Efficacy of Interventions for Sexually Abused Children – A Literature Review and Meta-Analysis of Treatment of Post Traumatic Stress Symptoms
DOI:
https://doi.org/10.12970/2310-8231.2014.02.01.2Keywords:
Child sexual abuse, Interventions, Post traumatic stress.Abstract
Background: Child sexual abuse is a significant risk factor for psychopathology. Earlier reviews indicate that psychosocial interventions may be effective for some symptoms, but a comprehensive picture is still lacking. Moreover, the rapid increase of research requires evaluations to be updated. The present systematic review aims at describing the research on intervention efficacy among sexually abused children, and analyses their effect in decreasing the post traumatic stress symptoms (PTSS).
Methods: The qualitative literature review offers the overview of recent interventions among sexually abused children. It describes the quality of evidence as well as the modality (group vs. individual, family vs. child only) and targeting (universal, selective, indicated) of the interventions. To evaluate the efficacy of interventions, the meta-analysis is applied.
Results: The results revealed 23 relevant studies with total of 31 intervention conditions published between 2000 and 2013. The meta-analysis showed that when intervention groups were compared to control groups with no treatment at all, interventions showed a large power of positive changes in PTSS. However, when cognitive behavioral therapy (CBT) groups were compared to control groups which received some other intervention, there was no difference in PTSS changes among experimental and control groups.
Conclusions: Results suggest that psychosocial interventions with sexually abused children are beneficial but it is still not clear, which are the most effective methods. The results also highlight the consequences of methodological decisions when conducting meta-analysis. However, because of some limitations of the study, the results of this review should be regarded as tentative and suggestive and further elaboration of the constantly growing evidence is needed.
References
Stoltenborgh M, van IJzendoorn MH, Euser EM, Bakermans-Kranenburg MJ. A global perspective on child sexual abuse: Meta-analysis of prevalence around the world. Child Maltreat 2011; 16: 79-101. http://dx.doi.org/10.1177/1077559511403920
Pereda N, Guilera G, Forns M, Gomez-Benito J. The prevalence of child sexual abuse in community and student samples: A meta-analysis. Clin Psychol Rev 2009; 29: 328-38. http://dx.doi.org/10.1016/j.cpr.2009.02.007
Maniglio R. The impact of child sexual abuse on health: A systematic review of reviews. Clin Psychol Rev 2009; 29: 647-57. http://dx.doi.org/10.1016/j.cpr.2009.08.003
Cutajar MC, Mullen PE, Ogloff JRP, Thomas SD, Wells DL, Spataro J. Psychopathology in a large cohort of sexually abused children followed up to 43 years. Child Abuse Neglect 2010; 23: 813-22. http://dx.doi.org/10.1016/j.chiabu.2010.04.004
Kendall-Tackett K, Williams L, Finkelhor D. Impact of sexual abuse on children: a review and synthesis of recent empirical studies. Psychol Bull 1993; 113: 164-80. http://dx.doi.org/10.1037/0033-2909.113.1.164
Berliner L, Elliott DM. Sexual abuse of children. In: The APSAC handbook on child maltreatment (2nd ed.), Myers JEB, Berliner L, Briere J, Hendrix CT, Jenney C & Reid T (eds). Thousand Oaks, CA: Sage2002; pp. 55-78.
Whealin JM. Women's report of unwanted sexual attention during childhood. J Child Sex Abus 2002; 11: 75-93. http://dx.doi.org/10.1300/J070v11n01_04
Willumsen T. Dental fear on sexually abused women. Eur J Oral Sci 2002; 109: 291-6. http://dx.doi.org/10.1034/j.1600-0722.2001.00069.x
Gilbert R, Widom C, Browne K, Fergusson D, Webb E, Janson J. Burden and consequences of child maltreatment in high-income countries. Lancet 2009; 373: 68-81. http://dx.doi.org/10.1016/S0140-6736(08)61706-7
Schore AN. Dysregulation of the right brain: a fundamental mechanism of traumatic attachment and the psychopathogenesis of posttraumatic stress disorder. Aust N Z J Psychiatry 2002; 36: 9-30. http://dx.doi.org/10.1046/j.1440-1614.2002.00996.x
Siegel JA. Aggressive behaviour among women sexually abused as children. Violence Vict 2000; 15: 235-55.
Connor DF, Doerfler LA, Volungis AM, Steingard RJ, Melloni RH Jr. Aggressive behaviour in abused children. Ann N Y Acad Sci 2003; 1008: 79-90. http://dx.doi.org/10.1196/annals.1301.009
Corby B. Child abuse: Towards a knowledge base (3rd ed.). Open University Press: Berkshire 2006.
Merrick M, Litrownik A, Everson M, Cox C. Beyond sexual abuse: The impact of other maltreatment experiences on sexualized behaviors. Child Maltreat 2008; 13: 122-32. http://dx.doi.org/10.1177/1077559507306715
Gladstone G, Parker G, Mitchell P, Malhi G, Wilhelm K, Austin M. Implications of childhood trauma for depressed women: An analysis of pathways from childhood sexual abuse to deliberate self-harm and revictimization. Am J Psychiatry 2004; 161: 1417-25. http://dx.doi.org/10.1176/appi.ajp.161.8.1417
Widom CS Post traumatic stress disorder in abused and neglected children grown up. Am J Psychiatry 1999; 156: 1223-9.
Cohen JA, Mannarino AP, Murray LK, Igelman R. Psychosocial interventions for maltreated and violence-exposed children. J Soc Issues 2006; 62: 733-66. http://dx.doi.org/10.1111/j.1540-4560.2006.00485.x
Corcoran J, Pillai V. A meta-analysis of parent-involved treatment for child sexual abuse. Res Social Work Prac 2008; 18: 453-64. http://dx.doi.org/10.1177/1049731507313980
Harvey TS, Taylor JE. A meta-analysis of the effects of psychotherapy with sexually abused children and adolescents. Clin Psychol Rev 2010; 30: 517-35. http://dx.doi.org/10.1016/j.cpr.2010.03.006
Hetzel-Riggin MD, Brausch AM, Montgomery BS. A meta-analytic investigation of therapy modality outcomes for sexually abused children and adolescents: an exploratory study. Child Abuse Neglect 2007; 31: 125-41. http://dx.doi.org/10.1016/j.chiabu.2006.10.007
Skowron E, Reineman DHS. Effectiveness of psychological interventions for child maltreatment: A meta-analysis. Psychother Theor Res Pract Train 2005; 42: 52-71. http://dx.doi.org/10.1037/0033-3204.42.1.52
Trask EV, Walsh K, DiLillo D. Treatment effects for common outcomes of child sexual abuse: A current meta-analysis. Aggress Violent Behav 2011; 16: 6-19. http://dx.doi.org/10.1016/j.avb.2010.10.001
Cohen JA, Berliner L, Mannarino AP. Treating traumatized children: a research review and synthesis. Trauma Violence Abuse 2000; 1: 29-45. http://dx.doi.org/10.1177/1524838000001001003
Macdonald G, Higgins J, Ramchandani P, et al. Cognitive-behavioral interventions for children who have been sexually abused. Cochrane Database Syst Rev 2012; 16: CD001930. http://dx.doi.org/10.4073/csr.2006.10
Macdonald G, Higgins J, Ramchandani P, et al. Cognitive-behavioural interventions for children who have been sexually abused. Cochrane Library 2012; 5. http://dx.doi.org/10.1002/14651858.CD001930.pub3
Coren E, Hutchfield J, Iredale W, Kelly A, Pilkington C, Yardley C. A meta-review of interventions to support children and their families in the aftermath of child sexual abuse. Canterbury Christ Church University: Department of Social Work, Community and Mental Health. Research Unit.2009
Biglan A, Mrazek PJ, Carnine D, Flay BR. The integration of research and practice in the prevention of youth problem behaviors. Am Psychologist 2003; 58: 433-41. http://dx.doi.org/10.1037/0003-066X.58.6-7.433
Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health 1999; 89: 1322-7. http://dx.doi.org/10.2105/AJPH.89.9.1322
Glasgow RE, Lichtenstein E, Marcus AC. Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. Am J Public Health 2003; 93: 1261-7. http://dx.doi.org/10.2105/AJPH.93.8.1261
Kelly C, Scharff D, LaRose J, Lobb Dougherty N, Stringer Hessel A, Brownson RC. A tool for rating chronic disease prevention and public health interventions. Prev Chronic Dis 2013; 10: E206. doi: 10.5888/pcd10.130173
Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998; 52: 377-84. http://dx.doi.org/10.1136/jech.52.6.377
Morris SB, DeShon RP. Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychol Methods 2002; 105-25. http://dx.doi.org/10.1037/1082-989X.7.1.105
Lipsey MW, Wilson DB. Practical Meta-analysis (Applied Social Research Methods Series, v. 49). Thousand Oaks, CA: Sage.2001
Coe R. 2002. It's the Effect Size, Stupid. What effect size is and why it is important. Paper presented at the Annual Conference of the British Educational Research Association, University of Exeter, England, 12-14 September 2002.
Cohen J. Statistical Power Analysis for the Behavioral Sciences, (2nd ed.), Lawrence Erlbaum Associates, Inc.: New Jersey.1988.
Gordon R. An operational classification of disease prevention. Public Health Reports 1983; 98: 107-9.
Reyes CJ, Asbrand JP. A longitudinal study assessing trauma symptoms in sexually abused children in play therapy. Int J Play Therapy 2005; 14: 25-47. http://dx.doi.org/10.1037/h0088901
Deblinger E, Stauffer LB, Steer RA. Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their nonoffending mothers. Child Maltreat 2001; 6: 332-434. http://dx.doi.org/10.1177/1077559501006004006
Jaberghaderi N, Greenwald R, Rubin A, Zand SO, Dolatabadi S. A comparison of CBT and EMDR for sexually-abused Iranian girls. Clin Psychol Psychot 2004; 11: 358-68. http://dx.doi.org/10.1002/cpp.395
Cohen JA, Deblinger E, Mannarino AP, Steer, RA. A multisite, randomized controlled trial for children with sexual abuse–related PTSD symptoms. J Am Acad Child Adolesc Psychiatry 2004; 43: 393-402. http://dx.doi.org/10.1097/00004583-200404000-00005
Cohen JA, Mannarino AP, Perel JM, Staron V. A pilot randomized control trial of combined trauma-focused CBT and sertraline for childhood PTSD symptoms. J Am Acad Child Adolesc Psychiatry 2007; 46: 811-9. http://dx.doi.org/10.1097/chi.0b013e3180547105
King JN, Tonge BJ, Mullen P, et al. Treating sexually abused children with posttraumatic stress symptoms: A randomized clinical trial. J Am Acad Child Adolesc Psychiatry 2000; 39: 1345-55. http://dx.doi.org/10.1097/00004583-200011000-00008
Cohen JA, Mannarino AP, Knudsen K. Treating sexually abused children: 1 year follow-up of a randomized controlled trial. Child Abuse Neglect 2005; 29: 135-45. http://dx.doi.org/10.1016/j.chiabu.2004.12.005
Trowell J, Kolvin I, Weeramanthri T, et al. Psychotherapy for sexually abused girls: psychopathologicaloutcome findings and patterns of change. Br J Psychiatry 2002; 180: 234-47. http://dx.doi.org/10.1192/bjp.180.3.234
Hubel GS, Maldonado RC, Tavkar P, Hansen DJ, Flood MF. Cognitive-behavioral group treatment for a sexually abused child and anonoffending caregiver: Case study and discussion. Clin Case Stud 2011; 10: 360-75. http://dx.doi.org/10.1177/1534650111422376
Deblinger E, Mannarino AP, Cohen JA, Runyon MK, Steer RA. Trauma-focused cognitive behavioral therapy for children: Impact of the trauma narrative and treatment length. Depress Anxiety 2011; 28: 67-75. http://dx.doi.org/10.1002/da.20744
Krahe B, Knappert L. A group-randomized evaluation of a theatre- based sexual abuse prevention programme for primary school children in Germany. J Community Appl Soc Psychol 2009; 11: 321-9. http://dx.doi.org/10.1002/casp.1009
Pretorius G, Pfeifer N. Group art therapy with sexually abused girls. S Afr J Psychol 2010; 40: 63-73. http://dx.doi.org/10.1177/008124631004000107
Tourigny M, Hébert M, Daigneault I, Simoneau AC. Efficacy of a group therapy for sexually abused adolescent girls. J Child Sex Abus 2005; 14: 71-93. http://dx.doi.org/10.1300/J070v14n04_04
Bagley C, LaChance M. Evaluation of a family-based programme for the treatment of child sexual abuse. Child Fam Socl Work 2000; 5: 205-13. http://dx.doi.org/10.1046/j.1365-2206.2000.00162.x
Barron IG, Topping KJ. Survivor experience of a child sexual abuse prevention program: A pilot study. J Interpers Violence 2013; 28: 2797-812. http://dx.doi.org/10.1177/0886260513488690
Baker KC, GLeason K, Naai R, Mitchell J, Trecker C. Increasing knowledge of sexual abuse: A study with elementary school children in Hawaii. Res Social Work Prac 2013; 23: 167-78. http://dx.doi.org/10.1177/1049731512468796
Nolan M, Carr A, Fitzpatrick C, et al. A comparison of two programmes for victims of child sexual abuse: A treatment outcome study. Child Abuse Rev 2002; 11: 103-23. http://dx.doi.org/10.1002/car.727
Duffany A, Panos PT. Outcome evaluation of a group treatment of sexually abused and reactive children. Res Social Work Prac 2009; 19: 291-303. http://dx.doi.org/10.1177/1049731508329450
Misurell JR, Springer C, Tryon WW. Game-based cognitive-behavioral therapy(GB-CBT) group program for children who have experienced sexual abuse: A preliminary investigation. J Child Sex Abus 2011; 20: 14-36. http://dx.doi.org/10.1080/10538712.2011.540000
Arnold EM, Kirk RS, Roberts AC, Griffith DP, Meadows K, Julian J. Treatment of incarcerated, sexually-abused adolescent females: An outcome study. Journal of Child Sexual Abuse 2003; 12: 123-139. http://dx.doi.org/10.1300/J070v12n01_06
Scott TA, Burlingame G, Starling M, Porter C, Lilly JP. Effects of individual client-centered play therapy on sexually abused children’s mood, self-concept, and social competence. Int J Play Therapy 2003; 12: 7-30. http://dx.doi.org/10.1037/h0088869
Pifalo T. Art therapy with sexually abused children and adolescents: Extended research study. J Am Art Ther Assoc 2006; 23: 181-5. http://dx.doi.org/10.1080/07421656.2006.10129337
Tjersland OA, Mossige S, Gulbrandsen W, Jense TK, Reichelt S. Helping families when child sexual abuse is suspected but not proven. Child Fam Social Work 2006; 11: 297-306. http://dx.doi.org/10.1111/j.1365-2206.2006.00409.x
Chaffin M. The changing focus of child maltreatment research and practice within psychology. J Social Issue 2006; 62: 662-82. h http://dx.doi.org/10.1111/j.1540-4560.2006.00482.x
Peltonen K, Punamaki R-L. Preventive interventions for children exposed to military and community violence and natural disasters: A literature view. Aggress Behav 2010; 36: 95-116. http://dx.doi.org/10.1002/ab.20334
Christley RM. Power and error: Increased risk of false positive results in underpowered studies. Open Epidemiol J 2010; 3: 16-9. http://dx.doi.org/10.2174/1874297101003010016
Silverman WK, Ortiz CD, Viswesvaran C, et al. Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. J Clin Child Adolesc Psychol 2008; 37: 156-83. http://dx.doi.org/10.1080/15374410701818293
Dominguez RZ. Evaluation of cognitive-behavioral and supportive treatments for sexually abused children: Analyzing the process of change using individual growth curve analyses [Phd dissertation]. University of Houston: Houston TX. 2001.
Brown S. An investigation of trauma symptom reduction in a clinical sample of sexually abused children using Trauma Symptom Checklist for Children [Phd dissertation]. Counseling and Psychological Services Dissertations. Paper 10. Georgia State University. 2007.
Hsu E. Parallel group treatment for sexually abused children and their nonoffending parents: An examination of treatment integrity and child and family outcome and satisfaction [Phd dissertation]. University of Nebraska-Lincoln.2003.
Grosz CA, Kempe RS, Kelly M. Extrafamilial sexual abuse: treatment for child victims and their families. Child Abuse Neglect 2000; 24: 9-23. http://dx.doi.org/10.1016/S0145-2134(99)00113-1
Holland P, Gorey K, Lidsay A. Prevention of mental health and behavior problems among sexually abused aboriginal children in care. Child Adolesc Soc Work J 2004; 21: 109-15. http://dx.doi.org/10.1023/B:CASW.0000022726.59560.6c
Coren E, Thomae M, Hutchfielde J, Iredale W. Report on the implementation and results of an outcomes-focused evaluation of child sexual abuse interventions in UK. Child Abus Rev 2013; 22: 44-59. http://dx.doi.org/10.1002/car.2200
Krakow B, Sandoval D, Schrader R, et al. Treatment of chronic nightmares in adjudicated adolescent girls in a residential facility. J Adolesc Health 2001; 29: 94-100. http://dx.doi.org/10.1016/S1054-139X(00)00195-6
Hanson RF, Saunders B, Kilpatrick D, Resnick H, Crouch JA, Duncan R. Impact of childhood rape and aggravated assault on adult mental health. Am J Orthopsychiatry 2001; 71: 108-19. http://dx.doi.org/10.1037/0002-9432.71.1.108
Haskett ME, Nears K, Sabourin Ward C, McPherson AV. Diversity in adjustment of maltreated children: Factors associated with resilient functioning. Clin Psychol Rev 2006; 26: 796-812. http://dx.doi.org/10.1016/j.cpr.2006.03.005
Small S, O’Connor C, Cooney S. Evidence-informed program improvement. What Works: Wisconsin Program Improvement Manual. University of Wisconsin-Madison: Madison 2008.
