer ses représentations d’attachement (Les Histoires d’Attachement ; Bretherton, Oppenheim, Buchsbaum, & Emde, 1990). Les données relatives à la description de l’AS subie ont été obtenues à l’aide des dossiers médicaux (Questionnaire sur la Victimisation de l’Enfant ; Parent & Hébert, 2006).

Résultats

Un patron d’attachement sécure est observé auprès de 58,6 % des enfants de l’échantillon et 73,3 % de l’ensemble des enfants rencontrés ont subi une AS qualifiée de très sévère. Les troubles de comportement cliniques intériorisés observés chez l’enfant victime sont prédits par la détresse psychologique du parent répondant, le caractère intra-familial de l’AS et le patron d’attachement désorganisé/désorienté des enfants. Les troubles de comportement cliniques extériorisés sont prédits par l’âge de l’enfant, ainsi que les patrons d’attachement évitant et désorganisé/désorienté.

Conclusions

Le patron d’attachement désorganisé/désorienté apporte une contribution significative unique à la prédiction des troubles de comportement intériorisés et extériorisés atteignant le seuil clinique, au-delà des caractéristiques de l’AS (sévérité et type) et de la détresse psychologique du parent. Ce résultat souligne l’importance des variables personnelles dans la prédiction des difficultés d’adaptation des enfants d’âge préscolaire ayant dévoilé une AS. Implications pratiques : l’intervention clinique auprès des enfants d’âge préscolaire victimes d’AS doit considérer les variables personnelles et familiales, telles que la sécurité d’attachement et la qualité de la relation parent–enfant.

Section snippets

Attachment security

The quality of the parent–child relationship in response to the distress expressed by the child is a central concept in attachment theory (Bowlby, 1969/1982, Bowlby, 1973, Bowlby, 1977, Bowlby, 1980). During their first year of life, children become emotionally attached to their parental figures and learn to organize their search for support and comfort according to their attachment figures’ responses to their emotional needs (Bowlby, 1977). Over the course of such interactions, children

Attachment security in adults or adolescents who have experienced sexual abuse

Several empirical relations have been established between attachment security and levels of symptomatology among adult or adolescent victims of SA during childhood. Roche et al. found that the attachment pattern of adult victims of SA during childhood contributes to the prediction of psychological distress beyond the characteristics of SA (Roche, Runtz, & Hunter, 1999). In addition, adults who suffered SA during childhood and who have an unresolved attachment pattern (resembling the

Participants

All non-offending parents and children between the ages of 3 and 6 years (89% girls and 11% boys, M = 4.80 years; SD = 0.87) consulting the Clinique de pédiatrie socio-juridique du centre hospitalier universitaire Mère-Enfant Sainte-Justine of Montreal (CHU Sainte-Justine) for medical evaluation purposes in the context of SA (disclosed or suspected) were solicited to participate in the study. During the course of the data collection, which took place over a period of 28 months, 189 children who

Results

Results are presented in three sections. First, descriptive data on the sample is provided. Then, chi-square analyses are conducted to explore the associations between characteristics of SA, parental psychological distress and attachment patterns, as well as with internalizing and externalizing behavior difficulties. Finally, hierarchical logistic regressions are performed to explore the contribution of characteristics of the SA and attachment patterns to the prediction of clinical levels of

Discussion

The objective of the present study was to document the profiles of preschoolers who have experienced SA, and to predict their symptoms using an attachment theory framework. The very young child's social network is often limited to the immediate family and few studies have addressed this vulnerable population following SA (Wood et al., 2004). This underscores the importance of applying a theoretical framework based on attachment in order to better understand the symptoms observed in preschool

Limitations

Some methodological limitations imply that the results of the present study must be interpreted with caution. The profiles of participating children cannot be generalized to all preschool children victims of SA, since recruitment was done in a hospital setting providing services on a voluntary basis. In addition, too few boys were recruited, which limited the possibility of conducting gender-specific analyses. Further efforts must be undertaken in future studies to increase the recruitment of

Conclusion

This study represents a first step towards a better understanding of the symptoms observed in preschool children experiencing SA. It provides relevant cues to guide intervention practices to promote the optimal development of young children despite the trauma they experienced. They are vulnerable and it is essential to document their needs.

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

Acknowledgements

This study was supported by a grant from the Fonds de recherche sur la société et la culture du Québec (FQRSC) awarded to Martine Hébert, Ph.D. and by doctoral scholarships awarded to the first author by the Social Sciences and Humanities Research Council of Canada (SSHRC) and the FQRSC, the Centre de recherche interdisciplinaire sur les problèmes conjugaux et les agressions sexuelles (CRIPCAS), and the research Team Violence sexuelle et santé (EVISSA). The author thank the children and the

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