Sexual Abuse and PTSD in Children
Child sexual abuse is a type of a traumatic event that may involve “unwanted and inappropriate sexual solicitation of, or exposure to, a child by an older person; genital touching or fondling; or penetration in terms of oral, anal or vaginal intercourse or attempted intercourse” (Andrews, Corry, Slade, Issakidis, & Swanston, 2004). A national survey comprised of 4,549 children in the United States found a 1-year sexual abuse prevalence rate of 6.1% (Finkelhor, Turner, Ormrod, Hamby, & Kracke, 2009). A portion of these victims of child sexual abuse may later develop psychiatric issues, including posttraumatic stress disorder (PTSD).
Despite an alarming prevalence of child sexual abuse and PTSD and their documented negative effects on a victim’s life, there is no empirically supported treatment that has been used in the primary care setting. A stepped care approach may provide an avenue for providers to engage in effective practices that may help those who seek mental health treatment in the primary care setting. This chapter will review literature on the topic and discuss detailed steps regarding how to effectively integrate a stepped-care model into the primary care setting, specifically for the purpose of assessing and treating PTSD in pediatric patients.
KeywordsStepped care Sexual abuse PTSD Children Trauma Primary care
- Achenbach, T. M. (1991a). Manual for the child behavior checklist/4-18 and 1991 profile. Burlington, VT: Department of Psychiatry, University of Vermont.Google Scholar
- Achenbach, T. M. (1991b). Manual for the Teacher’s report form and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry.Google Scholar
- Achenbach, T. M., & Rescorla, L. (2000). Manual for the child behavior checklist: Preschool forms and profiles. Burlington, VT: University of Vermont College of Medicine.Google Scholar
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.Google Scholar
- Andrews, G., Corry, J., Slade, T., Issakidis, C., & Swanston, H. (2004). Child sexual abuse. In Ezzati, M., Lopez, A. D., Rodgers, A., & Murray, C.J.L. (Eds.), Comparative quantification of health risks: Global and regional burden of disease attributable to selected major risk factors. Geneva, Switzerland: World Health Organization.Google Scholar
- Busner, J., & Targum, S. D. (2007). The clinical global impressions scale: Applying a research tool in clinical practice. Psychiatry (Edgmont), 4(7), 28.Google Scholar
- Finkelhor, D., Turner, H., Ormrod, R., Hamby, S., & Kracke, K. (2009). Children’s exposure to violence: A comprehensive national survey. Washington, DC: United States Department of Justice, Office of Justice.Google Scholar
- First, M. B., Williams, J. B., Karg, R. S., & Spitzer, R. L. (2016). Structured clinical interview for DSM-5 disorders: SCID-5-CV clinician version. Arlington, VA: American Psychiatric Association.Google Scholar
- Foa, E. B., Chrestman, K. R., & Gilboa-Schechtman, E. (2008). Prolonged exposure therapy for adolescents with PTSD emotional processing of traumatic experiences, therapist guide. New York, NY: Oxford University Press.Google Scholar
- Ford, J. D., Racusin, R., Daviss, W. B., Ellis, C. G., Thomas, J., Rogers, K., … Sengupta, A. (1999). Trauma exposure among children with oppositional defiant disorder and attention deficit–hyperactivity disorder. Journal of Consulting and Clinical Psychology, 67(5), 786.CrossRefPubMedGoogle Scholar
- Institute of Medicine (U.S.). (2008). Treatment of posttraumatic stress disorder: An assessment of the evidence. Washington, DC: National Academies Press.Google Scholar
- Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., … Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989.CrossRefGoogle Scholar
- Pat-Horenczyk, R., Rabinowitz, R. G., Rice, A., & Tucker-Levin, A. (2009). The search for risk and protective factors in childhood PTSD. In D. Brom, R. Pat-Horenczyk, & J. D. Ford (Eds.), Treating traumatized children risk, resilience and recovery. New York, NY: Routledge/Taylor & Francis Group.Google Scholar
- Prins, A., Bovin, M. J., Smolenski, D. J., Marx, B. P., Kimerling, R., Jenkins-Guarnieri, M. A., … Tiet, Q. Q. (2016). The primary care PTSD screen for DSM-5 (PC-PTSD-5): Development and evaluation within a veteran primary care sample. Journal of General Internal Medicine, 31(10), 1206–1211.CrossRefPubMedPubMedCentralGoogle Scholar
- Pynoos, R. S., Weathers, F. W., Steinberg, A. M., Marx, B. P., Layne, C. M., Kaloupek, D. G., … Kriegler, J. A. (2015). Clinician-Administered PTSD Scale for DSM-5 Child/Adolescent Version. Scale available from the National Center for PTSD at www.ptsd.va.gov.
- Scheeringa, M. S., Weems, C. F., Cohen, J. A., Amaya-Jackson, L., & Guthrie, D. (2011). Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three through six year-old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry, 52(8), 853–860.CrossRefPubMedGoogle Scholar
- Stauffer, L., & Deblinger, E. (1990). Let’s talk about taking care of you: An educational book about body safety. Hatfield, PA: Hope for Families.Google Scholar
- Stauffer, L. B., & Deblinger, E. (2004). Let’s talk about taking care of you: An educational book about body safety for young children. Hatfield, PA: Hope for Families.Google Scholar
- United States Department of Health and Human Services. (2015). Child maltreatment 2013. Washington, DC: Administration on Children, Youth and Families, Administration for Children and Families.Google Scholar
- Williams, M. B., & Poijula, S. (2016). The PTSD workbook: Simple, effective techniques for overcoming traumatic stress symptoms. Oakland, CA: New Harbinger Publications.Google Scholar