Family Practice Vol. 19, No. 1, 36-44
© Oxford University Press 2002
Original Paper |
Sexually abused children's behaviours: impact of gender and mother's experience of intra- and extra-familial sexual abuse
University of California, Los Angeles, Department of Education, 405 Hilgard Avenue, Los Angeles, CA 90095-1521, USA.
Estes LS and Tidwell R. Sexually abused children's behaviours: impact of gender and mother’s experience of intra- and extra-familial sexual abuse. Family Practice 2002; 19: 36–44.
Received 1 May 2001; Accepted 3 September 2001.
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Abstract |
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Objectives. Three questions guided the inquiry of this study: (i) the influence of a mother's experience of sexual abuse on the sexual abuse behaviours experienced by her child; (ii) to examine child behaviour as it relates to the type of sexual abuse and to gender; and (iii) to explore indicators of family functioning in incestuous and non-incestuous families.
Methods. Using two self-report assessment measures and a semi-structured intake interview, an intake group design was used with 104 sexually abused children (52 males and 52 females), and their 104 mothers (50 with a history of sexual abuse and 54 without such histories).
Results. The incested children displayed significantly more sexualized behaviour than children molested out of the home. Sexually abused males exhibited significantly more sexual behaviour than females. Incested mothers reported significantly more substance abuse on their own part and in their families of origin, and also more physical abuse in these same families.
Conclusions. The findings from this study suggest that incestuous families suffer from a multitude of problems such as intergenerational substance abuse and physical abuse. Also differences between male and female sexually abused children with regard to their sexualized behaviours were clearly noted.
Keywords. Children, incest, sexual abuse.
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Introduction |
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A man or woman raised in an incestuous family is likely to find a mate with a similar degree of role and boundary confusion. As such partners form their own family, they may create a family system similar to that of their families of origin.1 Because the incestuous family system is characterized by intense emotional relationships and diffuse boundaries, pathological behaviours are likely to develop.2,3 There appears to be a positive relationship between a mother's sexual abuse experience and the subsequent victimization of her child.4,5 Sadly, the family of procreation repeats many of the same dysfunctional behaviours that characterized the family of origin, including incest.
One purpose of this study, then, was to examine the role of the mother's experience of sexual abuse in cases of child sexual abuse. This is an important area of investigation since it is known that mothers who have themselves been sexually abused as children exhibit significantly more stress symptoms and physical symptoms than do those who have not experienced such abuse in childhood.6,7 To the extent that boundary issues and incest are subject to intergenerational transmission, the mother's history of incest should put a child at greater risk of incest but not at substantially greater risk of out-of-home molestation. Accordingly, the proportion of children with mothers who were incest victims should be higher among a group of children who are themselves incest victims than among a group of children who have been molested by an individual from outside the family. It is known that mothers who experience childhood incest are more likely than those with no history of sexual abuse to have children who will at some point be sexually abused.8,9 However, the interesting question is whether children of mothers who are incest survivors are more likely to experience incest or out-of-home molestation.
A number of previous studies have suggested that, as opposed to children molested outside the home, children who are victims of incest will display more behavioural problems stemming from the violation of a trusted relationship with the perpetrator,10–12 decreased levels of support following disclosure or discovery,13 as well as poorer family functioning in incestuous families and longer duration of abuse.1,11 Because these factors are associated with severe behavioural disturbance, they are more likely to be present in cases of incest than out-of-the-home abuse. The methods employed in this investigation offered an opportunity to examine this issue by confirming and extending these findings about behavioural differences between incest victims and children molested outside the home.
Although incest has serious consequences for both female and male victims, the greater preponderance of research has focused on females, largely because of the over-representation of female victims in treatment for sexual abuse.14 With increased awareness of the differences between female and male victims of sexual abuse (including incest), there are a number of investigations examining gender differences and sexual abuse.15,16 Hence, another purpose of the study was to determine whether there are differences between female and male incest victims in their behavioural symptoms.
In a study comparing the sexual behaviour of sexually abused and non-abused children, Friedrich and Grambsch17 found that behavioural differences existed between sexually abused girls and boys 7–12 years old. The boys displayed more overt sexual acting out than did the girls of the same age, suggesting that sexually abused boys in the indicated age range are less inhibited than girls of the same age and are more likely to engage in sexually acting out. Sexual inhibition in older girls who have been molested has been well documented.18 In 1992, Friedrich and Grambsch also found17 that, although younger sexually abused children (2–6 years old) have a higher propensity to engage in sexualized behaviours than do children who have not been abused, the gender difference that prevails among older children appears to be absent among younger children. In a study examining the general and sexual behavioural problems of sexually abused children,12 40% of the males and 45% of the females received elevated scores on the Internalizing scale of the Child Behavior Checklist,19 and 40% of the males and 37% of the females received elevated scores on the Externalizing scale. These findings, which are consistent with previous findings, suggest that girls engage in more internalizing behaviours than do boys, and that boys engage in more externalizing behaviours than do girls,12,20 and raise intriguing questions about gender differences in children's responses to sexual abuse, questions that have been difficult to answer given the dearth of boys in many studies. The sample available for this study included a relatively high proportion of males. For that reason, it was possible to make reliable male– female comparisons in the face of an increasing awareness that many boys are the victims of sexual abuse.
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Methods |
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To reiterate, the purposes of this study were first to examine the relationship, within a group of sexually abused children, between the mother's experience of sexual abuse and the type of sexual abuse experienced by her child. Also, it identified sexual and non-sexual behaviour patterns possibly related to abuse. Finally, it explored the differences between female and male incest victims in the behavioural symptoms they exhibit following the abuse.
Participants
The participants were 104 mothers and their children who received psychotherapeutic assistance at a local community mental health centre specializing in the assessment and treatment of childhood sexual abuse. Only biological mothers whose children resided with them were included. Participants were assigned to one of two groups based on the mothers' responses to questions about their own experience of sexual abuse: Mothers reporting childhood incest were assigned to the Childhood Incest (CI) group (n = 50); mothers reporting no childhood sexual abuse were assigned to the No Abuse (NA) group (n = 54).
t-tests were used to determine group differences with regard to demographic data. The mean age of the mothers was 31.2 years, with no significant age difference between the two groups (t = –0.75). The mean educational level of the mothers was 11.1 years, with no significant difference between the groups (t = 1.2).
In order to control for the accuracy of their assignment, all participants had been in treatment at the clinic for at least 3 months prior to inclusion in this study, giving each mother some time to reveal her own experience of sexual abuse, should one exist.
Participants were included in the study only if the abuse was substantiated, reducing the bias associated with the selection of participants based on existing symptoms. Sexual abuse was classified as substantiated if it met at least one of three criteria: (i) the child disclosed the abuse to two or more people; (ii) there was medical evidence of abuse; and (iii) there was a witness to the abuse or the perpetrator confessed to the abuse. The CI group included 25 sexually abused girls and 25 sexually abused boys. The NA group included 27 sexually abused girls and 27 sexually abused boys. Of the children in the sample, 80% (n = 83) were victims of incest, and the other 20% (n = 21) were victims of out-of-home molestation.
The children in this study ranged in age from 4 to 11 years old, the mean age being 5.8 years. The mean ages of the children in the two groups did not differ (t = –0.20). The sample was comprised primarily of incested children: 80% were victims of incest (n = 83), and the remaining 20% were victims of out-of-the-home molestation (n = 21). The final criterion for inclusion in the study was the requirement that all participants had received no psychological treatment prior to intake.
Chi-square analysis was used to determine group differences with regard to ethnicity and primary language. Twelve percent of the sample were Afro-Americans (n = 12), 50% were Caucasians (n = 52), 29% were Hispanic (n = 30), 1% were Pacific Islanders (n = 1) and 9% were classified as ‘other’ (n = 9). There existed a trend in the sample with regard to group ethnicity differences that approached significance. There were more Caucasians in the CI group (n = 32) than in the NA group (n = 20); and there were more Hispanics in the NA group (n = 21) than in the CI group (n = 9) [X(4, N = 104) = 8.87].
Eighty-two percent of the sample spoke English as a primary language (n = 85). Spanish was the primary language for 16% of the sample (n = 17), and 2% listed ‘other’ as their primary language (n = 2). Significant differences existed between the groups with regard to language. Spanish-speaking families were heavily represented in the NA group (26%), while only 6% of the families in the CI group were Spanish speaking.
The number of individuals per group closely reflected the base rates at this particular clinic. Referral observations suggest that approximately two-thirds of the mothers who bring children to the study clinic have themselves been victims of sexual abuse; most are incest victims and others are victims of molestation by a non-family member. Approximately one-third of the sexual abuse victims seen at the clinic are male.
Measures
Data collection for this investigation involved the use of standardized measures, as well as a semi-structured clinical interview designed to assess a wide range of historical and current behavioural information.
The Child Abuse Prevention/Intervention Services Interview.. The semi-structured clinical interview was given to each mother as part of the intake procedure. It was conducted in English or Spanish by a staff therapist trained in the use of the interview protocol. The administration of this protocol usually took 1–1.5 hours. This interview process involved both direct questioning and clinical observation of the mother and the child. In addition to constituting a principal source of demographic information, the interview obtained information on the experience of sexual abuse of both mother and child, as well as on the level of violence and substance abuse within the mother's family of origin and within the family of procreation. Information obtained from the interview was used to formulate a treatment plan and to assess the needs of the client. This type of interview is widely used to collect client information in clinical settings.
Child Behavior Checklist (CBCL).. The CBCL19 is a frequently used 118-item measure standardized for children age 4–16 years. It is available in both English and Spanish. The caretaker rates each of various behaviours as ‘not true’, ‘somewhat or sometimes true’ or ‘very true or often true’ of the target child currently or in the past 6 months.
Based on the results of factor analytic studies of behaviour problems, the CBCL items are grouped into two main scales, Internalizing and Externalizing elsewhere.12,19 The Internalizing factor comprises inwardly directed emotional symptoms manifested in behaviours characterized as fearful, inhibited, depressed and overcontrolled. The Externalizing factor comprises overt, maladaptive behaviours typically described as aggressive, antisocial and undercontrolled. Second order factor scores measure depression, social withdrawal, aggression, hyperactivity and sexual problems.21
The CBCL has often been used often with sexually abused children to assess subsequent behavioural problems. Compared with their non-abused peers, sexually abused children consistently receive significantly elevated scores on both the Internalizing and Externalizing scales.22,23
Child Sexual Behavior Inventory (CSBI).. The CSBI17 is a 35-item parent report, standardized on children 2–12 years old. It is available in English and Spanish, and is designed to assess a variety of sexual behaviours. The items, presented on a four-point response format, establish the presence and level of self-stimulation and sexual aggression, as well as addressing conduct associated with gender-role identification, and respect for personal boundaries.
The CSBI is psychometrically sound. The reliability of the instrument is excellent (
= 0.93). The CSBI has a demonstrated ability to discriminate sexually abused children from those who have not been abused. In addition, the CSBI has a demonstrated sensitivity to specific features of sexual abuse, including severity, force, and number of perpetrators.
Procedure
The mothers participating in this study had phoned the clinic seeking treatment for their children. The telephone intake interview consisted of questions regarding the child's presenting problem and related behaviour. After being accepted into treatment, the mothers were mailed a child application, an adult application, a CBCL, and the demographic portion of the CSBI.
All of the clinical interviews were conducted by trained intake clinicians who had advanced training in clinical interviewing, diagnosis, intervention, and treatment planning. Following the intake interview, the mother and her child were offered ongoing psychological treatment, which included one or more of the following: a sexual abuse evaluation, psychological testing, individual treatment, family treatment, group treatment and medication evaluation.
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Results |
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Mother's sexual abuse experience and type of child sexual abuse
It was predicted that children whose mothers were victims of incest in childhood are significantly more likely to be the victims of substantiated cases of incest than were children whose mothers reported no experience with sexual abuse. This hypothesis was not supported. Instead, mothers who had experienced incest were just as likely to have a child who experienced incest (84%) as were mothers with no such experience (76%). Additionally, mothers who had no history of incest were as likely to have a child who was molested outside of the home as mothers who experienced incest (16% versus 24%, respectively). A chi-square analysis revealed no significant differences between the two groups.
Behavioural differences in children based on type of abuse experienced
It was predicted that children who were the victims of incest would manifest more behavioural problems, according to the scores on the CBCL19 and the CSBI,17 than would children victimized by someone who was not a family member.
The results partially supported this hypothesis. The incest victims exhibited significantly more sexual behaviour on the CSBI than did those who were molested outside the home. As shown in Table 1
, the incest victims had significantly higher Total scores, as well as higher scores on the Self-Stimulation Subscale.
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On the other hand, the data in Table 2
indicate that there were no significant differences between the incest victims and the children molested out of the home in their scores on the CBCL with regard to behavioural problems.
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Gender, behaviour and sexual abuse
Older sexually abused male children (7–11 years old) were expected to exhibit significantly more overt sexual behaviour (e.g. touching sex parts in public, asking others to engage in sex acts) than were older sexually abused female children (7–11 years old), according to the scores obtained on the CSBI,17 but younger sexually abused male and female children (4–6 years old) were expected to exhibit similar levels of sexual behaviour. In other words, a gender by age interaction was predicted. In addition, younger sexually abused children were expected to demonstrate more sexualized behaviours than were older sexually abused children.
This prediction was partially fulfilled. The total CSBI scores obtained by the male and female participants did not differ, nor did the total scores of older and younger children. On the other hand, the CSBI Self-Stimulation scores of the males were higher than those of the females [F(1,96) = 8.12]. Also the CSB2 Self-Stimulation scores of the younger children were higher than those of the older children [F(1,96) = 6.59]. In addition, the males also had higher acting out scores on the CSBI than did the females [F(1,96) = 4.12, P < 0.05], but there were no differences between the older and younger children with regard to acting out scores. Mothers of the younger sexually abused males reported more Self-Stimulation in their children than did mothers of the younger sexually abused females [F(2,96) = 7.41, P < 0.05]. These results are presented in Table 3.
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Additionally, the sexually abused male children were expected to exhibit significantly more externalized behavioural problems than were the sexually abused female children, as measured on the CBCL.19 Specifically, mothers of the sexually abused males were expected to report more hyperactivity, delinquency and aggression than would the mothers of the female victims.
These results were consistent with expectations. Mothers of the sexually abused males reported more externalizing behavioural problems for their children than did the mothers of the sexually abused females [F(1,96) = 5.38, P < 0.05]. Mothers of the male victims also reported more aggression than did the mothers of female victims [F(1,96) = 4.92, P < 0.05]. With regard to type of abuse experienced, the mothers of incest victims of both genders reported more externalizing behavioural problems than did the mothers whose children were molested out of the home [F(1,96) = 3.42, P < 0.05]. The mothers of incest victims also reported more aggression in their children than did mothers whose children were molested by a non-family member [F(1,96) = 4.03, P < 0.05]. All significant results are presented in Table 4.
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It was also predicted that the sexually abused female children would exhibit significantly more internalized behavioural problems than would the male children, as measured on the CBCL.19 Specifically, mothers of the sexually abused females would report more social withdrawal, depression and somatic complaints than would the mothers of male victims.
There were no significant differences between male and female sexually abused children with regard to scores on the Internalizing scale and its subscales on the CBCL.
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Discussion |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
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This study examined aspects of incest as they relate to family functioning, child behaviour and the influence of a mother's experience of child sexual abuse in 104 sexually abused children and their mothers. There were an equal number of male and female children included in the study, and the mean age of the children was ~5.5 years. Each child had a substantiated history of child sexual abuse. Some mothers included in the study reported being subjected to childhood incest, while others reported no sexual abuse. The two groups of mothers did not differ with regard to age, educational level or income.
Three questions guided the implementation of this study. First, the examination of the mother's experiences of sexual abuse on the type of sexual abuse experienced by her child. Secondly, the determination of whether there are differences in behaviour between children who are incest victims and those molested by a non-family member. Thirdly, whether female and male incest victims differ with regard to their behaviour.
Mother's experience of sexual abuse and type of child sexual abuse
In this clinical sample of mothers and children, a mother's experience of sexual abuse (incest or no sexual abuse) was not relevant to the sexual abuse experienced by her child (incest or out-of-the-home molestation). The mothers who had experienced incest and those without such experiences were equally likely to have a child who had experienced incest. Furthermore, the mother's experience did not appear to predict the relationship between the child and the perpetrator: the biological father was the perpetrator with equal frequency in both groups.
There are several possible explanations for these findings. First, it is possible that the sample was not representative of sexually abused children and their families. The families in this study may have been less functional than non-clinical families of sexually abused children. It is also likely that families who present for treatment at a community mental health facility may differ from families who seek treatment in private practice settings or who do not enter treatment at all. The families in this investigation were predominantly low income, and most of the parents were not college educated. Restricted opportunities, poverty, negative experiences with the legal system, and lack of education may be important factors affecting the number of parents who are inclined to report the sexual abuse of their offspring.2
All of the children in this study were victims of sexual abuse. This limits, of course, the ability to examine intergenerational factors influencing sexual abuse. A control group that includes mothers who were incest victims and whose children have not been sexually abused would allow for a better understanding regarding why some families remain incestuous throughout generations, and others are able to break the cycle of abuse.
Although the findings did not meet the prediction, they are nevertheless congruent with previous research. Findings from other studies examining family functioning in out-of-the-home sexual abuse and incest have found that the type of sexual abuse experienced does not always differentiate these families. Survivors of out-of-the-home abuse frequently report serious problems in their families of origin.24
Behavioural differences
The children in this investigation who were identified as victims of incest exhibited significantly more sexualized behaviours than did the children who had been molested out of the home, according to their total scores on the CSBI.17 The children who were incest victims also engaged in more self-stimulating behaviour than did the children molested out-of-the-home. These findings are consistent with those of previous research.10–12,25,26 Children who are victims of incest may exhibit more severe behavioural problems because incest tends to involve more severe forms of abuse (e.g. longer duration, penetration) than does out-of-home molestation.
Gender and sexual abuse
It was predicted that the older sexually abused male children (7–11 years old) would exhibit significantly more overt sexual behaviour (e.g. touching of sex parts in public, asking others to engage in sex acts) than would the older sexually abused females of the same age group, as indicated by the scores obtained on the CSBI,17 while younger sexually abused male and female children (4–6 years of age) would exhibit similar levels of sexual behaviour, as indicated by their scores on the CSBI. Another prediction was that the younger children would demonstrate more sexual behaviour than the older children, as measured using the CSBI.
The present findings indicate that male children engaged in significantly more self-stimulating behaviours than did the female children, as reflected in the scores of the CSBI.17 These male participants also engaged in more sexual ‘acting out with others’, such as touching another child's private parts, than did the female children, as indicated by scores on the CSBI. These findings are consistent with those of other researchers who have examined the relationship between gender and sexual abuse.17,18 However, it is important to note that there were no differences in the total CSBI scores of the female and male participants.
As also predicted, the younger sexually abused children in this investigation did engage in more self-stimulating behaviours than did the older sexually abused children. There was also a gender and age interaction on self-stimulation scores, with the younger male victims engaging in significantly more self-stimulating behaviours than the younger female victims. This finding diverged from those of previous research which have suggested that there are no differences between younger male and female sexually abused children with regard to resultant sexual behaviour.17 An important finding of this study, however, is that the males engaged in significantly more sexual behaviour than did the females, regardless of age. Yet, the differences between the genders in their sexual behaviours were not extreme.
There were also no differences found between the male and female sexually abused children with regard to the type and frequency of internalized behaviours. This finding differs from those of previous investigations. Sexually abused females typically have been found to demonstrate significantly more internalized behaviours than male victims.12,20 This discrepancy may be related to sample differences. Friedrich et al. in their 1986 study,12 for example, used a predominately white, middle class sample. The participants in this investigation were in keeping with the recommendation of researchers such as Marotta and Asner27 who contend that because incest is a transcultural phenomenon, its effects cannot be measured fully without taking into account the role of culture in ameliorating or exacerbating symptoms.
This study's findings, similar to those of other investigations, indicate that the behavioural consequences of incest are more severe than those of out-of-the-home molestation. The participants in this study who were victims of incest were more inclined to engage in significantly more sexualized behaviour than did the molested children. It appears likely that incestuous abuse carries with it more severe consequences than does the abuse of a non-family member.28,29
Perhaps most importantly, the findings from this study clearly indicate that there are differences between female and male victims with regard to their behavioural manifestations. Unfortunately, research related to gender and sexual abuse is limited for males in treatment for sexual abuse.15,30,31 It is important to note that this study was somewhat unique in that it employed a high number of male participants, emphasizing the need for continued empirical investigations related to gender differences in sexually abused children. Although the predictions bearing on differences between sexually abused children with regard to age were not supported, the differences between males and females in this study were consistent with expectations.
While differences between the study's male and female participants are worth noting, it is also the area that reflects an important limitation of this investigation, i.e. the self-report instrument the mothers used to indicate the sexual behaviour of their offspring. Clearly this necessitates caution when interpreting the findings of this study. For example, one can only speculate on the issue of over- or under-reporting by the mothers when reporting the sexual behaviours of their offspring. Additionally, the mothers might be more disposed to notice the masturbatory behaviours of their male children rather than the masturbatory behaviour of their female children.
An increased awareness of the differences between children who are victims of incest and those who are molested out-of-the-home is important to treatment planning and counselling interventions.2 Evidence provided from this study indicates that children who are incest victims display more sexualized behaviours than do children who are molested out-of-the-home. This difference reflects the serious nature of incest. It is strongly suggested that the treatment given to incest victims might require intensive, long-term therapeutic work designed to reduce the victim's resultant sexualized behaviours. This notion is supported by the work of Lanktree and Briere32 who believe that sexualized behaviours tend to be highly resistant to treatment change.
The most important finding of this investigation is that it provides additional knowledge regarding gender differences among sexually abused children. This area of inquiry merits further investigations since more males are presenting themselves for treatment of sexual abuse. The opportunities and need for additional gender-related research are clear. In addition, there is also a need for the further development of gender-specific treatment strategies that are designed to examine and treat the behavioural manifestations of sexual abuse. The male sexually abused victims in this study exhibited significantly more overt sexual behaviour problems than did the female victims. This finding in itself may indicate that males may require a more specialized treatment for sexual abuse and its more serious sexual acting out behaviours.
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