Behavioral and Psychological Assessment of Child Sexual Abuse in Clinical Practice

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ABSTRACT

This paper discusses the behavioral and psychological assessment of Child Sexual Abuse (CSA) in clinical practice. Following a brief introduction regarding definition and etiology of CSA and discussion on issues of behavioral/ psychological consequences of CSA, the paper reviews the various approaches towards behavioral/psychological assessment in establishing validity of alleged CSA. The shortcomings of the various behavioral/psychological assessment procedures and the issues of general consensus on behavioral assessment in CSA have been reviewed. The role of behavioral/psychological assessment in child protection issues is also discussed.

Keywords: Child Sexual Abuse, psychological/behavioral consequences, psychological/behavioral assessment, child protection issues, mental health professionals, post-traumatic stress disorder

INTRODUCTION

In the last two decades there has been an explosion in the number of studies that have concentrated specifically on sexually abused children. Behavioral and psychological assessment of child sexual abuse (CSA) that includes identification, diagnosis, etiology, and social, physical and psychological consequences has been the focus of research. It is important to know about the social, environmental climate in which CSA occurs; indices of behavior and emotions which point towards it and the factors that preclude identification etc.

Definition of what act constitutes CSA has implications in behavioral assessment. The most comprehensive definition has been given by the Standing Committee on Sexually Abused Children (SCOSAC, 1984) which states that "any child below the age of consent may be deemed to have been sexually abused when a sexually matured person has engaged or permitted the engagement of that child in any activity of a sexual nature which is intended to lead to sexual gratification of the sexually mature person".

Another factor which should be kept in mind while doing behavioral and psychological assessment is the etiology of CSA. It has been suggested that four factors influence the occurrence of CSA (Finkelhor, 1984). First, it is the motivation of the abuser that includes the abuser's sexuality. Second factor is the absence of internal inhibitions (moral values of the adult). Third factor is the absence of external inhibitors (supervision of child by others) like protective family, secure attachment to the primary care giver, good monitoring of the child's whereabouts and confiding relationship for the child's increased chances of abuse (Budin & Johnson, 1989; Conte et al 1989). Last it is the lack of child's own resistance towards the adult also increases the chances of abuse.

BEHAVIORAL AND PSYCHOLOGICAL CONSEQUENCES OF CSA

The consequences of CSA are both psychological as well as physical. The behavioral and psychological assessment in child sexual abuse should focus on psychological consequences of CSA. Also, the wide range of serious long and short-term consequences of CSA including the need to prevent reactive abuse (abuse of other children by a victim) is one reason why all children suspected to be sexually abused need to be referred for psychological testing and treatment (Glasser et al 2001; Johnson 2004). Children can exhibit a myriad of immediate psychological consequences like emotional disturbances in form of fear, anxiety, depression, anger, hostility and low self-esteem (Browne & Finkelhor 1986; Bentovim et al 1988; Kendall-Tackett et al 1993). These children can also present with various anxiety disorder (fearfulness, nightmares, phobias etc), posttraumatic stress disorder (PTSD), hysterical reactions, depression, suicidal behavior, substance abuse etc. Research reports have shown that 20-70% of children with CSA suffer from posttraumatic stress disorder (Wolfe et al 1991; McLeer et al 1992). However, it has also been estimated that 1/3rd of the abused children show no psychological symptoms or only non-specific symptoms. …