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The Role of Psychological Instruments in The Assessment of Child Sexual Abuse PDF
The Role of Psychological Instruments in The Assessment of Child Sexual Abuse PDF
5: 239-251 (1996)
Instruments in the
Assessment of
Child Sexual Abuse
Psychological instruments such as behavioural rating scales or
psychometric tests have a useful part to play in the evaluation of child
sexual abuse, not as screening (i.e. ‘diagnostic’) devices but primarily
as adjuncts to the assessment interview. However, the use of formal
psychological instruments in their own right (i.e. on their own) for such
purposes is, as yet, very limited and problematic. In their strictly
adjunctive role they may provide additional evidence and/or indicate
areas for further investigation, without directly questioning the child
about the abuse and without being intrusive and leading. Finally, they
may help us to assess and measure psychological processes that are
influenced by and thus secondary to, sexual abuse. This paper seeks
to review the different types of psychological instruments and to
comment on their clinical and their research usage.
KEYWORDS:assessment; child sexual abuse; psychological instruments
‘The evaluation of
T he evaluation of sexual abuse may have different aims
and serve different purposes. Individuals who are
known to have been sexually abused may be evaluated to
sexual abuse may
assess the effects of the abuse on their functioning, to have dzgerent
identify the seriousness of the abuse for treatment purposes, aims and serve
for research, or to determine the allocation of resources.
Alternatively, investigations may be carried out in order to dzgerent purposes’
determine whether or not an individual has been abused or
information may be sought in order to provide proof or
evidence of abuse for legal purposes. Glaser and Frosh (1988)
emphasized the distinction between investigating an allega-
tion and investigating a suspicion of sexual abuse. While the
former would lead to investigation, and the gathering of
evidence, the latter would rely on clinical diagnosis or an
examination of the effects of sexual abuse.
Assessment Interviews
B ehaviour Scales
It was possible until only a few years ago to read that a
decision had been made as to whether a child had or had not
been abused based on whether the child did or did not
present with certain ‘core symptoms’, for example beha-
vioural regression, somatic complaints, fearfulness, bed-
wetting, and so on (Conte, 1991). However, it is patently an
erroneous idea that such disturbed behaviour necessarily
proves sexual abuse. It is recognized (Herbert, 1993) that
these problems are indicators of stress in childhood which
parallel those of children experiencing other traumas.
Stressors might be any of a number of events, including, ‘Stressors might
but not exclusively, sexual abuse.
One of the effects of sexual abuse can be some form of
be any of a number
inappropriate sexual behaviour on the part of the child. But of events,
as with other behavioural disturbance, not all abused including, but not
children exhibit sexualized behaviour while some non-
abused children do. One avenue for research in this area exclusively, sexual
would be the development of a standardized measure, based abuse’
on developmental psychological theories of children’s know-
ledge about sex, to assess the appropriateness of children’s
sex knowledge.
The Louisville Behaviour Checklist (LBC) (Miller, 1981)
appears to be one of the well-established behaviour rating
measures frequently used in sexual abuse research (Tufts,
New England Medical Centre, 1984; Gomes-Schwanz,
Horowiz and Sauzier, 1985; Gomes-Schwartz, Horowitz
and Cardarelli, 1990). This measure consists of a true-false
questionnaire that addresses childhood behaviour problems
and is completed by the parents.
Conte, Berliner and Schuerman (Conte and Berliner,
1988) developed two measures to assess the effects of sexual
abuse in a large sample of 369 sexually abused children
assessed at or near the point of disclosure. One of these
242 Babiker and Herbert
measures, the Child Behaviour Profile, was designed for
parents to complete and the other, the Symptom Checklist,
for the social worker to use. Both social workers and parents
were consistent in how they described the child on their
respective measures; however, they found a relatively poor
agreement between the two versions and this raised a
number of issues. The authors considered the hypothesis
that social workers focused on disturbance while parents
‘Parents and described a range of behaviours; and also that parents and
professionals are likely to view events and behaviour differ-
professionals are ently, in part because they use different perspectives to
likely to view assess the behaviour and in part because they see the child in
events and different environments and under different conditions.
It is clear that although significant differences emerge
behaviour between groups of abused and non-abused children on these
dzperent ly’ instruments-a matter of clinical importance-they do not
discriminate between the groups in a manner that makes
them useful in the evaluation of sexual abuse in an individual
case.
Questionnaire Assessment
Some researchers have attempted to establish the inter-
mediate (several years subsequent to abuse) negative effect of
sexual abuse on self-esteem, and the Piers-Harris has been a
popular test for this purpose in the United States (Elmer,
1977; Oates, Forrest and Peacock, 1985).
Whether or not the Piers-Harris would be useful in this
country to assess the long-lasting impact of sexual abuse on
self-esteem remains to be seen. Some preliminary work with
this test by one of the authors (GB) of this study suggests
that three out of the 80 test questions would almost certainly
need to be anglicized in order to make it applicable to
English schoolchildren. The Culture-Free Self-Esteem
Inventory (SEI) (Battle, 198l), on the other hand, appeared
to live up to its name in that within the same group of
children, in a parallel study to the work presented here,
Babiker (1991) found that it did not seem to pose problems
with comprehension.
‘Many of the Babiker (1991) found when both of these questionnaires
were administered to a sample of children (abused and not
questions on both abused) on care orders with Avon Social Services, many of
tests had to be the questions on both tests had to be thought through,
thought through, explained or discussed, as they referred, for example, to
‘parents’ and it was not clear to many children which parents
explained or (natural, old foster parent, new foster parent) were intended.
discussed’ Similarly, questions about school could not be assumed to be
Psychological Instruments in Assessment 243
entirely reliable with children who had possibly had a greater
than average number of changes of school or whose school
work and social adjustment at school might be influenced
temporarily by the instability of changes in home place-
ments. This points once again to the need for tailor-made
measures for use with the population being studied (see
Sabiker and Herbert, in preparation).
It is also important to bear in mind when using question-
naires with children that standardized administration could ‘Standardized
pose some difficulties; the tests may have to be administered
differently to different children, according to their reading
administration
age, needs or preference. In this respect, the Culture-Free could pose some
Inventory is more flexible, as it is designed for oral admin- dificu1ties’
istration for younger people and written administration in
the adult version.
Cognitive Tests
Until very recently, reports of standardized empirical
investigation into the cognitive signs of sexual abuse have
been extremely scarce. However, there have been reports of
cognitive testing of physically abused and neglected chil-
dren. Many well-validated psychometric tests exist for this
purpose. For a detailed review of the effects of maltreatment
on cognitive development, the reader is referred to the
chapter by J. L. Aber et al. (1989) in Cicchetti and Carlson’s
book on child maltreatment. Examination of intellectual ‘Examination of
factors in child abuse detecrion is lacking in consensus as to
conclusions. The area of development most likely to be
intellectual factors
affected was language, as these could be sea, as families in child abuse
whose members find it hard to communicate their feelings in detection is
words, using actions to express themselves instead (Lynch,
1988). This raises the question of whether a similar dynamic lacking in
could underlie sexual abuse and whether it would also be consensus’
expressed in difficulties with language.
The closest sexual abuse research has come to the area of
cognitive assessment is in evaluating scholastic achievement. ‘An assessment of
Behavioural and academic problems at school are commonly
reported symptoms for sexually abused school-aged children a child’s
(Adams-Tucker, 1981; Tong, Oates and McDowell, 1987). functioning that
Few, if any, studies, however, have been carried out which indicates an
were solely concerned with the measurement of the cognitive
effects of sexual abuse in children. abnormal pattern
Nevertheless, an assessment of a child’s functioning that of psychometric
indicates an abnormal pattern of psychometric results is, of
necessity, a matter of clinical concern (and action), whether
results is a matter
or not it is linked to physical or sexual abuse. of clinical concern’
244 Babiker and Herbert
Projective Tests