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Child sexual abuse is an important public health issue given its magnitude and the multiple associated consequences. The diversity of profiles in child victims of sexual abuse calls for a more personalized approach to treatment. Indeed, recent studies suggest that children display a variety of symptoms and that a subgroup of sexually abused children may present a profile of complex trauma. This article first presents a review of the scientific literature that positions Trauma-Focused Cognitive Behavioural Therapy (TF-CBT; Cohen et al., 2017) amongst the best practices to address trauma-related symptoms following child sexual abuse; whether it is co-occurring with other forms of violence or not. Various adaptations of TF-CBT therapy are proposed by the authors (Cohen et al., 2012) to treat children facing complex trauma. These adaptations are summarized and illustrated with the presentation of a clinical case involving two siblings from the same family.

Background Sexual behavior problems (SBP) in school-aged children is a social concern that draws increased attention amongst child protection services and practitioners. Past research that highlighted the variety in profiles and in behavioral manifestations of children with SBP emphasizes the importance of a well-informed and sensitive approach for appropriate intervention. However, studies validating the theoretically hypothesized vulnerability of children with SBP remains scarce. Objective This study aimed to further our understanding of the risk factors that influence the variety and severity of SBP. Participants and setting Eighty-eight child-adult dyads (35.2% girls, Mage = 9.1 years; SD = 2.2 years) referred for SBP by child protection services or public services between 2006 and 2010 participated in the study. Participants completed a series of questionnaires as part of their assessment in a specialized therapeutic center for SBP. Methods A theoretical model of risk factors was examined using multiple linear regression analysis. Results Amongst the factors identified, externalizing behavior problems were the most strongly associated with the variety (β = .50; p Conclusions This study outlines the high co-occurrence of SBP, externalizing behaviors and non-sexual victimization, which should raise concern for the assessment of the children and to further adapt treatment strategies and goals.

Child sexual abuse (CSA) can severely affect the mental health of children and their parents. While correlates of recovery have been documented in children, factors exacerbating parents’ adaptation to their child’s unveiling of CSA deserves further attention. Parents’ history of abuse has been inconsistently identified as a predictor of their distress in reaction to their child’s abuse disclosure. This study proposes a mediation model that explores various processes underlying mother’s psychological distress (posttraumatic stress disorder [PTSD], dissociation, and their comorbidity) following their children’s unveiling of CSA. It investigates the influence of mother’s own CSA, as well as of her exposure to additional forms of past and current victimization, on her reaction to the child’s CSA disclosure, while considering coping mechanisms as mediators (avoidance, problem solving, search for social support, and feeling of guilt). Data were collected through self-report measures completed by 298 mothers of children who had recently disclosed CSA. Path analyses revealed that mother’s exposure to interparental violence as a child acted as a primary predictor of dissociation and of its comorbidity with PTSD, while a history of CSA was directly and exclusively linked to dissociation. Being exposed to recent partner violence was indirectly related to trauma symptoms, with coping mechanisms acting as mediators. This study outlines the relationship between mother’s psychological distress and her cumulative, past, and current exposure to various forms of victimization. Exposure to interparental violence as a child represents a particularly important factor for identifying mothers most in need of support, as it is a significant predictor of dissociation and of its comorbidity with PTSD.

Summary Symptoms of preschoolers following sexual abuse are not as well documented as for other age groups. This is true both in terms of the associated consequences as well as treatment outcomes. This limitation may be related to the fact that preschoolers represent a subgroup for which it is particularly challenging to substantiate sexual abuse allegations. Younger children also represent a challenge in intervention due to their level of cognitive development and their limited ability to comprehend such complex topics, such as sexuality. Assessing the effects of interventions with this subgroup of children therefore represents a priority in the field. The aim of this paper is to discuss the challenges inherent to the implementation of a cognitive behavioural treatment, namely the Trauma-Focused-Cognitive Behavioural Therapy (TF-CBT; Cohen et al., 2006) with sexually abused preschoolers and to present the results of a pilot study assessing it's effects with a sample of 25 children. Results reveal positive outcomes related to treatment participation both in children and in their accompanying parent. Preschoolers have demonstrated a significant decrease in internalised and externalised behaviour problems as well as a decrease in dissociation symptoms. A significant decrease in psychological distress and post-traumatic stress symptoms was also observed in children's parents following therapy. A follow-up assessment conducted 1 year following the initial assessment revealed that therapeutic gains were maintained over time. Clinical experience highlights specific challenges with preschoolers that are discussed in terms of treatment adaptation.

The purpose of this study was to explore factors influencing the academic, cognitive, and social functioning of 50 Canadian French-speaking sexually abused girls (age 7 to 12 years). Contextual, personal, and family factors characterizing the environment of children postdisclosure were examined as potential predictors of outcomes 1 year later. The severity and duration of the abuse, exposure to other forms of victimization, and symptoms of dissociation were associated with outcomes over time in one or more of the three domains assessed. Personal variables were also identified as important protective factors, including younger age at disclosure, greater use of approach coping strategies, and children's involvement in structured extracurricular activities. Results are discussed in terms of clinical implications.

The present study attempted to identify individual and contextual factors associated with outcomes in a group of 63 latency-aged children disclosing sexual abuse (SA). Children reporting SA were found to display greater internalizing and externalizing behavioral difficulties as well as more sexualized behaviors relative to same-age non-abused peers. Mothers also reported these children as less socially competent than their peers. Family contextual factors appeared to be associated with behavioral difficulties and made a unique contribution to the prediction of externalizing and sexualized behaviors. Of the personal variables, avoidance coping was found to be linked to poorer outcomes. In examining possible factors linked to ‘resilient’ outcomes in a 6-month time-frame, family conflict and avoidance coping were found to be associated to clinical status in children reporting SA.

OBJECTIVES: The short-term outcomes of child sexual abuse (CSA) on academic, behavioral and social adaptation at school were examined in order to: (1) document the proportion of sexually abused (SA) girls struggling in school and define the nature of their difficulties, (2) explore whether different profiles of school adaptation could be identified, and (3) examine the different constellations of contextual, personal, and familial correlates of abuse for each profile. METHOD: The sample consisted of 100 French-speaking mother-daughter dyads. Girls (aged 7-12, M= 8.64) were administered cognitive functioning tests and completed self-report measures to assess symptomatology, perception of abuse, and support provided. Mothers and teachers completed questionnaires to assess child's emotional, social, behavioral, and academic functioning in school. RESULTS: Descriptive analyses showed that a substantial number of girls (54%) presented clinical school adaptation difficulties in at least one of the three domains evaluated. Cluster analysis revealed four distinctive school functioning profiles: (1) academic-specific, (2) acting out/withdrawn, (3) polyclinical, and (4) resilient. These were distinguished by degree of school functioning difficulties and number of domains affected. The profiles were further discriminated by elements of the CSA experience and contextual, familial, and personal factors. The number of spheres of functioning affected was proportional to the number of risk factors to which girls were exposed. DISCUSSION: Results suggest the need for a systematic and thorough assessment of SA child functioning at school and may guide mental health professionals in providing differential treatment on the basis of the emerged typology. PRACTICE IMPLICATIONS: Sexually abused children demonstrate a wide variability of responses, rendering the elaboration of a "one size fits all" treatment rather difficult. The emerged typology underscores the complex heterogeneity of school adjustment profiles and suggest that secondary effects of abuse on child's level of school functioning require specific assessment and close monitoring. This study raises practical questions as to whether such secondary effects could best be addressed as a primary treatment objective, or in addition to a trauma-focused approach, or as the sole treatment objective. Language: en