Psychosocial symptoms in very young children assessed for sexual abuse: A qualitative analysis from the ASAC study

• Published in: Child abuse & neglect Vol. 73; pp. 8 - 23
• Main Authors: Vrolijk-Bosschaart, T.F., Brilleslijper-Kater, S.N., Widdershoven, G.A.M., Teeuw, A.H., Verlinden, E., Voskes, Y., van Duin, E.M., Verhoeff, A.P., de Leeuw, M., Roskam, M.J., Benninga, M.A., Lindauer, R.J.L.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.11.2017; Elsevier Science Ltd
• Subjects: Abused children; Behavior problems; Child; Child Abuse; Child abuse & neglect; Child Abuse, Sexual - diagnosis; Child Abuse, Sexual - psychology; Child Behavior Disorders - etiology; Child Behavior Disorders - psychology; Child care services; Child Day Care Centers; Child development; Child sexual abuse; Child, Preschool; Children; Children & youth; Content analysis; Day care centers; Diagnosing; Emotions; Erotica; Experts; Female; Females; Focus Groups; Humans; Infant; Interdisciplinary aspects; Male; Medicine; Netherlands; Post traumatic stress disorder; Posttraumatic Stress Disorder; Psychosocial factors; Psychosocial problems; Psychosocial symptoms; Qualitative Research; Sexual Abuse; Social development; Social psychology; Stress Disorders, Post-Traumatic - etiology; Stress Disorders, Post-Traumatic - psychology; Symptoms; Toilet Training; Training; Victims; Young Children; CSA; PTSD; FGDs; OPD; Child sexual abuse; Diagnosing; AMC; ASAC; Psychosocial symptoms
• ISSN: 0145-2134; 1873-7757
• DOI: 10.1016/j.chiabu.2017.09.001

Child sexual abuse (CSA) is a worldwide problem with serious consequences. No recognizable symptom pattern for suspected CSA has yet been identified in very young children. We aim to investigate psychosocial symptoms in a sample of children with confirmed or strongly suspected CSA and the interpretations given to such symptoms by independent clinical experts. Secondly we examined whether experts were able to identify confirmed victims of severe CSA. A qualitative study including inductive content analysis of medical files and focus group discussions with independent experts on the interpretation of psychosocial symptoms was conducted. We included 125 children (76 boys, 60.8%, and 49 girls, 39.2%; median age 3.3 years; age range 0–11) who were involved in the Amsterdam sexual abuse case (ASAC) and had been examined for strongly suspected CSA. We identified four themes among the psychosocial symptoms: problems concerning emotions, behavior, toilet training, and development, whether or not associated with the daycare center or the perpetrator. Clinical experts identified signs of posttraumatic stress disorder (PTSD), regression in continence skills (not otherwise explained), and problems triggered by exposure to the perpetrator or the abuse location as concerning symptoms for CSA. Less concerning symptoms were designated as worrisome if they were numerous and there was no clear explanation for these symptoms. A clear symptom pattern was lacking and about half of the confirmed severe victims of CSA did not display any psychosocial problems. Therefore, it is difficult for experts to identify confirmed CSA victims. Thus, the assessment of suspected CSA should be over time and multidisciplinary.