Interventions for Sexually abused Children: Initial Treatment Outcome Findings

Treatment outcome for sexually abused preschool-age children and their parents was assessed, comparing the effectiveness of a cognitive-behavioral intervention to nondirective supportive treatment. Sixty-seven sexually abused preschool children and their parents were randomly assigned to either (1) cognitive-behavioral therapy adapted for sexually abused preschool children (CBT-SAP) or (2) nondirective supportive therapy (NST). Treatment consisted of 12 individual sessions for both the child and parent, monitored for integrity with the therapeutic model through intensive training and supervision, use of treatment manuals, and rating of audiotaped sessions. Parents completed the Child Behavior Checklist, the Child Sexual Behavior Inventory, and the Weekly Behavior Report to measure a variety of emotional and behavioral symptoms. Within-group comparison of pretreatment and posttreatment outcome measures demonstrated that while the NST group did not change significantly with regard to symptomatology, the CBT-SAP group had highly significant symptomatic improvement on most outcome measures. Repeated-measures analyses of variance demonstrated group x time interactions on some variables as well. Clinical findings also supported the effectiveness of the CBT-SAP intervention over NST. Findings provide strong preliminary evidence for the effectiveness of a specific cognitive-behavioral treatment model for sexually abused preschool children and their parents.

To review findings and conclusions from 29 studies that evaluated with quantitative outcome measures the effectiveness of treatments for sexually abused children. The studies overall document improvements in sexually abused children consistent with the belief that therapy facilitates recovery, but only five of them marshal evidence that the recovery is not simply due to the passage of time or some factor outside therapy. There has yet to be a true large-scale, randomized trial of treatment versus control. The studies suggest that certain problems, such as aggressiveness and sexualized behavior, are particularly resistant to change and that some children do not improve. A number of considerations that merit special attention in future sexual abuse therapy outcome research are identified, including (1) the diversity of sexually abused children, (2) the problem of children with no symptoms, (3) the possible existence of serious "sleeper" effects, (4) the importance of family context on recovery, (5) the utility of abuse-focused therapy and targeted interventions, (6) the optimal length of treatment, (7) the problem of treatment dropouts, and (8) the development and use of abuse-specific outcome measures. The need for more treatment outcome research is highlighted by the rising demand for accountability in the health care system that will increasingly require professionals in the field of sexual abuse treatment to justify their efforts and their methods.