Sexual Abuse of Children

Assessment, Research, and Treatment
  • Cynthia Cupit Swenson
  • Rochelle F. Hanson
Part of the Issues in Clinical Child Psychology book series (ICCP)


Child sexual abuse (CSA) has been the focus of considerable attention among researchers, clinicians, the courts, and, recently, the news media. In many cases assessment and treatment techniques have been under close scrutiny and professionals have been challenged to demonstrate the effectiveness of their work. More than ever, research-based methods are needed. This chapter presents research on assessment and treatment of sexually abused children. First, the prevalence of child sexual abuse is discussed. Second, mental health consequences related to CSA are summarized. Third, clinical assessment of sexually abused children and their families is reviewed. Finally, treatment of sexually abused children and their families is examined.


Sexual Abuse Abuse Child Child Sexual Abuse Mental Health Symptom Family Treatment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Abel, G. G., Mittelman, M., Becker, J. V., Rathner, J., & Rouleau, J. L. (1988). Predicting child molesters’ response to treatment. In R. A. Prentky & V. L. Quinsey (Eds.), Annals of the New York Academy of Science(pp. 223–235). New York: New York Academy of Science.Google Scholar
  2. Achenbach, T. M. (1991). Manual of the Child Behavior Checklist and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
  3. Adams-Tucker, C. (1982). Proximate effects of sexual abuse in childhood: A report on 28 children. American Journal of Psychiatry, 139,1252–1256.PubMedGoogle Scholar
  4. Alexander, P. C. (1985). A systems theory conceptualization of incest. Family Process, 24, 79–87.PubMedCrossRefGoogle Scholar
  5. Alexander, P. C., & Lupfer, S. L. (1987). Family characteristics and long-term consequences associated with sexual abuse. Archives of Sexual Behavior,16, 235–245.PubMedCrossRefGoogle Scholar
  6. APSAC (American Professional Society on the Abuse of Children). (1990). Guidelines for psychosocial evaluation of suspected sexual abuse in young children. Chicago: Author.Google Scholar
  7. Araji, S., & Finkelhor, D. (1986). Abusers: A review of the research. In D. Finkelhor (Ed.), A sourcebook on child sexual abuse(pp. 89–118). Newbury Park, CA: Sage.Google Scholar
  8. Becker, J. V., & Hunter, J. A., Jr. (1992). Evaluation of treatment outcome for adult offenders of child sexual abuse. Criminal Justice and Behavior, 19, 74–92.CrossRefGoogle Scholar
  9. Beitchman, J. H., Zucker, K. J., Hood, J. E., daCosta, G. A., Akman, D., & Cassavia, E. (1992). A review of the long-term effects of child sexual abuse. Child Abuse & Neglect, 15, 537–556.CrossRefGoogle Scholar
  10. Berliner, L. (1987). Treating the effects of sexual abuse on children. Journal of Interpersonal Violence, 2, 415–434.CrossRefGoogle Scholar
  11. Berliner, L., & Wheeler, J. R. (1988). Treating the effects of sexual abuse on children, Journal of Interpersonal Violence, 2, 415–434.CrossRefGoogle Scholar
  12. Brickman, P., Rabinowitz, V. C, Karuza, J., Coates, D., Cohen, E., & Kidder, L. (1982). Models of helping and coping. American Psychologist, 37, 368–384.CrossRefGoogle Scholar
  13. Briere, J. (1989). Trauma Symptom Checklist for Children. Odessa, FL: Psychological Assessment Resources.Google Scholar
  14. Briere, J. (1995). Trauma Symptom Inventory professional manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
  15. Briere, J., Elliott, D. M., Harris, K., & Cotman, A. (1995). Trauma Symptom Inventory: Psychometrics and association with childhood and adult victimization in clinical samples. Journal of Interpersonal Violence, 10, 387–401.CrossRefGoogle Scholar
  16. Cohen, J. A., & Mannarino, A. P. (1988). Psychological symptoms in sexually abused girls. Child Abuse & Neglect, 12, 571–577.CrossRefGoogle Scholar
  17. Cohen, J. A., & Mannarino, A. P. (1996). A treatment outcome study for sexually abused preschool children: Initial findings. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 42–50.PubMedCrossRefGoogle Scholar
  18. Craske, M. G., & Barlow, D. H. (1990). Therapist’s guide for the mastery of your anxiety and panic (MAP) program. Albany, NY: Graywind.Google Scholar
  19. Dalenberg, C. J., & Jacobs, D. A. (1994). Attributional analyses of child sexual abuse episodes: Empirical and clinical issues. Journal of Child Sexual Abuse, 3, 37–50.CrossRefGoogle Scholar
  20. Deblinger, E. (1992). Child sexual abuse. In A. Freeman & F. M. Dattilio (Eds.), Comprehensive casebook of cognitive therapy(pp 159–167). New York: Plenum Press.Google Scholar
  21. Deblinger, E. (1995, January). Cognitive behavioral interventions for treating school age sexually abused children. Paper presented at the San Diego Conference on Responding to Child Maltreat-ment, San Diego, CA.Google Scholar
  22. Deblinger, E., McLeer, S. V., & Henry, D. (1990). Cognitive behavioral treatment for sexually abused children suffering post-traumatic stress: Preliminary findings. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 747–752.PubMedCrossRefGoogle Scholar
  23. Derogatis, L. R. (1977). SCL-90: Administration, scoring, and procedure manual for the R(revised) version. Baltimore: Johns Hopkins University School of Medicine.Google Scholar
  24. Derogatis, L. R. (1983). The SCL-90-R: Administration, scoring, and procedures manual-II. Townson, MD: Clinical Psychometric Research.Google Scholar
  25. Everson, M. D., Hunter, W. M., Runyon, D. K., Edelsohn, G. A., & Coulter, M. L. (1989). Maternal support following disclosure of incest. American Journal of Orthopsychiatry, 59,197–206.PubMedCrossRefGoogle Scholar
  26. Eyberg, S. M., & Ross, A. W. (1978). Assessment of child behavior problems: The validation of a new inventory. Journal of Clinical Child Psychology, 7,113–116.CrossRefGoogle Scholar
  27. Finch, A. J., & Rogers, T. R. (1984). Self-report instruments. In T. H. Ollendick & M. Hersen (Eds.) Child behavior assessment: Principles and procedures. New York: Pergamon.Google Scholar
  28. Finch, A. J., Saylor, C. F., & Edwards G. E. (1985). Children’s Depression Inventory: Sex and grade norms for normal children. Journal of Consulting and Clinical Psychology, 53, 424–425.PubMedCrossRefGoogle Scholar
  29. Finkelhor, D. (1984). Child sexual abuse: New theory and research. New York: Free Press.Google Scholar
  30. Finkelhor, D., & Berliner, L. (1995). Research on the treatment of sexually abused children: A review and recommendations. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1408–1423.PubMedCrossRefGoogle Scholar
  31. Finkelhor, D., & Dziuba-Leatherman, J. (1994). Children as victims of violence: A national survey. Pediatrics, 94, 413–420.PubMedGoogle Scholar
  32. Fish, V., & Faynik, C. (1989). Treatment of incest families with the father temporarily removed: A structural approach. Journal of Strategic and Systemic Therapies, 8, 53–63.Google Scholar
  33. Frederick, C. J. (1985). Children traumatized by catastrophic situations. In S. Eth & R. S. Pynoos (Eds.), Post-traumatic stress disorders in children(pp 73–99). Washington, DC: American Psychiatric Press.Google Scholar
  34. Friedrich, W. N. (1995). Psychotherapy with sexually abused boys: An integrated approach. Thousand Oaks, CA: Sage.Google Scholar
  35. Friedrich, W. N., Grambsch, P., Broughton, D., Kuiper, J., & Beilke, R. L. (1991). Normative sexual behavior in children. Pediatrics, 88, 456–464.PubMedGoogle Scholar
  36. Friedrich, W. N., Grambsch, P., Damon, L., Hewitt, S., Koverola, C, Lang, R., Wolfe, V., & Broughton, D. (1992). The Child Sexual Behavior Inventory: Normative and clinical contrasts. Psychological Assessment, 4, 303–311.CrossRefGoogle Scholar
  37. Furniss, T. H. (1987). An integrated treatment approach to child sexual abuse in the family. Children and Society, 2,123–135.Google Scholar
  38. Giarretto, H. (1982). A comprehensive child sexual abuse treatment program. Child Abuse St Neglect, 6, 263–278.CrossRefGoogle Scholar
  39. Giarretto, H. (1989). Community-based treatment of the incest family. Psychiatric Clinics of North America, 12, 351–361.PubMedGoogle Scholar
  40. Giuli, C. A., & Hudson, W. W. (1977). Assessing parent-child relationship disorders in clinical practice: The child’s point of view. Journal of Social Service Research, 1, 77–92.CrossRefGoogle Scholar
  41. Hanson, R. F., Smith, D. W., Saunders, B. E., Swenson, C. C, & Conrad, L. (1995). Measurement in child abuse research: A survey of researchers. The APS AC Advisor, 8, 7–10.Google Scholar
  42. Harter, S., Alexander, P. C, & Neimeyer, R. A. (1988). Long-term effects of incestuous child abuse in college women: Social adjustment, social cognition, and family characteristics. Journal of Consulting and Clinical Psychology, 56, 5–8.PubMedCrossRefGoogle Scholar
  43. Hovestadt, A. J., Anderson, W. T., Piercy, F. P., Cochran, S. W, & Fine, M. (1985). A Family-of-Origin Scale. Journal of Marital and Family Therapy, 11(3), 287–297.CrossRefGoogle Scholar
  44. Hudson, W. W., Wung, B., & Borges, M. (1980). Parent-child relationship disorders: The parent’s point of view. Journal of Social Service Research, 3, 283–294.CrossRefGoogle Scholar
  45. Kahn, T. (1991). Pathways: A guided workbook for youth beginning treatment. Orwell, VT: Safer Society Press.Google Scholar
  46. Kelly, R. (1982). Behavioral reorientation of pedophiliacs: Can it be done? Clinical Psychology Review, 2, 387–408.CrossRefGoogle Scholar
  47. Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62,100–110.PubMedCrossRefGoogle Scholar
  48. Kendall, P. C, & Braswell, L. (1993). Cognitive-behavioral therapy for impulsive children(2nd ed.). New York: Guilford Press.Google Scholar
  49. Kendall-Tackett, K., Williams, L., & Finkelhor, D. (1993). Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113,164–180.PubMedCrossRefGoogle Scholar
  50. Kilpatrick, D. G., Edmunds, C. N., & Seymour, A. K. (1992). Rape in America: A report to the nation. National Victim Center.Google Scholar
  51. Kolko, D. J., & Swenson, C. C. (1996, January). Psychosocial evaluation and treatment of physically abused children. Workshop presented at the San Diego Conference on Responding to Child Maltreatment, San Diego, CA.Google Scholar
  52. Kovacs, M. (1992). The Children’s Depression Inventory. North Tonawanda, NY: Multihealth Systems.Google Scholar
  53. Lang, P. J. (1979). A bio-informational theory of emotional imagery. Psychophysiology, 16, 495–511.PubMedCrossRefGoogle Scholar
  54. Lang, R., Pugh, G., & Langevin, R. (1988). Treatment of incest and pedophilic offenders: A pilot study. Behavioral Sciences and the Law; 6, 239–255.CrossRefGoogle Scholar
  55. Lanktree, C. B., Briere, J., & Hernandez, P. (1991, August). Further data on the Trauma Symptom Checklist for Children (TSC-C): Reliability; validity and sensitivity to treatment. Paper presented at the annual meeting of the American Psychological Association, San Francisco.Google Scholar
  56. Letourneau, E. J., & Saunders, B. E. (1996). Measurement and assessment tools: New section—introduction. The APS AC Advisor, 9, 8–10.Google Scholar
  57. Lipovsky, J. A. (1991). Posttraumatic stress disorder in children. Family Community Health,14,42–51.Google Scholar
  58. Lipovsky, J. A., & Elliott, A. N. (1993). Individual treatment of the sexually abused child. The APSAC Advisor, 6,1–18.Google Scholar
  59. Lipovsky, J. A., & Hanson, R. F. (1992a, October). Multiple traumas in the histories of child/adolescent psychiatric inpatients. Paper presented at the annual meeting of the International Society for Traumatic Stress Studies, Los Angeles.Google Scholar
  60. Lipovsky, J. A., & Hanson, R. F. (1992b, November). Traumatic event histories of child adolescent psychiatric inpatients: What is being done to our children? Paper presented at the annual meeting of the Association for the Advancement of Behavior Therapy, Boston.Google Scholar
  61. Lipovsky, J. A., Hanson, R. F., & Hand, L. (1993, January). Sexual abuse, physical abuse, and witnessing violence in child/adolescent psychiatric inpatients: Relationship to psychopathology. Paper presented at the San Diego Conference on Responding to Child Maltreatment, San Diego, CA.Google Scholar
  62. Lipovsky, J. A., & Saunders, B. E. (1989, November). Characteristics of incest families and victim emotional responses. Paper presented at the annual meeting of the American Criminology Society, Reno, NV.Google Scholar
  63. Lipovsky, J. A., Saunders, B. E., & Hanson, R. F. (1992). Parent-child relationships of victims and siblings in incest families. Journal of Child Sexual Abuse, 1, 35–50.CrossRefGoogle Scholar
  64. Lipovsky, J. A., Saunders, B. E., & Murphy, S. M. (1989). Depression, anxiety, and behavior problems among victims of father-child sexual assault and nonabused siblings. Journal of Interpersonal Violence, 4, 452–468.CrossRefGoogle Scholar
  65. Lutzker, J. R., Bigelow, K. M., Swenson, C. C, Doctor, R. M., & Kessler, M. L. (in press). Problems related to child abuse and neglect. In S. Netherton, D. Holmes, & C. E. Walker (Eds.), Comprehensive textbook of child and adolescent disorders: A guide to DSM-IV. Google Scholar
  66. Mannarino, A. P., Cohen, J. A., & Berman, S. R. (1994). Journal of Clinical Child Psychology, 23, 204–211.CrossRefGoogle Scholar
  67. Mannarino, A. P., Cohen, J. A., Smith, J. A., & Moore-Motily, S. (1991). Six- and twelve-month follow-up of sexually abused girls. Journal of Interpersonal Violence, 6,494–511.CrossRefGoogle Scholar
  68. Marshall, W. L., & Barbaree, H. E. (1988). The long-term evaluation of a behavioral treatment program for child molesters. Behaviour Research and Therapy, 26, 499–511.PubMedCrossRefGoogle Scholar
  69. McCurdy, K., & Daro, D. (1994). Child maltreatment: A national survey of reports and fatalities. Journal of Interpersonal Violence, 9, 75–94.CrossRefGoogle Scholar
  70. Meinig, M. B., & Bonner, B. L. (1990). Returning the treated sex offender to the family. Violence Update, 1,1–11.Google Scholar
  71. Moos, R. H., & Moos, B. S. (1981). Family Environment Scale Manual. Palo Alto: Consulting Psychologists Press.Google Scholar
  72. Moos, R. H., & Moos, B. S. (1983). Adaptation and the quality of life in work and family settings. Journal of Community Psychology, 11,158–170.PubMedCrossRefGoogle Scholar
  73. Moos, R. H., & Moos, B. S. (1990). Conceptual and empirical approaches to developing family-based assessment procedures: Resolving the case of the Family Environment Scale. Family Process, 29, 199–208.PubMedCrossRefGoogle Scholar
  74. O’Donohue, W. T., & Elliott, A. N. (1992). Treatment of the sexually abused child: A review. Journal of Clinical Child Psychology, 21, 218–228.CrossRefGoogle Scholar
  75. Ollendick, T. H., & Cerny, J. A. (1981). Clinical behavior therapy with children. New York: Plenum Press.Google Scholar
  76. Parker, H., & Parker, S. (1986). Father-daughter sexual abuse: An emerging perspective. American Journal of Orthopsychiatry, 56, 531–549.PubMedCrossRefGoogle Scholar
  77. Piers, E. V. (1984). Piers-Harris Children’s Self-Concept Scale. Revised Manual, 1984. Los Angeles: Western Psychological Services.Google Scholar
  78. Reynolds, C. R., & Paget, K. D. (1981). Factor analysis of the Revised Children’s Manifest Anxiety Scale for blacks, whites, males and females. Journal of Consulting and Clinical Psychology, 49, 352–359.PubMedCrossRefGoogle Scholar
  79. Reynolds, C. R., & Richmond, B. O. (1978). “What I Think and Feel”: A revised measure of children’s manifest anxiety. Journal of Abnormal Child Psychology, 6, 271–280.PubMedCrossRefGoogle Scholar
  80. Ribbe, D. P., Lipovsky, J. A., & Freedy, J. R. (1995). Posttraumatic stress disorder. In A. R. Eisen, C. A. Kaemey, & C. E. Schaeffer (Eds.), Clinical Handbook of Anxiety Disorders in Children and Adolescents(pp. 317–356). Northvale, NJ: Jason Aronson.Google Scholar
  81. Ribordy, S. C. (1990). Treating intrafamilial child sexual abuse from a systemic perspective. Journal of Psychotherapy and the Family, 6, 71–88.CrossRefGoogle Scholar
  82. Rice, M. E., Quinsey, V. L., & Harris, G. T. (1991). Sexual recidivism among child molesters released from a maximum security psychiatric institution. Journal of Consulting and Clinical Psychology, 59, 381–386.PubMedCrossRefGoogle Scholar
  83. Saunders, B. E., McClure, S. M., & Murphy, S. M. (1986). Profile of incest offenders indicating treatability—Part I: Final report submitted to the U. S. Department of the Navy. Unpublished manuscript.Google Scholar
  84. Saunders, B. E., McClure, S. M., & Murphy, S. M. (1987, July). Structure, function, and symptoms in father-daughter sexual abuse families: A multilevel-multirespondent empirical assessment. Paper presented at the Family Violence Research Conference, Durham, NH.Google Scholar
  85. Saunders, B. E., & Schuchts, R. A. (1987). Assessing parent-child relationships: A report of normative scores and revalidation of two clinical scales. Family Process, 26, 373–381.PubMedCrossRefGoogle Scholar
  86. Saylor, C. F., Swenson, C. C, Stokes, S. J., Wertlieb, D., & Casto, Y. (1994, August). The Pediatric Emotional Distress Scale: A brief new screening measure. Paper presented at the annual meeting of the American Psychological Association, Los Angeles.Google Scholar
  87. Sgroi, S. M. (1982). Handbook of clinical intervention in child sexual abuse. Lexington, MA: Lexington Books.Google Scholar
  88. Shapiro, J. P. (1989). Self-blame versus helplessness in sexually abused children: An attributional analysis with treatment recommendations. Journal of Social and Clinical Psychology, 8, 442–455.CrossRefGoogle Scholar
  89. Silovsky, J. F., & Hembree-Kigin, T. L. (1994). Family and group treatment for sexually abused children: A review. Journal of Child Sexual Abuse, 3,1–20.CrossRefGoogle Scholar
  90. Smiljanich, K., & Briere, J. (1993, August). Sexual abuse history and trauma symptoms in a university sample. Paper presented at the annual meeting of the American Psychological Association, Toronto, Ontario, Canada.Google Scholar
  91. Sorenson, T., & Snow, B. (1991). How children tell: The process of disclosure in child sexual abuse. Child Welfare League of America, 70, 3–15.Google Scholar
  92. Spielberger, C. C. (1973). Preliminary manual for the State-Trait Anxiety Inventory for Children (“How I Feel Questionnaire”). Palo Alto, CA: Consulting Psychologists Press.Google Scholar
  93. Stauffer, L. B., & Deblinger, E. (1996). Cognitive behavioral groups for nonoffending mothers and their young sexually abused children: A preliminary treatment outcome study. Child Maltreatment, 1, 65–76.CrossRefGoogle Scholar
  94. Swenson, C. C. (1996, February). Group treatment for physically abused children. Workshop presented at the second annual Colloquium of the South Carolina Professional Society on the Abuse of Children, Charleston, SC.Google Scholar
  95. Swenson, C. C, Saylor, C. F., Stokes, S., Ralston, M. E., Smith, D. E., Hanson, R. F., & Saunders, B. E. (1994, January). Anxiety and fear in traumatized children: The validity of a new brief screening instrument. Paper presented at the San Diego Conference on Responding to Child Maltreatment, San Diego, CA.Google Scholar
  96. Tong, L., Oakes, K., & McDowell, M. (1987). Personality development following sexual abuse. Child Abuse & Neglect,11, 371–383.CrossRefGoogle Scholar
  97. Williams, L. M., & Finkelhor, D. (1990). The characteristics of incestuous fathers: A review of recent studies. In W. L. Marshall, D. R. Laws, & H. E. Barbaree (Eds.). Handbook of sexual assault: Issues, theories, and treatment of the offender(pp. 231–255). New York: Plenum Press.Google Scholar
  98. Wolfe, D., Sas, L., & Wekerle, C. (1994). Factors associated with the development of posttraumatic stress disorder among child victims of sexual assault. Child Abuse & Neglect, 18, 37–50.CrossRefGoogle Scholar
  99. Wolfe, V. V., & Gentile, C. (1992). Psychological assessment of sexually abused children. In W. T. O’Donohue and J. H. Geer (Eds.), The sexual abuse of children: Theory, research, and therapy (pp. 143–187). Hillsdale, NJ: Erlbaum.Google Scholar
  100. Wolfe, V. V., Gentile, C., Michienczi, T., Sas, L, & Wolfe, D. A. (1991). The Children’s Impact of Traumatic Events Scale: A measure of post-sexual abuse PTSD symptoms. Behavioral Assessment, 13, 358–383.Google Scholar
  101. Wolfe, V. V., Gentile, C., & Wolfe, D. A., (1989). The impact of sexual abuse on children: A PTSD formulation. Behavior Therapy, 20, 215–228.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Cynthia Cupit Swenson
    • 1
  • Rochelle F. Hanson
    • 2
  1. 1.Department of Psychiatry and Behavioral Science, Family Services Research CenterMedical University of South CarolinaCharlestonUSA
  2. 2.Center for Sexual Assault/Abuse Recovery and EducationUniversity of FloridaGainesvilleUSA

Personalised recommendations