Signs and effects of sexual abuse in young children, in the short, medium, and long terms

Little research has been done on the warning signs of sexual abuse in very
young children, or on the consequences that such abuse - including the
persistence of the abusive pornographic images on the Internet - might have for
the children and their parents. Most abuse studies so far have focused on
girls, in particular on girls who were sexually abused within their nuclear or
extended families. The effects of sexual abuse can be severe, and a variety of
risk factors, as well as protective factors, may influence those effects.
Sexual abuse may affect the psychosocial, emotional, cognitive, and physical
development of children, their relationships with one or both of their parents,
and the relations between parents.

In the episode known as the Amsterdam child abuse case, infants and very young
children were victimized by a day-care employee. The chief perpetrator was from
outside their families, and most of the victims were boys. Research involving
the children and their parents would enable clearer recognition and
understanding of the signs of sexual abuse in very young children, the risk
factors and protective factors in sexual abuse, and the consequences the abuse
might have. This would facilitate early detection of symptoms and prompt
therapeutic intervention when child sex abuse is suspected.

The purpose of the study is to systematically document the signs and symptoms
of sexual abuse in infants and very young children and the short-, medium-, and
long-term effects of the abuse, including the effects of the persistence of
pornographic Internet images, on the children and their parents. The study will
examine the psychological, social, emotional, cognitive, and physical
development, and developmental problems, of children; the psychological
well-being of their parents; and the quality of interactions between parents
and children and between parents. The primary outcome measures will be
posttraumatic stress symptoms, dissociative symptoms, age-inappropriate sexual
behaviors and knowledge, behavioral problems, and the quality of parent-child
interaction. Within the primary study group, we will also assess whether parent
and child outcomes in cases of confirmed abuse differ from outcomes in cases of
strongly suspected abuse without sufficient legal evidence.

(I): Recognizing sexual abuse in very young children
The initial assessment (T0) took place shortly after disclosure of the abuse
case in December, 2010. In the Academic Medical Centre (AMC), five outpatient
teams were appointed, composed of three types of professionals (pediatrician,
parent adviser, and child psychologist or child development expert). Each team
made systematic diagnoses of the physical and psychological effects of sexual
abuse (confirmed or suspected) in children and their parents. A total of 130
children and their parents were examined; in 125 cases, parents authorized the
use of anonymized data for research purposes. For 87 of the children, a
criminal case file now exists in which sexual abuse has been demonstrated by
investigators and/or acknowledged by the chief perpetrator.

(II): Longitudinal (cross-sequential) study
We will conduct a cross-sequential longitudinal study (Bell, 1953; Schaie &
Hertzog, 1982; Trickett et al., 2011) involving children who have experienced
sexual abuse or for whom there are strong suspicions of abuse (the *KSM group,*
standing for kinderen die seksueel misbruikt zijn). A cross-sequential
longitudinal design will enable us to systematically determine the effects of
sexual abuse by combining three research techniques: (1) examining the same
children at different ages (longitudinal study); (2) examining children of
different ages at the same point in time (cross-sectional study); and (3)
examining children of different ages at different points in time
(cross-sequential study).

(III): Qualitative study
In the qualitative study, parents will be interviewed with a focus on their
experiences with the health and social services, the impact of legal procedures
and media attention, and the impact of the Internet dissemination of the child
pornographic material. To enhance in-depth analysis and explanation of the
longitudinal data, we will also form a focus group to obtain feedback on the
quantitative outcomes (II). Therapists who treat children and parents involved
in the abuse case will also be interviewed about their clinical experiences.

Participation in this study does not hold any risks. Questions can be demanding
for parents and children. Researchers conducting the interviews are
well-trained and have extensive experience in conducting interviews with
children and parents.
The time for the measures will be limited to a minimum. There will be only one
point of measurement per year.