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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.

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.

A cluster analysis is used to explore differential outcomes in 123 French Canadian children reporting sexual abuse contrasted with 123 control children. Mothers' reports of behavioral problems on the Child Behavior Checklist, abuse-related variables, personal factors, and family characteristics are used as potential variables discriminating clusters. Results reveal four clusters: (a) anxiety constellation group refers to children displaying behavior problems on a subset of scales, (b) the severe distress group refers to children showing a broader array of behavior problems, (c) victims of less severe sexual abuse (SA) group consists of children disclosing mostly extrafamilial SA, and (d) resilient children refers to children who, while disclosing severe abuse, rely less on avoidance coping. Findings underscore the need to go beyond abuse-related variables to orient treatment for children disclosing sexual abuse and for tailoring interventions to distinct subgroups.

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

L’agression sexuelle pendant l’enfance peut être un événement traumatique pour l’enfant et les membres de sa famille. Il s’agit d’un acte criminel qui nécessite des mesures d’évaluation, d’intervention et souvent de protection immédiate. Dans certains cas, ces mesures donneront lieu à des procédures légales. Bien que nous ayons une connaissance de plus en plus approfondie des conséquences associées à l’agression sexuelle et des interventions thérapeutiques efficaces, nous en savons peu sur l’influence des procédures judiciaires sur le rétablissement des enfants. Cette étude analyse les différentes trajectoires judiciaires d’enfants victimes d’agression sexuelle et leur influence sur la santé mentale des enfants ayant bénéficié d’une psychothérapie dans un centre d’appui aux enfants (CAE). Les résultats indiquent que pour près du tiers des enfants (28 %), des procédures légales allant jusqu’au témoignage à la cour ont été entreprises, le plus souvent, avant la psychothérapie. Les résultats révèlent que dans certaines circonstances, les implications judiciaires ont un effet bénéfique sur le bien-être des enfants. On observe des gains thérapeutiques plus importants chez les enfants qui ont témoigné à la cour et chez ceux pour qui il y a eu des procédures judiciaires, que pour ceux pour qui il n’y a pas eu d’implication légale. Ces résultats initiaux soulignent l’importance de mieux documenter le volet judiciaire et contribuent à définir les conditions favorisant un meilleur rétablissement chez les enfants victimes d’agression sexuelle., Sexual abuse during childhood can be traumatic for children and their families. The criminal aspect of this form of victimization requires specialized evaluations, interventions, and, often, immediate measures to ensure the child’s protection. In some cases, these lead to legal procedures. Although our knowledge regarding the consequences of child sexual abuse and effective therapeutic interventions continues to increase, we know little of the impact of legal procedures on these children’s rehabilitation. This study examines the various judiciary trajectories followed by sexually abused children and their influence on the mental health of children receiving therapeutic services in a Child Advocacy Center (CAC). Results show that about a third of the children (28 %) were involved in legal actions, sometimes including a court appearance, usually before therapy began. Our findings indicate that in some circumstances legal activities had beneficial effects on the children’s mental health. We observed greater therapeutic gains in children who testified in court and in children for whom legal procedures were undertaken than in children for whom no legal actions were taken. These initial findings underline the need for better documentation of the judicial component of such children’s experience and can help identify conditions that facilitate recovery in sexually abused children., La agresión sexual durante la infancia puede ser un evento traumático para el niño y los miembros de su familia. Consiste en un acto criminal que precisa de medidas de evaluación, de intervención y, a menudo, de protección inmediata. En ciertos casos, dichas medidas darán lugar a procesos judiciales. Si bien nuestro conocimiento sobre las consecuencias asociadas a la agresión sexual y a los tratamientos terapéuticos eficaces es cada vez más profundo, poco sabemos sobre la influencia del proceso judicial sobre el restablecimiento de los niños. El presente artículo analiza las diferentes trayectorias judiciales de los niños víctimas de agresión sexual y de su influencia sobre la salud mental de aquéllos que obtuvieron una psicoterapia en un centro de ayuda a los niños. Los resultados indican que, para casi el tercio de los niños (28 %), se han realizado procedimientos judiciales, llegando incluso al testimonio en el tribunal, la mayoría de las veces antes que la psicoterapia. Los resultados revelan que, en ciertas circunstancias, las implicaciones judiciales tienen un efecto terapéutico sobre el bienestar de los niños. Se observan beneficios terapéuticos más importantes en los niños que han declarado en los tribunales y en aquéllos para los cuales se realizaron procesos judiciales que en aquéllos para los cuales no hubo implicación legal alguna. Estos resultados iniciales subrayan la importancia de documentar mejor el aspecto jurídico y contribuyen a definir las condiciones que favorezcan una mejor recuperación de los niños víctimas de agresión sexual.