Child sexual abuse in a sample of male and female Hispanic and White nonclinical adolescents: Extending the reliability and validity of the Trauma Symptom Inventory (TSI)

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Content CHILD SEXUAL ABUSE IN A SAMPLE OF MALE AND FEMALE HISPANIC AN D WHITE NONCLINICAL ADOLESCENTS: EXTENDING THE RELIABILITY AND VALIDITY OF THE TRAUMA SYMPTOM INVENTORY (TSI) by D avid Thom as M unoz A D issertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillm ent of the Requirem ents for the Degree of DOCTOR OF PHILOSOPHY (Counseling Psychology) A ugust 1996 Copyright 1996 David Thomas Mufioz UMI Number: DP25596 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. DmmtMm Rublisfeng UMI DP25596 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code ProQuest ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 UNIVERSITY OF SOUTHERN CALIFORNIA THE GRADUATE SCHOOL UNIVERSITY PARK LOS ANGELES, CALIFORNIA 90007 ?h-D- ' % This dissertation, written by D a v id T hom as M ufioz under the direction of h . } - . ? ....... Dissertation Committee, and approved by all its members, has been presented to and accepted by The Graduate School, in partial fulfillment of re quirements for the degree of DOCTOR OF PHILOSOPHY Dean of G raduate Studies Date . . . . . I . .......... DISSERTATION COMMITTEE C hairperson L 11 Dedication I t can he said that on any long journey only one can tru ly be at your side. God has blessed me w ith Victoria, and I thank God fo r Victoria. I ll Acknowledgment T - J L S I j j m m mTust iti the Lovd w ith all your heart and lean not ^ ^ " o n your own understanding; in all your ways acknowledge him , and he will make your paths draight" (Proverbs 3:5-6). IV Table of Contents List of T ables................................................................................................ v List of F igures.................... vii A bstract......................................................................................................... viii Chapter I: Introduction and Literature R e v ie w .................................. 1 Chapter II: M eth o d..................................................................................... 42 Chapter III: R esu lts................................................................................... 55 Chapter rV: D iscussion............................................................................. 94 References.................................................................................................... 125 A ppendix A: Parent Consent— English F o rm ..................................... 144 A ppendix B: Parent Consent— Spanish F o rm ..................................... 146 A ppendix C: Verbal Instructions to Subjects...................................... 148 A ppendix D: Student Consent F o rm ..................................................... 149 A ppendix E: Subject Resource S heet..................................................... 151 A ppendix F: Child M altreatm ent Interview Scale— Short Form ... 152 A ppendix G: The Traum a Synptom In v en to ry ................................. 161 V List of Tables Tables 1. Dem ographic C haracteristics...................................................... 45 2. Reliability Analysis: Cronbach's Index of Internal Consistency...................................................................................... 56 3. F Tests of Sexually A bused and Inconsistent G roup Scores on Each D ependent V ariable........................................................ 59 4. F Tests of N onabused and Inconsistent G roup Scores on Each D ependent V ariable.............................................................. 60 5. Subjects Self-Identified as Victims of Child Sexual Abuse, G rouped by G ender, R ace/Ethnicity, and E thnicity/G ender........................................................................... 66 6. Identity and Gender of P erp etrato r............................................ 67 7. N um ber of P erpetrators................................................................ 70 8. Bartlett U nivariate H om ogeneity of Variance Tests of D ependent V ariables..................................................................... 71 9. F Tests on Each D ependent Variable by Sexual A buse H istory, Race / Ethnicity, and G en d e r........................................ 73 10. F Tests on Each D ependent Variable by Sexual A buse H istory and G en d er....................................................................... 74 11. F Tests on Each D ependent Variable by Sexual A buse H istory and R a c e /E th n ic ity ..................................................... 75 12. F Tests on Each D ependent Variable by Race/ Ethnicity and G en d er....................................................................................... 76 13. F Tests of H ispanic Students and W hite Students Scores on Each D ependent V ariable........................................................ 78 VI Tables 14. F Tests of M ale and Female Scores on Each D ependent V ariable.......................................................................... 80 15. F Tests of M ale and Female Scores on Each D ependent Variable w ith Sexual Abuse H istory as a C o v ariate............. 81 16. F Tests of Sexually A bused and N onabused G roup Scores on Each D ependent V ariable........................................................ 85 17. F Tests on Sexually A bused and N onabused Subjects' M eans on Each D ependent Variable, G rouped by All Subjects, G ender, Race/ Ethnicity, and R ace/E thnicity by G en d er............................................................................................... 86 18. ANOVA/ANCOVA: F Tests for TSI-Total S core................... 89 19. Predictive Ability of the TSI on Various G roups of Subjects: Discrim inant Analysis R esu lts.................................. 90 vu List of Figures Figures 1. M eans of the Sexually A bused G roup, the Inconsistent G roup, and the N onabused G roup across the dependent variables............................................................................................ 57 2. M eans of nonabused subjects and subjects inconsistently reporting child sexual abuse across the dependent variables............................................................................................ 61 3. Subjects self-identified as victim s of child sexual abuse, grouped by eth n icity /g en d er...................................................... 65 4. Subjects self-identified as victims of child sexual abuse, grouped by gender of p erp etrato r.............................................. 68 5. M eans of H ispanic and W hite subjects across the dependent variables........................................... 79 6. M eans of m ale and female subjects across the dependent variables............................................................................................ 82 7. M eans of sexually abused subjects and nonabused subjects across the dependent variables................................... 84 V lll Abstract This study w as designed to extend the reliability and validity of the T raum a Sym ptom Inventory (TSI) to nonclinical m ale and fem ale adolescents. T hrough the use of a self-report instrum ent, a sam ple of 223 predom inately H ispanic and W hite 16 to 19 year old high school students w as identified as either victims of child sexual abuse or as nonabused. Reliability analyses on the tw elve scales of the TSI revealed a m ean alpha of .82, and predictive validity w as dem onstrated at a m arginally acceptable level w hen the TSI w as found to accurately classify sexually abused and nonabused subjects in 69.1 percent of the cases. Across all of the dependent variables, subjects w ho inconsistently reported on the self-report m easure that they had been sexually abused w ere found to be sim ilar to subjects w ho consistently reported that they had been sexually abused. H ispanic females reported being victim s of child sexual abuse at significantly higher rates than their H ispanic m ale or W hite peers. W hile female victim s of child sexual abuse identified m ale perpetrators in 91.9 percent of cases, m ale victim s of child sexual abuse identified female perpetrators in 52.9 percent of cases. The hypothesis th at sexually abused adolescents significantly differ from their nonabused peers on all dependent variables w as supported by the results. M ultivariate analysis of variance results indicated no significant overall differences on the d ependent variables betw een sexually abused males and females, and no overall differences w ere found betw een sexually abused H ispanic and W hite subjects. The findings as they relate to the IX hypotheses and other issues are discussed, im plications for theory and interventions are explored, and directions for future research are addressed. 1 Chapter I: Introduction and Literature Review The topic of child sexual abuse has generated a great deal of research in recent years. This research has enlightened the scientific com m unity and the general public to the negative short and long term im pacts of sexual victim ization, m ade significant contributions to our understanding of child sexual abuse victims, and has provided essential inform ation on viable treatm ent m odalities for survivors. The preponderance of research has focused on tw o major areas: (1) studies conducted w ith individuals previously identified as victims of child sexual abuse; and (2) research focusing on the identification of individuals that have been victim s of child sexual assault. Research em ploying subjects previously identified as victim s of child sexual abuse has provided im portant inform ation about the im pacts of sexual abuse on a variety of groups. This type of research, how ever, has its lim itations, for it generally em ploys persons from clinical populations that have sought out, received, or have been referred to the m ental health system. It is well docum ented that individuals that seek psychological treatm ent experience m ore sym ptom s than individuals w ho do not access the m ental health system (Tsai, Feldm an-Sum m ers, & Edgar, 1979). It is therefore difficult to generalize results obtained from research em ploying clinical sam ples to the general population. C hild sexual abuse research that focuses on the identification of individuals that have been sexually abused has contributed to 2 our understanding of this issue in the w ays m entioned above, and these studies have generally em ployed individuals from nonclinical populations. The use of nonclinical sam ples in the m ajority of this research m akes the findings of these studies m ore generalizable than those studies that em ploy clinical sam ples only. Peters, W yatt, and Finkelhor (1986) conducted a w ide ranging review of the child sexual abuse research and found abuse rates of 6 percent to 62 percent in females, and 3 percent to 31 percent in males. These researchers com m ented that w hile the low er rates (6 percent and 3 percent) reported in these studies suggest that sexual abuse is a serious problem for both boys and girls, the higher reported rates (62 percent and 31 percent) suggest a problem of near epidem ic proportions. O ne of the major reasons for the w ide discrepancy in the child sexual abuse rates reported above is related to the various m ethods em ployed to identify individuals that have been sexually abused. N ot only have the researchers in this field failed to agree on such fundam ental issues such as the definition of child sexual abuse, b u t there has also been little agreem ent on w hich m easures to use to identify sexual abuse victims (Briere, 1992b). The m easures used to differentiate individuals that have been sexually abused from those w ho have not been sexually victim ized are the keys to research that focuses on identifying individuals that have been victim s of child sexual abuse. W ithout an accurate m eans of differentiating these tw o groups, research is confounded, as sexually abused individuals are designated to the nonabused 3 group, and nonabused subjects are m isidentified as victim s of child sexual abuse. Frequently, researchers have used m easures w ith unknow n reliability and validity or generic m easures that are insensitive to sexual abuse-specific sym ptom atology to identify individuals that have been victims of child sexual abuse (Briere, 1992a). A lthough there m ay never be a litm us-test m easure developed to identify those individuals that have been victim s of child sexual abuse, it is essential that m easures w ith acceptable reliability and validity that are sensitive to sexual abuse-specific sym ptom atology be em ployed in child sexual abuse research. Before these m easures can be developed, it is im perative for researchers to becom e well aquainted w ith the research on the long term im pacts of child sexual abuse. For instrum ents to be sensitive to sexual abuse-specific sym ptom atology, their item s m ust be developed from the know ledge gained through long-term im pact studies. The constraints on the generalization of results is a factor facing all research, and has loom ed large in child sexual abuse research. M ost long-term im pact studies in this area have restricted them selves to W hite female subjects. A lthough recent investigations have included male subjects (e.g., Briere, Evans, Runtz, & W all, 1988; M endel, 1995; W ellm an, 1993) and other racial and ethnic groups (e.g.. M ermen, 1994; W yatt, 1988; W yatt, N ew com b, & Riederle, 1993), the great m ajority of research has been confined to one segm ent of the population, m aking the generalizability of results problem atic. 4 The dearth of research in the area of sexual abuse history in nonclinical adolescents— specifically nonclinical ethnic m inority adolescents— and the im pacts of child sexual abuse in this population has led to the current study. It has never been acceptable to infer the im pacts of child sexual abuse on a w ide variety of racial, ethnic, and adolescent populations from the results obtained from studies em ploying alm ost exclusively W hite female or clinical sam ples. M aking such inferences is not only inappropriate b u t allows the scientific com m unity to stop short in its investigation of the im pacts of child sexual abuse before im portant questions are answ ered about other specific racial, ethnic, and developm ental age groups. C hapter one of this paper has been divided into ten sections. The first three sections discuss the long-term im pacts of child sexual abuse, the im pacts of sexual abuse on children and adolescents, and the m ethodological issues facing child sexual abuse research. The next four sections present the statem ent of the problem , the purpose of the study, the research questions, and the hypotheses. Finally, the last three sections delineate the lim its of the study, definitions, and the outline of the rem ainder of the paper. Long-Term Im pacts of Child Sexual A buse Researchers have docum ented m any long-term im pacts experienced by individuals w ho have been sexually abused as children. These long-term im pacts have been classified into two m ajor categories: (1) the psychological effects of child sexual abuse; 5 and (2) the dysfunctional behaviors and relationships that result from child sexual abuse (Briere, 1992a). Psychological Effects. Long-term psychological responses to child sexual abuse are the internalized set of reactions or sequelae experienced by survivors of child sexual assault. Researchers have show n that individuals sexually abused as children experience sym ptom s of Posttraum atic Stress D isorder m ore often than individuals w ho have not been sexually abused as children (Briere, C otm an, H arris, & Smiljanich, 1992; Courtois, 1988; M eiselm an, 1990; Rowan, Foy, Rodriguez, & Ryan, 1994). Furtherm ore, victims of child sexual abuse are m ore likely to experience depression, fear and anxiety, and sleep difficulties than individuals w ho have not been victim s of child sexual abuse (Bagley & Ramsay, 1986; Briere, Evans, Runtz, & W all, 1988; Briere & Runtz, 1989; Briere & Woo, 1991; Elliot & Briere, 1992; Gom es-Schwartz, H orow itz, & Cardelli, 1990; Koverola, Pound, H eger, & Lytle, 1993; Lanktree, Briere, & Zaidi, 1991; Stein, Golding, Siegel, Burnam , & Sorenson, 1988). O ther long-term psychological effects include a tendency to have low self-esteem, suffering from pervasive feelings of deserving to be sexually abused, and carrying a sense of stigm atization, betrayal, and pow erlessness (Briere, 1992a; Browne & Finkelhor, 1986; Finkelhor & Browne, 1985; Jehu, 1988). In addition, individuals sexually abused as children tend to be hyper vigilant to danger in the environm ent and have a preoccupation w ith control (Briere, 1992a). Finally, researchers have indicated that childhood sexual abuse predisposes individuals to dissociative experiences. 6 Dissociative A m nesia, im paired self-reference, and the developm ent of Dissociative Identity D isorder (Atlas & H iott, 1994; Briere, 1989a; Briere & Conte, 1993; Briere & Runtz, 1987a, 1987b, 1988, 1990; Cole & P utnam , 1992; C hu & Dill, 1990; DiTomasso & Routh, 1993; H erm an & Schatzow, 1987; M cCann & Pearlm an, 1990; Putnam , 1993; Putnam , Guroff, Silberman, Barb an, & Post, 1986; Ross et al., 1990). D ysfunctional Behaviors and R elationships. Dysfunctional behaviors and relationships often receive m ore attention from therapists and researchers than the psychological effects m entioned above. A lthough these im pacts are not necessarily m ore significant than psychological internalized long-term effects, they are m ore obvious and m ore often becom e the focus of the m ental health and crim inal justice system s (Briere, 1992a). Researchers com paring individuals w ho have been sexually abused w ith those w ho have not been sexually assaulted have found significant differences betw een the tw o groups in long-term psychosocial functioning. Victims of child sexual abuse often experience relationship difficulties, sexual dissatisfaction, and sexual disturbance (Briere & Runtz, 1987b; Brunngraber, 1986; Courtois, 1988; Elliot & Briere, 1992; Elliot & G abrielson-Cabush, 1990; K endall-Tackett & Simon, 1988; M altz & H olm an, 1987; Runtz & Briere, 1988; Stein, Golding, Siegel, Burnam , & Sorenson, 1988; W yatt & N ew com b, 1990). Studies have also indicated that individuals sexually abused as children dem onstrate age-inappropriate sexual aw areness and behavior, aggressive behavior, com pulsive behaviors, and deficient 7 affect regulation skills (Briere, 1992a; Friedrich, 1991, 1993; Rokous, Carter, & Prentky, 1988; Stukas-Davies, 1990). A ccording to yet another body of research, individuals w ho have been victim s of child sexual abuse are prone to engage in m anipulation, hom osexual activity, substance abuse, prostitution, and self- m utilation (Bagley & Young, 1987; Briere, 1992a; Briere, Henschel, Smiljanich, & M orlan-M agallanes, 1990; Briere & W oo, 1991; Brown & A nderson, 1991; From uth, 1986; Runtz & Briere, 1986; Shapiro, 1987; Singer, Petchers, & H ussey, 1989; van der Kolk, Perry, & H erm an, 1991). In addition, researchers have found that individuals w ho w ere sexually abused as children are m ore susceptible than those w ho w ere not to suicidality, codependence, bulim ia, revictim ization, and Borderline Personality D isorder (Alexander & Lupfer, 1987; Briere, 1992a; Briere, Evans, Runtz, & Wall, 1988; Briere & Woo, 1991; Briere & Zaidi, 1989; Bryer, Nelson, Miller, & Krol, 1987; Fisher, 1991 Ogata, et al., 1990; Piran, Lerner, Garfinkel, K ennedy, & Brouillette, 1988; Root & Fallon, 1989; Steiger & Zanko, 1990; Runtz, 1987; Russell, 1986). Im pacts of Child Sexual A buse on C hildren and Adolescents The m ajority of child sexual abuse research has relied on clinical or college sam ples (Greenwald, Leitenberg, Cado, & Tarran, 1990). Clinical populations present tw o problem s: (1) they represent only a sm all segm ent of survivors of child sexual abuse; and (2) survivors of child sexual abuse w ho seek therapy tend to report m ore psychological sym ptom s than those w ho do not (Tsai, Feldm an-Sum m ers, & Edgar, 1979). Child abuse studies w ith 8 college students suffer from generalizability problem s because they represent narrow age ranges, lim ited racial and ethnic diversity, and higher socioeconomic levels. In addition, m any of these college studies use a retrospective m odel that depends heavily on the accuracy of subjects' m em ories, w hich are believed to have a high degree of unreliability for inform ation about childhood sexual history (Briere, 1992b). A lthough m ost of the child sexual abuse research has focused on ad u lt victims, a review of epidem iological studies suggests that at least one in four girls and one in ten boys w ill be victims of sexual abuse before age 18 (Finkelhor, 1993). W hile girls are significantly m ore at risk than boys for sexual victim ization, the discrepancy is m uch less than previously thought (Finkelhor, 1993). U ntil recently, the issue of the child sexual abuse of m ales has gone virtually unrecognized by m ental health professionals. A case study published tw enty years ago by A w ad (1976) on father-son incest provides a clear example: the author indicated that he could find only three other cases of father-son sexual abuse described in the literature. The following review of research presents a w ide range of im pacts experienced by children and adolescents w ho have been sexually abused. The initial sections review developm ental effects of sexual abuse. Later sections explore im pacts of child sexual abuse by exam ining variables specific to child sexual abuse. Preschool C hildren. In studies of preschoolers, researchers look for sexual behaviors considered inappropriate for this age level. 9 M ian, W ehrspann, Klajner-Diam ond, LeBaron, and W inder (1986) developed an operational definition of "sexualized" behavior that included the sexual play w ith dolls, m asturbation, seductive behavior, and age-inappropriate sexual know ledge. This research did not include a com parison group. H ow ever, a later study that included both sexually abused and nonabused children determ ined that inappropriate sexual behavior w as considerably m ore prevalent in sexually abused children (Goldston, Turnquist, & K nutson, 1989). By using a variety of assessm ent tools such as the Child Behavior Checklist (Friedrich, 1989), projective draw ings (H ibbard, R oghm ann & H oekelm an, 1987), and observations of free play w ith anatom ically correct dolls (Boat & Everson, 1988), researchers have identified the presence of inappropriate sexual behaviors or sexual traum a. In addition. Fagot, H agan, Youngblade, and Potter (1989) found that preschoolers w ho had experienced sexual abuse w ere m ore passive in free play than their nonabused peers. M any of the behaviors presented in this section vary w idely am ong children, and considerable caution needs to be exercised in attem pting to infer the occurrence or nonoccurrence of child sexual abuse on the basis of sexualized behavior (Beitchman, Zucker, H ood, da Costa, & A km an, 1991). O bviously, m uch m ore research is needed in this area to further clarify the effects of sexual abuse on preschool children. School-Age C hildren. Research has indicated consistently that w hen com pared to their nonabused peers, adults w ho w ere 10 sexually abused as children score higher on m easures of anxiety and depression and dem onstrate low er self-esteem. The research on children, how ever, has been less definitive along these dim ensions (M ennen & M eadow , 1994). Ratings by teachers and parents on standardized questionnaires have indicated that sexually abused school-age children have m ore behavioral and em otional problem s than their nonabused peers (Cohen & M annarino, 1988; Einbender & Friedrich, 1989). W hen sexually abused children self-report on standardized m easures of w ell being, how ever, the results are equivocal (Cohen & M annarino, 1988; Tong, Oates, & M cDowell, 1987). Research is also inconclusive on the question of w hether sexually abused school-age children are m ore or less em otionally disturbed than other children w ho w ere referred for clinical problem s b u t had not suffered from sexual abuse (Cohen & M annarino, 1988; G oldston, T urnquist, & K nutson, 1989). Cohen and M annarino (1988) reported no significant differences w hen they com pared levels of depression and self-esteem of sexually abused girls w ith those of their nonabused peers. In their study of sexually abused and nonabused fem ale children, Einbender and Friedrich (1989) found no significant differences for depression. C ontrary to the C ohen and M annarino (1988) findings, how ever, Einbender and Friedrich (1989) found that the sexually abused group scored significantly low er on a m easure of self-esteem than nonabused group. 11 K overola, Pound, H eger, and Lytle (1993) studied 39 girls aged 6 to 12 referred to a clinic for evaluation of suspected child abuse. They found that 67 percent of these children w ere experiencing sym ptom s consistent w ith a diagnosis of depression. McLeer, Deblinger, Atkins, Foa, and Ralphe (1988) found that the m ajority of their sam ple of outpatient sexually victim ized children scored in the clinical range for depression. Lipovsky, Saunders, and M urphy (1989) studied incest victim s and their nonabused siblings. A lthough the sexually abused subjects w ere significantly m ore depressed than the nonabused siblings, unlike the findings of Einbender and Friedrich (1989), neither group scored in the clinical range for depression. Also, the sexually abused and nonabused subjects show ed no significant difference in anxiety or self-esteem, b u t both groups scored in the clinical range on a m easure of self esteem. G om es-Schw artz, H orow itz and C ardarelli (1990), com paring subjects over age 6, found no differences in self-esteem betw een sexually abused and nonabused children. Similarly, in a study w hich com pared sexually abused, physically abused, and nonabused children, no differences w ere found am ong the groups on self-esteem. M ore recently, M ennen and M eadow (1994) adm inistered m easures of self-esteem, depression, and anxiety that h ad been standardized on nonclinical sam ples to 83 sexually abused children. The girls' scores w ere significantly different from those of the standardized sam ples across all three m easures: anxiety and depression scores w ere high, w hile self-esteem scores 12 w ere low. The m ale children's scores, how ever, on the three m easures d id not differ significantly from the m easures' stan d ard ized sam ples. A cadem ic and behavioral problem s are often associated w ith school-age children w ho have been sexually abused (Tong, Oates, & M cDowell, 1987). U nfortunately, these studies do not include clinical control groups; determ ining the extent to w hich problem s are a function of sexual abuse is, therefore, not possible from their data (Beitchman, Zucker, H ood, da Costa, & A km an, 1991). M oreover, children w ho are developm entally disabled, suffer from learning disabilities, or w ho have low intelligence m ay have higher risk of being sexually abused as children than regular education students, m aking interpretation of their data regarding academic and behavioral problem s even less straightforw ard.^ Sexually abused school-age children appear to be m ore likely than their nonabused and clinical peers to m anifest inappropriate sexual behaviors such as excessive m asturbation, sexual aggression, and sexual preoccupation (Deblinger, McLeer, Atkins, Ralphe, & Foa, 1989; Einbender & Friedrich, 1989). Friedrich, Beilke, and U rquiza (1988) conducted a study of 64 boys aged 3 to 8 years, 31 of w hom h ad been sexually abused, and 33 of w hom w ere diagnosed as conduct disordered. The parents of these boys com pleted the C hild Behavior Checklist (CBCL), w hich is designed to assess social com petence, internalization, and externalization. The sexually abused boys w ere rated as significantly m ore sexualized than their conduct-disordered counterparts, and w ere 13 com m only rated as m asturbating too m uch, being interested in pornography, and reenacting their abuse w ith siblings. Sexualized behavior appears to m anifest itself in sexually abused children from the preschool years to adolescence (Beitchman, Zucker, H ood, da Costa, & A km an, 1991). A dolescents. Several researchers investigating the sym ptom atology of sexually abused adolescents have provided clear evidence of depressive sym ptom s, low self-esteem, and suicidal ideation a n d /o r suicidal behavior in this population (Gom es-Schwartz, H orow itz, & Sauzier, 1985; Sansonnet-H ayden, H aley, M arriage, & Fine, 1987). Furtherm ore, Lindberg and D istad (1985) reported that in a study of 27 adolescents w ith histories of incest, one-third had attem pted suicide and all of the subjects w ere judged to have poor self-concepts. "A cting-out" behaviors such as truancy, running aw ay, chem ical abuse, and prom iscuity have often been associated w ith adolescents w ho have experienced sexual abuse (Gom es-Schwartz, H orow itz, & Sauzier, 1985; R untz & Briere, 1986; Sansonnet- H ayden, H aley, M arriage, & Fine, 1987). H ow ever, som e results in these areas are conflicting. G oldston, Turnquist, and K nutson (1989) reported only partial support for the acting-out theory of sexual abuse. These researchers found that sexually abused adolescents w ere runaw ays significantly m ore often than nonabused control subjects, b u t drug abuse w as m ore com m on am ong the controls. Four other indices of acting-out behavior did not differentiate the tw o groups. Burgess, H artm an, and 14 M cCorm ack (1987) studied sexually abused adolescents w ho had been involved in sex rings; results indicated a higher incidence of street d ru g use, com pulsive m asturbation, physical fights w ith friends and fam ily m em bers, and delinquent behavior am ong the sexually abused subjects than am ong the nonabused control subjects. Briere (1984) has suggested that the self-destructive and acting-out tendencies of adolescents w ho have been sexually abused m ay be early signs of the developing Borderline Personality Disorder. Brooks (1985) com pared 16 sexually abused adolescent inpatients w ith nonabused psychiatric controls on the Brief Sym ptom Inventory (BSI). Results indicated that 63 percent of the sexually abused group show ed significant elevations on the BSI w hen com pared to the nonabused controls. The profiles of the sexually abused subjects w ith elevations indicated suicidal and self-destructive ideation, depression, hostility, som atization, and paranoid and psychotic indicators. A tlas and H iott (1994) studied 57 successive m ale and female adm issions into an acute adolescent inpatient unit. The authors found th at the adolescent inpatients w ith histories of either physical or sexual abuse show ed m oderate to severe dissociation. In addition, there w as a trend tow ard higher dissociation in adolescents w ho h ad been sexually abused. G oldston, T urnquist, and K nutson (1989) exam ined sexual behaviors of 195 girls aged 2 to 18 years w ho w ere consecutive adm issions to three m ental health agencies. Sexually inappropriate 15 behaviors as defined by the authors w ere found to be far m ore prevalent in the sexually abused group than in the nonabused control group. Scott and Stone (1986) com pared M M PI profiles of adult and adolescent psychotherapy clients w ho had been subjected to father figure-son incest as children. Results indicated that adults scored significantly higher than adolescents on the depression scale, b u t adolescents obtained significantly higher scores on the hypom ania scale. A hypom ania scale elevation is indicative of elevated m ood, flight of ideas, excitability, brief periods of depression, and purposeless behavior. Both groups show ed clinical elevations on the schizophrenia scale, w hich m easures alienation and w ithdraw al from interpersonal relationships. C hild sexual abuse m ay predispose survivors to gender identify confusion and hom osexuality (Beitchman, Zucker, H ood, da Costa, & A km an, 1991). Sebold (1987) interview ed 22 therapists w ho w ere counseling sexually abused boys. These therapists reported that their clients h ad considerable preoccupation w ith sexual identity issues, and that these w ere m anifested as hom ophobic concerns. Regarding such concerns, m oreover, W atkins and Bentovim (1992) have advised that a distinction m ust be m ade betw een the fear of hom osexuality and the developm ent of a hom osexual preference. A lthough Finkelhor (1984) noted that the belief that m olestation leads to a hom osexual lifestyle is a m yth, he did find that boys victim ized by older m en w ere significantly m ore likely to 16 engage in hom osexual activity than nonabused boys. In addition, Johnson and Shrier (1987) reported that am ong victim s m olested by m ales, boys h ad a significantly greater probability of identifying them selves as hom osexual than girls. G ender Differences. Little attention has been given to male victim s of child sexual abuse in the research literature, m aking gender com parisons in this area difficult to accom plish. Young, Bergandi, and Titus (1994) proposed tw o factors for the lack of research on m ales abused as children: (1) the fact that the entire dom ain of sexual abuse as an area of study evolved from the rape m odel, w here sexual abuse w as conceptualized prim arily as that of a fem ale victim and a m ale perpetrator; and (2) society's strongly held reluctance to accept that m ales are vulnerable to sexual victim ization. A lthough a few child sexual abuse researchers (e.g.. Briere, Evans, Runtz, & Wall, 1988, H unter, 1991; Young, Bergandi, & Titius, 1994) have looked specifically at the effects of gender, m ost have relied on studies em ploying m ale and fem ale adults w ho have retrospectively reported that they h ad been sexually abused as children. A dditionally, som e researchers (e.g., Briere, Evans, Runtz, & W all, 1988; U rquiza & Crow ley, 1986; Young, Bergandi, & Titus, 1994) have reported finding no clear gender differences am ong individuals w ho have been victim s of child sexual abuse. H ow ever, difficulties m aking gender com parisons aside, there is som e evidence that the long-term im pacts of sexual abuse m ay be related to the gender of the victim (Beitchman et al., 1992). 17 In a stu d y of psychology undergraduates w ith histories of child sexual abuse, m ale subjects reported poor social adjustm ent at a higher rate than female subjects (Seidner, Calhoun, & Kilpatrick, 1985). H unter (1991) investigated a sam ple of adult m ale and fem ale individuals that had been sexually abused as children. A lthough he reported there to be m ore sim ilarities than differences betw een m ale and female victim s of child sexual abuse, som e differences w ere noted. H unter reported that males dem onstrated m ore elevated levels of anxiety, w orry, and rum ination than fem ales, especially in identity related issues. In addition, female victim s show ed m ore evidence of body im age problem s than their m ale counterparts. Pierce and Pierce (1985) exam ined referrals from a child abuse hotline and found that force w as significantly m ore com m on am ong m ale victim s of child sexual abuse than fem ale victims. In contrast, a national survey conducted by the Los Angeles Times of 2,626 A m erican m en and w om en over age 18 found that force w as used in fifteen percent of the sexual abuse incidents involving m ales, and in nineteen percent of the sexual abuse incidents involving females (Finkelhor, H otaling, Lewis, and Smith, 1990). The Los Angeles Times survey also indicated that m ales w ere m ore likely than fem ales never to have disclosed their child sexual abuse to anyone. Ram sey-K lawsnik (1990) reached the sam e conclusion and stated that the sexual abuse of m ales m u st be m ore severe and obvious than cases involving females before protective services w ill becom e involved. This argum ent is supported by 18 Pierce and Pierce's (1985) finding that boys w ere rem oved from their hom es by protective services following the discovery of child sexual abuse significantly less frequently than girls, despite the m uch greater severity of the abuse endured by the boys. H unter, G oodw in, and W ilson (1992) conducted a study w ith non-clinical m ale and fem ale children, adolescents, and adults that had been sexually abused as children. One of the areas explored by these researchers w as the influence of gender of victim on the level and p attern of self-blam e and m olester-blam e. Results indicated that w hile an inverse relationship betw een self-blame and m olester-blam e w as found for females, m ales did not dem onstrate this inverse relationship. The researchers hypothesized that w hile fem ales m ake a relatively clear distinction betw een self-blame and m olester-blam e, this distinction m ay not be as psychologically discernible for m ales. It w as hypothesized that m ales m ay sim ultaneously internalize and externalize responsibility for their sexual abuse victim izations. The researchers further suggested that this lack of clarity regarding role boundaries in m ales is consistent w ith clinical data that indicates that m ales identify w ith their perpetrators. These findings are consistent w ith w hat M endel (1995) calls p erhaps the single m ost prom inent issue for the m ale survivor of child sexual abuse— the fear of perpetrating. Bruckner and Johnson (1987) found that in their groups for adult male survivors of child sexual abuse, alm ost all of the participants w orried that they w ere fated to perpetuate the cycle of sexual abuse. 19 The preponderance of research findings that have addressed the gender of those individuals w ho perpetrate child sexual abuse has indicated that m ale perpetrators overw helm ingly outnum ber female perpetrators (e.g., Finkelhor, H otaling, Lewis, & Smith, 1990; Russell, 1986; Spencer & D unklee, 1986). M any of these studies included few or no m ale victims. Furtherm ore, research th at has targeted the sexual victim ization of m ale children and relied on reported cases of child sexual abuse or w ere based u p o n investigation of sexual abuse evaluations has indicated that the overw helm ing m ajority of perpetrators are m ale (Faller, 1987; R einhart, 1987; Spencer & Dunklee, 1986). H ow ever, research em ploying m ale subjects and utilizing self-report m easures reveals a very different picture of the prevalence of female perpetration (M endel, 1995). Fritz, Stoll, & W agner (1981) reported a female perpetration rate of 60 percent in their sam ple of m ale college students. In a clinical study of sexually abused m en, O lson (1990) noted th at over 60 percent of the incest survivors h ad been sexually abused by their m others. In addition, in a study that em ployed a clinical sam ple of 121 m ale survivors of sexual abuse, M endel (1995) reported that 46 percent of his sam ple h ad been sexually victim ized by fem ale perpetrators. It appears that as m ore and m ore quality research is accom plished in the area of sexual abuse em ploying m ale as w ell as fem ale subjects, a m ore accurate u n derstanding of m ale and female perpetration will em erge. R acial/E thnic Differences. A lthough an im pressive am ount of research has been accom plished in the area of child sexual abuse. 2 0 relatively few studies have focused on the racial/ethnic differences that m ay exist am ong individuals that have been sexually abused. In their extensive review of the long-term effects of child sexual abuse, Beitm an et al. (1992), d id not discuss the racial/ethnic differences as they pertain to the effects a n d /o r prevalence rates of child sexual abuse. M any studies do not even report the ethnic breakdow n of their sam ples (e.g., Briere & Runtz, 1989; Elliott, 1994; Young, Bergandi, & Titus, 1994). Furtherm ore, w h at little research that has been done in this area is often equivocal. A nd finally, W yatt (1990) reported that there has been even less child sexual abuse research focusing on N ative-A m erican and A sian-A m erican sam ples than on A frican-A m erican and H ispanic groups. W yatt, N ew com b, and Riederle (1993) concluded that the prevalence of child sexual abuse is com m ensurate in W hite and A frican-A m erican females, b u t they w ent on to state that sexual abuse research lacks "m ethodologically sound studies conducted w ith com m unity sam ples that are stratified by ethnicity" (p. 44). W yatt (1985) reported subtle differences betw een the circum stances and characteristics of child sexual abuse experienced by W hite and A frican-A m erican females. She found that A frican-Am erican preteen fem ales are m ore likely than their female W hite peers to experience contact sexual abuse b y m ale A frican-Am erican perpetrators w ho are m em bers of the nuclear or extended family. In contrast. W hite fem ales w ere m ore likely than their African- A m erican counterparts to encounter W hite m ale perpetrators w ho involve them in noncontact sexual abuse outdoors or contact sexual 2 1 abuse incidents indoors during the early childhood years. In addition, A frican-A m erican fem ales w ere m ore likely than their W hite fem ale peers not to involve law enforcem ent w hen they w ere sexually abused. These findings are sim ilar to those reported in Lindholm and W iley's (1986) study of child abuse reports accum ulated by the Los Angeles C ounty Sheriff's D epartm ent. African-A m erican fem ale children w ere significantly less likely to be reported as sexually abused than H ispanic or W hite girls. In a com m unity study, Russell (1986) found no differences in child sexual abuse victim ization rates am ong W hite, African- A m erican, and H ispanic w om en, b u t reported a low er rate am ong A sian-A m erican w om en. In contrast, in a postal questionnaire study w ith over one thousand participants, Kercher and McShane (1984) found that H ispanic females reported child sexual victim ization at twice the rate of W hite and A frican-Am erican females. In another com m unity sam ple, how ever, the child sexual abuse prevalence rate w as found to be significantly higher for W hite fem ales than H ispanic females (Siegel, Sorenson, G olding, Burnam , & Stein, 1987). Research on the effects of child sexual abuse across racial/eth n ic groups has been m inim al. M ennen (1994) studied the sym ptom s of depression, anxiety, and self-concept in a sam ple of H ispanic, A frican-A m erican, and W hite sexually abused girls. Sym ptom levels w ere found not to significantly differ across the three racial/eth n ic groups. In contrast, Russell (1986) found that higher percentages of H ispanic w om en reported significant traum a 2 2 as a result of their sexual victim ization as com pared to W hite, A sian-A m erican, and A frican-A m erican w om en. It is clear that far m ore research is needed to discover w hether or not the ethnicity of an individual is a m ediating factor that influences the effects of child sexual abuse. Sum m ary of D evelopm ental and Abuse-Specific Research. The m ajority of child sexual abuse research on children and adolescents has been conducted w ith clinical sam ples; w ithout additional studies, the findings of child sexual abuse research using clinical sam ples cannot be generalized to sexually abused children in the general population. The research literature suggests that the only com m on im pact of sexual abuse across developm ental levels is sexualized behavior. A lthough sexualized behavior varies from early childhood through adolescence, them es of sexual preoccupation and seductive behavior have been found across developm ental levels. The research is equivocal on w hether child sexual abuse results in em otional problem s in children across developm ental levels. H ow ever, research on adolescents w ho have been sexually abused provides the m ost consistent evidence that a history of sexual abuse is correlated w ith higher levels of depression, dissociation, hypom ania, anxiety, and low er self-esteem. In addition, research on adolescents has indicated that acting out in the form of running aw ay from hom e and confusion over gender identity result from child sexual abuse. 23 The lim ited am ount of research on m ale victim s of child sexual abuse m ay m ake gender com parisons prem ature. A lthough m any of the findings are equivocal and there m ay be m ore sim ilarities than differences betw een m ale and fem ale victim s of sexual abuse, there is som e evidence that the long-term im pacts of child sexual abuse is related to the gender of the victim. Male victim s of sexual abuse have dem onstrated higher levels of anxiety, w orry, rum ination, and poor social adjustm ent than fem ale victims. Female victim s m ay have m ore body im age problem s than their m ale counterparts, and research has generally indicated that m ale victim s of sexual abuse tend to be less prone to disclose their sexual victim ization than their female peers. Furtherm ore, research has indicated that although fem ale victim s m ake a relatively clear distinction betw een self-blame and m olester-blam e, this distinction m ay not be as psychologically discernible in m ale victim s of sexual abuse and lead to the phenom enon of m ale victim s identifying w ith their perpetrators. It has been hypothesized that the identification of sexual abuse victim s w ith their perpetrators m ay predispose victim s to perpetuate the cycle of sexual abuse. Finally, recent research findings have indicated that fem ale perpetration rates of m ale victim s m ay be m uch higher than reported in earlier studies of child sexual abuse. M ost child sexual abuse research studies have failed to adequately address w hether or not racial/eth n ic differences exist am ong individuals that have been sexually abused. Q uantity of racial/eth n ic research aside, as in m uch of the developm ental and 24 abuse-specific research review ed above, a substantial am ount of the racial/eth n ic research is equivocal. In general, research has revealed com m ensurate prevalence rates of child sexual abuse in W hite and A frican-A m erican females, w ith only subtle differences betw een these tw o racial groups in the circum stances and characteristics of reported child sexual abuse. Research on the effects of child sexual abuse across racial/ethnic groups has been m inim al and conflicting, w ith few studies em ploying African- A m erican and H ispanic subjects, and even few er studies em ploying such racial/eth n ic groups as A sian-A m ericans an d N ative Am ericans. A dditionally, there have been very few studies that have explored the prevalence and effects of child sexual abuse in ethnic m inority males. In view of the lim itations of current research, gender and race/ethnicity exam ined together or separately, cannot be ruled out as im portant risk factors of child sexual abuse (W yatt, 1990) M ethodological Issues Facing Child Sexual A buse Research Serious m ethodological issues confront child sexual abuse researchers. A m ong them are: (1) definitions; (2) identification of survivors; (3) survivor repression and m em ory loss; (4) identification of m ale survivors; and (5) approaches used to identify im pacts of child sexual abuse. These child sexual abuse research issues m u st be addressed adequately if this area of study is going to establish the foundation needed in order to provide reliable and valid inform ation that can be generalized to w ide sections of the affected population. 25 D efinitions. O ne of the m ain problem s in the stu d y of child sexual abuse is the w ide range of definitions used by various researchers (Violato & G enius, 1993). In their review s of child sexual abuse research, Browne and Finkelhor (1986) and Beitchm an et al. (1992), noted that few studies em ploy congruous definitions of w h at constitutes child sexual abuse. For exam ple, Russell (1984) defined sexual abuse as any unw anted sexual experience before age 14, the com pleted or attem pted rape of an individual before age 17, or any instance of incest before the victim turned 18. Briere and R untz (1988), on the other hand, restricted their definition of child sexual abuse to actual sexual contact betw een an individual under age 15 w ith another individual 5 or m ore years older. Some studies (e.g., Fritz, Stoll, & W agner, 1981) exam ined only adult perpetrators and preadolescent m ale victims; w hile other studies have used age lim its variously set at 13, 14, or 18 years in their definitions of child sexual abuse (M endel, 1995). Some definitions restrict child sexual abuse to actual sexual contact, elim inating such noncontact form s of sexual abuse as exhibitionism and exposure to pornography (Briere, 1992). Definitions of w hat constitutes child sexual abuse are alm ost as num erous as the researchers exploring this critical area. M artin, A nderson, Rom ans, M ullen, & O'Shea (1993) indicated that reliable data based on agreed-upon definitions are im portant in order to ad d objectivity to our thinking in this area of study. Furtherm ore, disparate definitions used in child sexual abuse research have often m ade findings from various studies either incom parable or contradictory (Violato & G enius, 1993). 26 Identification of Survivors. Peters, W yatt, and Finkelhor (1986) reported that the num ber and types of questions w hich are asked of subjects are related to successful identification of individuals w ho have experienced child sexual abuse. Researchers (e.g., Russell, 1983; W yatt, 1985) w ho have identified child sexual abuse cases by asking several specific descriptive questions about m any sexual areas have obtained higher identification rates than researchers w ho have asked if subjects have been sexually abused in only one or tw o vague questions (Bifulco, Brown, & A dler, 1991; M ullen, R om ans-Clarkson, W alton, & H erbison, 1988). Similarly, relatively low identification rates w ere obtained w hen researchers offered a definition of child sexual abuse and asked subjects if they had ever experienced sim ilar violations (Baker & D uncan, 1985; Siegel, Sorenson, G olding, Burnham , & Stein, 1987). G enerally, sexual abuse research em ploying face-to-face interview s has yielded higher identification rates than self adm inistered questionnaire research (M artin, A nderson, Rom ans, M ullen, & O'Shea, 1993). Researchers have attributed the higher rate from interview s to the opportunity afforded subjects to develop rap p o rt w ith the interview er (Peters, W yatt, & Finkelhor, 1986). The low er rates obtained by self-adm inistered questionnaire research, how ever, m ay have m ore to do w ith the questions them selves than the type of adm inistration. For exam ple, face-to-face interview research relying on a single question about sexual abuse experiences (M ullen, Rom ans-Clarkson, W alton, & H erbison, 1988; Siegel, Sorenson, G olding, Burnham , & Stein, 1987) yielded low er 27 identification rates than self-adm inistered questionnaire research asking m any descriptive questions (Badgley et al., 1984; From uth, 1986). In addition, the anonym ity afforded subjects in self adm inistered questionnaire research m ay encourage subjects to be m ore forthcom ing regarding their sexual histories than child sexual abuse research th at em ploys m ethodologies that require subjects to give u p anonym ity w hen answ ering questions about their sexual histories. In a stu d y that em ployed both self-adm inistered questionnaires and face-to-face interview s, fifteen percent of subjects w ho adm itted being sexually victim ized by a close family m em ber reported their sexual abuse only on the self-adm inistered questionnaire (M artin, A nderson, Rom ans, M ullen, & O'Shea, 1993). In sum m ary, child abuse research has suggested th at the asking of num erous descriptive questions, face-to-face interview s, and affording subjects anonym ity all play significant roles in the identification of individuals that have experienced child sexual abuse. Survivor R epression and M em ory Loss Issues. The identification of persons w ho have experienced child sexual abuse is affected by the tendency of som e individuals to repress traum atic experiences. H erm an and Schatzow 's (1987) stu d y on repression and sexual abuse in outpatient w om en found that 64 percent of the subjects had experienced at least partial am nesia regarding their sexual victim ization at som e point in their lives. In a nationw ide stu d y of 420 fem ales and 30 m ales w ho reported histories of child sexual abuse and w ere in individual and group therapy, 59 percent 28 of the subjects reported a tim e period before age 18 w hen they could not recall their first child sexual abuse experience (Briere and Conte, 1993). Such findings suggest that the child sexual abuse identification rate of a particular sam ple is dependent not only on the accuracy a n d /o r w illingness of subjects to report child sexual abuse m em ories, b u t on the aw areness of such m em ories. Identification of M ale Survivors. Pierce and Pierce (1985) concluded that the under-reporting of m ale child sexual abuse m ay be linked to society's view that boys are "tough," they do not need protection, and if they are sexually abused they have nobody to blam e b u t them selves. N asjleti (1980) indicated that m ale victim s tend to rem ain silent about their sexual victim ization because society does not perm it m ales to express feelings of helplessness and vulnerability. A dditionally, H unter (1990) asserted that the stereotype that all sexually abused m ales becom e child m olesters inhibits sexually victim ized m ales from disclosing their childhood and adolescent histories of sexual abuse. Some heterosexual m ales m ay believe that being sexually abused by another m ale m ay have caused them to becom e latently hom osexual. H om osexual m ales w ho have been sexually abused as children, on the other hand, m ay feel that their sexual orientation caused them to be sexually victim ized by m en, or that their victim ization caused them to be hom osexual (Briere, 1992a). These conclusions often lead sexually abused m ales to develop feelings of guilt, sham e, and self-betrayal (Elliot & Briere, 1991a). Boys w ho have suffered sexual abuse by adult w om en m ay also question their 29 gender identity or orientation. Their m ale peers, adult males, and the m edia often lead boys to believe that sex betw een boys and adult w om en is or should be exciting, harm less, and glam orous. W hen boys dislike or feel uncom fortable or feel victim ized by their sexual encounters w ith w om en, they are likely to question their sexual orientation or their m asculinity (H unter, 1990). A nother issue that m ay influence the reporting of m ale child sexual abuse is the grow ing debate on w hether m other-son incest is actually a rare occurrence or w hether it is under-reported (Banning, 1989; K rug, 1989; Law son, 1991, 1993; Chasnoff et al., 1986; Russell, 1984). A lthough the m ajority of child sexual abuse research has reported fem ale perpetration rates of 5 to 15 percent (Bentovim, Boston, & Van Elburg, 1987; Faller, 1989), a few studies have reported rates of fem ale sexual abuse of m ale children of 43 to 70 percent (Fritz, Stoll, & W agner, 1981; From uth & Burkhart, 1989; M endel, 1995; M cCarty, 1986; O lson, 1990; Ram sey-Klawsnik, 1990). Banning (1989) reported that the under-reporting of m other- son incest is m uch like the difficulty Freud (1896/1962) had w hen attem pting to convince his colleagues at the tu rn of the century of the possibility that father-daughter incest w as at the foundation of his fem ale clients' neuroses. Freud's ideas in this area w ere so unacceptable to the psychological com m unity at the tim e that he later revised his theory and stated that his patients w ere m erely reporting fantasies of being sexually abused by their fathers. Banning also proposed that the failure to report m other-son incest is 30 influenced to a great extent by society's unw illingness to believe that w om en can com m it such acts. W atkins and Bentovim (1992) reported that, in contrast to the grow ing am ount of research about m other-son incest, relatively few studies on father-son incest have been conducted. This is the case even though fathers are cited as am ong the m ost frequent sexual abusers of their sons (Faller, 1989; V ander M ey, 1988). Justice and Justice (1979) explained one possible cause of this under-reporting as society's denial that the taboo of incest is often broken and its uneasiness w ith the existence of hom osexuality. The sexual abuse of m ales m ust be vigorously p u rsu ed through research. H unter (1990) p u t it this way: We can never significantly m odify the w ay som e m en view and treat w om en as long as w e ignore the w ay som e w om en treat boys. Likewise, w e can not expect to have a society of gentle m en w ho tu rn to other m en for su p p o rt and nurturance as long as w e tolerate m en abusing and neglecting boys. (p. 43) A pproaches U sed to Identify the Im pacts of C hild Sexual A buse. M ethodological problem s w ith the m easures used to determ ine the long-term effects of child sexual abuse have yet to be resolved. Elliott and Briere (1991b) stated that, although the preponderance of research indicates a m ultitude of negative long term effects resulting from child sexual abuse, the m easures used in m any of these studies have either been ad hoc instrum ents lacking in reliability a n d /o r validity, or m easures that w ere not originally developed w ith reference to sexual abuse. These m easures are not 31 sensitive to sexual abuse-specific sym ptom atology. M any researchers (Berliner, 1987; Briere, 1987; Conte, 1987; Finkelhor, 1987) have focused on the need for the developm ent of new instrum ents that are sensitive to sexual abuse issues. Im pact m easures of child sexual abuse m ay be divided into tw o categories: (1) construct approaches, and (2) sym ptom approaches (Elliott & Briere, 1991b). C onstruct approaches attem pt to link clinical phenom ena already believed to exist in the general population, such as "hysteria" or "anxiety," to child sexual abuse. Elliott and Briere (1991b) point out that exam ining the relationship betw een existing psychological disorders and childhood traum as such as incest is valuable. H ow ever, the construct approach is inadequate if the construct in question does not represent a real phenom enon or if sexual abuse im pacts do not m atch "the specific p attern of disturbance associated w ith the construct in question" (p. 58). The sym ptom approach addresses only problem s that are reportable or observable, such as anger/ irritability, depression, dissociation, sexual concerns, and tension reduction behaviors. This approach exam ines variations betw een sexually abused and non-sexually abused individuals. D ata obtained from self adm inistered questionnaires designed specifically to be sensitive to sexual abuse issues supplem ent our understanding of the exact form of sexual abuse-related sym ptom atology (Elliott & Briere, 1991b). The T raum a Sym ptom Checklist-40 (TSC-40; Elliott & Briere, 1992), the T raum a Sym ptom Checklist for C hildren (TSC-C; Briere, 1989b), and the T raum a Sym ptom Inventory (TSI; Briere, 32 1991; Briere, C otm an, H arris, & Smiljanich, 1992) are self adm inistered questionnaires developed to address the sym ptom approach issues delineated above. Statem ent of the Problem Research em ploying a sym ptom approach that uses instrum ents specifically designed to be sensitive to child sexual abuse issues needs to investigate im pacts of child sexual abuse in nonclinical m ale and fem ale adolescents d raw n from a variety of racial/eth n ic backgrounds. The im portance of such research lies in its potential to raise society's level of aw areness concerning the dep th and b read th of the child sexual abuse problem . Such research w ill pro v id e educators and com m unity agencies w ith data they need for developing and im plem enting program s vital to helping adolescents w ho have been negatively affected by sexual victim ization. Purpose of the Study This stu d y has three m ain purposes: (1) to identify nonclinical adolescents w ho have been victim ized by child sexual abuse; (2) to gather data on the em otional im pacts experienced by nonclinical adolescents w ho have been sexually abused; and (3) to determ ine w hether an instrum ent th at utilizes a sym ptom approach to m easure reportable a n d /o r observable behaviors such as anxious arousal, an g er/irritab ility , defensive avoidance, depression, dissociation, dysfunctional sexual behavior, intrusive experiences, im paired self reference, sexual concerns, and tension reduction 33 behavior can accurately differentiate betw een adolescents w ho have been sexually abused and those w ho have n o t been sexually abused. Research Q uestions This research w ill answ er the follow ing questions: 1. To w h at extent will a series of item s that ask direct questions regarding child sexual abuse history and derived from an instrum ent validated on adults be able to identify adolescents w ho have experienced child sexual abuse? M ore specifically: a. Will a set of item s derived from the C hildhood M altreatm ent S tu d y -S h o rt Form (Briere, 1991b) successfully identify adolescents w ho have been victim s of child sexual abuse? b. Will significant differences across the d ependent variables be discovered am ong the adolescent group that consistently reported no sexual abuse history, the adolescent group that inconsistently reported a history of child sexual abuse, and the adolescent group that consistently reported sexual abuse history? 2. To w h at extent w ill a sym ptom approach, self adm inistered questionnaire, specifically designed to be sensitive to sexual abuse issues and norm ed on adults, identify sexual abuse history in adolescents? M ore specifically: a. To w hat extent will the Traum a Sym ptom Inventory (TSI) differentiate betw een adolescents w ho have been sexually abused and adolescents w ho have n o t been sexually abused? 34 b. Will each of the tw elve subscales and the total score of the TSI differentiate betw een adolescents w ho have been sexually abused an d adolescents w ho have not been sexually abused? c. If the TSI differentiates individuals w ho have been sexually abused from those w ho have not, will the differences be m erely statistical in nature or will they have clinical significance as well? 3. Will one subscale or group of subscales of the T raum a Sym ptom Inventory stand out as being significantly m ore accurate in identifying sexual abuse history in adolescents than other subscales? M ore specifically: a. W ill the D ysfunctional Sexual Behavior and Sexual C oncerns subscales of the TSI be significantly m ore accurate than the other subscales of the TSI in identifying sexual abuse history in adolescents? b. W ill the TSI total score for each subject be the m ost accurate m eans of identifying sexual abuse history in adolescents? 4. W ill the Traum a Sym ptom Inventory identify the im pacts experienced by adolescents that have experienced child sexual abuse? M ore specifically: a. W ill the TSI identify a group of sym ptom s/behaviors that differentiate adolescents w ho have been sexually abused from adolescents w ho have not been sexually abused? 35 b. W ill the sym ptom s/behaviors found to differentiate adolescents w ho have been sexually abused from adolescents w ho have n o t differ in kind a n d /o r in degree? 5. W ill the scores obtained from the T raum a System Inventory significantly vary across the dem ographic variables of race/ethnicity, gender, and age? M ore specifically; a. Will the rate of fem ale adolescents identified by the TSI as victim s of child sexual abuse differ significantly from the rate of m ale adolescents identified as victim s of sexual abuse? b. W ill fem ale adolescents identified as survivors of child sexual abuse differ significantly from m ale adolescents identified as survivors of child sexual abuse on the dependent variables? c. W ill the rate of H ispanic adolescents identified by the TSI as victim s of child sexual abuse differ significantly from the rate of W hite adolescents identified as victim s of child sexual abuse? d. Will H ispanic adolescents identified as survivors of child sexual abuse differ significantly from H ispanic adolescents identified as not having experienced child sexual abuse on the d ep en d en t variables? e. W ill any significant trends em erge from the interactions betw een sex and race/eth n icity across the dependent variables? 6. W ill the T raum a Sym ptom Inventory be a sufficiently reliable and valid instrum ent to be used in future child sexual abuse research w ith adolescents? 36 H ypotheses H ypothesis 1: The Traum a Sym ptom Inventory w ill be found to dem onstrate sufficient reliability and validity to be used in future child sexual abuse research on adolescents. H ypothesis 2: The TSI will dem onstrate clinical utility in discrim inating adolescents that have been sexually abused from their nonabused peers. H ypothesis 3: The D ysfunctional Sexual Behavior and Sexual Concerns subscales of the TSI will be found to be significantly m ore accurate than the other scales of the TSI in identifying sexual abuse history. H ypothesis 4: O n the CMIS— SF, adolescents w ho inconsistently reported that they h ad been sexually abused will not differ significantly across all dependent variables from adolescents w ho reported consistently that they h ad been sexually abused. H ypothesis 5: N o significant differences w ill be found across the d ep en d en t variables betw een H ispanic adolescents an d W hite adolescents w ho have been sexually abused. H ypothesis 6: N o significant differences will be found across the d ep en d en t variables betw een fem ale and m ale adolescents w ho have been sexually abused. H ypothesis 7: Sexually-abused adolescents w ill differ significantly from their nonabused peers across all dep en d en t variables. 37 Limits to the Study 1. This stu d y w as restricted to 16 to 19-year-old m ale and fem ale students attending one suburban high school in Southern California. The sam ple w as predom inately W hite and H ispanic (87.9 percent). A dditionally, inform ation regarding the socioeconom ic levels of the subjects w as not obtained. This sam ple m ay or m ay not represent the general population of adolescents. 2. Participation in this study w as voluntary and required signed inform ed consent of both the subjects and the subjects' legal guardians. These conditions m ay or m ay have not skew ed the sam ple represented in this study. 3. A nxious arousal, anger/irritability, defensive avoidance, depression, dissociation, dysfunctional sexual behavior, intrusive experiences, im paired self reference, sexual concerns, and tension reduction behavior w ere tested w ith one instrum ent. The T raum a Sym ptom Inventory. 4. The validity and reliability of the item s taken from the Child M altreatm ent Study— Short Form (Briere, 1991b) have not been dem onstrated for adolescent groups. 5. The validity and reliability of the T raum a Sym ptom Inventory (Briere, 1991, Briere, C otm an, H arris, & Smiljanich, 1992) have not been dem onstrated for adolescent groups. D efinitions For the purpose of this study, the following term s w ere defined as follows: 38 Affect R egulation Skills. These abilities are sophisticated m ethods of affect tolerance and m odulation that are considerably less m aladaptive than other m ethods of dealing w ith anxiety, such as tension-reduction activities (i.e., chem ical abuse, indiscrim inate sex) an d dissociation (Briere, 1992). C hild Sexual A buse. The child sexual abuse definition used in this stu d y w as derived from the C hildhood M altreatm ent Interview Schedule— Short F orm /R evised (Briere, 1991b). This definition consists of the follow ing elements: 1. Sexual contact betw een an adult and a child younger than 17 years of age. Sexual contact w as defined as being kissed in a sexual m anner, being touched in a sexual m anner, or being forced to touch som eone else's sexual parts. 2. Sexual contact betw een m inors, w hen one individual is 5 years or m ore younger than the other individual. In this instance, sexual contact w as defined in the sam e m anner as indicated in item one above. 3. Forced sexual contact betw een a child younger than 17 years of age and another individual of any age. C onstruct A pproach. This is a m ethod of research in the study of the long-term effects of child sexual abuse. The construct approach attem pts to link abstract or vague clinical phenom ena already felt to exist in the general population, such as "hysteria" or "anxiety", to child sexual abuse. This approach uses m easures that are not specifically designed to be sensitive to sexual abuse issues (Elliott & Briere, 1991b). 39 D issociation. This condition is a disruption in the usually integrated functions of consciousness, m em ory, identity, or perception of the w orld. This disorder m ay be su d d en or gradual, tem porary or chronic (Am erican Psychiatric A ssociation, 1994). D issociative A m nesia (form ally Psychogenic Am nesia). The essential feature of this disorder is an inability to recall im portant personal data th at is usually of a traum atic or stressful nature. The sym ptom s cause clinically significant distress a n d /o r im pairm ent in social, occupational, or other areas of functioning, and are not due to the direct effects of a substance or a m edical condition (A m erican Psychiatric A ssociation, 1994). D issociative Identity D isorder (form ally M ultiple Personality Disorder). The essential feature of this disorder is the presence of tw o or m ore distinct identities or personality states th at recurrently take control of a person. The person is unable to rem em ber im portant personal inform ation, the extent of w hich cannot be explained by norm al forgetfulness. Each personality state m ay have its ow n distinct history, identity, and self-im age (Am erican Psychiatric A ssociation, 1994). Im paired Self-Reference. A lthough the concept of self is seen as a critical construct to psychological health, as yet, it has not been clearly defined by object relations and self psychology theorists (Briere, 1992). Stern (1985) defined the self as a distinct and integrated aspect of an individual's personality. H e described the self as the "agent of actions, the experiencer of feelings, the m aker of intentions, the architect of plans " (pp. 5-6). Im paired self-reference 40 refers to an individual w ho, due to severe early childhood traum a a n d /o r m altreatm ent, loses partial access to his or her sense of self "w hether or not she or he can refer to, and operates from , an internal aw areness of personal existence that is stable across contexts, experiences, and affects" (Briere, 1992, p. 43). N oncontact C hild Sexual A buse. Child sexual abuse betw een an ad u lt and a child that consists of exhibitionism , exposure to pornographic m aterial, etc. that does not involve a physical interaction. Posttraum atic Stress D isorder. The essential feature of this disorder is the developm ent of characteristic sym ptom s following exposure to an extrem e traum atic event that involves threatened death or serious injury; or the w itnessing of death, threatened death or injury of a person; or learning about the unexpected death, threatened death, or injury of a fam ily m em ber or close associate. The person's response to the event m ust involve intense fear, helplessness, a n d /o r horror, a num bing of general responsiveness, and the individual m ust undergo persistent reexperiencing of the traum atic event (Am erican Psychiatric Association, 1994). Sym ptom A pproach. This is a m ethod of research in the stu d y of the long-term effects of child sexual abuse. The sym ptom approach lim its itself to problem s that are reportable or observable, such as posttraum atic stress, dissociation, sleeping disturbance, anxiety, depression, and sexual concerns. This approach exam ines variations betw een sexually abused and non-sexually abused individuals. The actual data obtained from self-adm inistered 41 questionnaires specifically designed to be sensitive to sexual abuse issues are used to supplem ent our u n derstanding of the exact form of sexual abuse-related sym ptom atology (Elliott & Briere, 1991b). O utline of the R em ainder of the Study The rem ainder of this p aper w ill follow the follow ing sequence. C hapter tw o presents inform ation regarding the com m unity and school settings w here the study took place, dem ographic facts about the subjects, procedures used in data collection, descriptions of the instrum ents used in the study, and a description of the statistical techniques used in the analysis of the data. The third chapter presents the results, and the fourth chapter discusses the results of the study as they relate to the hypotheses and other areas of concern, addresses the im plications for theory and intervention, and discusses im plications for future research. Footnote 1. The current author holds a credential in the State of California as a school psychologist, and has w orked extensively w ith special education students durin g the p ast tw elve years. Clinical experience w ith this population has suggested that special education students m ay be at higher risk for sexual victim ization than their regular education peers. 42 Chapter II: Method This chapter presents inform ation regarding the com m unity and school settings w here the study took place, dem ographic facts about the subjects, procedures used in data collection, descriptions of the instrum ents used in the study, and a description of the statistical techniques used in the analysis of the data. Setting The stu d y took place in a city 15 miles east of Los Angeles, California. This suburban com m unity consisted of 80,600 people at the tim e of the study, and its m edian household incom e is above the m edian household incom e for Los Angeles C ounty (H ornor, 1995). A ccording to 1990 Federal Census D ata, the ethnic com position of this com m unity is as follows: W hite - 34.4 percent, H ispanic - 39.0 percent, A sian-A m ericans - 3.3 percent, A frican-A m ericans - 1.3 percent, and O ther - 22.0 percent (H om or, 1995). The stu d y took place in a com prehensive high school of 1,854 9th-12th grade students, 14-19 years of age. The school's stu d en t population at the tim e of the stu d y w as 71.1 percent H ispanic, 23.3 percent W hite, 2.3 percent A sian-A m erican, 1.2 percent A frican-A m erican, an d 2.1 percent w ere designated as O ther. School district statistics indicated th at 22 percent of the students at this school lived w ith p are n t/g u a rd ia n s w ho w ere receiving A id to Families w ith D ependent C hildren (AFDC). Subjects Subjects for the study w ere d raw n from a target group of 760 junior an d senior students aged 16-19 attending the high school 43 described above. The target group w as represented by 53.8 percent fem ales, 46.2 percent m ales, 69.1 percent H ispanics, 25.4 percent W hite students, 3 percent A sian-A m ericans, 1.1 percent African- A m ericans, and 1.4 percent students identified as O ther. P arent inform ed-consent letters (see A ppendix A) in English w ere m ailed hom e to the guardians of all of the students in the target group. In addition, a Spanish translation of the p aren t inform ed-consent letter (see A ppendix B) w as m ailed to the hom e of each target group stu d en t w ith a Spanish surnam e. The p aren t inform ed-consent letter detailed the general purposes of the study, explained the possible risks to individuals w ho participated in the study, em phasized that participation in the study w as com pletely voluntary, and included telephone num bers w here the researcher could be contacted to answ er questions about the research. The p aren t consent letter encouraged guardians to attend one of tw o inform ation m eetings that the researcher planned as an opportunity for guardians to clarify any concerns they m ight have about the research project, and to give them the opportunity to study the m aterials used in the study. P aren t/g u ard ian s w ere asked to return signed p aren t consent form s to the researcher in a stam ped and addressed envelope provided to them by the researcher. The researcher visited each junior and senior English class at the target high school, and gave a series of five m inute presentations about the research project. A t the conclusion of each presentation, p aren t inform ed-consent letters w ere given to each stu d en t in either English or Spanish depending on the preference of the individual 44 students. The parent inform ed-consent letters distributed in the junior and senior English classes w ere identical to the consent letters m ailed to the target subjects' hom es, except, instead of asking the guard ian to m ail the signed parent consent letter to the researcher, the researcher requested signed letters to be returned im m ediately to the high school. D istributing the parent inform ed- consent letter twice, once through the m ail, and once through the classroom visitations m entioned above, w as done in order to m axim ize the sam ple size. A total of 226 (29.7 percent of the target group) signed p aren t inform ed-consent letters w ere returned to the researcher; those students for w hom consent w as given form ed the initial sam ple for the current study. The sam ple w as reduced by three subjects w hen prior to data collection, one student m oved out of the area, one parent rescinded consent, and one student requested that she be excluded from the study. The final sam ple of 223 16-19 year old students represented 29.3 percent of the target group, and included 145 (65 percent) fem ales, 78 (35 percent) m ales, 142 (63.7 percent) H ispanics, 54 (24.2 percent) W hite students, 6 (2.7 percent) A sian-A m ericans, 4 (1,8 percent) A frican-A m ericans, and 17 (7.6 percent) students identified as O ther. The m ean age of the subjects w as 17.2 years at the tim e the stu d y w as conducted. Table 1 contrasts the dem ographic characteristics of the target school population w ith the dem ographic characteristics of the study's sam ple. Significantly m ore fem ale students than m ale students volunteered to be subjects for this study than w ould have Table 1 Dem ographic Characteristics 45 C haracteristic Target School Population N % Sam ple n % Chi-Square U Fem ales 409 53.8 145 65.0 Chi-Square (1, N = 760) = 15.96, M ales 351 46.2 78 35.0 p < .001 16 Year Olds n /a n /a 58 26.0 17 Year Olds n /a n /a 106 47.5 n /a 18 Year Olds n /a n /a 57 25.6 19 Year Olds n /a n /a 2 .9 11th Graders 420 55.3 122 54.7 Chi-Square (1, N = 760) = .02, 12th Graders 340 44.7 100 44.8 p < .90 H ispanics 516 67.9 142 63.7 W h ites 201 26.4 54 24.2 Chi-Square (3, N = 749) = 2.90, Asian-Americans 24 3.2 6 2.7 p < .50 African-Americans 8 1.1 4 1.8 O ther 11 1.4 17 7.6 See N ote Female H ispanics 284 39.6 96 49.0 Female W hites 109 15.2 32 16.3 Chi-Square (3, N = 717) = 12.69, Male H ispanics 232 32.4 46 23.5 p < .01 Male W hites 92 12.8 22 11.2 Note. More subjects identified them selves as "Other" than were indicated in school records. Some subjects identified them selves as "Other" even though school records had them registered as either White, Hispanic, Asian-American, or African-American, n /a = not avalable. 46 been expected given the gender m ake-up of the target school population (chi-square [1, N = 760] = 15.96, p < .001). There w ere no significant differences betw een the target population and the sam ple in the num ber of eleventh and tw elfth grade students (chi- square [1, N = 760] = .02, p < .90), or in the num ber H ispanic, W hite, A sian-A m erican, or A frican-A m erican students th at participated in the stu d y (chi-square [3, n = 749] = 2.90, p < .50). H ow ever, significantly m ore H ispanic fem ales and significantly few er H ispanic m ales participated in his study th an w o u ld have been expected given the eth n ic/g en d er m ake-up of the target school population (chi-square [3, n = 717] = 12.69, p < .01). Finally, m ore subjects identified their race/eth n icity as "Other" th an w ere indicated in the school records for the target population. Some subjects identified them selves as "Other" even though school records h ad them registered as either, A frican-Am erican, A sian- A m erican, H ispanic, or W hite. Procedure In accordance w ith the high school's established procedures, subjects w ere sum m oned individually out of their classes and reported to an office in the school library. Subjects w ere inform ed verbally regarding the follow ing issues (see A ppendix C): (1) the purposes of the study; (2) the voluntary nature of their participation in the study; (3) the provisions taken to ensure confidentiality and anonym ity of their responses to research items; and (4) the lim its of confidentiality. Subjects w ere asked to read the subject inform ed- consent form (see A ppendix D) that delineated all of the areas listed 47 above, and included statem ents regarding the possible risks to individuals w ho participated in the study, and inform ation about w hom subjects could contact if they h ad questions about the study. All 223 subjects agreed to participate in the stu d y and signed inform ed-consent forms. Subjects w ere seated in a room or a private area isolated from other individuals and given a packet containing tw o surveys. Subjects w ere told to read the instructions for each survey carefully and answ er all items. Subjects w ere asked to place their com pleted surveys in the pro v id ed unm arked 9 x 12 inch envelopes before returning them to the researcher. These m easures w ere taken for tw o reasons: (1) to protect the anonym ity and confidentiality of the subjects' responses to the surveys; and (2) to com ply w ith C alifornia's suspected child abuse law w hich m andates the reporting of all suspected cases of child abuse to law enforcem ent a n d /o r child w elfare agencies. W hen subjects com pleted and retu rn ed the research m aterials, the researcher gave them a resource sheet (A ppendix E) that listed the following: (1) the Los Angeles C ounty child abuse hotline telephone num ber; (2) local agencies that provide low -cost counseling services for victim s of child abuse; and (3) reading references that focus on various aspects of child abuse. In stru m en ts C hildhood M altreatm ent Interview Schedule— Short Form (CMIS— SF; Briere 1991a; A ppendix F). This self-report retrospective m easure contains item s th at elicit inform ation from 48 the follow ing areas: (1) dem ographic data such as age, race, and gender; (2) m ental health treatm ent history; (3) parental disorder; (4) parental psychological availability; (5) psychological abuse; (6) physical abuse; and (7) child sexual abuse. The author of this m easure does not offer reliability or validity inform ation for the CMIS— SF, b u t this m easure gives subjects m ultiple opportunities to disclose sexual abuse history through a series of descriptive questions that probe child sexual abuse history. These descriptive questions give the m easure face validity. Peters, W yatt, and Finkelhor (1986) reported that the num ber and types of questions asked subjects influence identification of individuals w ho have experienced child sexual abuse. The CMIS— SF dem ographic inform ation and the child sexual abuse data w ere used in the current study. A t the request of school district officials, certain sexual abuse item s on the CMIS— SF w ere m odified, and other item s w ere elim inated com pletely. School officials believed that asking high school students about specific sexual acts (e.g., anal intercourse, placem ent of an object into the vagina) w ere not appropriate areas of inquiry w ith adolescents. The m easure's effectiveness at discrim inating betw een individuals sexually abused as children from nonabused individuals m ay have been dim inished w ith these changes. The researcher, how ever, believed that even w ith these m odifications, the CMIS— SF w ould provide the inform ation needed to categorize subjects as form er child sexual abuse victim s or as nonabused. 49 Subjects w ere designated as victim s of child sexual abuse if their answ ers to the sexual abuse questions on the CMIS— SF satisfied one or m ore of the follow ing criteria: (1) sexual contact betw een an ad u lt and a child younger than 17 years of age (sexual contact w as defined as being kissed in a sexual m anner, being touched in a sexual m anner, or being forced to touch som eone else's sexual parts); (2) sexual contact betw een m inors, w hen one individual is 5 years or m ore younger than the other individual; and (3) forced sexual contact betw een a child younger than 17 years of age and another individual of any age. Subjects responded to the descriptive questions on sexual abuse history in one of three distinct patterns: (1) they indicated consistently across all sexual abuse item s that they h ad not been sexually abused; (2) they responded consistently across all sexual abuse item s that they had been sexually abused; or (3) they reported inconsistently across the sexual abuse item s that they h ad been sexually abused. In order to avoid m isplacing subjects w ithin the child sexual abuse independent variable, three levels of child sexual abuse history w ere form ed that coincided w ith the response patterns m entioned above. T raum a Sym ptom Inventory (TSI; Briere, 1991, Briere, C otm an, H arris, & Smiljanich, 1992; A ppendix G). This self adm inistered instrum ent m easures the possible outcom es of child and ad u lt traum as using a sym ptom approach that lim its itself to problem s, feelings, or conditions that subjects can clearly describe (for further discussion on the sym ptom approach, please see 50 C hapter I). Item s on this m easure w ere derived from the know ledge gained from research on the im pacts of traum a on children and adults. The authors of the TSI divided childhood victim ization into tw o categories: interpersonal and non-interpersonal traum a. Subjects w ere classified as having experienced childhood interpersonal victim ization if prior to age 17 they experienced physical abuse (defined as intentional caretaker actions that left specific injuries on children) or sexual abuse (defined as forced sexual contact, or sexual contact w hen the victim w as 5 or m ore years younger than the perpetrator). C hildhood non-interpersonal traum a w as defined as individuals experiencing prio r to age 17 an accident or natu ral disaster that caused them to fear for their lives, or resulted in significant loss of property, bodily injury, or the death of a loved one (Briere, Elliott, & Smiljanich, 1993). A d u lt victim ization w as also classified as either interpersonal or non-interpersonal traum a. A dult interpersonal traum a w as said to be experienced if after age 17 subjects w ere physically or sexually assaulted w ithin or outside of a sexual relationship. Subjects w ere classified as having an ad u lt non-interpersonal traum a if after age 17 they experienced an accident or natural disaster that caused them to fear for their lives, or resulted in the significant loss of property, bodily injury, or the death of a loved one (Briere, Elliott, & Sm iljanich, 1993). The TSI is a m ajor revision and expansion of earlier m easures (Traum a Sym ptom C hecklist— 33 [TSC— 33]; T raum a Sym ptom 51 Checklist— 40 [TSC— 40]) developed by Briere and R untz (1989) and Elliott and Briere (1992). These earlier developed versions of sym ptom approach m easures have been used in num erous studies to delineate the im pacts of child sexual abuse, and to differentiate betw een individuals that have been sexually abused as children and those w ho have not been sexually abused (Briere & Runtz, 1989; Elliott & Briere, 1991a; G old, M ilan, M ay all, & Johnson, 1994). W hile the earlier versions of this instrum ent w ere intended as research m easures, Briere, Elliott, and Smiljanich (in press) indicated that w hen the TSI is fully developed, it m ay becom e a valuable tool in clinical settings as a m eans of identifying the im pacts of various form s of child abuse and other posttraum atic events. The TSI consists of 119 item s. The item s are sum m ed to produce 12 scales: (1) A typical Response; (2) Response Level; (3) A nxious A rousal; (4) A nger / Irritability; (5) Defensive A voidance; (6) D epression; (7) Dissociation; (8) D ysfunctional Sexual Behavior; (9) Intrusive Experiences; (10) Im paired Self Reference; (11) Sexual Concerns; and (12) Tension Reduction Behavior. The m easure also includes a total score. Subjects respond to the 119 sym ptom s by rating how often they have experienced each in the last six m onths (from 0 = never to 3 = often). The TSI dem onstrated acceptable internal consistency, w ith individual scales ranging in reliability from .78 to .93 for university subjects (m ean 0(=.87), an d from .87 to .92 for adult clinical subjects (m ean a=.90). Furtherm ore, the TSI exhibited predictive validity for 52 childhood traum a and interpersonal victim ization for both m ale and fem ale adults. A dditionally, concurrent and increm ental validity w ere dem onstrated w ith the Brief Sym ptom Inventory and tw o m easures of dissociation (Briere, Elliott, & Smiljanich, 1993). A t the request of school district officials, four item s on the TSI w ere elim inated, one item from the D ysfunctional Sexual Behavior scale, and three item s from the Sexual C oncerns scale. These item s w ere view ed as unacceptable because school officials saw them as presum ing that the respondent w as involved in a sexual relationship. D ata A nalysis All 223 adolescents (145 fem ales and 78 m ales) com pleted both the TSI and the set of item s derived from the CMIS— SF. M issing values on the TSI w ere replaced by the m ean values of specific gender by sexual abuse history by ethnicity groups. For exam ple, the m issing values of a sexually abused H ispanic fem ale subject w ere replaced w ith the m ean values of the sexually abused H ispanic fem ale group. This procedure w as em ployed as a m ore precise alternative to replacing m issing values w ith group m eans of the total sam ple. This m ethod allow ed for the possibility that differences existed am ong specific gender by sexual abuse history by ethnic groups. The race/eth n icity variable w as collapsed into three categories, H ispanic (n = 142), W hite (n = 54), and O ther (n = 27). A sian-A m ericans (n = 6), A frican-A m ericans (n = 4 ), and O ther (n = 17) w ere com bined to becom e "Other" because of sm all sam ple 53 sizes. For this reason, racial/eth n icity com parisons w ere lim ited only to H ispanic and W hite students. The initial statistical technique utilized in the data analysis addressed the issue of reliability. C ronbach's Index of Internal Consistency w as perform ed to address the reliability of the TSI. Prelim inary M ultivariate Analyses of V ariance (MANOVAs) w ere conducted to determ ine the suitability of com bining those students w ho consistently reported on the CMIS— SF that they had been victim s of child sexual abuse w ith subjects w ho inconsistently reported on the CMIS— SF that they had been sexually victim ized into one "sexually abused" group. D em ographic data w as analyzed em ploying nonparam etric m easures. The percentages of four eth n ic/g en d er groups (female H ispanics, fem ale W hites, m ale H ispanics, & m ale W hites) reporting sexual abuse victim ization w ere com pared. In addition, the identities and gender of the perpetrators of child sexual abuse w ere explored, and the relationships of the perpetrators of child sexual abuse to the victim s of sexual abuse w ere analyzed. A 3-w ay M ANOVA w as conducted to evaluate overall effects and control for inflations in alpha level due to the com putation of m ultiple com parisons. This 2X2X2 M ANOVA w as em ployed to assess the interaction effects of sexual abuse history by gender by ra c e / ethnicity. Three 2-w ay M ANOVAs and three one-w ay M ANOVAs w ere conducted to evaluate the interaction effects and m ain effects of sexual abuse history by gender, sexual abuse history by 54 race/eth n icity , race/eth n icity by gender, sexual abuse history, gender, and race/ethnicity. In addition, the TSI Total Score w as analyzed separately. The A nalysis of Variance (ANOVA) and A nalysis of Covariance (ANCOVA) procedures w ere utilized to explore this data. Finally, the TSFs ability to predict subjects' self-reported histories of child sexual abuse w as explored. A discrim inant analysis (DA) w as conducted to address the predictive ability of the TSI. 55 Chapter III: Results This chapter presents the results of the study. The statistical analysis is presented in eight sections: Reliability, Prelim inary M ultivariate A nalyses of Variance, Prevalence of C hild Sexual A buse, P erpetrators of Child Sexual A buse, Final M ultivariate A nalyses of Variance, TSI Total Score, Predictive V alidity, and the Sum m ary. R eliability The internal consistency of the T raum a Sym ptom Inventory w as investigated to m easure the extent to w hich the item s on the scale relate to the sam e construct as indicated by their inter relatedness and hom ogeneity. The coefficient A lpha (Cronbach, 1951) p rocedure w as em ployed to m easure reliability in term s of overlapping variance am ong scale items. The reliability coefficients obtained for each of the tw elve subscales and for the TSI total score are reported in Table 2. N ine of the thirteen A lpha coefficients reached the .79-.90 range, w hile tw o coefficients fell w ithin the .74- .77 range. O nly the Tension R eduction Behavior reliability coefficient (.69) fell slightly below the .70 level. In addition, the reliability coefficient for the TSI Total Score w as found to be above .97. Prelim inary M ultivariate A nalyses of V ariance M ultivariate A nalysis of Variance (MANOVA) indicated that students assigned to the three levels of child sexual abuse history (sexually abused, nonabused, and those w ho inconsistently reported th at they h ad been sexually abused) differed significantly 56 Table 2 Reliability A nalysis: C ronbach's Index of Internal C onsistency T raum a Sym ptom Inventory (TSI) Scale N um ber of Cases a V alue A typical response 223 .74 Response Level 223 .79 A nger / Irritability 223 .87 A nxious A rousal 223 .77 Defensive A voidance 223 .88 D epression 223 .89 D issociation 223 .82 D ysfunctional Sexual Behavior 223 .79 Im paired Self Reference 223 .84 Intrusive Experiences 223 .87 Sexual C oncerns 223 .83 Tension R eduction Behavior 223 .69 TSI Total Score 223 .97 across the dep en d en t variables, F (2, 220) = 2.43, p < .0005 (see Figure 1). The M ANOVA procedure further indicated that the m ain effect of the sexually abused group vs. the inconsistent group, F (1, 83) = .11, p = .684, and the m ain effect of the inconsistent group vs. the nonabused group, F (1,155) = 1.23, p = .265, w ere not significant. 57 c r > I f ) o s ID I % • T 3 I æ I I T 3 O ) I I 1 I I I I T 3 I t I I P -i 58 G iven the exploratory n atu re of this prelim inary analysis and to exam ine the data further, post hoc com parisons w ere conducted in order to give the reader a broader view of the m ain effects. G roup m eans w ere com pared through one-w ay analyses of variance (ANOVAs), em ploying both nonadjusted p values and the Bonferroni correction for m ultiple com parisons (adjusted p value = .004). As indicated in Table 3, across all d ep en d en t variables, there w ere no significant differences betw een the responses of the stu d en ts w ho indicated consistently across all sexual abuse item s on the CM IS— SF that they h ad been sexually abused as children, and those subjects w ho reported inconsistently across the sexual abuse history item s that they h ad been sexually abused as children. In contrast. Table 4 indicates that the nonabused and inconsistent groups differed significantly across four d ep en d en t variables, approached significance on tw o d ep en d en t variables, and m ean scores w ere in the expected direction on the six other dependent variables (see Figure 2). Subjects w ere classified as sexually abused if on any item of the CMIS— SF they offerred inform ation that m et the study's operational definition of child sexual abuse. This procedure of classifying subjects w as based on the conceptualization that victim s of child sexual abuse often require several opportunities to divulge their sexual victim ization in a research setting. A ccordingly, in the current study, subjects w ho consistently indicated that they had been victim s of child sexual abuse w ere com bined w ith subjects w ho inconsistently reported their child sexual abuse victim ization 59 Table 3 D ependent Variable A bused Inconsistent T raum a Sym ptom M ean M ean U nivariate Inventory (TSI) Scale (n = 66) (n = 19) F A typical response 5.52 5.32 .02 Response Level 21.83 20.63 .85 A nger / Irritability 15.35 15.26 .00 A nxious A rousal 12.79 12.26 .21 D efensive A voidance 13.98 11.21 3.24 D epression 13.33 11.79 1.04 D issociation 12.21 12.68 .13 D ysfunctional Sexual Behavior 5.41 4.21 .92 Im paired Self Reference 14.17 13.58 .16 Intrusive Experiences 11.95 9.53 2.60 Sexual C oncerns 5.09 3.84 .95 Tension R eduction Behavior 7.47 7.21 .06 Note, df = (1, 83). 60 Table 4 F Tests of N onabused and Inconsistent G roup Scores on Each D ependent Variable T raum a Sym ptom Inventory (TSI) Scale N onbused M ean (n = 138) Inconsistent M ean (11=19) U nivariate F A typical response 3.09 5.32 6.81** Response Level 18.24 20.63 3.00 A n g er/Irritab ility 12.29 15.26 3.32 A nxious A rousal 9.67 12.26 4.84** Defensive A voidance 9.20 11.21 1.67 D epression 9.36 11.79 2.49 D issociation 8.41 12.68 10.i9***a D ysfunctional Sexual Behavior 2.58 4.21 3.61* Im paired Self Reference 10.78 13.58 3.48* Intrusive Experiences 7.39 9.53 2.35 Sexual C oncerns 3.56 3.84 .09 Tension R eduction Behavior 5.02 7.21 5.24** Note, df = (1,155). ^F value is statistically significant w hen Bonferroni correction for m ultiple com parisons is applied (p value = .004). *p_< .065. **p.< .03. .003. 61 e n ê I I I •S I f f I en i 1 Ç A I (N I ' ï I t 62 into one "sexually abused" group for the rem ainder of the analysis of the data. The inconsistent subjects responded to the item s on the CMIS- -SF in three distinctive patterns. In order to better u n d erstan d these three groups of subjects, the follow ing discussion delineates each of these response patterns. G roup 1 consisted of 8 subjects w ho identified perpetrators of child sexual abuse by gender a n d /o r relationship in early item s on the CMIS— SF, b u t in later item s responded w ith "zeros" or "no answ er" to item s that asked about the num ber of perpetrators of child sexual abuse or the num ber of incidents of sexual abuse. The current w riter hypothesizes th at these subjects initially identified perpetrators, b u t because of their denial regarding their sexual victim ization later retracted these disclosures. A nother possible explanation for the inconsistent response p attern of this group is their w illingness to disclose sexual abuse perpetrators, b u t their refusal to provide specifics regarding the num ber of perpetrators or the num ber of sexual abuse incidents. G roup 2 consisted of 7 subjects w ho did not identify perpetrators of sexual abuse by gender or relationship in early item s of the CMIS— SF, b u t in later item s identified one or m ore p erpetrators of child sexual abuse, an d one or m ore incidents of sexual abuse. The current author hypothesizes th at these subjects did not w ish to identify the relationship a n d /o r gender of their perpetrators of sexual abuse (e.g., "I can't disclose th at m y m other m olested me!"), b u t felt com fortable indicating the num ber of 63 perp etrato rs and the num ber of sexual abuse incidents that they had experienced. G roup 3 consisted of 4 subjects w ho did not supply specific inform ation regarding the gender or relationship of their perpetrators, and responded w ith "zeros" or "no answ er" to item s th at asked about the num ber of perpetrators of child sexual abuse and the num ber of incidents of sexual abuse experienced. H ow ever, they responded "yes" w hen asked if they h ad been sexually abused before the age of 17. The current w riter theorizes that although these subjects did not feel com fortable supplying specific inform ation regarding their sexual victim ization (e.g., relationship and gender of perpetrator, num ber of incidents of sexual abuse), they w ere com fortable acknow ledging that they h ad indeed been sexually victim ized as children. A nother possible explanation for the response p attern of this group m ay have to do w ith the item s that w ere elim inated from the version of the CMIS— SF em ployed in the current study. These deleted item s (e.g., "About how m any tim es d id any one...have oral, anal, or vaginal intercourse w ith you...before age 17...?") m ay have m ore accurately described the sexual victim ization experienced by the subjects in this group. W ith the absence of these descriptive item s, these subjects m ay have decided to endorse a general item regarding child sexual abuse w hile ignoring other item s that d id n o t accurately describe their sexual victim ization. 64 Prevalence of C hild Sexual A buse A nalysis of the ethnicity/ gender d ata w as revealing, w ith 27.3% of W hite m ales, 28.1% of W hite females , and 23.9% of H ispanic m ales reporting that they h ad been victim s of child sexual abuse. In contrast, 54.2% of fem ale H ispanic fem ales reported being sexually abused. These results are significant, chi-square (3, n = 196) = 16.38, p < .001, and suggested that the fem ale H ispanics of this sam ple w ere significantly m ore likely to be sexually abused as children th an the W hite adolescents and the m ale H ispanic adolescents w ho participated in the stu d y (see Figure 3). Table 5 com pares the subjects w ho identified them selves as victim s of child sexual abuse w ith nonabused subjects. G ender data indicated that 45.5 percent of fem ale subjects reported that they had been victim s of child sexual abuse. In contrast, 24.4 percent of m ale subjects rep o rted child sexual victim ization. These results are significant, chi-square (1, N = 223) = 10.09, p < .01. R ace/ethnicity data revealed th at 44.4 percent of H ispanic subjects indicated that they h ad been victim s of child sexual abuse, w hile 27.8 percent of the W hite subjects disclosed that they w ere sexually victim ized as children. These results are significant, chi-square (1, n = 196) = 4.62, p < .05. Overall, the study found that 38.1 percent of the sam ple indicated they had been victim s of child sexual abuse. P erpetrators of Child Sexual A buse Table 6 addresses the identity and gender of the perpetrators of child sexual abuse. M ale victim s w ere significantly m ore likely than fem ale victim s to be sexually abused by fem ale perpetrators. 65 54.20% jg, < .001 28.10% 27.30% u 30 23.90% Fem ale M ale Fem ale M ale H ispanics H isp an ics W hite W hite Subjects Figure 3. Subjects self-identified as victim s of child sexual abuse, grouped by ethnicity/gender. an d fem ale victim s w ere significantly m ore likely than m ale victim s to be sexually abused by m ale perpetrators (chi-square [1, n = 79] = 14.76, p < .001) W hen fem ale victim s of child sexual abuse identified the gender of their assailants, m ale perpetrators w ere identified 91.9 percent of the tim e. In contrast, w hen m ale victim s reported the gender of their assailants, fem ale perpetrators w ere 6 6 Table 5 Subjects Self-Identified as Victims of C hild Sexual A buse, G rouped by G ender, R ace/E thnicity, and E thnicity/G ender Abused Nonabused Chi-Square Group n % n % u Females 66 45.5 79 54.5 Chi-Square (1, N = 223) = Males 19 24.4 59 75.6 10.09, n < .01 Hispanics 63 44.4 79 55.6 Chi-Square (1, n = 196) = Whites 15 27.8 39 72.2 4.62, p. < .05 Female Hispanics 52 54.2 44 45.8 Female Whites 9 28.1 23 71.9 Chi-Square (3, n = 196) = Male Hispanics 11 23.9 35 76.1 16.38, p < .001 Male Whites 6 27.3 16 72.7 identified in 52.9 percent of cases. A dditionally, w hile 6.9 percent of fem ale victim s reported being sexually assaulted by both m ale and fem ale perpetrators, all m ale subjects reported being sexually victim ized exclusively by either m ale or fem ale perpetrators (see Figure 4). The relationship of the perpetrator of sexual abuse to the victim of sexual abuse yielded interesting findings (see Table 6). Fem ale adolescents identified a p aren t figure as the p erpetrator of sexual abuse 9.1 percent of the tim e, w hile m ales identified a parent figure as the perpetrator in 5.3 percent of sexual assaults (chi-square [1, n = 85] = .2860, p = .593). Fem ale adolescents identified fam ily 67 Table 6 Identity and Gender of Perpetrator Females in = 66) Males (n = 19) Identity and Gender^ n % b n % b Mother figure 0 0.0 1 5.3 Father figure 6 9.1 0 0.0 Grandfather 3 4.5 0 0.0 Sister 1 1.5 0 0.0 Brother 4 6.1 0 0.0 Aunt 1 1.5 0 0.0 Uncle 11 16.7 2 10.5 Female cousin 1 1.5 2 10.5 Male cousin 8 12.1 2 10.5 Male relative 2 3.0 1 5.3 Female friend 0 0.0 6 31.6 Male friend 32 48.5 2 10.5 Friend 4 6.1 3 15.8 Female babysitter 2 3.0 1 5.3 Male babysitter 0 0.0 1 5.3 Male Teacher 1 1.5 0 0.0 Female stranger 0 0.0 1 5.3 Male stranger 3 4.5 2 10.5 Identity and gender not identified 8 12.3 3 15.8 ^Subjects had the opportunity to identify an unlimited number of perpetrators of both genders and various identitiies. ^Percentages do not equal 100% since students could have been sexually abused by more than one perpetrator. 6 8 § I 91.90% M ale Victims of Sexual A buse Fem ale V ictim s of Sexual A buse 52.90% 8.10% 6.90% < .001 M ale Fem ale M ale and P erpetrator Perpetrator Fem ale P erpetrators Perpetrators of A buse Figure 4. Subjects self-identified as victim s of child sexual abuse, grouped by gender of perpetrator. m em bers as the perpetrators in 53.2 percent of the cases, w hile m ales identified fam ily m em bers as the perpetrators of sexual abuse in 57.9 percent of the sexual assaults. In addition, 12.9 percent and 26.3 percent of fem ale and m ale subjects respectively reported being 69 sexually abused by both fam ily m em bers and non-fam ily m em bers (chi-square [2, n = 80] = 1.99, p = .370). Fem ale subjects w ere significantly m ore likely than m ale subjects to be sexually abused by a p aren t figure (chi-square [1, n = 7] rz 7.00, p < .01). O nly one m ale adolescent (5.3 percent) and no fem ale adolescents identified a m other figure as the p erpetrator of sexual abuse. In contrast, six fem ale adolescents (9.1 percent) and no m ales identified father figures as perpetrators of child sexual abuse. Table 7 illustrates the num ber of perpetrators identified by the m ale and fem ale adolescents w ho participated in this study. The m ajority of the sam ple (62.1 percent of fem ales and 52.6 percent of m ales, chi-square [1, n = 81] = .55, p = .461) indicated that they had been sexually abused by one perpetrator, w hile 90.6 percent indicated that they had been sexually abused by three or less p erpetrators (92.4 percent for fem ales and 84.2 percent for m ales, chi-square [1, n = 81] = 1.87, p = .171). Final M ultivariate A nalyses of V ariance M ultivariate A nalysis of V ariance (MANOVA) can be p roperly used w ith a particular d ata set if tw o underlying assum ptions are satisfied. The first assum ption addresses the degree to w hich the d ependent variables correlate. In the current d ata analysis, the Bartlett test of sphericity (1582.19 w ith 66 df) show ed that the dependent variables w ere sufficiently interrelated to m eet the assum ptions for the M ANOVA procedure. The second im p o rtan t assum ption is th at of hom ogeneity of variance on all 70 Table 7 N um ber of P erpetrators Females fn = 66) Males (n = 19) n % n % O ne 41 62.1 10 52.6 Two 12 18.2 6 31.6 Three 8 12.1 0 0.0 Four 1 1.5 0 0.0 M ore Than Five 1 1.5 2 10.5 N um ber N ot Identified 3 4.5 1 5.3 variables. This assum ption w as not m et (see Table 8), indicating th at som e of the d ata represent a non-norm ally distributed population. Therefore, the results obtained from M ANOVA analyses in this stu d y m u st be view ed w ith caution. H ow ever, the current researcher felt that given the robustness of this test, the use of this param etric statistical analysis w as w arranted. Tables and figures are presented to clarify the results of the study. Table 9, 10, 11, 12, 13,14,15, and 16 present the m ean scores on the TSI scales for subjects divided b y child sexual abuse history (abused vs. nonabused) by race/eth n icity by gender, sexual abuse history by gender, sexual abuse history by race/ethnicity, race/eth n icity by gender, ra c e / ethnicity, gender, gender w ith sexual abuse history as a covariate, and sexual abuse history. Furtherm ore, 71 Table 8 Bartlett U nivariate H om ogeneity of Variance Tests of D ependent V ariables T raum a Sym ptom Inventory (TSI) Scale Bartlett Box F (7, 10877) P V alue A typical response 3.92 .00% R esponse Level 2.00 .05 A nger / Irritability 1.42 .19 A nxious A rousal 1.32 .23 Defensive A voidance 1.15 .33 D epression .70 .67 D issociation 1.37 .21 D ysfunctional Sexual Behavior 2.80 .01% Im paired Self Reference 1.01 .43 Intrusive Experiences 1.16 .32 Sexual C oncerns .96 .46 Tension R eduction Behavior 1.24 .27 ^This p value suggests a nonhom ogeneous population. given the exploratory nature of this study, post hoc com parisons are provided in order to give the reader a m ore com plete view of the interaction and m ain effects. G roup m eans w ere com pared through one-w ay analyses of variance (ANOVAs), em ploying both nonadjusted p values and the Bonferroni correction for m ultiple 72 com parisons (adjusted p value = .004). Finally, figures 5, 6 and 7 depict the m eans for the m ain effects of race/ethnicity, gender, and sexual abuse history. M ANOVAs w ere perform ed to assess the interaction effects of the predictor variables. The 3-w ay M ANOVA indicated th at the interaction effect of race/eth n icity by sexual abuse history by gender w as n o t significant, F (12,177) = .93, p = .520 (see Table 9). Given the nonsignificant outcom e of the 3-w ay M ANOVA, three 2-w ay M ANOVAs w ere conducted. The 2-way interaction effects of sexual abuse history by gender (F [12, 208] = .52, p = .903), sexual abuse history by race/eth n icity (F [12,181] = 1.09, p = .370), and race/eth n icity by gender (F [12,181] = .418, p = .955) w ere also not significant (see Tables 10,11, & 12). To explore the data further, post hoc one-w ay ANOVAs w ere perform ed. There w as only one significant finding discovered from the post hoc com parisons m ade on the 2-w ay M ANOVAs. Sexually abused W hite subjects w ere found to score significantly higher on the A nxious A rousal d ep en d en t variable than sexually abused H ispanic subjects, F (1, 192) = 4.04, p < .05. The nonsignificant results obtained from the 3-w ay and 2- w ay M ANOVAs prom p ted the researcher to perform one-w ay M ANOVAs to assess the m ain effects of race/ethnicity, gender, and sexual abuse history. The m ain effect of race/ethnicity, F (12,183) = 1.61, p = .092, w as m arginally nonsignificant. To explore the data further, p o st hoc univariate com parisons w ere perform ed and revealed th at H ispanic subjects scored significantly higher on the 73 g P 1 I 1 I 1 i I I I I Ü h I P h . 2 3 I oo o NO 00 C O m co in co I I oq oo o m 00 ON NO e s e s NO 3 o o6 N NO r s ON NO eo co N N N fO N o N O co NO cc NO NO C O NO in NO in cq NO I I 3 3 m m in t s ! '<1 co O J C N C l ON I I C I Cl Cl • 2 ^ a II ^ Cl •g E n I Ci t — ' e n C O ON es O s O ON NO es 00 m en cq O LO eq O eq eq oo es C n Î ï—1 NO O s ON oo en o ON eo en N NO NO eq eo N eo eq eq NO eo ON es ON eo ON oô eo co K en S - H NO t - H NO NO co es oo 00 o eo m S - H m m co es cq co NO eo eo eo eo m NO es o N O I N X NO eo eo I N X N NO en es en O ON cq NO ON ON es es ON oô oô oô es S - H NO CO en oo NO NO oo eo I N X en eo co es eq ON es en I N X es ON co eo eo C O NO eo ON is! I N X I N X % ON i N x es en OO oo e n ON cS oq en en es en es eo oô es eo co ON es cS ON eo en w N ON eo NO en oo oo o OO oo oo es s q oo en CN| o eo ON en NO en es m es en es es g * 8 * ... u « ïï I l > S I g D O O en M 74 Table 10 G ender TSI Scale A bused M ale M (n = 19) N o n ab u sed M ale M (n = 59) A bused Fem ale M (n = 66) N o n ab u sed Fem ale M (n = 79) F Value AR 4.68 2.32 5.70 3.66 .07 RL 20.68 17.00 21.82 19.16 .37 AI 13.84 11.03 15.76 13.23 .02 AA 12.47 8.83 12.73 10.30 .72 DA 11.89 7.69 13.79 10.33 .15 D 12.89 7.76 13.02 10.54 1.96 DIS 11.89 7.15 12.44 9.34 .99 DSB 6.37 2.69 4.79 2.49 1.20 ISR 13.53 9.88 14.18 11.44 .24 IE 9.95 6.19 11.83 8.29 .01 SC 5.32 3.44 4.67 3.65 .40 TRB 7.26 4.59 7.45 5.34 .20 N ote, df = (1,219). M = M ean; AR = A typical Response; RL = Response Level; AI = A nger/Irritability; AA = A nxious A rousal; DA = D efensive A voidance; D = D epression; DIS = Dissociation; DSB = D ysfunctional Sexual Behavior; ISR = Im paired Self Reference; IE = Intrusive Experiences; SC = Sexual Concerns; TRB Tension R eduction Behavior. 75 Table 11 R ace/E th n icitv TSI Scale A bused H isp an ic M (n = 63) N o nabused H isp an ic M (n = 79) A bused W hite M (n = 15) N onabused W hite M (n = 39) F V alue AR 5.95 3.37 4.06 2.67 .70 RL 21.25 18.14 23.73 18.49 1.25 AI 15.40 12.58 16.00 11.62 .51 AA 12.33 9.95 14.80 9.18 4.04*% DA 13.54 9.86 13.00 9.36 .00 D 13.16 9.86 13.27 8.79 .31 DIS 12.21 8.90 13.33 7.90 1.29 DSB 5.37 2.70 4.13 2.90 .99 ISR 14.21 11.71 14.47 9.95 .95 IE 11.63 8.27 11.13 6.87 .19 SC 4.40 3.68 5.47 3.77 .08 TRB 7.52 5.14 7.07 5.23 .15 Note, df = (1,192). M = M ean; AR = A typical Response; RL = Response Level; AI = A nger/Irritability; AA = A nxious A rousal; DA = D efensive A voidance; D = D epression; DIS = Dissociation; DSB = D ysfunctional Sexual Behavior; ISR = Im paired Self Reference; IE = Intrusive Experiences; SC = Sexual Concerns; TRB = Tension R eduction Behavior. % F value is n o t statistically significant w hen Bonferroni correction for m ultiple com parisons is applied (p value = .004). ^p < .05. 76 Table 12 F Tests on Each D ependent V ariable by R ace/E thnicity and G ender TSI Scale Fem ale H ispanic M (n = 96) M ale H ispanic M (n = 46) Fem ale W hite M (n = 32) M ale W hite M (n = 22) F Value AR 5.16 3.17 3.34 2.64 .86 RL 20.26 17.98 20.59 19.00 .13 AI 14.49 12.46 13.53 11.82 .02 AA 11.51 9.96 11.00 10.36 .32 DA 12.82 8.72 10.69 9.91 2.59 D 12.11 9.67 10.22 9.77 .94 DIS 11.15 8.74 10.03 8.50 .22 DSB 3.91 3.83 3.47 2.91 .11 ISR 13.42 11.57 11.28 11.09 .68 IE 10.93 7.33 8.41 7.55 1.93 SC 4.29 4.13 4.19 4.32 .04 TRB 6.52 5.52 5.94 5.45 .14 N ote, df = (1,192). M = M ean; AR = A typical Response; RL = R esponse Level; AI = A nger/ Irritability; AA = A nxious A rousal; DA = D efensive A voidance; D = D epression; DIS = Dissociation; DSB = D ysfunctional Sexual Behavior; ISR = Im paired Self Reference; IE = Intrusive Experiences; SC = Sexual Concerns; TRB Tension R eduction Behavior. 77 A typical R esponse d ep en d en t variable than W hite subjects. In addition, although the m ean differences betw een H ispanic and W hite subjects w ere not significant across the rem aining dependent variables, H ispanic subjects' m ean scores w ere higher th an W hite subjects' m ean scores on ten of tw elve dep en d en t variables (see Table 13 and Figure 5). In contrast, the m ain effect of gender, F (12, 210) = 2.02, p = .024, w as significant, w ith fem ale subjects scoring significantly higher than m ale subjects on nine of the tw elve d ep en d en t variables (see Table 14). W hen com pared to their m ale peers, fem ale subjects w ere found to exhibit significantly higher levels of A typical R esponse an d Response Level, and dem onstrate significantly m ore sym ptom s of A nger/ Irritability, A nxious A rousal, D efensive A voidance, D epression, D issociation, Im paired Self Reference, and encounter m ore Intrusive Experiences. Interestingly, w hen a one-w ay M ANCOVA procedure w as em ployed to explore the m ain effect of gender w ith sexual abuse history as a covariate, the m ain effect of gender, F (12, 209) = 1.55, p = .108, w as not significant. H ow ever, to explore the d ata further, post hoc univariate com parisons of the M ANCOVA results indicated that w hen com pared to their m ale peers, fem ale subjects w ere found to score significantly higher across seven depen d en t variables (see Table 15). Furtherm ore, Figure 6 show s that fem ale subjects scored higher than m ale subjects on eleven of tw elve d ep en d en t variables. Finally, the m ain effect of sexual abuse history w as highly significant, F (12, 210) = 4.30, p < .0005. O n all d ep en d en t variables, sexually abused subjects scored significantly 78 Table 13 D ependent Variable H isp an ic W hite T raum a Sym ptom M ean M ean U nivariate Inventory (TSI) Scale (n = 142) (n = 54) F A typical R esponse 4.51 3.06 4.67*% R esponse Level 19.52 19.94 .21 A n g er/Irritab ility 13.83 12.83 .93 A nxious A rousal 11.01 10.74 .12 D efensive A voidance 11.49 10.37 1.18 D epression 11.32 10.04 1.65 D issociation 10.37 9.41 1.11 D ysfunctional Sexual Behavior 3.88 3.24 .87 Im paired Self Reference 12.82 11.20 2.71 Intrusive Experiences 9.76 8.06 3.03 Sexual C oncerns 4.24 4.24 .00 Tension R eduction Behavior 6.20 5.74 .47 Note, df = (1,196). % F value is n o t statistically significant w hen Bonferroni correction for m ultiple com parisons is applied (p value = .004). *p < .04. 79 I ■ [ s '5 D < M î I I - ë I m ¥ i I § I m I 80 Table 14 F Tests of M ale and Fem ale Scores on Each D ependent V ariable T raum a Sym ptom Inventory (TSI) Scale M ale M ean (n = 78) Fem ale M ean (n = 145) U nivariate F A typical R esponse 2.90 4.57 8.65**a Response Level 17.90 20.37 10.04**a A nger / Irritability 11.72 14.38 8.54**a A nxious A rousal 9.72 11.41 6.30* D efensive A voidance 8.72 11.90 12.46**a D epression 9.01 11.67 9.08**a D issociation 8.31 10.75 9.83**a D ysfunctional Sexual Behavior 3.59 3.54 .01 Im paired Self Reference 10.77 12.69 5.06* Intrusive Experiences 7.10 9.90 11 ll**a Sexual C oncerns 3.90 4.11 .12 Tension R eduction Behavior 5.24 6.30 3.35 Note, df = (1,221). ^F value is statistically significant w hen Bonferroni correction for m ultiple com parisons is applied (p value = .004). *p < .0 3 . **p<.01. 81 Table 15 F Tests of M ale and Fem ale Scores on Each D ependent Variable w ith Sexual A buse H istory U sed as a C ovariate T raum a Sym ptom Inventory (TSI) Scale M ale M ean (n = 78) Fem ale M ean (n = 145) U nivariate F A typical R esponse 2.90 4.57 4.72*a R esponse Level 17.90 20.37 5.72*a A nger / Irritability 11.72 14.38 5.31*a A nxious A rousal 9.72 11.41 2.77 D efensive A voidance 8.72 11.90 7.33**a D epression 9.01 11.67 5.08*a D issociation 8.31 10.75 4.94*a D ysfunctional Sexual Behavior 3.59 3.54 1.15 Im paired Self Reference 10.77 12.69 2.29 Intrusive Experiences 7.10 9.90 6.11*a Sexual C oncerns 3.90 4.11 .01 Tension R eduction Behavior 5.24 6.30 1.02 Note. d f= (1,220). ^F value is n o t statistically significant w h en Bonferroni correction for m ultiple com parisons is applied (p value = .004). *p < .04. **p < .01. 82 e n S I I t I 1 a f e n î I l> 83 higher th an their nonabused peers (see Figure 7). Table 16 indicates th at sexually abused subjects scored significantly higher th an their n onabused counterparts in A typical Response and R esponse level, an d dem onstrated m ore indicators of A nger/Irritability, A n x io u s/A ro u sal, D efensive A voidance, D epression, Dissociation, D ysfunctional Sexual Behavior, Im paired Self Reference, Intrusive Experiences, Sexual Concerns, and Tension R eduction Behavior than their nonabused peers. To com plem ent the M ANOVA results discussed above, one w ay analyses of variance (ANOVAs) w ere conducted to determ ine the equality of sexually abused an d nonabused subjects’ m eans on all d ep en d en t variables across a variety of subsam ples, including; fem ales, m ales, H ispanics, H ispanic fem ales, H ispanic m ales. W hite fem ales, and W hite males. Results of these ANOVAs em ploying both nonadjusted p values and the Bonferroni correction for m ultiple com parisons (adjusted p value = .004) are found in Table 17. Findings indicated th at significant differences w ere found betw een sexually abused and nonabused subjects on the m ajority of the d ep en d en t variables across the subsam ples of fem ale, m ale, H ispanic, and W hite subjects. O nly the d ep en d en t variable Sexual C oncerns h ad nonsignificant F values across these subsam ples. In contrast, nonsignificant differences w ere found betw een sexually abused and nonabused subjects on the m ajority of the d ep en d en t variables across the subsam ples of H ispanic female, H ispanic m ale. W hite fem ale, an d W hite m ale subjects. 84 o < M 1 } ê I ÿ w e n '2 I S 2 W en ■ 2 •S I en 'o i I l> 85 Table 16 D ependent Variable A bused N o n ab u sed T raum a Sym ptom M ean M ean U nivariate Inventory (TSI) Scale (n = 85) (n = 138) F A typical response 5.47 3.09 18.66**a R esponse Level 21.56 18.24 19.58’ ^ ’ ^a A nger / Irritability 15.33 12.29 11.72*a A nxious A rousal 12.67 9.67 21.97**a Defensive A voidance 13.36 9.20 23.06**a D epression 12.99 9.36 18.33’ ^*^ D issociation 12.32 8.41 28.21**a D ysfunctional Sexual Behavior 5.14 2.58 21.20^^^ Im paired Self Reference 14.04 10.78 15.83**a Intrusive Experiences 11.41 7.39 25.18**a Sexual C oncerns 4.81 3.56 4.49^" T ension R eduction Behavior 7.41 5.02 18.89**^ Note, df = (1, 221). value is statistically significant w hen Bonferroni correction for m ultiple com parisons is applied (p value = .004). *p < .04. < .0005. 86 g t ta' U Q I o O ) I ' 1 1 I î 0 1 P L , 1 tÈ ' M W P U l i t c a 1 I I < I I I I # > P P I ( X , > ( X , I P X , > P X , }l c a ^ I (N c p j I I % ? o M E . 0 0 % ? Os Cs| 0 0 c o % % C M \o I I % l 3 i n m OS o 6 ■ = } < la i n C M o' c o c i I I o o s CN R r j o % o q c e C M P c e c r > I I % l 3 C O CN s ô C N J c s i c e $ f \o C N f O OS o \ a s % so O O o c e c r > o I I % l I I 3 <N c e SO ( N c e ? d I I à & k k R k o o c e S T f c e I I % l 3 la N sO i n c o sô o ô c e c e C M N % l C l > p x , I p x , % l H ZI î î * î O o CM o o VO o o O CO c e o o C M s o CsJ c o c o o s CM m m o ô r S N o ô «3 f î î t OS l a la CO M O O (N o s o c o sO CM <N CO o o CM sO o s ô OS OS c ô la O Csi ? t ? 1 * O O CN o s sO SO l e C M o SO la C M p 0 C 3 C M c e p o s la C M O O K o O m is! c e is! ( C ? ? * * * * * m m i n O s O c e O o S O o C p O N p C i S O N O s i n O o s d o o v O O Ô s o s g s S 0 0 i r i PP 0 0 o ô Q M g l II lt I s fi iî I I " I 3? I§ II P i , % là M Pf II U P O 1 1 y | i lîi l„ nj V PI & H l l v p p Pi 87 TSI Total Score The TSI Total Score w as n o t entered into the M ANOVA analyses. The analysis of variance (ANOVA) procedure w as used to explore these interaction effects and m ain effects. A 3-way ANOVA indicated th at the interaction effect of race/eth n icity by sexual abuse history by gender w as n o t significant, F (1,188) = 1.32, p = .252. G iven the nonsignificant outcom e of the 3-w ay ANOVA, three 2- w ay A N OV A s w ere conducted. The 2-w ay ANOVAs indicated that the 2-w ay interaction effects of sexual abuse history by gender (F [1, 219] = .96, p = .329), sexual abuse history by race/eth n icity (F [1,192] = .37, p = .544), and race/eth n icity by gender (F [1,192] = .94, p = .334) w ere not significant. The nonsignificant results obtained from the 3-w ay and 2-way ANOVAs p ro m p ted the researcher to perform separate one-w ay ANOVAs to assess the m ain effects of race/eth n icity , gender, and sexual abuse history. The m ain effect of race/eth n icity , F (1, 194) = 2.42, p = .121, w as not significant. The m ean TSI total score for H ispanic subjects w as 132, w hile the m ean TSI total score for W hite subjects w as 118. The m ain effect of gender, F (1, 221) = 9.86, p = .002, w as significant. The m ean TSI total score of 134 for fem ale subjects w as significantly higher than the m ean TSI total score of 109 for m ale subjects. Furtherm ore, a one-w ay A N CO VA w as perform ed on gender w ith sexual abuse history as a covariate. This ANCOVA procedure, F (1, 220) = 4.49, p < .04, w as also significant. Finally, sim ilar to the M ANOVA results discussed earlier, the m ain effect for sexual abuse history w as highly significant, F (1, 221) = 36.93, p < .0005. The m ean TSI total 8 8 score for victim s of child sexual abuse w as 153, w hile the m ean TSI total score for nonabused subjects w as 108. Results of the TSI Total Score analyses em ploying b o th nonadjusted p values and the Bonferroni correction for m ultiple com parisons (adjusted p value = .004) are found in Table 18. Predictive V alidity A discrim inant analysis w as perform ed on the tw elve d ep en d en t variables to determ ine the overall predictive validity of the TSI. Classification results derived from the discrim inant analysis indicated th at the TSI correctly classified 64.7 percent of the sexually abused group as sexually abused, w hile 35.3 percent of the sexually abused group w ere incorrectly classified as nonabused. In contrast, the TSI correctly classified 71.7 percent of the nonabused group as nonabused subjects, w hile 28.3 percent of the nonabused group w as incorrectly classified as sexually abused (see Table 18). O verall, the TSI accurately classified 69.1 percent of the cases as either sexually abused or nonabused. Furtherm ore, the discrim inant function w h en com bining all of the d ep en d en t variables of the TSI, chi-square (12, N = 223) = 47.22, p < .00005, w as highly significant. 1 D iscrim inant analyses w ere conducted on several subsam ples of subjects to determ ine w hether or not the TSI had predictive utility w ithin these subgroups. Table 19 indicates the results of these analyses. The discrim inant functions for fem ale subjects, chi-square (12, n = 145) = 23.35, p < .03, and m ale subjects, chi-square (12, n = 78) = 21.63, p < .05, w ere significant. Fem ale 89 Table 18 A N O V A /A N C O V A : F Tests for TSI-Total Score Interaction E ffects/M ain Effects Degrees of Freedom F Value Sexual A buse H istory by G ender by Race / E thnicity (1,188) 1.32 Sexual A buse H istory by G ender (1, 219) .96 Sexual A buse H istory by R ace/E thnicity (1, 192) .37 R ace/E thnicity by G ender (1, 192) .94 Race / E thnicity (1, 194) 2.42 — H ispanic M ean = 132 — W hite M ean = 118 G ender (1, 221) 9.86^^a — Fem ale M ean = 134 — M ale M ean = 109 G ender w ith Sexual A buse H istory as a C ovariate (1, 220) 4.49'' Sexual A buse H istory (1, 221) 36.93*'"'^ — Sexually A bused M ean = 153 — N o n ab u sed M ean = 108 ^F value is statistically significant w hen Bonferroni correction for m ultiple com parisons is applied (p value = .004). * p < .0 4 . **p<.003. *^*p<.0005. 90 g C O CO CO I 0 0 in o, I o \ I S . ' CM oo I I C O cn O N C M O o \ I 3 I 91 subjects w ere correctly classified at a rate of 66.2 percent, w hile m ale subjects w ere accurately classified at a rate of 74.4 percent. In addition, the discrim inant functions for H ispanic subjects, chi- square (12, n = 142) = 26.21, p < .02, and W hite subjects, chi-square (12, n = 54) = 23.01, p < .03, w ere significant, w ith accurate classification rates of 65.5 percent an d 79.6 percent respectively. In contrast, the discrim inant functions for H ispanic fem ales, chi- square (12, n = 96) = 15.84, p = .20, and H ispanic m ales, chi-square (12, n = 46) = 11.24, p = .51, w ere n o t significant, w hile dem onstrating accurate classification rates of 65.6 percent and 80.4 percent respectively. Finally, the discrim inant functions for W hite fem ales, chi-square (12, n = 32) = 13.94, p = .30, and W hite m ales, chi-square (12, n = 22) = 14.90, p = .24, w ere n o t significant, even th o u g h discrim inant analyses revealed accurate classification rates of 81.3 an d 90.9 respectively. D iscrim inant analyses w ere perform ed to determ ine the accuracy of the in d iv id u al subscales in predicting sexual abuse history. The d ep en d en t variable D issociation w as the single m ost accurate predictor of group m em bership, correctly classifying 67.3 percent of the cases (chi-square [1, N = 223] = 26.49, p < .00005). The ranking of the rem aining d ep en d en t variables according to their ability to correctly classify cases as sexually abused an d nonabused w as as follow s (classification rate an d discrim inant function in parentheses): Tension R eduction Behavior (65.9 percent, chi-square [1, N = 223] = 18.08, p < .00005), TSI Total Score (65.5 percent, chi- square [1, N = 223] = , p < .00005), D ysfunctional Sexual Behavior 92 (64.6 percent, chi-square [1, N = 223] = 20.20, p < .00005), Intrusive Experiences (64.1 percent, chi-square [1, N = 223] = 23.79, p < .00005), A typical R esponse (63.2 percent, chi-square [1, N = 223] = 17,87, p < .00005), A nxious A rousal (61.9 percent, chi-square [1, N = 223] = 20.90, p < .00005), D efensive A voidance (61.4 percent, chi- square [1, N = 223] = 21.88, p < .00005), D epression (61.4 percent, chi-square [1, N = 223] = 17.57, p < .00005), R esponse Level (61.4 percent, chi-square [1, N = 223] = 18.72, p < .00005), Im paired Self Reference (60.1 percent, chi-square [1, N = 223] = 15.25, p < .001), A n g er/ Irritability (59.6 percent, chi-square [1, N = 223] = 11.39, p < .001), an d Sexual C oncerns (54.7 percent, chi-square [1, N = 223] = 4.44, p < .04). The discrim inant analyses suggested th at each of the d ep en d en t variables h ad a m easure of utility in accurately classifying subjects as sexually abused an d nonabused. S u m m ary Reliability analysis indicated th at the TSI dem onstrated m arginally acceptable reliability in the current study. A cross m ost d ep en d en t variables, subjects w ho inconsistently reported on a self- rep o rt m easure that they w ere sexually abused w ere found to be sim ilar on the TSI dep en d en t variables to subjects w ho consistently rep o rted th at they h ad been victim s of child sexual abuse. H ispanic fem ales rep o rted being victim s of child sexual abuse at significantly higher rates th an their H ispanic m ale and W hite peers. Fem ale victim s of sexual abuse identified m ale perpetrators in the great m ajority of cases, w hile m ale victim s of sexual abuse identified fem ales perpetrators in the m ajority of cases. M ANOVA results 93 indicated th at sexually abused subjects differed significantly from their nonab u sed counterparts on all d ep en d en t variables. In addition, no significant overall differences w ere found on the d ep en d en t variables betw een sexually abused m ales and females, and no overall differences w ere found betw een sexually abused H ispanic an d W hite subjects. Finally, discrim inant analysis indicated th at the TSI dem onstrated statistically significant and m arginally acceptable levels of predictive ability. C hapter 4 discusses the results of the study, an d considers the w ider im plications of its findings. The results are discussed as they relate to the hypotheses an d other areas of concern, im plications for theory an d intervention are discussed, and ideas for future research are addressed. Footnote 1. It is im p o rtan t to rem em ber that although a chi-square distribution b ased on W ilks lam bda m ay be significant, it provides m inim al inform ation regarding the effectiveness of the discrim inant function in classification. It serves as a test of the null hypothesis th at the sam ple m eans are equal (Noru^is, 1994). 94 Chapter IV: Discussion This chapter discusses the results of the study, an d considers the w ider im plications of its findings. The chapter is divided into six sections: The Findings as They Relate to the H ypotheses, G eneral D iscussion of the Findings, Im plications for Theory, Intervention Im plications, F uture Research, and Conclusion. The Findings as They Relate to the H ypotheses H ypothesis 1 stated: The T raum a Sym ptom Inventory w ill be found to dem onstrate sufficient reliability and validity to be used in future child sexual abuse research on adolescents. Ind iv id u al TSI scales ranged in reliability from .69 to .89 (m ean a = .82). These alpha levels are considerably low er than the TSI alpha levels reported b y Briere, Elliott, and Smiljanich (1993) for university subjects ( m ean a = .87) and ad u lt clinical subjects (m ean a = .90). It appears th at the elim ination of three item s from the Sexual C oncerns scale an d one item from the D ysfunctional Sexual Behavior scale in the version of the TSI em ployed in the current stu d y m ay have low ered the alpha levels of these scales, and in tu rn com prom ised the overall reliability of the TSI in the current study. The question of how large these coefficients m u st be before they are accepted as evidence of the m easure's reliability m u st be addressed. G uilford (1956) and H elm stadter (1964) have indicated th at alpha coefficients of .70 to .80 are reasonable for m ost tests. Salvia and Y sseldyke (1988) argued that coefficients in the .80s are sufficient for screening purposes, w hile H am m ill, Brown, and Bryant (1989) concluded th at .80 is the m inim um level of acceptable 95 reliability, w hile .90 is preferred. U sing these guidelines as benchm arks, the TSI dem onstrated m arginally acceptable reliability in the current study, and w ith som e m odifications (e.g., restoring the TSI item s th at w ere elim inated for the current study) could have a m easure of utility in future sexual abuse research w ith adolescents. O verall, the TSI accurately classified 69.1 percent of the cases as either victim s of child sexual abuse or nonabused. The D issociation scale w as the single m ost accurate predictor of group m em bership, correctly classifying 67.3 percent of the cases, w ith the other scales correctly classifying 54.7-65.9 percent of the subjects as either sexually abused or nonabused. The four TSI item s th at w ere n o t adm inistered to the subjects in the current stu d y m ay have com prom ised this m easures ability to accurately classify subjects as sexually abused or nonabused. In the current study, the predictive ability of the TSI h ad its foundation in the degree of accuracy dem onstrated by the CMIS— SF to classify the subjects as either sexually abused or nonabused. A lthough the C M IS-SF w as m odified for use in this stu d y to m axim ize its ability to correctly classify adolescents in a school setting, additional m odifications w ill m ake it a m uch m ore accurate instrum ent. For exam ple, the CMIS— SF did n o t adequately address the issue of "date rape", a topic th at has received a significant am o u n t of attention by adolescents th ro u g h the m edia in recent years. Furtherm ore, the issue of force w as addressed only once in the sexual abuse section of the CM IS— SF. The lack of em phasis on the issue of force on the CMIS— SF m ay have m ade it an easy topic 96 for subjects to choose to ignore. Finally, the overall form at of the CMIS— SF is flaw ed. The fill-in the blank, only answ er the portions th at apply to you form at, gives individuals far too m uch latitude in selecting w hich p arts of the m easure they m ay w ish to com plete. A m ore forced-choice form at (sim ilar to the TSI) w o u ld be m ore appropriate. For exam ple, the CMIS— SF asks, "Has anyone ever kissed you in a sexual w ay, or touched your body in a sexual w ay, or m ade you touch their sexual parts?" Subsequently, subjects are prov id ed the op p o rtu n ity to place a check m ark in a space for "yes" or "no", and they are provided w ith the opportunity to identify by check m arks a variety of fam ily m em bers w ho have interacted w ith them in the m anner described in the item p resented above. W ith this form at, subjects have the opportunity to selectively choose w hich p arts of the m easure to answ er. M ore accurate inform ation w o u ld be obtained if the subjects w ere asked specific inform ation about specific individuals. For exam ple asking; (1) "Has your father or m ale g u ard ian ever kissed you in a sexual w ay, or touched your b o d y in a sexual w ay, or m ade you touch their sexual parts?"; (2) "Has your m other or fem ale guard ian ever kissed you in a sexual w ay, or touched your body in a sexual w ay, or m ade you touch their sexual parts?"; etc. For each such item , the subjects w ould be presented w ith the forced choice of "yes" or "no". These types of item s w o u ld m ake it m ore difficult for subjects to arbitrarily ignore certain sections of the CMIS— SF. G iven the noted shortcom ings of the CMIS— SF, an d the lim itations placed on the researcher by the school district regarding the use of certain item s of the TSI, the TSI 97 d em o n strated m arginally acceptable predictive ability could have application in future child sexual abuse research w ith adolescents. H ypothesis 2 stated : The TSI w ill dem onstrate clinical utility in discrim inating adolescents that have been sexually abused from their n o nabused peers. A lthough the findings of the current study suggested th at the TSI has application in future child sexual abuse research, the clinical use of this m easure is far m ore uncertain. Table 19 gives an overview of the TSI's ability to accurately classify in d iv id u als as sexually abused and nonabused. W hile over 90 p ercent of W hite m ales w ere correctly classified as sexually abused an d nonabused, only 57.1 percent of H ispanic subjects w ere correctly classified as sexually abused. A lthough the findings of the cu rren t stu d y indicated th at there is som e evidence th at the TSI could have clinical utility for som e groups of individuals, m uch m ore research is required before the TSI can be used effectively as a clinical m easure w ith adolescents. H ypothesis 3 stated: The D ysfunctional Sexual Behavior and Sexual C oncerns scales of the TSI w ill be found to be significantly m ore accurate than the other scales of the TSI in identifying sexual abuse history. This hypothesis w as not sup p o rted b y the findings of the cu rren t study. The D ysfunctional Sexual Behavior scale accurately classified 64.6 percent of subjects as sexually abused and n o n ab u sed in the current study. Tw o other scales (Dissociation and Tension R eduction Behavior) classified subjects at higher rates. The Sexual C oncerns scale accurately classified 54.7 percent of subjects as sexually abused and nonabused. This represented the w o rst rate 98 of accuracy in classification am ong the d ep en d en t variables. As m entioned earlier, the deleted item s from both of these scales m ay have com prom ised their ability to accurately classify subjects. H ypothesis 4 stated: O n the CMIS— SF, adolescents w ho inconsistently reported th at they h ad been sexually abused w ill not differ significantly across all d ep en d en t variables from adolescents w ho rep o rted consistently th at they h ad been sexually abused. This hypothesis w as su p p o rted by the prelim inary M ANOVA findings. A lthough the M ANOVA procedures em ployed to explore the m ain effects of the sexually abused group versus the inconsistent group and the nonab u sed group versus the inconsistent group w ere not significant, p o st hoc analyses clearly indicated th at the inconsistent group w as m ore sim ilar to the sexually abused group than to the nonabused group. These findings su p p o rt the concept advanced by Peters, W yatt, an d Finkelhor (1986), th at the num ber and types of questions asked of subjects are related to successful identification of ind iv id u als th at have been victim s of child sexual abuse. These results w ere obtained despite the fact that several item s of the C hildhood M altreatm ent Study— Short Form designed specifically to differentiate sexually abused subjects from nonabused subjects w ere elim inated w h en school officials characterized the excluded item s as in ap p ro p riate areas of inquiry w ith nonclinical adolescents in a public school setting. H ypothesis 5 stated: N o significant differences w ill be found across the d ep en d en t variables betw een H ispanic adolescents and W hite adolescents w ho have been sexually abused. This hypothesis 99 w as largely su p p o rted by the findings of the study. The 2-w ay M ANOVA, sexual abuse history by race/ethnicity, w as n o t significant. Furtherm ore, post hoc analysis of variance found only one significant difference across the d ep en d en t variables. Sexually abused W hite subjects w ere found to score significantly higher on the A nxious A rousal d ep en d en t variable than their sexually abused H ispanic peers. H ypothesis 6 stated: N o significant differences w ill be found across the d ep en d en t variables betw een fem ale an d m ale adolescents w ho have been sexually abused. This hypothesis w as su p p o rted by the results of the study. The 2-w ay M ANOVA, sexual abuse history b y gender, w as not significant. F urtherm ore, post hoc analysis of variance indicated no significant differences on all d ep en d en t variables. These results su p p o rt the findings of other researchers w ho have looked specifically at the gender differences am ong individuals th at have been sexually abused (e.g., Briere, Evans, R untz, & W all, 1988; U rquiza & C row ley, 1986; Young, B ergandi, & Titius, 1994). H ypothesis 7 stated: Sexually-abused adolescents wiU differ significantly from their nonabused peers across all d ep en d en t variables. This hypothesis w as sup p o rted by the findings of the study. The one-w ay M ANOVA for sexual abuse history w as highly significant. In addition, p o st hoc univariate analysis discovered significant differences on all d ep en d en t variables. These results are sim ilar to a large b o d y of research th at has investigated the negative im pacts of child sexual victim ization (e.g., Beitchm an, Zucker, 100 H ood, daC osta, & A km an, 1991; Briere, 1992; Brow ne & Finkelhor, 1986; Russell, 1983, 1984, 1986). The results suggested th at sim ilar to research findings on adults sexually abused as children, sexually abused adolescents experience significant negative im pacts as a result of their victim ization. G eneral D iscussion of the F indings Prevalence of C hild Sexual Abuse. The m ost revealing finding of this stu d y involved the eth n icity /g en d er of those subjects th at indicated th at they h ad been victim s of child sexual abuse. H ispanic fem ales w ho p articipated in this study w ere found to be significantly m ore likely to rep o rt being victim s of child sexual abuse than their H ispanic m ale an d W hite m ale and fem ale peers. H ispanic fem ales rep o rted child sexual abuse at a rate of 54.2 percent, com pared to the child sexual abuse rates of 23.9 percent, 27.3 percent, and 28.1 percent reported by H ispanic m ales. W hite m ales, and W hite fem ales respectively. In som e w ays these results are sim ilar to the findings of a self-report postal questionnaire study conducted by K ercher and M cShane (1984) in Texas. In th at study, 21.7 percent of the H ispanic w om en w ho filled out and retu rn ed a survey booklet reported th at they h ad been victim s of child sexual abuse com pared to 10.4 percent of A frican-A m erican w om en and 9.8 percent of W hite w om en. A retu rn rate of 53 percent in the K ercher an d M cShane (1984) stu d y h am pered the researchers ability to generalize their results to the ad u lt popu latio n in Texas. Sim ilarly, a participation rate of 29.3 percent in the current stu d y 101 h inders any attem pts to generalize the results of this stu d y to the entire p o p u latio n of the target high school. A lthough it is im portant to use caution w hen attem pting to generalize the findings of any study, it is equally im portant not to ignore the possible ram ifications of research data. Lynch, Stern, O ates, an d O'Toole (1993) studied the fam ilies of 187 children w ith histories of sexual abuse. This stu d y w as designed to assess the behavioral an d em otional effects of sexual abuse in children im m ediately after the abuse w as revealed, and 18 m onths after initial disclosure. The researchers found th at the m ore dysfunctional fam ilies in their research sam ple refused to participate in their research project. F urtherm ore, the stu d y families an d the non-participating fam ilies did not significantly differ on the sexual abuse variables. A lthough there is no w ay of ascertaining the child sexual abuse rates of those students w ho d id not participate in the current study, the Lynch, Stern, O ates, and O ’ Toole stu d y m entioned above suggests that a factor in the n o n participation of som e of the adolescents in this stu d y m ay have been a result of fam ilial dysfunction and not necessarily d u e to the lack of sexual abuse victim ization in the non-participating group. P erpetrators of Abuse. A second m eaningful finding of the nonparam etric analyses w as the gender of those individuals identified as child sexual abuse perpetrators. Fem ale victim s of sexual abuse identified m ale perpetrators in 91.9 percent of sexual assaults. These results are consistent w ith a large b o d y of research that have explored the gender of sexual abuse perpetrators w hen 102 fem ales are the victim s of child sexual abuse (e.g.. M erm en, 1994; Russell, 1984). In contrast, m ale victim s of child sexual abuse identified fem ale p erpetrators in 52.9 percent of cases. W hile these results are contrary to the findings of several studies that have rep o rted the preponderance of sexual abuse perpetrators to be m en even w hen the victim s are boys (e.g., Faller, 1987; R einhart, 1987), a grow ing b o d y of research has identified fem ale p erp etratio n rates th at are sim ilar to those found in this study (e.g., M endel, 1995; O lson, 1990; R am sey-K law snik, 1990; Risen & Koss, 1987). Results of the current stu d y indicated th at 6.1 percent of fem ale subjects th at indicated that they h ad been sexually abused, reported being sexually victim ized by a parent. In each case the identified p erp etrato r w as a father figure. In contrast, only one m ale subject, or 5.3 percent of the m ale abused group, reported being sexually victim ized by a p arental figure. In this one case, a m other figure w as identified as the perpetrator. A t initial glance this data w ould seem to su p p o rt the theory that the prevalence of m other- child incest is low — significantly low er than the father-child rate of incest. H ow ever, these findings need to be view ed w ithin the context of how subjects w ere included in this study. Initially, w ritten p arental inform ed-consent w as needed before individual students w ere approached regarding their participation in the research project. In addition, over 78 percent of the paren tal inform ed-consent form s w ere signed by m others or fem ale guardians. It seem s reasonable to assum e that p aren ts th at gave their perm ission to allow their students to participate in a child 103 m altreatm ent stu d y w o u ld also be those p arents w ho have n o t p erp etrated sexual abuse u p o n their children. Follow ing this line of reasoning, m others th at have p erp etrated m other-child incest m ay have refused to allow their adolescents to participate in the current study. F urtherm ore, the rate of father-child incest reported in this stu d y m ay be a low estim ate of the true prevalence of father-child incest for sim ilar reasons. Interaction Effects. The nonsignificant 3-w ay M A NOVA (sexual abuse history by gender by race/ethnicity) findings of the cu rren t stu d y are sim ilar to the findings obtained by M ennen (1994), w ho fo u n d no significant differences in the sym ptom s of depression, anxiety, and self-concept am ong H ispanic, A frican- A m erican, and W hite sexually abused girls. H ow ever, the current findings are contrary to Russell's (1986) findings w hich found that higher percentages of H ispanic w om en rep o rted significant traum a as a resu lt of their sexual victim ization as com pared to W hite, A sian-A m erican an d A frican-A m erican w om en. Race / ethnicity. The m ain effect of race/eth n icity w as m arginally nonsignificant (p = .092), an d H ispanic subjects' m ean scores w ere found to be higher than W hite subjects' m ean scores across eleven of tw elve d ep en d en t variables. In addition, an A N O V A perform ed on the TSI Total Score found that H ispanic subjects scored significantly higher on TSI Total Score than their W hite peers. These findings m ay indicate th at H ispanic subjects are m ore em otionally at-risk than their W hite peers. W yatt (1990) has h y pothesized th at ethnic m inority children in the U nited States are 104 often subjected to num erous form s of victim ization in addition to child sexual abuse because they are exposed to institutionalized racism th ro u g h o u t their lives. W hile the discussion of racial/eth n ic issues ap art from the issue of child sexual abuse is beyond the scope of this paper, W yatt's (1990) assertions regarding the traum a im posed u p o n ethnic m inority children d u e to their generally low er socioeconom ic status, exposure to inordinate am ounts of violence, and an internalization of stigm as im posed u p o n them by a racist society is one explanation th at m ay account for the higher m eans obtained b y the H ispanic subjects. G ender. A lthough the m ain effect of gender w as found to be statistically significant w hen entered into a one-w ay M ANOVA, gender w as found not to be statistically significant w hen entered into a M ANGO VA w ith sexual abuse history as a covariate. These findings suggested th at the differences found betw een m ale and fem ale subjects across the d ep en d en t variables w ere on large p art d u e to the fact th at m ore fem ale than m ale subjects in this study w ere found to be victim s of child sexual abuse. H ow ever, post hoc univariate analysis of the M ANGO VA results found fem ale subjects' m eans to be significantly higher than their m ale counterparts on seven d ep en d en t variables. In addition, an ANGOVA perform ed on the TSI Total Score w ith sexual abuse history as a covariate found th at fem ale subjects scored significantly higher on TSI Total Score than their m ale peers. Furtherm ore, M ANGO VA results aside, fem ale m ean scores w ere higher than m ale m ean scores on eleven of the tw elve d ep en d en t variables. The results are inconclusive, b u t it 105 is clear th at even after controlling for sexual abuse history, the fem ale subjects th at p articipated in this study ten d ed to dem onstrate rnore signs of A nger / Irritability, Intrusive Experiences, D epression, D issociation, an d D efensive A voidance th an their m ale peers. Im plications for T heory The theory p roposed in the introduction of this p ap er suggested th at instrum ents sim ilar to the TSI that are developed w ith item s sensitive to sexual abuse-specific sym ptom atology pro v id e an accurate m eans of statistically differentiating sexually abused individuals from their nonabused counterparts. The item s of these sym ptom approach m easures are developed from the research on the im pacts of child sexual abuse. The overall findings of the current stu d y strongly su p p o rt this claim. The differences found betw een abused and n onabused subjects in this stu d y on all of the d ep en d en t variables w ere significant. H ow ever, the findings of this stu d y are m uch less definitive on this issue w h en the differences betw een sexually abused an d n onabused subjects w ithin subsam ples are analyzed (see Table 17). W hile sexually abused and n o n ab u sed H ispanic fem ales an d W hite m ales w ere differentiated at statistically significant levels on the m ajority of the d ep en d en t variables, H ispanic m ales and W hite fem ales w ere differentiated at statistically significant levels on very few d ep en d en t variables. A lthough subsam ple size plays a role in this issue, m uch m ore research is needed to determ ine w hether or not the TSI has equal 106 utility in statistically differentiating sexually abused and n o n ab u sed in dividuals across dem ographic groups. The theory presented in the introduction of this p ap er also im plied th at sym ptom approach m easures can accurately classify subjects as either victim s of child sexual abuse or nonabused. The issue of the TSI's utility at such classification is a m atter of degree. A lthough, as discussed above, the TSI dem onstrated the ability to discrim inate sexually abused and n o n ab u sed individuals at a highly significant level, statistically significant differences do not alw ays translate into effectiveness in classification (N orusis, 1994). For exam ple, the TSI's classification rate of 69.1 percent derived from the current study, m ay or m ay not m eet the needs of researchers, an d w o u ld be considered a low rate of classification for clinical use. F urtherm ore, sim ilar to the inconsistent m anner that the TSI statistically differentiated subsam ples of abused and no n ab u sed subjects, classification rates varied w idely across the subsam ple groups. W hile 93.7 percent of W hite m ales w ere accurately classified as nonabused, only 59.6 percent of H ispanic fem ales w ere accurately classified as sexually abused (see Table 19). A lthough it is p rem atu re to say th at the TSI should be used for classification p u rp o ses for W hite m ales and n o t for H ispanic fem ales, one m atter is certain, m ore research is needed to determ ine the TSI's utility in the classification of ind iv id u als as sexually abused or nonabused. 107 Intervention Im plications Prevention. C hild abuse prevention efforts occur at the prim ary, secondary, an d tertiary levels. P rim ary intervention efforts target the general population as a w ay of reducing or preventing m altreatm ent, an d include high school life skills classes th at prom ote positive p arenting skills training, an d school-based sexual abuse prevention program s. Secondary prevention program s focus on identified high-risk groups in their attem pt to p rev en t m altreatm ent, such as parenting skills training for groups (e.g., step-fathers) considered at risk of p erp etratin g child sexual abuse. Finally, tertiary prevention program s target services to perpetrators or victim s of abuse as a m eans to reduce or prev en t child abuse. Exam ples of tertiary program s include therapeutic program s for know n pedophiles, an d program s th at em phasize the developm ent of p arenting skills am ong individuals th at have been identified as abusive to children. (Thom pson, 1994). The great m ajority of sexual abuse prevention program s are of the prim ary prevention variety, and largely consist of the sexual abuse prevention program s that have been created for an d im plem ented in schools. G iven the trem endous num bers of children and adolescents th at are being sexually abused each year, and the m ounting evidence th at indicates that sexual abuse causes negative sym ptom s in these groups, program s w ith proven efficiency at preventing child sexual abuse need to be devised and im plem ented. There has been a w id esp read proliferation of p rim ary prevention program s in the p ast fifteen years, w hich has led to efforts at docum enting their 108 effectiveness. The review s of p rim ary prevention program s have p ro d u ced disparate results. Some researchers (e.g., Finkelhor & Strapko, 1992; Tutty, 1990) have reported predom inately positive results, w hile other researchers (e.g., Reppucci & H au g aard , 1989) have indicated th at it continues to rem ain unclear w h eth er or not p rim ary prevention program s actually w ork. F urtherm ore, som e have suggested th at preventing child sexual abuse is im possible (e.g., M elton, 1992). N ot only are adolescents frequently the victim s of child sexual abuse, they are very often the perpetrators of sexual abuse (Becker, C unningham -R athner, & K aplan, 1986). In a stu d y of ninety-one child sex offenders, Elliott, Browne, and Kilcoyne (1995) reported th at a th ird of the offenders that participated in their stu d y h ad com m itted their first offense as juveniles. For these reasons, adolescents ap p ear to be an appropriate target p o pulation for preventive program s. H igh schools are view ed as good settings for the im plem entation of p rim ary prevention program s since they are the source of a large percentage of child sexual abuse reports (Pow ers & Eckenrode, 1986). In addition, high schools offer a prom ising environm ent for interactive instruction of large num bers of adolescents (Barth, D erezotes, & D anforth, 1991). In their review of 60 high school-level child abuse prevention program s, Barth, D erezotes, an d D anforth (1991) found th at program s w ere typically less than tw o hours in duration, w ere not integrated into existing fam ily life education program s, an d focused 109 on "date rape", sexual abuse prevention, m ale perpetrators, fem ale victim s, and the basics of reporting abuse. Furtherm ore, m ost p rim ary p revention program s lim ited their instructional m ethods to dem onstration and lecture, even though the authors reported that role playing w as the m ost effective learning strategy. The researchers found th at in general these program s did n o t em phasize content designed to help adolescents avoid becom ing child abusers. W hen this topic w as addressed, it w as covered briefly. W hen the topic of protection from child abuse w as discussed ap art from date rape, generally self-protection skills from m ale strangers w ere taught, ignoring the possible threats posed by fam ily m em bers and friends of the family. Furtherm ore, m any preventive program s em phasized the "say no" strategy th at is often em ployed in p rim ary p revention program s for younger children, even though researchers (e.g.. Sang, 1994) are finding th at this strategy m ay have adverse effects on children w hen they use this intervention and it is n o t successful in preventing sexual abuse victim ization. Finally, the researchers noted th at m ost prim ary prevention program s p resen ted inform ation on the identification an d reporting of child abuse in a relatively straight forw ard m anner w ith o u t discussing the rath er com plex and controversial aspects of identifying and rep o rtin g child abuse. Existing adolescent sexual abuse p rim ary prevention pro g ram s all aim to increase students' aw areness and u n d erstan d in g of sexual abuse. Far few er preventive program s attem p t to assist students to alter their attitudes, skills, and 110 behaviors so th at they w ill be less likely to be abused or abuse, and m ore likely to rep o rt sexual abuse (Barth, D erezotes, & D anforth, 1991). A large b o d y of prevention research em ploying adolescents as subjects an d in ten d ed to p revent sm oking, substance abuse, and teen pregnancy has p ro v id ed a w ealth of inform ation th at is often not incorporated in the designs of sexual abuse prevention program s (Evans, 1988; Kirby, 1984; K lepp, H alper, & Perry, 1986). Preventive studies outside the area of sexual abuse have indicated th at altering behavior requires m ore than exposure an d aw areness. Practicing, observing, and rehearsing in the hom e an d in the com m unity are seen as critical factors in changing behavior (Prochaska & D iC lem ente, 1986; Schw artz, 1988). The issue of rehearsing sexual abuse preventive m easures in the hom e is su p p o rted by Barth, D erezotes, and D anforth (1991). These researchers indicated that parents have influence on adolescents, and focusing on creative tactics of involving paren ts in preventive program s m ay prove beneficial in influencing adolescents view s of sexual abuse. Barth, M iddleton, & W agm an (1989) indicated that prevention program s can influence know ledge, b u t behavior change is rarely achieved w ith o u t incorporating the practice of skills. These assertions are su p p o rted by child abuse prevention program s that found th at role playing increased program efficiency (H arvey, Forehand, Brow n, & H olm es, 1988; W urtele, M arrs, & M iller-Perrin, 1987). I l l A lthough an im pressive b o d y of research has established that children an d adolescents do learn the concepts tau g h t b y p rim ary prevention sexual abuse program s, these program s continue to flourish even though there is no evidence th at suggests th at prim ary p revention program s actually help children and adolescents avoid sexual abuse victim ization (Finkelhor & Strapko, 1992). M elton (1992) indicated th at a substantially stronger research base for these p rim ary prevention program s m u st be developed before these program s should continue to be initiated or expanded. R osenberg and R eppucci (1985) suggested th at ecologically oriented research is n eed ed to identify the necessary and sufficient conditions for child abuse. F urtherm ore, these researchers indicated th at com parative studies of preventive approaches are needed to ascertain the strategies th at are m ost effective for specific target groups. Finally, the n eed for long-term follow -up studies are view ed as essential in order to realize the full potential of preventive efforts. Teaching our children and adolescents aw areness of the issues su rro u n d in g child sexual abuse, facilitating their behavioral changes on this issue, and developing their u n d erstan d in g on how they can receive assistance if they have been sexually victim ized sh o u ld be am ong the highest priorities in education. It is far m ore difficult for children an d adolescents to learn in school if they are being sexually traum atized a n d /o r suffering the negative im pacts of sexual abuse. R ather th an teach sexual abuse aw areness and prevention as a separate unit, a far better approach w o u ld be to infuse sensitive topics such as sexual abuse into existing school 112 curricula. This approach w ould allow stu d en ts to explore various aspects of child sexual abuse th ro u g h English, social studies, and science classes, an d get aw ay from the inadequate tw o-hour presentation form at th at m any schools currently em ploy. Lim ited and inad eq u ate sexual abuse prevention program s m ay ease the m inds of educators w ho are desperate to address the tragedy of child sexual abuse, b u t as m entioned above, the research on the effectiveness of such lim ited program s is highly questionable. The prevention of child sexual abuse th ro u g h teacher training has yielded som e prom ising prelim inary results. R andolph and G old (1994) conducted a stu d y w hich utilized a teacher training curriculum developed by H azzard, Kleem eier, Pohl, and W ebb (1988). In their study, 21 kindergarten-12th grade teachers received six hours of training in three tw o-hour sessions. The training consisted of a series of w orkshops presented by professionals know ledgeable in victim sym ptom ology, statistics, short- and long term effects of sexual abuse, reporting procedures, em otions felt w hile reporting, an d handling disclosures. A n equal num ber of teachers received no special training and served as a control group. Both groups w ere given pretest, posttest, and follow -up m easures. Relative to the control group, trained teachers dem onstrated significant increases in the follow ing areas: know ledge about child sexual abuse, attitudes regarding prevention, distinguishing behavioral indicators of abuse, and appropriate interventions in suspected abuse cases. A 3-m onth follow -up revealed th at w hen com pared to control subjects, trained teachers w ere m ore likely to 113 have participated in behaviors related to the training. These behaviors included talking to children about abuse issues an d filing suspected child abuse reports. There is a need to develop p rim ary prevention program s that are developm entally an d culturally appropriate for teenagers and their parents. A dolescents are easily alienated if the content of a p ro g ram or its presentation are not m atched to their level of m atu rity and understanding. F urtherm ore, program s m ay need to be adjusted depen d in g on the cultural com position of the audience. For exam ple, an adolescent from one ethnic group m ay view suggestions m ade regarding assertiveness on a date differently than an adolescent from another ethnic group (Barth, D erezotes, & D anforth, 1991). In the current study, the m ajority of H ispanic fem ale subjects rep o rted th at they h ad been victim s of child sexual abuse. It w o u ld be culturally insensitive to assum e th at prevention program s developed from research conducted w ith W hite fem ales w o u ld autom atically be app ro p riate for H ispanic fem ales. M illan an d R abiner (1992) suggested th at w h en providing sexual abuse prevention program s for Latino children, not only m u st the prevention strategies being tau g h t be age appropriate, the variables of English language developm ent, acculturation level, an d cultural an d socioeconom ic issues m u st be addressed. H errerias (1988) indicated th at a com prehensive child abuse prim ary prevention p ro g ram for Latino p arents should include a b ilin g u al/b icu ltu ral curriculum , in-hom e an d group p aren tin g lessons, in d iv id u al and fam ily counseling sessions, an d other supportive services such as 114 inform ation on form al education courses an d em ploym ent opportunities. Furtherm ore, researchers (e.g., N evid & Javier, 1992; C ostantino, M algady, & Rogler, 1986) have indicated that presen tin g inform ation in the form of "novelas" (i.e., soap operas) and "cuentos" (i.e., story telling) m ay be an effective w ay of presenting a w ide range of possible situations an d behaviors to L atino p articipants as a m eans of generating discussion and exploration of sensitive topics. Finally, sexual abuse prevention p rogram s need to be delivered by individuals w ho are culturally sensitive, an d w ho are accepted and tru sted by the Latino com m unity (M illan & Rabiner, 1992). The stu d y of child sexual abuse perpetrators is another area of research th at m ay have a significant im pact on w hich elem ents should be included in sexual abuse p rim ary prevention program s. Elliott, Brow ne, and Kilcoyne (1995) interview ed 91 child sex offenders about the m ethods they em ployed to target children for victim ization. T hrough these interview s, the authors com piled dozens of suggestions m ade b y perpetrators that m ay be im portant factors to consider w hen developing sexual abuse preventive program s. Finally, R osenberg and R eppucci (1985) suggested th at com m unity-w ide m edia cam paigns m ay also play a crucial role in the p rim ary prevention of child abuse. These authors stressed that offering crisis services as an integral p a rt of such a m edia cam paign in the form of telephone h o t lines m ay give parents an d other 115 individuals th at are u n d er stress valuable inform ation and options p rio r to com m itting acts of m altreatm ent against children. Researchers (e.g., G arbarino & K ostelny, 1994; R osenberg & Reppucci, 1985) have long advocated the targeting of high-risk groups for the prevention of child abuse. These secondary prevention efforts target families and other groups that by virtue of psychological vulnerabilities a n d /o r environm ental factors are at higher jeopardy than other groups of abusing children. U nfortunately, existing research indicates th at conventional socioeconom ic and dem ographic risk factors are less salient for child sexual abuse than for other form s of child m altreatm ent such as physical abuse an d neglect (G arbarino & K ostelny, 1994). In addition, variables related to fam ily com m unication account for significantly less of the variance in sexual abuse (M elton, 1992). H ow ever, K aufm an and Zigler (1992) indicated th at there is som e evidence th a t suggests th at children living w ithin certain fam ily structures do experience increased prevalence rates of child sexual abuse. These environm ents include single-parent fam ilies, step- fam ilies, an d children of teen m others. The authors suggested that an alternative to universal p rim ary prevention program s m ay be the targeting of these at-risk groups for intervention. In addition, these researchers indicated th at given th at m any children are sexually exploited by neighbors, strangers, and relatives w hile their parents are at w ork, the expansion of extended after-school program s staffed b y trained professionals an d paraprofessionals w ould be an alternative m ethod of decreasing the risk of child sexual abuse. 116 The m ajority of child sexual abuse prevention program s have im plicitly or otherw ise im plied th at children and adolescents are responsible for preventing their ow n sexual victim ization. These program s are often based on the concept th at y o u th can learn strategies th at w ill discourage offenders, even though it is recognized th at adults have the ability to m anipulate an d physically overpow er children and adolescents. Society m u st take responsibility for the protection of its children, an d m ake efforts at keeping adults' behaviors w ith y o u th w ithin suitable b o u n d s (K aufm an & Zigler, 1992). Legislation. In recent years, a grow ing num ber of states have enacted new an d innovative law s aim ed at protecting children from convicted sex offenders. This legislation can be g ro u p ed into three areas: (1) law s th at require sex offenders to register w ith law enforcem ent agencies; (2) law s authorizing public notification w hen a convicted sex offender m oves into a com m unity; an d (3) legislation th at perm its the involuntary incarceration of violent sexual p red ato rs even after these individuals have served their crim inal sentences (M yers, 1996). The pu rp o se of these law s is to increase com m unity aw areness regarding the w hereabouts of convicted sex offenders, and in som e cases to ensure th at sexual p red ato rs never have access to children. Prelim inary research has indicated th at although public notification of sex offenders living in a com m unity has n o t app eared to low er recidivism , sexual offenders w ho particip ated in com m unity notification program s w ere arrested for n ew sexual crim es m uch m ore quickly than sexual 117 offenders w ho w ere released w ith o u t public notification (W ashington State Institute for Public Policy, 1995). There are those (e.g., Freem an-Longo, 1996) w ho contend that these law s violate the constitutional rights of convicted sex offenders, their fam ilies, and in som e cases the rights of sexual abuse victim s an d their families. In addition, this type of legislation m ay have little effect on the actions of sex offenders w ho have not been convicted of a sexual offense. N evertheless, these law s are an indication th at som e legislators, no d o u b t due in p art to the p ro d d in g of the constituencies that they represent, are finally taking som e assertive steps to address the issue of child sexual abuse th ro u g h legislation. Investigation and Prosecution. The organizational m odel of a law enforcem ent agency w ill determ ine how various reported crim es are addressed. H u m p h rey s (1996) com pared tw o different m odels of police intervention in child sexual abuse cases in N ew South W ales, A ustralia. The researcher com pared a "fragm ented" police child m istreatm ent u n it w ith a "closed" police child m istreatm ent unit. The "fragm ented" u n it w as com posed of police officers th at w o u ld interview child w itnesses of child sexual abuse crim es, an d then refer the case to a generalist detective to com plete the investigation. The "closed" u n it consisted of officers actively involved in child abuse prevention program s and training. These officers interview ed child w itnesses of child sexual abuse crim es, an d carried out the full investigation w ithin their ranks. H u m p h rey s found th at significantly m ore child victim s of sexual 118 abuse w ere interview ed by the "closed" m istreatm ent u n it than the "fragm ented" police unit. In addition, significantly m ore alleged p erp etrato rs of child sexual abuse w ere interview ed by the "closed" un it th an the "fragm ented" police unit. Finally, d u rin g the period of the study, 52 percent of the alleged perpetrators in the "closed" police unit's child sexual abuse cases w ere prosecuted, com pared to the 24 percent of alleged p erpetrators that w ere prosecuted as a result of the "fragm ented" police unit's investigations. The researcher rep o rted th at of the parents of the sexually abused children th at agreed to be interview ed as p art of the research study, all p aren ts w ho h ad experienced the "closed" u n it reported that they w ere satisfied w ith the police response they experienced. In contrast, no p aren t interview ed from the "fragmented " police unit sam ple m ade any positive rem arks regarding their experience of the police response they encountered. The response of law enforcem ent agencies to reported cases of child sexual abuse is a critical factor in the fight to elim inate or substantially reduce sexual crim es against children an d adolescents. The effective, assertive, and com passionate investigation an d prosecution of child sexual abuse cases m ay have the effect of having m ore victim s of sexual abuse com e forw ard to the authorities, and serve as a strong w arning to individuals that p rey sexually on youth that their sexual crim es w ill not go u n p u n ish e d . C om m unity Response. Effective sexual abuse prevention and the prosecution of individuals th at sexually abuse children 119 d em an d s the cooperation of m any facets of a com m unity, including: parents, educators, school boards, churches, com m unity leaders, legislators, com m unity m ental health providers, law enforcem ent, an d private therapists. It m u st be u n d ersto o d th at once adolescents are encouraged to dialog about sexual abuse, those w ho have been sexually victim ized w ill often need to have access to quality and low -cost therapeutic services in the form of counseling groups, in d iv id u al therapy, self-help groups, etc. Ideally, therapists w ith expertise in the area of sexual abuse w o u ld provide counseling services in schools, churches and other com m unity locations already frequented by victim s of sexual abuse and their families. This accom m odation w o u ld m axim ize the possibility th at they w ill receive the expert m ental health treatm ent they need for pro p er healing. Professionals in fields th at have contact w ith adolescents n eed to becom e w ell aw are of the behavioral and em otional sym ptom s of child sexual abuse. F urtherm ore, these professionals need to becom e com fortable discussing sexual abuse issues w ith adolescents, an d routinely ask adolescents w ho are dem onstrating sym ptom s of sexual abuse if they currently are or have been victim s of sexual abuse. The m ere fact th at an ad u lt has show n genuine concern b y asking questions to rule out sexual abuse w ill serve notice to the adolescent th at there is at least one individual w ho is concerned about h is /h e r w elfare. Im plem entation of a w ide ranging plan to p rev en t child sexual abuse, and the offering of therapeutic services to all victim s 120 of sexual abuse w ho require such services w o u ld be a vast dep artu re from society's current view of the child sexual abuse issue. The research on the prevalence and effects of child sexual abuse suggests th at this issue has reached epidem ic proportions. U nfortunately, society has refused to accept this view , and continues to offer m eager resources an d solutions to m eet this crisis. F uture Research R ace/E thnicity and G ender as Risk Factors. G iven the substantial interest that has been generated over the issue of child sexual abuse in the general p o pulation an d am ong researchers over the last several years, it is surprising and som ew hat alarm ing how little research has been conducted on ethnic m inority individuals w ho have been victim s sexual victim ization. Sim ilar to other areas of inquiry, m ost studies on child sexual abuse are conducted w ith W hite subjects. A lthough the m ajority of researchers are careful to note th at the findings obtained w ith W hite subjects should not be generalized to m inority populations, research em ploying ethnic m inority subjects to substantiate or negate findings from these studies often never takes place. M ost researchers w ould steadfastly claim th at they lim it their investigations to issues of im portance. U nfortunately, m ost researchers exam ine areas of concern w hile ignoring large portions of the population that are affected by these issues. The K ercher and M cShane (1984) stu d y review ed earlier and the cu rren t stu d y have indicated th at fem ale H ispanics m ay be m ore at risk for child sexual abuse th an other groups. The results of 121 these tw o studies form the foundation for an area of inquiry that needs to fully investigated. Prevalence research needs to be conducted to ascertain w hether the results of these studies w as caused by sam pling error, or if indeed H ispanic fem ales are m ore at risk than other groups of being sexually victim ized. The issue of gender as a risk factor of child sexual abuse needs further exploration in order to conclusively determ ine w hether or not the experience of m ale victim s of child sexual abuse substantially differs from the experience of fem ale victim s. A lthough the current stu d y found no significant gender by sexual abuse interaction effect, m ore research is needed in this area. F urtherm ore, as m ore and m ore research is conducted w ith m ale victim s of child sexual abuse, w e m ay gain u n d erstan d in g not only of the effects of child sexual abuse on m ales and how they coincide and differ from the experience of fem ale victim s, b u t also gain insight on the gender of the perpetrators of sexual abuse. N ot long ago, the p red o m in an t im pression w as that the great m ajority of child sexual abuse w as p erp etrated by males. The results of this stu d y and others review ed in this p aper (e.g., F rom uth & Burkhart, 1989; M endel, 1995) clearly indicate that the num bers of fem ale perpetrators of sexual abuse— especially w hen boys are the targets of abuse— are m uch higher than previously im agined. D evelopm ent of Test Instrum ents. A lthough the TSI d em o n strated m arginally acceptable levels of reliability and predictive ability in the current study, continued research is w arran ted in order to develop the TSI's utility w ith adolescent 122 sam ples. F urtherm ore, although the current findings are encouraging, m uch m ore d ata is needed in order th at norm s m ay be developed for various groups (e.g., clinical an d nonclinical adolescents, Flispanics, fem ales, etc.). This norm ative d ata is essential if the TSI is to be developed into a useful clinical in stru m en t for adolescents. A dditionally, future research is needed to assess w hether or not extrem e scores on the A typical R esponse an d R esponse Level scales indicate an invalid protocol, sim ilar to the validity scales on the MMPI-2. Finally, other form s of validity (e.g., concurrent validity) need to be established for this m easure. The CMIS— SF p ro v ed reasonably effective in classifying adolescent subjects into sexually abused and nonabused categories in the current study, b u t as noted earlier, several key changes in the form at of this m easure could significantly im prove its utility w ith adolescent sam ples. Furtherm ore, efforts at establishing the reliability and validity of this survey are needed to justify its use in child sexual abuse research. C um ulative Effects of C hildhood T raum a. The plethora of m edia attention and research on child sexual abuse in recent years has heightened the aw areness of clinicians an d the general po p u latio n regarding the effects an d treatm ent of sexual • victim ization. U nfortunately, other form s of childhood traum a have n o t received the sam e level of scrutiny. D espite a grow ing aw areness on the p a rt of clinicians about the possible negative effects experienced by children from natural disasters, poverty, exposure to neighborhood violence, physical and m ental abuse, and 123 institutional racism , few studies have addressed the cum ulative effects of childhood traum a on psychological functioning. This is one factor th at m akes it very difficult to predict sexual abuse history, for exam ple, from an in stru m en t such as the TSI. Individuals w ho have n o t been sexually abused m ay score high on the TSI because of a childhood trau m a th at is unrelated to sexual abuse. In addition, research is need ed to discover w hether certain types of childhood traum a are m ore prone to negative effects than other form s of childhood traum a. Furtherm ore, m ore research is required to determ ine w hether or n o t individuals that experience num erous types of traum atic events are m ore em otionally at risk than individuals w ho have experienced few er form s of traum atic life events. U n iv ersity /S eco n d ary School P artnerships. There is a dearth of research on nonclinical adolescents across a w ide range of topics (including child sexual abuse) and relatively few universities are attem pting to em ploy adolescents from h ig h school settings as subjects in their research projects. This u nfortunate situation deprives researchers access to a large pool of nonclinical adolescent subjects, and denies high school districts valuable inform ation about their clients th at w o u ld assist them in p ro v id in g m eaningful program s for students. A dditionally, the lack of research on nonclinical adolescents lim its our u n d erstan d in g of one of the m ost tu rb u len t an d critical stages of h u m an developm ent. U niversities should p rom ote m utually advantages p artn ersh ip s w ith high school districts th at encourage trusting relationships based on the 124 strong com m itm ent an d sincere desire of both groups to better u n d ersta n d an d m eet the needs of adolescents. These p artn ersh ip s w o u ld be an opportunity for universities to m ove aw ay from em ploying sam ples of convenience in their research projects— such as m iddle to u p p er-m id d le class W hite college stu d en ts— an d p ro v id e high school districts w ith a valuable ally in their efforts to m eet the educational and em otional needs of students. C onclusion C hild sexual abuse research is a very im portant area of study. Each year m illions of children in this country are sexually victim ized, an d as a result m any experience the negative im pacts th a t have been w ell docum ented by research. Research efforts need to be expan d ed to include ethnic m inorities, m ales, an d nonclinical adolescents. F urtherm ore, there is a need for research th at attem pts to identify individuals w ho have been victim s of child sexual abuse, b u t w ho have not com e fo rw ard to receive therapeutic interventions th a t m ay decrease the negative im pacts of sexual victim ization. W ithout such studies, researchers and society in general w ill never fully u n d erstan d the w id esp read negative im pacts of child sexual abuse. 125 References A lexander, P. C., & Lupfer, S. L. (1987). Fam ily characteristics and long-term consequences associated w ith sexual abuse. A rchives of Sexual Behavior. 16. 235-245. A m erican Psychiatric A ssociation. (1994). 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Journal of Interpersonal Violence. 9. 291- 306. 144 Appendix A: Parent Consent— English Form Dear Parent/Guardian: My name is David Munoz, and I am a doctoral candidate at the University of Southern California. I am conducting a research project a t ___________ High School in order to complete my Ph.D. in Counseling Psychology. I have worked for t h e _______________ High School District as a school psychologist for ten years, and I am currently assigned t o ________ a n d _________ High Schools. I am requesting that you allow your son or daughter to participate in my study. Your authorization will give your student the unique opportunity of being involved in a research project. My study involves having junior and senior students a t ________ High School fill-out two surveys that ask explicit questions related to fam ily life, adolescent sexual concerns, family violence, traumatic experiences, and other areas of concern to adolescents. Your student's participation will require approximately 20 minutes of class time. Your student's teacher will n o t penalize him/her for taking class time to participate in this research project. To protect your student's identity, all of his/her answers will be anonymous. Your student's name will not appear in any research paper or document. Under no circumstances will your student's responses be made available to any individual, school, or agency. Participation in this research project is voluntary. If at any time before or during the study you or your son or daughter should wish to revoke consent and end participation in the study, this can be done without any explanation to the researcher and without any penalty to your student. The purpose of this research project is to broaden the validity of the measures used in this study and to increase our knowledge base regarding high school students. The information gained through this research project will provide educators with a more accurate understanding of adolescents, provide for more meaningful teacher inservice training, identify student concerns that may affect classroom performance, and identify areas of student need that are not addressed adequately by the school system at this time. Although the survey items address sensitive issues, a highly respected team of researchers at the University of Southern California has reviewed this study's procedures and instruments and found the potential risks to students participating in this research project to be minimal. Some students may experience a degree of emotional upset from addressing sensitive life issues. At the conclusion of students' participation in this research project, they will be given an information sheet listing both individuals they can speak to and reading materials they can consult if they feel further exploration of issues 145 discussed in the surveys is warranted. All materials used in this study are available for parents/guardians to review by contacting David Munoz at (909) You are encouraged to attend one of two parent information meetings to be held at 7:00 P.M. on Thursday, March 30, 1995, and 7.00 P.M. on Tuesday, April 4, 1995 in t h e __________High School library. During these meetings parents will have an opportunity to meet with the researcher, discuss the research study, and review the materials to be used in the research project. If you have questions regarding this research project but are unable to attend one of the parent meetings, please feel free to contact David Munoz at (9 0 9 )__________ . On the University of Southern California campus, there is a committee known as the Institutional Review Board to which any questions or concerns can and should be addressed regarding this study. This board can be reached at USC Admin. 300, MC 4019, University Park, L.A., CA, 90089-4019, or at (213) 740- 6711. Your signature below indicates that you have read this form, that you understand it, and that you agree that your son or daughter may participate in this study. Guardian's Signature_______________________________________Date_________ Student's Name (Please print)______________________________ Grade. Relationship to Student_______________________ Telephone #_______ Individuals interested in obtaining information regarding the results of this study should contact David Munoz at (9 0 9 )____________ during the Fall, 1995 semester. PLEASE RETURN THIS FORM TO DAVID MUNOZ. ONTARIO. CA 91761. AS SOON AS POSSIBLE IN THE STAMPED AND ADDRESSED ENVELOPE PROVIDED. Thank you for you time and your consideration. David T. Munoz, M.S. School Psychologist Michael Newcomb, Ph.D. Professor/D issertation Committee Chairperson, Division of Counseling Psychology 146 Appendix B: Parent Consent— Spanish Form Estimados Padres/Guardianes: Mi nombre es David Munoz y soy candidato a! doctorado de la Universidad del Sur de California (USC). Estoy conduciendo un proyecto de investigacion en la Escuela S ecundaria________ para completar mi doctorado en psicologfa. He trabajado como psicologo en el distrito escolar d e __________por diez ahos y ûltimamente estoy asignado a las escuelas secundarias d e __________ y de Por medio de esta carta estoy pidiendo su permiso para que su hijo/a participe en mi investigacion. Su autorizaciôn le darâ a su estudiante la oportunidad de ser parte de un proyecto investigatorio. Mi estudio requiere que estudiantes de tercer y cuarto ano de la Escuela Secudaria __________ completen dos cuestionarios que hacen preguntas explicitas relacionadas a la vida fam iliar, preocupaciones sexuales de adolescentes, violencia familiar, experiencias traumâticas, y otras areas que preocupan a los adolescentes. La participaciôn de su estudiante requiere aproximadamente veinte minutes de tiempo escolar. La maestra/o no catigara a su estudiante por tomar tiempo de sus lecciones para participar con este proyecto de investigacion. Todas las respuestas a los cuestionarios serân anonimas para protejer a los estudiantes. El nombre de su estudiante no aparecera en ningun reporte de investigacion o documente. Ninguna persona, escuela o agenda trendrà accesso a las respuestas de su estudiante. La participaciôn en este proyecto es voluntaria. Si en cualquier tiempo usted y su hijo/a desean revocar su consentimiento y participaciôn en el estudio, podran hacerlo sin dar ninguna explicaciôn al investigador y sin que su estudiante sea perjudicado. El propôsito de esta investigaciôn es para ampliar la validez de las medidas que se usàn en este estudio y para aumentar nuestra base de conocimiento respeto a los estudiantes de escuela secundaria. La informaciôn obtenida por medio de la investigaciôn proveera a educadores un entendimiento mas acertado ace rca de los adolescentes, proveera entrenamiento mas significâtivo para los maestros, identificarâ problèmes que pueden afectar el comportamiento escolar de los estudiantes, y identificarâ las areas de servicios estudiantiles que no se estân tratando adecuadamente en el sistema escolar. Aunque las preguntas del cuestionario tratan temas delicados, un equipo muy respetable de investigadores de la Universidad de Sur de California (USC) ha revisado los procedimientos e instrumentos de este estudio, y ha determinado que los riesgos potenciales a los estudiantes son minimos. Algunos estudiantes pueden experimenter un poco de molestia emocional al tratar temas delicados. A la conclusiôn de su participaciôn en este proyecto, se les darâ informaciôn 147 ace rca de personas con las que pueden hablar y materiales que pueden leer y consulter para obtener mas informaciôn ace rca de los temas discutidos en los cuestionarios. Todos los materiales usados en este estudio pueden ser revisados por los padres/guardianes. Si desea revisarlos puede ponerse en contacte con el senor David Munoz al siguiente numéro: (9 0 9 )____________. Los padres estan invitados a aslstir una de dos juntas informativas que se llevarân acabo el jueves, 30 de marzo, y martes, el 4 de abril a las siete de la noche en la biblioteca de la Escuela S ecundaria________ . Durante estas juntas, los padres tendrân la oportunidad de conocer al investigador, discutir el estudio , y repasar los materiales que se usarân en el proyecto de investigaciôn. Si tiene preguntas ace rca del proyecto y no puede asistir a la reuniôn, por favor ponganse en contacte con David Munoz al siguiente numéro: (909) _________ . En la Universidad del Sur de California (USC) bay un comité que se conoce como la Mesa de Repaso Institucional a donde se pueden y deben dirigir preguntas ace rca de este proyecto. Se puede comunicar con este comité en la la siguiente direcciôn: USC Administration 300, MC 4019, University Park, L.A., CA 90089- 4019. O pueden llamara al siguiente numéro: (213) 740-6711. Su firma indica que usted ha lefdo y ha comprendido esta forma y que esta de acuerdo en que participe su hijo/a en este proyecto. Firma de Padre o Guardian________________________________ Fecha_____ Nombre del Estudiante____________________________________ Grado. (en letras de molde, por favor) Relaciôn al estudiante_____________________________ Teléfono____ Personas interesados en obtener informaciôn acerca de los resultados del estudio deben ponerse en contacte con David Muhoz al siguiente numéro: (909) ___________. durante el semestre del otoho de 1995. POR FAVOR DEVUELVA ESTA FORMA A DAVID MUNOZ. ONTARIO. CA 91761. LO MAS PRONTO POSIBLE EN EL SOBRE INCLUIDO. Gracias por su atenciôn y consideraciôn. David Muhoz, M.S. Psicôlogo Escolar Michael Newcomb, Ph.D. Profesor, Moderador del Comité del Disertaciôn, Ramo de Psicologfa 148 Appendix C: Verbal Instructions to Subjects You are involved in an important research project being conducted jointly by the high school district and the University of Southern California. This study is an attempt to gain information about high school students in order to provide educators with a more accurate understanding of adolescents, to provide for more meaningful teacher training, to identify students' concerns that may effect classroom performance, and to identify areas of student need that are not adequately addressed by the school system at this time. Inside this packet that 1 will soon be handing out to you there are two surveys. These surveys ask about things that may have happened to you in the past or that you are currently experiencing. These surveys ask many personal questions about you, your family, and others that you have come into contact with. Your answers to the items on these surveys will be anonymous. This means that your responses to the items on the surveys can not be linked to you. 1 hope to get your frank and honest answers to these items. If you should choose to give up your anonymity and disclose to myself or any school official any intention to hurt yourself or others, or disclose to me or any school official a personal instance of child abuse, such a disclosure by law will be reported to the appropriate agency, and if necessary to your parents. Are there any questions? Your participation in this study is voluntary, and if at any time before or during the study you wish to end your participation, you may do so without any explanation to me, and without any penalty to yourself. Please read each item carefully, and answer each item fully. In addition, please do not discuss this study with any other students. It is very important that you keep your answers to the survey items to yourself, and that you do not discuss the contents of the surveys with other students. Thank you very much for your participation and your cooperation in this research project. 149 A ppendix D: Student Consent Form Dear Student: My name is David Munoz, and I am a doctoral candidate at the University of Southern California. I am conducting a research project a t __________ High School in order to complete my Ph.D. in Counseling Psychology. My study involves having junior and senior students at _________ High School fill-out two surveys that ask specific questions related to family life, human sexuality, domestic violence, relationships, and other areas of concern to adolescents. Your participation will require approximately 20 minutes. Your teacher will not penalize you for participating in this project during class time. The purpose of this study is to gain information about high school students in order to provide educators with a more accurate understanding of adolescents, to provide for more m eaningful teacher inservice training, to identify student concerns that may affect classroom perform ance, and to identify areas of student need that are not adequately addressed by the school system at this time. To protect your identity, all of your answers will be anonymous. This means that your responses to items on the surveys can not be linked to you. Under no circumstances will your responses be made available to any individual, school, or agency, unless you choose to v e rb a lly notify the researcher that you were or are a victim of child abuse or that you are a lethal threat to yourself or others. In such cases, the appropriate authorities will be informed, and in most cases your parents will be notified. Participation in this research project is voluntary. If at any time before or during the study you should wish to end your participation in the study, this can be done w ithout explanation to the researcher, and without penalty to you. 150 The potential risks to you from participating in this study are minimal. Some students may experience a degree of emotional upset from answering questions that address sensitive life issues. When you have completed the surveys you will be given an information sheet listing both individuals you can speak to and reading materials you can consult if you feel further exploration of issues discussed in the surveys is warranted. If you have any questions or concerns regarding this study you can and should speak to Mrs. ________________, Assistant Principal of Guidance a t ___________High School. In addition, you can contact me directly at ( 2 1 3 ) _________ , e x t . or Your signature below indicates that you have read this form, that you understand it, and that you agree to participate in this study. S ig n a tu re ________________________________________D ate_________ Student's Name (Please print)_______________________________ Thank you for you time and your consideration. David T. Muhoz, M.S. School Psychologist Michael Newcomb, Ph.D. P rofessor/D issertation Com m ittee Chairperson, Division of Counseling Psychology 151 Appendix E: Subject Resource Sheet RESOURCES ORGANIZATIONS/COUNSELING AGENCIES Child Abuse Hotline for Los Angeles Countv. 1-800-540-4000. This toll-free 800 number allows any individual to report a "suspected" incident of child abuse without the toll-free number appearing on his/her phone bill. Family Service of Whittier. 7702 Washington Avenue, Suite C, Whittier, CA 90601, (310) 698-7941. This counseling agency provides individual counseling services to people 18 years and older. Fees are based on an individual's ability to pay. Intercommunity Child Guidance Center. 8106 8. Broadway, Whittier, CA 90606, (310) 692-0383. This agency provides individual counseling services to children and adolescents through age 18. F ees are based on an individual’ s ability to pay. Individuals who have been victims of physical and/or sexual abuse may qualify for free counseling services under a program called "Sensitive Services.” P r o |e c t S IS T E R . P.O. Box 621, Claremont, CA 91711, (909) 626-HELP (626-4357). This program offers com prehensive services to male and female adults, adolescents, and children who have been sexually assaulted. These services include information about: the reporting of sexual abuse; short-term and long term counseling for survivors of sexual abuse; and support groups that em phasize the sexual-assault healing process. Services are free or based on an individual’s ability to pay. If an individual is unable to take advantage of the services provided at Project SISTER headquarters, the caller will be directed to low-cost and/or free counseling services available in the caller's area of residence. RAINN fRape. Abuse, and Incest National Network). Washington, D.C., 1-800-656-HOPE. This is new non-profit organization that connects the caller to one of 506 counseling centers throughout the nation. This toll-free 800 number allows a survivor of abuse the opportunity to obtain information about various forms of abuse and/or counseling services without the toll-free number appearing on his/her phone bill. The caller is referred to low-cost or free counseling services available in his/her area of residence. BOOKS THAT ARE AVAILABLE THROUGH YOUR GUIDANCE COUNSELOR AT WHITTIER HIGH SCHOOL AND IN LOCAL BOOKSTORES Adult Children of Abusive Parents, by Steven Farmer, Ballantine Books, New York, NY, 1989. This book describes a healing program for those who have been physically, sexually, or emotionally abused. Banished Knowledge, by Alice Miller, Anchor Books, New York, NY, 1990. This is sensitive and compassionate book about how and why our society continues to destroy the human spirit of children through various forms of abuse. Beginning to Heal, by Ellen Bass and Laura Davis, Harper Perennial, New York, NY, 1993. A first book for survivors of child sexual abuse. The Courage to Heal: A Guide for Women Survivors of Sexual Abuse, by Ellen B ass and Laura Davis, Harper & Row, New York, NY, 1988. This book explores all aspects of the healing process. Although directed to female survivors, you will find that it speaks directly and profoundly to male survivors of sexual abuse. How Long Does It Hurt?, by Cynthia Mather and Kristina Debye, Jossey-B ass, San Francisco, CA, 1994. This is a guide to recovering from incest and sexual abuse for teenagers, their friends, and their families. Victims No Longer, by Mike Lew, Harper Collins, New York, NY, 1990. This book explores the issues surrounding men recovering from incest and other sexual child abuse. 152 Appendix F: Child Maltreatment Interview Scale-Short Form Childhood Maltreatment Interview Schedule — Short Form (REVISED) OMIS - SF(R) John Briere, Ph.D. Department of Psychiatry University of Southern California School of Medicine 1991 Adapted from the full OMIS, published as an appendix in J. Briere (in press), Child Abuse Trauma: Theorv and Treatment of the Lastino Effects. Newbury Park, CA: Sage Publications. 153 Age:_____ Grade:______ Sex: Male Female_____ Race: Caucasian/W hite Black Asian_____ Hispanic Other_____ Are you currently receiving or have you ever received counseling or psychiatric treatm ent? Yes No_____ The follow ing survey asks about things that may have happened to you In the past, or that you are currently experiencing. Please answer all of the questions that you can as honestly as possible. 1) Have any of your parents, step-parents, or foster-parents ever had problems with drugs or alcohol that lead to medical problems, divorce or separation, being fired from work, or being arrested for Intoxication In public or while driving? Yes No_____ If yes, whom? (Please check all that apply.) Mother Father Step-m other S tep-father ______Foster-m other Foster-father About how old were you when it started? years old About how old were you when it stopped? years old [Check here if it hasn't stopped yet.. ] GO TO NEXT PAGE 154 2) Have you ever seen one of your parents hit or beat up your other p arent? Yes No_____ If yes, how many times can you recall this happening? tim es Has your father ever hit your mother? Yes No_____ Has your mother ever hit your father? Yes No_____ About how old were you when it started? years old About how old were you when it stopped? years old [Check here if it hasn't stopped yet. J Has one or more of these times resulted in someone needing medical care or the police being called? Yes No_____ 3) On average, before aae 8. how much did you fee! that your fa th e r/s te p -fa th e r/fo s te r-fa th e r loved and cared about you? Not at all Very much 1 2 3 4 4) On average, before age 8 . how much did you feel that your m o th e r/s te p -m o th e r/fo s te r-m o th e r loved and cared about you? Not at all Very much 1 2 3 4 5) On average, from age 8 through age 16. how much did you feel that your fa th e r /s te p -fa th e r /fo s te r -fa th e r loved and cared about you? Not at all Very much 1 2 3 4 GO TO NEXT PAGE 155 6) On average, from aae 8 through aae 16. how much did you feel that your m o th e r/s te p -m o th e r/fo s te r-m o th e r loved and cared about you? Not at all 1 Very much 4 7) When you were 16 or younger, how often did the following happen to you in the average vear? Answer for your parents or step-parents or foster parents or other adult In charge of you as a child: Once Tw ice 3 -5 6 -1 0 11-20 Over 20 a a tim es tim es tim es tim es Never year year a year a year a year a y < A) Yell at you 0 1 2 3 4 5 6 B) Insult you 0 1 2 3 4 5 6 0) Criticize you 0 1 2 3 4 5 6 D) Try to make you feel guilty 0 1 2 3 4 5 6 E) Ridicule or humiliate you 0 1 2 3 4 5 6 F) Embarrass you in front of others 0 1 2 3 4 5 6 G) Make you feel like you were a bad person 0 1 2 3 4 5 6 GO TO NEXT PAGE 156 8) Has a parent, step-parent, foster-parent, or other adult In charge of you as a child ever done something to you on purpose (for example, hit or punch or cut you, or push you down) that made you bleed or gave you bruises or scratches, or that broke bones or teeth? Yes No_____ If yes, who did this? (Please check all that apply.) Mother Father Step-m other S tep-father ______Foster-m other ______Foster-father Other (Please indicate relationship to you. How often did this happen before age 17? times How old were you the first time? years How old were you the last time (before age 17)? years Were you ever hurt so badly that you had to see a doctor or go to the hospital? Yes No_____ At what ages did this occur? (_ GO TO NEXT PAGE 157 9) Has anyone ever kissed you in a sexual way, or touched your body In a sexual way, or made you touch their sexual parts? Yes No_____ Did this ever happen with a family member? Yes No____ If yes, with whom? (Please check all that apply.) ______ M other/step-m other/foster-m other ______ F a th e r/ste p -fa th e r/fo ste r-fa th e r Brother .Sister .Grandfather Grandmother Uncle Aunt .Male cousin Female cousin Other (Please specify individual's gender and relationship to you. __________________) At what ages did this occur? (___________________ ) Did this ever happen with someone 5 or more vears older than you were at the time? Yes No_____ If yes, with whom? (Please check all that apply.) A female friend (at what ages______________ ) A male friend (at what ages______________ ) A female stranger (at what ages______________ ) A male stranger (at what ages______________ ) GO TO NEXT PAGE 158 _A family member (Please check all that apply.) ______Mot her/step-m ot her/foster-m other ______ F a th e r/ste p -fa th e r/fo ste r-fa th e r Brother Sister .Grandfather Grandmother _Uncle Aunt .Male cousin Female cousin _Other (Please specify individual's gender and relationship to you. ____________________ ) At what ages did this occur? (_____________ ) _A teacher, doctor, or other professional (Please specify individual's gender and profession _______________ ) At what ages did this occur? (___________________ ) ______ A babysitter or nanny (Please specify individual's gender____________ ) At what ages did this occur? (___________________ ) ______ Someone else not mentioned above (Please specify individual's gender and relationship to you.________________________ ) At what ages did this occur? (__________________) Did anyone ever use physical force on any of these occasions? Yes No_____ If yes, whom? (Please specify individual's gender and relationship to you.__________________________ ) GO TO NEXT PAGE 159 At what ages did this occur? (__________________\ Overall, about how many times were you kissed or touched in a sexual way or made to touch someone else's sexual parts bv someone five or more vears older than you before age 17? tim es Overall, how many people (five or more years older than you) did this? people 10) To the best of your knowledge, before age 17, have you ever been: A) Sexually abused? Yes No_____ B) Phvsicallv abused? Yes No. GO TO NEXT PAGE 160 Please answer the following questions only If you are 17 years old or older. 11) Since age 17, have you experienced any of the following? A) Rape or sexual assault? Yes No_____ If yes, how old were you the last time it happened? years old B) Being beaten or hit or battered in a sexual or romantic relationship? Yes No_____ If yes, how old were you the last time it happened? years old C) Physically attacked or assaulted by someone who wasn't a sex partner? Yes No_____ If yes, how old were you the last time it happened? years old D) Involved in an auto accident, fire, earthquake, or other event that caused you to fear for your life and/or to be physically injured? Yes No_____ If yes, how old were you the last time it happened? years old E) Being present when someone else was assaulted, injured, or killed? Yes No_____ If yes, how old were you the last time it happened? years old STOP. PLEASE CHECK TO MAKE SURE YOU ANSWERED ALL ITEMS, PLACE YOUR SURVEYS INTO THE LARGE ENVELOPE, THEN GIVE THE LARGE ENVELOPE TO THE EXAMINER. THANK YOU FOR YOU COOPERATION AND EFFORT. 161 Appendix G: The Trauma Symptom Inventory T S I Trauma Symptom Inventory John Briere, Ph.D. DIRECTIONS: Please indicate how often each of the foiiowing experiences have happened to in the iast six months. Reproduced by special permission of the Publisher, Psychological A ssessm ent R esources, Inc., 16204 North Florida Avenue, Lutz, Florida 33549, from the Trauma Symptom Inventory by John Briere, Ph.D., copyright 1991, 1992, by PAR, Inc. Further reproduction is prohibited without permission of PAR, Inc. 162 1. Heart pounding or beating too fast...................... 2. Nightmares or bad dreams........................................ 3. Trying to forget about a bad time in your life. 4. Unwanted sexual thoughts.......................................... 8. Feeling em pty in side............................................................................... 9. S a d n e s s............................................................................................................... 1 0 . "Flashbacks" (sudden m em ories or images of upsetting th in g s ).................................................................................................................. 11. Not being able to say "no" when someone wanted to have sex with you, but you didn't want sex................................................. 1 2 . Feeling like you were outside of your body............................... 13. Lower back p ain........................................................................................ 14. Sudden disturbing memories when you were not expecting th e m ....................................................................................................................... 1 5 . W anting to c ry .................................................................................. 1 6 . Bad feelings about sex.......................................................................... 1 7 . Not feeling happy..................................................................................... 1 8 . Becoming angry for little or no reason........................................ 19. Feeling like you don't know who you really are........................ 2 0 . Feeling d epressed ...................................................................................... 2 1 . Being bothered by m em ories.............................................................. 24. Your mind going blank. Never 0 1 2 Often 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 GO TO NEXT PAGE 163 26. Not enjoying things you used to enjoy. 32. Feeling g u ilty ................................................. 33. Feeling tense or "on edge"................. 34. Getting into trouble because of sex. 35. Not feeling like your real self.......... 38. Not being sure of what you want in life. 41. Starting argum ents or picking fights to get your anger o u t.......................................................................................................................... 42. Suddenly feeling afraid for little or no reason............... .......... 43. Having sex or being sexual to keep from feeling lonely or sa d ......................................................................................................................... 45. Not being able to feel your emotions. 46. Confusion about your sexual feelings. 47. Using drugs other than m arijuana...... 48. Feeling ju m p y.................................................... 50. Feeling paralyzed for minutes at a tim e....... 51. Needing other people to tell you what to do. N ever 0 1 2 Often 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 GO TO NEXT PAGE 164 N ever 52. Yelling or telling people off when you felt you shouldn't h ave....................................................................................................................... 0 53. Flirting or "coming on" to someone to get attention..................... 0 54. Sexual thoughts or feelings when you thought you shouldn't have th e m ....................................................................................................... 0 55. Intentionally hurting yourself (for example, by scratching, cutting, or burning) even though you weren't trying to com m it s u ic id e ............................................................................................. 0 56. Aches and pains....................................................................................... 0 57. Having a feeling that something bad was about to happen 0 58. Sexual fantasies about being dominated or overpowered 0 59. High anxiety................................................................................................. 0 60. W ishing you had more money.............................................................. 0 61. N erv o u s n e s s ..................................................................................................... 0 62. Getting confused about what you thought or believed................ 0 63. Avoiding things that you knew would upset you..................... . 0 6 4 . Feeling tired................................................................................................. 0 6 5 . Feeling mad or angry inside............................................................ 0 66. Getting into trouble because of your drinking......................... 0 6 7 . Staying away from certain people or places because they reminded you of something................................................................ 0 68. One side of your body going numb................................................ 0 6 9 . Wishing you could stop thinking about sex............................... 0 7 0 . Suddenly remembering something upsetting from your past.. 0 7 1 . Wanting to hit someone or something......................................... 0 7 2 . Feeling hopeless........................................................................................ 0 7 3 . Hearing someone talk to you who wasn't really there............. 0 7 4 . Suddenly being reminded of something bad................................ 0 GO TO NEXT PAGE Often 3 3 165 76. Sudden feelings of anger........................... 77. Trying to block out certain memories. 78. S exual p ro blem s............................................... 80. V iolent dream s. 82. Just for a moment, seeing or hearing something upsetting that happened earlier in your life................................................. 84. Frightening or upsetting thoughts popping into your mind. .. 86. Wanting to have sex with someone who you knew was bad for y o u .......................................................................................................................... 87. Feeling down and unhappy................................................................. 0 88. Feeling ashamed about your sexual feelings or behavior. .. 89. Trying to keep from being alone................................................ 90. Losing your sense of taste............................................................ 92. Having the same (or nearly the same) bad dream over and over a g a in ....................................................................................................... 93. Your feelings or thoughts changing when you were with other p e o p le................................................................................................... 94. Worrying that someone is trying to steal your ideas.............. 95. Taking drugs or alcohol to stop your feelings............................ 0 96. Not letting yourself feel bad about the past.......................... 97. Feeling like things weren't real................................................. N ever 0 1 2 Often 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 GO TO NEXT PAGE 166 Never Often 99. Not eating or sleeping for two or more days............................. 0 1 2 3 100. Drinking or taking drugs to stop certain thoughts or memories............................................................................................................ 0 1 2 3 101. Trying not to have any feelings about something that once hurt you........................................................................................................... 0 1 2 3 102. Painful and disturbing memories 0 1 2 3 103. Daydreaming................................................................................................... 0 1 2 3 104. Trying not to think or talk about things in your life that were painful.................................................................................................. 0 1 2 3 105. Feeling like life wasn't worth living............................................ 0 1 2 3 106. Being startled or frightened by sudden noises.......................... 0 1 2 3 107. Seeing people from the spirit world............................................. 0 1 2 3 108. Trouble controlling your temper.................................................... 0 1 2 3 109. Being easily influenced by others................................................. 0 1 2 3 110. Wishing you didn't have any sexual feelings............................ 0 1 2 3 111. Wanting to set fire to a public building...................................... 0 1 2 3 112. Feeling afraid you might die or be injured............................... 0 1 2 3 113. Feeling so depressed that you avoided people............................ 0 1 2 3 114. Thinking that someone was reading your mind.......................... 0 1 2 3 115. Feeling worthless 0 1 2 3 167 T S I Scoring Sheet Critical items are Directions: Sum individual items to form scale scores interpreted individually. Client Name:___________________________________ Validity Scales Clinical Scales A typical Response Response Level Anxious Arousal A ng er/ Ir r it a b ilit y Defensive Avoidance Depression Dissociation 25 5 27 5 3 9 12 50 7 33 18 6 15 24 68 9 37 40 28 20 31 73 13 48 41 67 36 35 90 17 59 44 77 72 45 94 33 61 52 96 105 49 99 37 106 65 101 113 97 107 56 112 71 104 115 98 1 1 1 60 108 103 114 64 Sum Sum Sum Sum Sum Sum Sum Critical Item s Dysfunctional Sexual B ehavior In tru s iv e Experiences Im paired S elf Reference Sexual Concerns Tension Reduction Behavior 23 22 2 8 46 30 30 34 1 0 19 54 41 34 43 14 29 69 43 36 53 70 38 78 52 47 79 74 51 88 53 55 81 80 62 11 0 55 58 83 82 85 79 66 86 84 93 89 105 109 Sum Sum Sum Sum Sum

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Creator Munoz, David Thomas (author)

Core Title Child sexual abuse in a sample of male and female Hispanic and White nonclinical adolescents: Extending the reliability and validity of the Trauma Symptom Inventory (TSI)

Contributor Digitized by ProQuest (provenance)

Degree Doctor of Philosophy

Degree Program Counseling Psychology

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,Psychology,Social Sciences

Language English

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c30-327818

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University of Southern California Dissertations and Theses