Cognitive-behavioural interventions for children who have been sexually abused

Background: Despite differences in how it is defined, there is a general consensus amongst clinicians and researchers that the sexual abuse of children and adolescents (’child sexual abuse’) is a substantial social problem worldwide. The effects of sexual abuse manifest in a wide range of symptoms, including fear, anxiety, post-traumatic stress disorder and various externalising and internalising behaviour problems, such as inappropriate sexual behaviours. Child sexual abuse is associated with increased risk of psychological problems in adulthood. Cognitive-behavioural approaches are used to help children and their non-offending or ’safe’ parent tomanage the sequelae of childhood sexual abuse. This review updates the first Cochrane review of cognitive-behavioural approaches interventions for children who have been sexually abused, which was first published in 2006.

Objectives: To assess the efficacy of cognitive-behavioural approaches (CBT) in addressing the immediate and longer-term sequelae of sexual abuse on children and young people up to 18 years of age.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2011 Issue 4); MEDLINE (1950 to November Week
3 2011); EMBASE (1980 to Week 47 2011); CINAHL (1937 to 2 December 2011); PsycINFO (1887 to November Week 5 2011); LILACS (1982 to 2 December 2011) and OpenGrey, previously OpenSIGLE (1980 to 2 December 2011). For this update we also searched ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP).

Selection criteria: We included randomised or quasi-randomised controlled trials of CBT used with children and adolescents up to age 18 years who had experienced being sexually abused, compared with treatment as usual, with or without placebo control.

Data collection and analysis: At least two review authors independently assessed the eligibility of titles and abstracts identified in the search. Two review authors independently extracted data from included studies and entered these into Review Manager 5 software. We synthesised and presented data in both written and graphical form (forest plots).

Main results: We included 10 trials, involving 847 participants. All studies examined CBT programmes provided to children or children and a nonoffending parent. Control groups included wait list controls (n = 1) or treatment as usual (n = 9). Treatment as usual was, for the most part, supportive, unstructured psychotherapy. Generally the reporting of studies was poor. Only four studies were judged ’low risk of bias’ with regards to sequence generation and only one study was judged ’low risk of bias’ in relation to allocation concealment. All studies were judged ’high risk of bias’ in relation to the blinding of outcome assessors or personnel; most studies did not report on these, or other issues of bias. Most studies reported results for study completers rather than for those recruited.

Depression, post-traumatic stress disorder (PTSD), anxiety and child behaviour problems were the primary outcomes. Data suggest that CBT may have a positive impact on the sequelae of child sexual abuse, but most results were not statistically significant. Strongest evidence for positive effects of CBT appears to be in reducing PTSD and anxiety symptoms, but even in these areas effects tend to be 'moderate’ at best. Meta-analysis of data from five studies suggested an average decrease of 1.9 points on the Child Depression Inventory immediately after intervention (95% confidence interval (CI) decrease of 4.0 to increase of 0.4; I2 = 53%; P value for heterogeneity = 0.08), representing a small to moderate effect size. Data from six studies yielded an average decrease of 0.44 standard deviations on a variety of child post-traumatic stress disorder scales (95% CI 0.16 to 0.73; I2 = 46%; P value for heterogeneity = 0.10). Combined data from five studies yielded an average decrease of 0.23 standard deviations on various child anxiety scales (95% CI 0.3 to 0.4; I2=0%; P value for heterogeneity = 0.84). No study reported adverse effects.

Authors’ conclusions: The conclusions of this updated review remain the same as those when it was first published. The review confirms the potential of CBT to address the adverse consequences of child sexual abuse, but highlights the limitations of the evidence base and the need for more carefully conducted and better reported trials.

An Inconvenient Truth: Barriers to Truth Recovery in the Aftermath of Institutional Child Abuse in Ireland

Contemporary settled democracies, including the United States, England and Wales and Ireland, have witnessed a string of high profile cases of institutional child abuse in both church and state settings. Set against the broader literature on transitional justice, this analysis argues that there are significant barriers to truth recovery within the particular context of historical institutional abuse by the clergy in the Republic of Ireland. In the main, I argue that the frameworks of the inquiries and commissions into historical institutional child abuse are not conducive to truth recovery or the search for justice in dealing with the legacy of an abusive past. It is the church-state relationship which makes the Irish situation noteworthy and unique. The Catholic Church and child care institutions are especially self-protective, secretive and closed by nature and strongly discourage the drawing of attention to any deficiencies in organisational procedures. The nature of the public inquiry process also means that there is often a rather linear focus on accountability and apportioning blame. Collectively, such difficulties inhibit fuller systemic investigation of the veracity of what actually happened and, in turn, meaningful modification of child care policies. The article concludes by offering some thoughts on implications for transitional justice discourses more broadly as well as the residual issues for Ireland and other settled democracies in terms of moving on from the legacy of institutional child abuse.

'Grooming' and the Sexual Abuse of Children:Institutional, Internet and Familial Dimensions

‘Grooming’ and the Sexual Abuse of Children: Institutional, Internet and Familial Dimensions critically examines the official and popular discourses on grooming, predominantly framed within the context of on-line sexual exploitation and abuse committed by strangers, and institutional child abuse committed by those in positions of trust.

Set against the broader theoretical framework of risk, security and governance, this book argues that due to the difficulties of drawing clear boundaries between innocuous and harmful motivations towards children, pre-emptive risk-based criminal law and policy are inherently limited in preventing, targeting and criminalising ‘grooming’ behaviour prior to the manifestation of actual harm. Through examination of grooming against the complexities of the onset of sexual offending against children and its actual role in this process, the author broadens existing discourses by providing a fuller, more nuanced conceptualisation of grooming, including its role in intra-familial and extra-familial contexts. There is also timely discussion of new and emerging forms of grooming, such as ‘street’ or ‘localised’ grooming, as typified by recent cases in Rochdale and Oldham, and ‘peer-to-peer’ grooming.

The first inter-disciplinary, thematic, and empirical investigation of grooming in a multi-jurisdictional context, ‘Grooming’ and the Sexual Abuse of Children draws on extensive empirical research in the form of over fifty interviews with professionals, working in the fields of sex offender risk assessment, management or treatment, as well as child protection or victim support in the four jurisdictions of the United Kingdom and the Republic of Ireland. Impeccably presented and meticulously considered, this book will be of interest to criminologists and those working and studying in the field of policing and criminal justice studies, as well as policy makers and practitioners in the areas of child protection and sex offender management.

Older people's views of support services in response to elder abuse in communities across Ireland

Purpose – This paper seeks to present findings from the first all-Ireland study that consulted older people on their perceptions of interventions and services to support people experiencing abuse.

Design/methodology/approach – Utilising a grounded theory approach, 58 people aged 65 years and over took part in focus groups across Ireland. Four peer-researchers were also trained to assist in recruitment, data collection, analysis, and dissemination.

Findings – Participants identified preventative community-based approaches and peer supports as important mechanisms to support people experiencing, and being at risk of, elder abuse. Choices regarding care provision and housing, as well as opportunities for engagement in community activities where they can discuss issues with others, were identified as ways to prevent abuse.

Originality/value – The development of elder abuse services has traditionally been defined from the perspective of policy makers and professionals. This study looked at the perspective of the end-users of such services for the first time. The research also gave an active role to older people in the research process. The policy implication of the findings from this research is that enhanced attention and resources should be directed to community activities that enable older people to share their concerns informally thereby gaining confidence to seek more formal interventions when necessary.

Defending the Faith(s)?:Democracy and Hereditary Right in England

The persistence of traditional monarchies in modern societies, which are otherwise characterized by democratic and egalitarian values, remains a paradox in the social sciences. In part this is attributable to the lack of psychological investigation into the relationship between subject and sovereign, and in particular the ways in which the political and social values of the citizenry shape understandings of a hereditary monarch’s right to represent a national community. Adopting the qualitative analysis methods of discursive psychology and grounded theory, the current study examines vernacular accounts of nationhood and monarchy in England in both formalized conversational interviews (n = 60) and impromptu street interviews (n = 56). Focusing on accounts of Prince Charles’s recent proposal to change the role of the monarch, from “Defender of the (Christian) Faith” to “Defender of Faiths,” those in favor treated it as a positive step towards reflecting a diverse (religious) community, bringing the monarchy into line with current concerns of pluralism and upholding
values of personal choice and individual rights. Participants who rejected the proposed change in title construed it as antithetical to these values in terms of reflecting personal stake and interest, an abuse of power, or an imposition on other faiths. In all accounts, the prime concern was in safeguarding the political and social values of the citizenry. In conclusion it is argued that the study of subjects’ relationship to the monarch, its function and legitimacy, can provide an opportunity to examine how values can characterize a national community and facilitate national diversity.

A retrospective study of the behavioural and psychological symptoms of mid and late phase Alzheimer's disease

To document the behavioural and psychological symptoms in patients with a diagnosis of established Alzheimer's disease (AD) for at least 3 years.

Nitrofuran antibiotic metabolites detected at parts per million concentrations in retina of pigs - a new matrix for enhanced monitoring of nitrofuran abuse

Nitrofuran metabolite residues AOZ, AMOZ, AHD and SEM were detected at parts per million concentrations in retina of pigs fed therapeutic doses of nitrofuran antibiotics. Discovery of this residue depot may allow widespread technology transfer to laboratories lacking LC-MS/MS thus improving global monitoring of these drugs.