Elsevier

Child Abuse & Neglect

Volume 38, Issue 6, June 2014, Pages 1083-1093
Child Abuse & Neglect

Effects of the child–perpetrator relationship on mental health outcomes of child abuse: It's (not) all relative

https://doi.org/10.1016/j.chiabu.2014.02.017Get rights and content

Abstract

The present study was conducted to better understand the influence of the child–perpetrator relationship on responses to child sexual and physical trauma for a relatively large, ethnically diverse sample of children and youth presenting for clinical evaluation and treatment at child mental health centers across the United States. This referred sample includes 2,133 youth with sexual or physical trauma as their primary treatment focus. Analyses were conducted to ascertain whether outcomes were dependent on the perpetrator's status as a caregiver vs. non-caregiver. Outcome measures included psychiatric symptom and behavior problem rating scales. For sexual trauma, victimization by a non-caregiver was associated with higher posttraumatic stress, internalizing and externalizing behavior problems, depression, and dissociation compared to youth victimized by a caregiver. For physical trauma, victimization by a non-caregiver was also associated with higher posttraumatic symptoms and internalizing behavior problems. The total number of trauma types experienced and age of physical or sexual trauma onset also predicted several outcomes for both groups, although in disparate ways. These findings are consistent with other recent studies demonstrating that perpetration of abuse by caregivers results in fewer symptoms and problems than abuse perpetrated by a non-caregiving relative. Thus, clinicians should not make a priori assumptions that children and adolescents who are traumatized by a parent/caregiver would have more severe symptoms than youth who are traumatized by a non-caregiver. Further exploration of the role of the perpetrator and other trauma characteristics associated with the perpetrator role is needed to advance our understanding of these findings and their implications for clinical practice.

Section snippets

Participants

Data for this study were obtained from the National Child Traumatic Stress Network (NCTSN) Core Data Set (CDS). Data in the CDS were collected from 14,088 children and youth aged birth to 21 years who presented for clinical evaluation due to exposure to a traumatic event (e.g., physical abuse, sexual abuse, domestic violence, accident) at one of 56 NCTSN-funded centers across the United States from 2004 to 2010. NCTSN centers include community-based, hospital, and university organizations

Results

Mixed regression models for sexual trauma by a caregiver vs. non-caregiver revealed that sexual trauma perpetrated by a non-caregiver resulted in significantly higher scores on the UCLA PTSD-RI Total Severity score, CBCL Internalizing and Externalizing T-scores, and the TSCC-A Depression and Dissociation scales at the time of treatment intake (see Table 3). Regarding other predictors in the model, number of trauma types experienced by the child was significantly associated with all outcome

Discussion

Prior research and clinical work have underscored the importance of examining perpetrator–child relationships in evaluating child abuse outcomes. Considerable evidence in research with adult non-clinical samples has indicated worse adult outcomes when the individual, as a child sexual trauma victim, had been dependent on and/or trusted the perpetrator (e.g., Goldsmith et al., 2012). Early research with child samples (e.g., Kendall-Tackett et al., 1993) also seemed to support this finding, but

Summary

Previous studies have shown inconsistencies about the effects of the child–perpetrator relationship on mental health outcomes of children and youth who have been abused. On the one hand, some investigators found that outcomes are worse for those youth who have a ‘close’ relationship with the abuser. In contrast, others demonstrated the opposite or that the degree of closeness between the child and perpetrator has no differential effect. The present study was designed to further examine the

Acknowledgements

The views, policies, and opinions expressed are those of the authors and do not necessarily reflect those of the Substance Abuse and Mental Health Services Administration nor the U.S. Department of Health and Human Services. We would like to acknowledge the 56 sites within the National Child Traumatic Stress Network that have contributed data to the Core Data Set as well as the children and families who have contributed to our growing understanding of child traumatic stress. We also greatly

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    This article was developed (in part) under grant numbers 3U79SM054284-10S, 5U79SM058147-04 (LJK), K23 DA023334 (CSS) and 5U79SM059297-03 (JKAA) from the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

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