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University of Southern California Dissertations and Theses
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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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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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INFORM ATION TO USERS
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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)
by
David Thomas Munoz
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree of
DOCTOR OF PHILOSOPHY
(Counseling Psychology)
August 1996
Copyright 1996 David Thomas Munoz
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UMI Number: 9705149
UMI Microform 9705149
Copyright 1996, by UMI Company. All rights reserved.
This microform edition is protected against unauthorized
copying under Title 17, United States Code.
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UNIVERSITY OF SOUTHERN CALIFORNIA
THE GRADUATE SCHOOL
UNIVERSITY PARK
LOS ANGELES, CALIFORNIA 90007
This dissertation, written by
under the direction of h i . ? ....... 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
David Thomas Mufioz
Dean o f Graduate Studies
DISSERTATION COMMITTEE
Chairperson
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Dedication
/
't can be said that on any long journey only one can truly be
at your side. God has blessed me with Victoria, and I thank
God for Victoria.
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Acknowledgment
T
mrust in the Lord with all your heart and lean not
on your own understanding; in all your ways
acknowledge him, and he will make your paths
straight" (Proverbs 3:5-6).
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Table of Contents
List of Tables.................................................................................... v
List of Figures................................................................................... vii
Abstract............................................................................................ viii
Chapter I: Introduction and Literature Review.............................. 1
Chapter U; Method.......................................................................... 42
Chapter HI: Results......................................................................... 55
Chapter IV: Discussion.................................................................... 94
References........................................................................................ 125
Appendix A: Parent Consent— English Form................................. 144
Appendix B : Parent Consent— Spanish Form................................ 146
Appendix C: Verbal Instructions to Subjects................................. 148
Appendix D: Student Consent Form.............................................. 149
Appendix E: Subject Resource Sheet.............................................. 151
Appendix F: Child Maltreatment Interview Scale— Short Form... 152
Appendix G: The Trauma Synptom Inventory............................. 161
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V
List of Tables
Tables
1. Demographic Characteristics............................................... 45
2. Reliability Analysis: Cronbach's Index of Internal
Consistency........................................................................... 56
3. F Tests of Sexually Abused and Inconsistent Group Scores
on Each Dependent Variable................................................. 59
4. F Tests of Nonabused and Inconsistent Group Scores on
Each Dependent Variable...................................................... 60
5. Subjects Self-Identified as Victims of Child Sexual Abuse,
Grouped by Gender, Race/Ethnicity, and
Ethnicity/Gender................................................................. 66
6. Identity and Gender of Perpetrator...................................... 67
7. Number of Perpetrators........................................................ 70
8. Bartlett Univariate Homogeneity of Variance Tests of
Dependent Variables............................................................ 71
9. F Tests on Each Dependent Variable by Sexual Abuse
History, Race/Ethnicity, and Gender................................... 73
10. F Tests on Each Dependent Variable by Sexual Abuse
History and Gender.............................................................. 74
11. F Tests on Each Dependent Variable by Sexual Abuse
History and Race/Ethnicity.................................................. 75
12. F Tests on Each Dependent Variable by Race/Ethnicity
and Gender........................................................................... 76
13. F Tests of Hispanic Students and White Students Scores
on Each Dependent Variable................................................ 78
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vi
Tables
14. F Tests of Male and Female Scores on Each Dependent
Variable................................................................................. 80
15. F Tests of Male and Female Scores on Each Dependent
Variable with Sexual Abuse History as a Covariate 81
16. F Tests of Sexually Abused and Nonabused Group Scores
on Each Dependent Variable................................................. 85
17. F Tests on Sexually Abused and Nonabused Subjects'
Means on Each Dependent Variable, Grouped by All
Subjects, Gender, Race/Ethnicity, and Race/Ethnicity by
Gender................................................................................... 86
18. ANOVA/ANCOVA: F Tests for TSI-Total Score................ 89
19. Predictive Ability of the TSI on Various Groups of
Subjects: E)iscriminant Analysis Results.............................. 90
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List of Figures
Figures
1. Means of the Sexually Abused Group, the Inconsistent
Group, and the Nonabused Group across the dependent
variables................................................................................ 57
2. Means of nonabused subjects and subjects inconsistently
reporting child sexual abuse across the dependent
variables................................................................................ 61
3. Subjects self-identified as victims of child sexual abuse,
grouped by ethnicity/gender................................................ 65
4. Subjects self-identified as victims of child sexual abuse,
grouped by gender of perpetrator......................................... 68
5. Means of Hispanic and White subjects across the
dependent variables............................................................... 79
6. Means of male and female subjects across the dependent
variables................................................................................ 82
7. Means of sexually abused subjects and nonabused
subjects across the dependent variables............................... 84
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viii
Abstract
This study was designed to extend the reliability and validity
of the Trauma Symptom Inventory (TSI) to nonclinical male and
female adolescents. Through the use of a self-report instrument, a
sample of 223 predominately Hispanic and White 16 to 19 year old
high school students was identified as either victims of child sexual
abuse or as nonabused. Reliability analyses on the twelve scales of
the TSI revealed a mean alpha of .82, and predictive validity was
demonstrated at a marginally acceptable level when the TSI was
found to accurately classify sexually abused and nonabused
subjects in 69.1 percent of the cases. Across all of the dependent
variables, subjects who inconsistently reported on the self-report
measure that they had been sexually abused were found to be
similar to subjects who consistently reported that they had been
sexually abused. Hispanic females reported being victims of child
sexual abuse at significantly higher rates than their Hispanic male
or White peers. While female victims of child sexual abuse
identified male perpetrators in 91.9 percent of cases, male victims of
child sexual abuse identified female perpetrators in 52.9 percent of
cases. The hypothesis that sexually abused adolescents
significantly differ from their nonabused peers on all dependent
variables was supported by the results. Multivariate analysis of
variance results indicated no significant overall differences on the
dependent variables between sexually abused males and females,
and no overall differences were found between sexually abused
Hispanic and White subjects. The findings as they relate to the
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hypotheses and other issues are discussed, implications for theory
and interventions are explored, and directions for future research
are addressed.
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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
community and the general public to the negative short and long
term impacts of sexual victimization, made significant
contributions to our understanding of child sexual abuse victims,
and has provided essential information on viable treatment
modalities for survivors. The preponderance of research has
focused on two major areas: (1) studies conducted with individuals
previously identified as victims of child sexual abuse; and (2)
research focusing on the identification of individuals that have been
victims of child sexual assault.
Research employing subjects previously identified as victims
of child sexual abuse has provided important information about the
impacts of sexual abuse on a variety of groups. This type of
research, however, has its limitations, for it generally employs
persons from clinical populations that have sought out, received, or
have been referred to the mental health system. It is well
documented that individuals that seek psychological treatment
experience more symptoms than individuals who do not access the
mental health system (Tsai, Feldman-Summers, & Edgar, 1979). It
is therefore difficult to generalize results obtained from research
employing clinical samples to the general population.
Child sexual abuse research that focuses on the identification
of individuals that have been sexually abused has contributed to
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2
our understanding of this issue in the ways mentioned above, and
these studies have generally employed individuals from nonclinical
populations. The use of nonclinical samples in the majority of this
research makes the findings of these studies more generalizable
than those studies that employ clinical samples only.
Peters, Wyatt, and Finkelhor (1986) conducted a wide 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 commented that while the lower 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
epidemic proportions. One of the major reasons for the wide
discrepancy in the child sexual abuse rates reported above is related
to the various methods employed to identify individuals that have
been sexually abused. Not only have the researchers in this field
failed to agree on such fundamental issues such as the definition of
child sexual abuse, but there has also been little agreement on
which measures to use to identify sexual abuse victims (Briere,
1992b).
The measures used to differentiate individuals that have been
sexually abused from those who have not been sexually victimized
are the keys to research that focuses on identifying individuals that
have been victims of child sexual abuse. Without an accurate
means of differentiating these two groups, research is confounded,
as sexually abused individuals are designated to the nonabused
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3
group, and nonabused subjects are misidentified as victims of child
sexual abuse. Frequently, researchers have used measures with
unknown reliability and validity or generic measures that are
insensitive to sexual abuse-specific symptomatology to identify
individuals that have been victims of child sexual abuse (Briere,
1992a). Although there may never be a litmus-test measure
developed to identify those individuals that have been victims of
child sexual abuse, it is essential that measures with acceptable
reliability and validity that are sensitive to sexual abuse-specific
symptomatology be employed in child sexual abuse research.
Before these measures can be developed, it is imperative for
researchers to become well aquainted with the research on the long
term impacts of child sexual abuse. For instruments to be sensitive
to sexual abuse-specific symptomatology, their items must be
developed from the knowledge gained through long-term impact
studies.
The constraints on the generalization of results is a factor
facing all research, and has loomed large in child sexual abuse
research. Most long-term impact studies in this area have restricted
themselves to White female subjects. Although recent
investigations have included male subjects (e.g., Briere, Evans,
Runtz, & Wall, 1988; Mendel, 1995; Wellman, 1993) and other racial
and ethnic groups (e.g., Mennen, 1994; Wyatt, 1988; Wyatt,
Newcomb, & Riederle, 1993), the great majority of research has been
confined to one segment of the population, making the
generalizability of results problematic.
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4
The dearth of research in the area of sexual abuse history in
nonclinical adolescents— spedfically nonclinical ethnic minority
adolescents— and the impacts of child sexual abuse in this
population has led to the current study. It has never been
acceptable to infer the impacts of child sexual abuse on a wide
variety of racial, ethnic, and adolescent populations from the results
obtained from studies employing almost exclusively White female
or clinical samples. Making such inferences is not only
inappropriate but allows the scientific community to stop short in
its investigation of the impacts of child sexual abuse before
important questions are answered about other specific racial, ethnic,
and developmental age groups.
Chapter one of this paper has been divided into ten sections.
The first three sections discuss the long-term impacts of child
sexual abuse, the impacts of sexual abuse on children and
adolescents, and the methodological issues facing child sexual
abuse research. The next four sections present the statement of the
problem, the purpose of the study, the research questions, and the
hypotheses. Finally, the last three sections delineate the limits of the
study, definitions, and the outline of the remainder of the paper.
Long-Term Impacts of Child Sexual Abuse
Researchers have documented many long-term impacts
experienced by individuals who have been sexually abused as
children. These long-term impacts have been classified into two
major categories: (1) the psychological effects of child sexual abuse;
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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
shown that individuals sexually abused as children experience
symptoms of Posttraumatic Stress Disorder more often than
individuals who have not been sexually abused as children (Briere,
Cotman, Harris, & Smiljanich, 1992; Courtois, 1988; Meiselman,
1990; Rowan, Foy, Rodriguez, & Ryan, 1994). Furthermore, victims
of child sexual abuse are more likely to experience depression, fear
and anxiety, and sleep difficulties than individuals who have not
been victims of child sexual abuse (Bagley & Ramsay, 1986; Briere,
Evans, Runtz, & Wall, 1988; Briere & Runtz, 1989; Briere & Woo,
1991; Elliot & Briere, 1992; Gomes-Schwartz, Horowitz, & Cardelli,
1990; Koverola, Pound, Heger, & Lytle, 1993; Lanktree, Briere, &
Zaidi, 1991; Stein, Golding, Siegel, Bumam, & Sorenson, 1988).
Other 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 stigmatization, betrayal,
and powerlessness (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 environment and have a preoccupation with control (Briere,
1992a). Finally, researchers have indicated that childhood sexual
abuse predisposes individuals to dissociative experiences,
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6
Dissociative Amnesia, impaired self-reference, and the development
of Dissociative Identity Disorder (Atlas & Hiott, 1994; Briere, 1989a;
Briere & Conte, 1993; Briere & Runtz, 1987a, 1987b, 1988,1990; Cole
& Putnam, 1992; Chu & Dill, 1990; DiTomasso & Routh, 1993;
Herman & Schatzow, 1987; McCann & Pearlman, 1990; Putnam,
1993; Putnam, Guroff, Silberman, Barban, & Post, 1986; Ross et al.,
1990).
Dysfunctional Behaviors and Relationships. Dysfunctional
behaviors and relationships often receive more attention from
therapists and researchers than the psychological effects mentioned
above. Although these impacts are not necessarily more significant
than psychological internalized long-term effects, they are more
obvious and more often become the focus of the mental health and
criminal justice systems (Briere, 1992a). Researchers comparing
individuals who have been sexually abused with those who have
not been sexually assaulted have found significant differences
between the two 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 & Gabrielson-Cabush, 1990; Kendall-Tackett & Simon,
1988; Maltz & Holman, 1987; Runtz & Briere, 1988; Stein, Golding,
Siegel, Bumam, & Sorenson, 1988; Wyatt & Newcomb, 1990).
Studies have also indicated that individuals sexually abused as
children demonstrate age-inappropriate sexual awareness and
behavior, aggressive behavior, compulsive behaviors, and deficient
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7
affect regulation skills (Briere, 1992a; Friedrich, 1991,1993; Rokous,
Carter, & Prentky, 1988; Stukas-Davies, 1990). According to yet
another body of research, individuals who have been victims of
child sexual abuse are prone to engage in manipulation,
homosexual activity, substance abuse, prostitution, and self-
mutilation (Bagley & Young, 1987; Briere, 1992a; Briere, Henschel,
Smiljanich, & Morlan-Magallanes, 1990; Briere & Woo, 1991; Brown
& Anderson, 1991; Fromuth, 1986; Runtz & Briere, 1986; Shapiro,
1987; Singer, Petchers, & Hussey, 1989; van der Kolk, Perry, &
Herman, 1991). In addition, researchers have found that
individuals who were sexually abused as children are more
susceptible than those who were not to suiddality, codependence,
bulimia, revictimization, and Borderline Personality Disorder
(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, Lemer,
Garfinkel, Kennedy, & Brouillette, 1988; Root & Fallon, 1989; Steiger
& Zanko, 1990; Runtz, 1987; Russell, 1986).
Impacts of Child Sexual Abuse on Children and Adolescents
The majority of child sexual abuse research has relied on
clinical or college samples (Greenwald, Leitenberg, Cado, & Tarran,
1990). Clinical populations present two problems: (1) they
represent only a small segment of survivors of child sexual abuse;
and (2) survivors of child sexual abuse who seek therapy tend to
report more psychological symptoms than those who do not (Tsai,
Feldman-Summers, & Edgar, 1979). Child abuse studies with
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8
college students suffer from generalizability problems because they
represent narrow age ranges, limited radal and ethnic diversity,
and higher socioeconomic levels. In addition, many of these college
studies use a retrospective model that depends heavily on the
accuracy of subjects' memories, which are believed to have a high
degree of unreliability for information about childhood sexual
history (Briere, 1992b).
Although most of the child sexual abuse research has focused
on adult victims, a review of epidemiological studies suggests that
at least one in four girls and one in ten boys will be victims of sexual
abuse before age 18 (Finkelhor, 1993). While girls are significantly
more at risk than boys for sexual victimization, the discrepancy is
much less than previously thought (Finkelhor, 1993). Until recently,
the issue of the child sexual abuse of males has gone virtually
unrecognized by mental health professionals. A case study
published twenty years ago by Awad (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 wide range of
impacts experienced by children and adolescents who have been
sexually abused. The initial sections review developmental effects
of sexual abuse. Later sections explore impacts of child sexual
abuse by examining variables specific to child sexual abuse.
Preschool Children. In studies of preschoolers, researchers
look for sexual behaviors considered inappropriate for this age level.
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9
Mian, Wehrspann, Klajner-Diamond, LeBaron, and Winder (1986)
developed an operational definition of "sexualized" behavior that
included the sexual play with dolls, masturbation, seductive
behavior, and age-inappropriate sexual knowledge. This research
did not include a comparison group. However, a later study that
included both sexually abused and nonabused children determined
that inappropriate sexual behavior was considerably more
prevalent in sexually abused children (Goldston, Tumquist, &
Knutson, 1989). By using a variety of assessment tools such as the
Child Behavior Checklist (Friedrich, 1989), projective drawings
(Hibbard, Roghmann & Hoekelman, 1987), and observations of free
play with anatomically correct dolls (Boat & Everson, 1988),
researchers have identified the presence of inappropriate sexual
behaviors or sexual trauma. In addition, Fagot, Hagan,
Youngblade, and Potter (1989) found that preschoolers who had
experienced sexual abuse were more passive in free play than their
nonabused peers.
Many of the behaviors presented in this section vary widely
among children, and considerable caution needs to be exercised in
attempting to infer the occurrence or nonoccurrence of child sexual
abuse on the basis of sexualized behavior (Beitchman, Zucker,
Hood, da Costa, & Akman, 1991). Obviously, much more research
is needed in this area to further clarify the effects of sexual abuse on
preschool children.
School-Age Children. Research has indicated consistently
that when compared to their nonabused peers, adults who were
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10
sexually abused as children score higher on measures of anxiety
and depression and demonstrate lower self-esteem. The research
on children, however, has been less definitive along these
dimensions (Mennen & Meadow, 1994). Ratings by teachers and
parents on standardized questionnaires have indicated that
sexually abused school-age children have more behavioral and
emotional problems than their nonabused peers (Cohen &
Mannarino, 1988; Einbender & Friedrich, 1989). When sexually
abused children self-report on standardized measures of well
being, however, the results are equivocal (Cohen & Mannarino,
1988; Tong, Oates, & McDowell, 1987).
Research is also inconclusive on the question of whether
sexually abused school-age children are more or less emotionally
disturbed than other children who were referred for clinical
problems but had not suffered from sexual abuse (Cohen &
Mannarino, 1988; Goldston, Tumquist, & Knutson, 1989). Cohen
and Mannarino (1988) reported no significant differences when they
compared levels of depression and self-esteem of sexually abused
girls with those of their nonabused peers. In their study of sexually
abused and nonabused female children, Einbender and Friedrich
(1989) found no significant differences for depression. Contrary to
the Cohen and Mannarino (1988) findings, however, Einbender and
Friedrich (1989) found that the sexually abused group scored
significantly lower on a measure of self-esteem than nonabused
group.
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11
Koverola, Pound, Heger, 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 were
experiencing symptoms consistent with a diagnosis of depression.
McLeer, Deblinger, Atkins, Foa, and Ralphe (1988) found that the
majority of their sample of outpatient sexually victimized children
scored in the clinical range for depression. Lipovsky, Saunders, and
Murphy (1989) studied incest victims and their nonabused siblings.
Although the sexually abused subjects were significantly more
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 showed no significant difference in anxiety or self-esteem,
but both groups scored in the clinical range on a measure of self
esteem.
Gomes-Schwartz, Horowitz and Cardarelli (1990), comparing
subjects over age 6, found no differences in self-esteem between
sexually abused and nonabused children. Similarly, in a study
which compared sexually abused, physically abused, and
nonabused children, no differences were found among the groups
on self-esteem. More recently, Mennen and Meadow (1994)
administered measures of self-esteem, depression, and anxiety that
had been standardized on nonclinical samples to 83 sexually
abused children. The girls' scores were significantly different from
those of the standardized samples across all three measures:
anxiety and depression scores were high, while self-esteem scores
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12
were low. The male children's scores, however, on the three
measures did not differ significantly from the measures'
standardized samples.
Academic and behavioral problems are often associated with
school-age children who have been sexually abused (Tong, Oates, &
McDowell, 1987). Unfortunately, these studies do not include
clinical control groups; determining the extent to which problems
are a function of sexual abuse is, therefore, not possible from their
data (Beitchman, Zucker, Hood, da Costa, & Akman, 1991).
Moreover, children who are developmentally disabled, suffer from
learning disabilities, or who have low intelligence may have higher
risk of being sexually abused as children than regular education
students, making interpretation of their data regarding academic
and behavioral problems even less straightforward.1
Sexually abused school-age children appear to be more likely
than their nonabused and clinical peers to manifest inappropriate
sexual behaviors such as excessive masturbation, sexual
aggression, and sexual preoccupation (Deblinger, McLeer, Atkins,
Ralphe, & Foa, 1989; Einbender & Friedrich, 1989). Friedrich, Beilke,
and Urquiza (1988) conducted a study of 64 boys aged 3 to 8 years,
31 of whom had been sexually abused, and 33 of whom were
diagnosed as conduct disordered. The parents of these boys
completed the Child Behavior Checklist (CBCL), which is designed
to assess social competence, internalization, and extemalization.
The sexually abused boys were rated as significantly more
sexualized than their conduct-disordered counterparts, and were
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13
commonly rated as masturbating too much, being interested in
pornography, and reenacting their abuse with siblings. Sexualized
behavior appears to manifest itself in sexually abused children from
the preschool years to adolescence (Beitchman, Zucker, Hood, da
Costa, & Akman, 1991).
Adolescents. Several researchers investigating the
symptomatology of sexually abused adolescents have provided
clear evidence of depressive symptoms, low self-esteem, and
suicidal ideation and/or suicidal behavior in this population
(Gomes-Schwartz, Horowitz, & Sauzier, 1985; Sansonnet-Hayden,
Haley, Marriage, & Fine, 1987). Furthermore, Lindberg and Distad
(1985) reported that in a study of 27 adolescents with histories of
incest, one-third had attempted suicide and all of the subjects were
judged to have poor self-concepts.
"Acting-out" behaviors such as truancy, running away,
chemical abuse, and promiscuity have often been associated with
adolescents who have experienced sexual abuse (Gomes-Schwartz,
Horowitz, & Sauzier, 1985; Runtz & Briere, 1986; Sansonnet-
Hayden, Haley, Marriage, & Fine, 1987). However, some results in
these areas are conflicting. Goldston, Tumquist, and Knutson
(1989) reported only partial support for the acting-out theory of
sexual abuse. These researchers found that sexually abused
adolescents were runaways significantly more often than
nonabused control subjects, but drug abuse was more common
among the controls. Four other indices of acting-out behavior did
not differentiate the two groups. Burgess, Hartman, and
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14
McCormack (1987) studied sexually abused adolescents who had
been involved in sex rings; results indicated a higher incidence of
street drug use, compulsive masturbation, physical fights with
friends and family members, and delinquent behavior among the
sexually abused subjects than among the nonabused control
subjects. Briere (1984) has suggested that the self-destructive and
acting-out tendencies of adolescents who have been sexually
abused may be early signs of the developing Borderline Personality
Disorder.
Brooks (1985) compared 16 sexually abused adolescent
inpatients with nonabused psychiatric controls on the Brief
Symptom Inventory (BSI). Results indicated that 63 percent of the
sexually abused group showed significant elevations on the BSI
when compared to the nonabused controls. The profiles of the
sexually abused subjects with elevations indicated suicidal and
self-destructive ideation, depression, hostility, somatization, and
paranoid and psychotic indicators.
Atlas and Hiott (1994) studied 57 successive male and female
admissions into an acute adolescent inpatient unit. The authors
found that the adolescent inpatients with histories of either physical
or sexual abuse showed moderate to severe dissociation. In
addition, there was a trend toward higher dissociation in
adolescents who had been sexually abused.
Goldston, Tumquist, and Knutson (1989) examined sexual
behaviors of 195 girls aged 2 to 18 years who were consecutive
admissions to three mental health agencies. Sexually inappropriate
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15
behaviors as defined by the authors were found to be far more
prevalent in the sexually abused group than in the nonabused
control group.
Scott and Stone (1986) compared MMPI profiles of adult and
adolescent psychotherapy clients who had been subjected to father
figure-son incest as children. Results indicated that adults scored
significantly higher than adolescents on the depression scale, but
adolescents obtained significantly higher scores on the hypomania
scale. A hypomania scale elevation is indicative of elevated mood,
flight of ideas, excitability, brief periods of depression, and
purposeless behavior. Both groups showed clinical elevations on
the schizophrenia scale, which measures alienation and
withdrawal from interpersonal relationships.
Child sexual abuse may predispose survivors to gender
identify confusion and homosexuality (Beitchman, Zucker, Hood,
da Costa, & Akman, 1991). Sebold (1987) interviewed 22 therapists
who were counseling sexually abused boys. These therapists
reported that their clients had considerable preoccupation with
sexual identity issues, and that these were manifested as
homophobic concerns. Regarding such concerns, moreover,
Watkins and Bentovim (1992) have advised that a distinction must
be made between the fear of homosexuality and the development of
a homosexual preference.
Although Finkelhor (1984) noted that the belief that
molestation leads to a homosexual lifestyle is a myth, he did find
that boys victimized by older men were significantly more likely to
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16
engage in homosexual activity than nonabused boys. In addition,
Johnson and Shrier (1987) reported that among victims molested by
males, boys had a significantly greater probability of identifying
themselves as homosexual than girls.
Gender Differences. Little attention has been given to male
victims of child sexual abuse in the research literature, making
gender comparisons in this area difficult to accomplish. Young,
Bergandi, and Titus (1994) proposed two factors for the lack of
research on males abused as children: (1) the fact that the entire
domain of sexual abuse as an area of study evolved from the rape
model, where sexual abuse was conceptualized primarily as that of
a female victim and a male perpetrator; and (2) society's strongly
held reluctance to accept that males are vulnerable to sexual
victimization. Although a few child sexual abuse researchers (e.g.,
Briere, Evans, Runtz, & Wall, 1988, Hunter, 1991; Young, Bergandi,
& Titius, 1994) have looked specifically at the effects of gender, most
have relied on studies employing male and female adults who have
retrospectively reported that they had been sexually abused as
children. Additionally, some researchers (e.g., Briere, Evans, Runtz,
& Wall, 1988; Urquiza & Crowley, 1986; Young, Bergandi, & Titus,
1994) have reported finding no dear gender differences among
individuals who have been victims of child sexual abuse. However,
difficulties making gender comparisons aside, there is some
evidence that the long-term impacts of sexual abuse may be related
to the gender of the victim (Beitchman et al., 1992).
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17
In a study of psychology undergraduates with histories of
child sexual abuse, male subjects reported poor social adjustment at
a higher rate than female subjects (Seidner, Calhoun, & Kilpatrick,
1985). Hunter (1991) investigated a sample of adult male and
female individuals that had been sexually abused as children.
Although he reported there to be more similarities than differences
between male and female victims of child sexual abuse, some
differences were noted. Hunter reported that males demonstrated
more elevated levels of anxiety, worry, and rumination than
females, especially in identity related issues. In addition, female
victims showed more evidence of body image problems than their
male counterparts.
Pierce and Pierce (1985) examined referrals from a child
abuse hotline and found that force was significantly more common
among male victims of child sexual abuse than female victims. In
contrast, a national survey conducted by the Los Angeles Times of
2,626 American men and women over age 18 found that force was
used in fifteen percent of the sexual abuse incidents involving
males, and in nineteen percent of the sexual abuse incidents
involving females (Finkelhor, Hotaling, Lewis, and Smith, 1990).
The Los Angeles Times survey also indicated that males were
more likely than females never to have disclosed their child sexual
abuse to anyone. Ramsey-Klawsnik (1990) reached the same
conclusion and stated that the sexual abuse of males must be more
severe and obvious than cases involving females before protective
services will become involved. This argument is supported by
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18
Pierce and Pierce's (1985) finding that boys were removed from their
homes by protective services following the discovery of child sexual
abuse significantly less frequently than girls, despite the much
greater severity of the abuse endured by the boys.
Hunter, Goodwin, and Wilson (1992) conducted a study with
non-clinical male and female children, adolescents, and adults that
had been sexually abused as children. One of the areas explored by
these researchers was the influence of gender of victim on the level
and pattern of self-blame and molester-blame. Results indicated
that while an inverse relationship between self-blame and
molester-blame was found for females, males did not demonstrate
this inverse relationship. The researchers hypothesized that while
females make a relatively clear distinction between self-blame and
molester-blame, this distinction may not be as psychologically
discernible for males. It was hypothesized that males may
simultaneously internalize and externalize responsibility for their
sexual abuse victimizations. The researchers further suggested that
this lack of clarity regarding role boundaries in males is consistent
with clinical data that indicates that males identify with their
perpetrators. These findings are consistent with what Mendel
(1995) calls perhaps the single most prominent issue for the male
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, almost all of the participants
worried that they were fated to perpetuate the cycle of sexual abuse.
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19
The preponderance of research findings that have addressed
the gender of those individuals who perpetrate child sexual abuse
has indicated that male perpetrators overwhelmingly outnumber
female perpetrators (e.g., Finkelhor, Hotaling, Lewis, & Smith, 1990;
Russell, 1986; Spencer & Dunklee, 1986). Many of these studies
included few or no male victims. Furthermore, research that has
targeted the sexual victimization of male children and relied on
reported cases of child sexual abuse or were based upon
investigation of sexual abuse evaluations has indicated that the
overwhelming majority of perpetrators are male (Faller, 1987;
Reinhart, 1987; Spencer & Dunklee, 1986). However, research
employing male subjects and utilizing self-report measures reveals
a very different picture of the prevalence of female perpetration
(Mendel, 1995). Fritz, Stoll, & Wagner (1981) reported a female
perpetration rate of 60 percent in their sample of male college
students. In a clinical study of sexually abused men, Olson (1990)
noted that over 60 percent of the incest survivors had been sexually
abused by their mothers. In addition, in a study that employed a
clinical sample of 121 male survivors of sexual abuse, Mendel
(1995) reported that 46 percent of his sample had been sexually
victimized by female perpetrators. It appears that as more and
more quality research is accomplished in the area of sexual abuse
employing male as well as female subjects, a more accurate
understanding of male and female perpetration will emerge.
Racial/Ethnic Differences. Although an impressive amount
of research has been accomplished in the area of child sexual abuse,
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20
relatively few studies have focused on the radal/ethnic differences
that may exist among individuals that have been sexually abused.
In their extensive review of the long-term effects of child sexual
abuse, Beitman et al. (1992), did not discuss the radal/ethnic
differences as they pertain to the effects and/or prevalence rates of
child sexual abuse. Many studies do not even report the ethnic
breakdown of their samples (e.g., Briere & Runtz, 1989; Elliott, 1994;
Young, Bergandi, & Titus, 1994). Furthermore, what little research
that has been done in this area is often equivocal. And finally,
Wyatt (1990) reported that there has been even less child sexual
abuse research focusing on Native-American and Asian-American
samples than on African-American and Hispanic groups.
Wyatt, Newcomb, and Riederle (1993) conduded that the
prevalence of child sexual abuse is commensurate in White and
African-American females, but they went on to state that sexual
abuse research lacks "methodologically sound studies conducted
with community samples that are stratified by ethnidty" (p. 44).
Wyatt (1985) reported subtle differences between the circumstances
and characteristics of child sexual abuse experienced by White and
African-American females. She found that African-American
preteen females are more likely than their female White peers to
experience contact sexual abuse by male African-American
perpetrators who are members of the nudear or extended family. In
contrast, White females were more likely than their African-
American counterparts to encounter White male perpetrators who
involve them in noncontact sexual abuse outdoors or contact sexual
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21
abuse incidents indoors during the early childhood years. In
addition, African-American females were more likely than their
White female peers not to involve law enforcement when they were
sexually abused. These findings are similar to those reported in
Lindholm and Wiley's (1986) study of child abuse reports
accumulated by the Los Angeles County Sheriffs Department.
African-American female children were significantly less likely to
be reported as sexually abused than Hispanic or White girls.
In a community study, Russell (1986) found no differences in
child sexual abuse victimization rates among White, African-
American, and Hispanic women, but reported a lower rate among
Asian-American women. In contrast, in a postal questionnaire
study with over one thousand participants, Kercher and McShane
(1984) found that Hispanic females reported child sexual
victimization at twice the rate of White and African-American
females. In another community sample, however, the child sexual
abuse prevalence rate was found to be significantly higher for White
females than Hispanic females (Siegel, Sorenson, Golding, Bumam,
& Stein, 1987).
Research on the effects of child sexual abuse across
racial/ethnic groups has been minimal. Mennen (1994) studied the
symptoms of depression, anxiety, and self-concept in a sample of
Hispanic, African-American, and White sexually abused girls.
Symptom levels were found not to significantly differ across the
three racial/ethnic groups. In contrast, Russell (1986) found that
higher percentages of Hispanic women reported significant trauma
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22
as a result of their sexual victimization as compared to White,
Asian-American, and African-American women. It is clear that far
more research is needed to discover whether or not the ethnicity of
an individual is a mediating factor that influences the effects of
child sexual abuse.
Summary of Developmental and Abuse-Specific Research.
The majority of child sexual abuse research on children and
adolescents has been conducted with clinical samples; without
additional studies, the findings of child sexual abuse research using
clinical samples cannot be generalized to sexually abused children
in the general population. The research literature suggests that the
only common impact of sexual abuse across developmental levels is
sexualized behavior. Although sexualized behavior varies from
early childhood through adolescence, themes of sexual
preoccupation and seductive behavior have been found across
developmental levels.
The research is equivocal on whether child sexual abuse
results in emotional problems in children across developmental
levels. However, research on adolescents who have been sexually
abused provides the most consistent evidence that a history of
sexual abuse is correlated with higher levels of depression,
dissociation, hypomania, anxiety, and lower self-esteem. In
addition, research on adolescents has indicated that acting out in
the form of running away from home and confusion over gender
identity result from child sexual abuse.
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23
The limited amount of research on male victims of child
sexual abuse may make gender comparisons premature. Although
many of the findings are equivocal and there may be more
similarities than differences between male and female victims of
sexual abuse, there is some evidence that the long-term impacts of
child sexual abuse is related to the gender of the victim. Male
victims of sexual abuse have demonstrated higher levels of anxiety,
worry, rumination, and poor social adjustment than female victims.
Female victims may have more body image problems than their
male counterparts, and research has generally indicated that male
victims of sexual abuse tend to be less prone to disclose their sexual
victimization than their female peers. Furthermore, research has
indicated that although female victims make a relatively clear
distinction between self-blame and molester-blame, this distinction
may not be as psychologically discernible in male victims of sexual
abuse and lead to the phenomenon of male victims identifying with
their perpetrators. It has been hypothesized that the identification
of sexual abuse victims with their perpetrators may predispose
victims to perpetuate the cycle of sexual abuse. Finally, recent
research findings have indicated that female perpetration rates of
male victims may be much higher than reported in earlier studies of
child sexual abuse.
Most child sexual abuse research studies have failed to
adequately address whether or not radal/ethnic differences exist
among individuals that have been sexually abused. Quantity of
radal/ethnic research aside, as in much of the developmental and
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24
abuse-specific research reviewed above, a substantial amount of the
radal/ethnic research is equivocal. In general, research has
revealed commensurate prevalence rates of child sexual abuse in
White and African-American females, with only subtle differences
between these two radal groups in the circumstances and
characteristics of reported child sexual abuse. Research on the
effects of child sexual abuse across radal/ethnic groups has been
minimal and conflicting, with few studies employing African-
American and Hispanic subjects, and even fewer studies employing
such radal/ethnic groups as Asian-Americans and Native
Americans. Additionally, there have been very few studies that
have explored the prevalence and effects of child sexual abuse in
ethnic minority males. In view of the limitations of current
research, gender and race/ethnidty examined together or
separately, cannot be ruled out as important risk factors of child
sexual abuse (Wyatt, 1990)
Methodological Issues Facing Child Sexual Abuse Research
Serious methodological issues confront child sexual abuse
researchers. Among them are: (1) definitions; (2) identification of
survivors; (3) survivor repression and memory loss; (4)
identification of male survivors; and (5) approaches used to identify
impacts of child sexual abuse. These child sexual abuse research
issues must be addressed adequately if this area of study is going to
establish the foundation needed in order to provide reliable and
valid information that can be generalized to wide sections of the
affected population.
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25
Definitions. One of the main problems in the study of child
sexual abuse is the wide range of definitions used by various
researchers (Violato & Genius, 1993). In their reviews of child
sexual abuse research, Browne and Finkelhor (1986) and Beitchman
et al. (1992), noted that few studies employ congruous definitions of
what constitutes child sexual abuse. For example, Russell (1984)
defined sexual abuse as any unwanted sexual experience before age
14, the completed or attempted rape of an individual before age 17,
or any instance of incest before the victim turned 18. Briere and
Runtz (1988), on the other hand, restricted their definition of child
sexual abuse to actual sexual contact between an individual under
age 15 with another individual 5 or more years older. Some studies
(e.g., Fritz, Stoll, & Wagner, 1981) examined only adult perpetrators
and preadolescent male victims; while other studies have used age
limits variously set at 13,14, or 18 years in their definitions of child
sexual abuse (Mendel, 1995). Some definitions restrict child sexual
abuse to actual sexual contact, eliminating such noncontact forms
of sexual abuse as exhibitionism and exposure to pornography
(Briere, 1992). Definitions of what constitutes child sexual abuse are
almost as numerous as the researchers exploring this critical area.
Martin, Anderson, Romans, Mullen, & O'Shea (1993) indicated that
reliable data based on agreed-upon definitions are important in
order to add objectivity to our thinking in this area of study.
Furthermore, disparate definitions used in child sexual abuse
research have often made findings from various studies either
incomparable or contradictory (Violato & Genius, 1993).
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26
Identification of Survivors. Peters, Wyatt, and Finkelhor
(1986) reported that the number and types of questions which are
asked of subjects are related to successful identification of
individuals who have experienced child sexual abuse. Researchers
(e.g., Russell, 1983; Wyatt, 1985) who have identified child sexual
abuse cases by asking several specific descriptive questions about
many sexual areas have obtained higher identification rates than
researchers who have asked if subjects have been sexually abused in
only one or two vague questions (Bifulco, Brown, & Adler, 1991;
Mullen, Romans-Clarkson, Walton, & Herbison, 1988). Similarly,
relatively low identification rates were obtained when researchers
offered a definition of child sexual abuse and asked subjects if they
had ever experienced similar violations (Baker & Duncan, 1985;
Siegel, Sorenson, Golding, Burnham, & Stein, 1987).
Generally, sexual abuse research employing face-to-face
interviews has yielded higher identification rates than self
administered questionnaire research (Martin, Anderson, Romans,
Mullen, & O'Shea, 1993). Researchers have attributed the higher
rate from interviews to the opportunity afforded subjects to develop
rapport with the interviewer (Peters, Wyatt, & Finkelhor, 1986). The
lower rates obtained by self-administered questionnaire research,
however, may have more to do with the questions themselves than
the type of administration. For example, face-to-face interview
research relying on a single question about sexual abuse
experiences (Mullen, Romans-Clarkson, Walton, & Herbison, 1988;
Siegel, Sorenson, Golding, Burnham, & Stein, 1987) yielded lower
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27
identification rates than self-administered questionnaire research
asking many descriptive questions (Badgley et al., 1984; Fromuth,
1986). In addition, the anonymity afforded subjects in self
administered questionnaire research may encourage subjects to be
more forthcoming regarding their sexual histories than child sexual
abuse research that employs methodologies that require subjects to
give up anonymity when answering questions about their sexual
histories. In a study that employed both self-administered
questionnaires and face-to-face interviews, fifteen percent of
subjects who admitted being sexually victimized by a close family
member reported their sexual abuse only on the self-administered
questionnaire (Martin, Anderson, Romans, Mullen, & O'Shea, 1993).
In summary, child abuse research has suggested that the asking of
numerous descriptive questions, face-to-face interviews, and
affording subjects anonymity all play significant roles in the
identification of individuals that have experienced child sexual
abuse.
Survivor Repression and Memory Loss Issues. The
identification of persons who have experienced child sexual abuse
is affected by the tendency of some individuals to repress traumatic
experiences. Herman and Schatzow's (1987) study on repression
and sexual abuse in outpatient women found that 64 percent of the
subjects had experienced at least partial amnesia regarding their
sexual victimization at some point in their lives. In a nationwide
study of 420 females and 30 males who reported histories of child
sexual abuse and were in individual and group therapy, 59 percent
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28
of the subjects reported a time period before age 18 when 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 sample is dependent not only on
the accuracy and/or willingness of subjects to report child sexual
abuse memories, but on the awareness of such memories.
Identification of Male Survivors. Pierce and Pierce (1985)
concluded that the under-reporting of male child sexual abuse may
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
blame but themselves. Nasjleti (1980) indicated that male victims
tend to remain silent about their sexual victimization because
society does not permit males to express feelings of helplessness
and vulnerability. Additionally, Hunter (1990) asserted that the
stereotype that all sexually abused males become child molesters
inhibits sexually victimized males from disclosing their childhood
and adolescent histories of sexual abuse.
Some heterosexual males may believe that being sexually
abused by another male may have caused them to become latently
homosexual. Homosexual males who have been sexually abused
as children, on the other hand, may feel that their sexual orientation
caused them to be sexually victimized by men, or that their
victimization caused them to be homosexual (Briere, 1992a). These
conclusions often lead sexually abused males to develop feelings of
guilt, shame, and self-betrayal (Elliot & Briere, 1991a). Boys who
have suffered sexual abuse by adult women may also question their
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29
gender identity or orientation. Their male peers, adult males, and
the media often lead boys to believe that sex between boys and adult
women is or should be exciting, harmless, and glamorous. When
boys dislike or feel uncomfortable or feel victimized by their sexual
encounters with women, they are likely to question their sexual
orientation or their masculinity (Hunter, 1990).
Another issue that may influence the reporting of male child
sexual abuse is the growing debate on whether mother-son incest is
actually a rare occurrence or whether it is under-reported (Banning,
1989; Krug, 1989; Lawson, 1991,1993; Chasnoff et al., 1986; Russell,
1984). Although the majority of child sexual abuse research has
reported female perpetration rates of 5 to 15 percent (Bentovim,
Boston, & Van Elburg, 1987; Faller, 1989), a few studies have
reported rates of female sexual abuse of male children of 43 to 70
percent (Fritz, Stoll, & Wagner, 1981; Fromuth & Burkhart, 1989;
Mendel, 1995; McCarty, 1986; Olson, 1990; Ramsey-Klawsnik,
1990). Banning (1989) reported that the under-reporting of mother-
son incest is much like the difficulty Freud (1896/1962) had when
attempting to convince his colleagues at the turn of the century of
the possibility that father-daughter incest was at the foundation of
his female clients' neuroses. Freud's ideas in this area were so
unacceptable to the psychological community at the time that he
later revised his theory and stated that his patients were merely
reporting fantasies of being sexually abused by their fathers.
Banning also proposed that the failure to report mother-son incest is
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30
influenced to a great extent by society's unwillingness to believe that
women can commit such acts.
Watkins and Bentovim (1992) reported that, in contrast to the
growing amount of research about mother-son incest, relatively few
studies on father-son incest have been conducted. This is the case
even though fathers are dted as among the most frequent sexual
abusers of their sons (Faller, 1989; Vander Mey, 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 with the existence of homosexuality.
The sexual abuse of males must be vigorously pursued
through research. Hunter (1990) put it this way:
We can never significantly modify the way some men
view and treat women as long as we ignore the way
some women treat boys. Likewise, we can not expect to
have a society of gentle men who turn to other men for
support and nurturance as long as we tolerate men
abusing and neglecting boys. (p. 43)
Approaches Used to Identify the Impacts of Child Sexual
Abuse. Methodological problems with the measures used to
determine 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 multitude of negative long
term effects resulting from child sexual abuse, the measures used in
many of these studies have either been ad hoc instruments lacking
in reliability and/or validity, or measures that were not originally
developed with reference to sexual abuse. These measures are not
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31
sensitive to sexual abuse-specific symptomatology. Many
researchers (Berliner, 1987; Briere, 1987; Conte, 1987; Finkelhor,
1987) have focused on the need for the development of new
instruments that are sensitive to sexual abuse issues.
Impact measures of child sexual abuse may be divided into
two categories: (1) construct approaches, and (2) symptom
approaches (Elliott & Briere, 1991b). Construct approaches attempt
to link clinical phenomena already believed to exist in the general
population, such as "hysteria" or "anxiety," to child sexual abuse.
Elliott and Briere (1991b) point out that examining the relationship
between existing psychological disorders and childhood traumas
such as incest is valuable. However, the construct approach is
inadequate if the construct in question does not represent a real
phenomenon or if sexual abuse impacts do not match "the specific
pattern of disturbance associated with the construct in question" (p.
58). The symptom approach addresses only problems that are
reportable or observable, such as anger/irritability, depression,
dissociation, sexual concerns, and tension reduction behaviors.
This approach examines variations between sexually abused and
non-sexually abused individuals. Data obtained from self
administered questionnaires designed specifically to be sensitive to
sexual abuse issues supplement our understanding of the exact
form of sexual abuse-related symptomatology (Elliott & Briere,
1991b). The Trauma Symptom Checklist-40 (TSC-40; Elliott &
Briere, 1992), the Trauma Symptom Checklist for Children (TSC-C;
Briere, 1989b), and the Trauma Symptom Inventory (TSI; Briere,
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32
1991; Briere, Cotman, Harris, & Smiljanich, 1992) are self-
administered questionnaires developed to address the symptom
approach issues delineated above.
Statement of the Problem
Research employing a symptom approach that uses
instruments specifically designed to be sensitive to child sexual
abuse issues needs to investigate impacts of child sexual abuse in
nonclinical male and female adolescents drawn from a variety of
racial/ethnic backgrounds. The importance of such research lies in
its potential to raise society's level of awareness concerning the
depth and breadth of the child sexual abuse problem. Such research
will provide educators and community agencies with data they
need for developing and implementing programs vital to helping
adolescents who have been negatively affected by sexual
victimization.
Purpose of the Study
This study has three main purposes: (1) to identify
nonclinical adolescents who have been victimized by child sexual
abuse; (2) to gather data on the emotional impacts experienced by
nonclinical adolescents who have been sexually abused; and (3) to
determine whether an instrument that utilizes a symptom approach
to measure reportable and/or observable behaviors such as anxious
arousal, anger/irritability, defensive avoidance, depression,
dissociation, dysfunctional sexual behavior, intrusive experiences,
impaired self reference, sexual concerns, and tension reduction
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33
behavior can accurately differentiate between adolescents who have
been sexually abused and those who have not been sexually abused.
Research Questions
This research will answer the following questions:
1. To what extent will a series of items that ask direct
questions regarding child sexual abuse history and derived from an
instrument validated on adults be able to identify adolescents who
have experienced child sexual abuse?
More specifically:
a. Will a set of items derived from the Childhood
Maltreatment Study-Short Form (Briere, 1991b) successfully
identify adolescents who have been victims of child sexual abuse?
b. Will significant differences across the dependent
variables be discovered among 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 what extent will a symptom approach, self
administered questionnaire, specifically designed to be sensitive to
sexual abuse issues and normed on adults, identify sexual abuse
history in adolescents?
More specifically:
a. To what extent will the Trauma Symptom Inventory
(TSI) differentiate between adolescents who have been sexually
abused and adolescents who have not been sexually abused?
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34
b. Will each of the twelve subscales and the total score of
the TSI differentiate between adolescents who have been sexually
abused and adolescents who have not been sexually abused?
c. If the TSI differentiates individuals who have been
sexually abused from those who have not, will the differences be
merely statistical in nature or will they have clinical significance as
well?
3. Will one subscale or group of subscales of the Trauma
Symptom Inventory stand out as being significantly more accurate
in identifying sexual abuse history in adolescents than other
subscales?
More specifically:
a. Will the Dysfunctional Sexual Behavior and Sexual
Concerns subscales of the TSI be significantly more accurate than
the other subscales of the TSI in identifying sexual abuse history in
adolescents?
b. Will the TSI total score for each subject be the most
accurate means of identifying sexual abuse history in adolescents?
4. Will the Trauma Symptom Inventory identify the impacts
experienced by adolescents that have experienced child sexual
abuse?
More specifically:
a. Will the TSI identify a group of symptoms/behaviors
that differentiate adolescents who have been sexually abused from
adolescents who have not been sexually abused?
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35
b. Will the symptoms/behaviors found to differentiate
adolescents who have been sexually abused from adolescents who
have not differ in kind and/or in degree?
5. Will the scores obtained from the Trauma System
Inventory significantly vary across the demographic variables of
race/ethnicity, gender, and age?
More specifically:
a. Will the rate of female adolescents identified by the TSI
as victims of child sexual abuse differ significantly from the rate of
male adolescents identified as victims of sexual abuse?
b. Will female adolescents identified as survivors of child
sexual abuse differ significantly from male adolescents identified as
survivors of child sexual abuse on the dependent variables?
c. Will the rate of Hispanic adolescents identified by the
TSI as victims of child sexual abuse differ significantly from the rate
of White adolescents identified as victims of child sexual abuse?
d. Will Hispanic adolescents identified as survivors of
child sexual abuse differ significantly from Hispanic adolescents
identified as not having experienced child sexual abuse on the
dependent variables?
e. Will any significant trends emerge from the interactions
between sex and race/ethnicity across the dependent variables?
6. Will the Trauma Symptom Inventory be a sufficiently
reliable and valid instrument to be used in future child sexual abuse
research with adolescents?
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36
Hypotheses
Hypothesis 1: The Trauma Symptom Inventory will be found
to demonstrate sufficient reliability and validity to be used in future
child sexual abuse research on adolescents.
Hypothesis 2: The TSI will demonstrate clinical utility in
discriminating adolescents that have been sexually abused from
their nonabused peers.
Hypothesis 3: The Dysfunctional Sexual Behavior and Sexual
Concerns subscales of the TSI will be found to be significantly more
accurate than the other scales of the TSI in identifying sexual abuse
history.
Hypothesis 4: On the CMIS— SF, adolescents who
inconsistently reported that they had been sexually abused will not
differ significantly across all dependent variables from adolescents
who reported consistently that they had been sexually abused.
Hypothesis 5: No significant differences will be found across
the dependent variables between Hispanic adolescents and White
adolescents who have been sexually abused.
Hypothesis 6: No significant differences will be found across
the dependent variables between female and male adolescents who
have been sexually abused.
Hypothesis 7: Sexually-abused adolescents will differ
significantly from their nonabused peers across all dependent
variables.
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37
Limits to the Study
1. This study was restricted to 16 to 19-year-old male and
female students attending one suburban high school in Southern
California. The sample was predominately White and Hispanic
(87.9 percent). Additionally, information regarding the
socioeconomic levels of the subjects was not obtained. This sample
may or may not represent the general population of adolescents.
2. Participation in this study was voluntary and required
signed informed consent of both the subjects and the subjects' legal
guardians. These conditions may or may have not skewed the
sample represented in this study.
3. Anxious arousal, anger/irritability, defensive avoidance,
depression, dissociation, dysfunctional sexual behavior, intrusive
experiences, impaired self reference, sexual concerns, and tension
reduction behavior were tested with one instrument, The Trauma
Symptom Inventory.
4. The validity and reliability of the items taken from the
Child Maltreatment Study— Short Form (Briere, 1991b) have not been
demonstrated for adolescent groups.
5. The validity and reliability of the Trauma Symptom
Inventory (Briere, 1991, Briere, Cotman, Harris, & Smiljanich, 1992)
have not been demonstrated for adolescent groups.
Definitions
For the purpose of this study, the following terms were
defined as follows:
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38
Affect Regulation Skills. These abilities are sophisticated
methods of affect tolerance and modulation that are considerably
less maladaptive than other methods of dealing with anxiety, such
as tension-reduction activities (i.e., chemical abuse, indiscriminate
sex) and dissociation (Briere, 1992).
Child Sexual Abuse. The child sexual abuse definition used
in this study was derived from the Childhood Maltreatment
Interview Schedule— Short Form/Revised (Briere, 1991b). This
definition consists of the following elements:
1. Sexual contact between an adult and a child younger than
17 years of age. Sexual contact was defined as being kissed in a
sexual manner, being touched in a sexual manner, or being forced to
touch someone else's sexual parts.
2. Sexual contact between minors, when one individual is 5
years or more younger than the other individual. In this instance,
sexual contact was defined in the same manner as indicated in item
one above.
3. Forced sexual contact between a child younger than 17
years of age and another individual of any age.
Construct Approach. This is a method of research in the
study of the long-term effects of child sexual abuse. The construct
approach attempts to link abstract or vague clinical phenomena
already felt to exist in the general population, such as "hysteria" or
"anxiety", to child sexual abuse. This approach uses measures that
are not specifically designed to be sensitive to sexual abuse issues
(Elliott & Briere, 1991b).
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39
Dissociation. This condition is a disruption in the usually
integrated functions of consciousness, memory, identity, or
perception of the world. This disorder may be sudden or gradual,
temporary or chronic (American Psychiatric Association, 1994).
Dissociative Amnesia (formally Psychogenic Amnesia). The
essential feature of this disorder is an inability to recall important
personal data that is usually of a traumatic or stressful nature. The
symptoms cause clinically significant distress and/or impairment
in social, occupational, or other areas of functioning, and are not
due to the direct effects of a substance or a medical condition
(American Psychiatric Association, 1994).
Dissociative Identity Disorder (formally Multiple Personality
Disorder). The essential feature of this disorder is the presence of
two or more distinct identities or personality states that recurrently
take control of a person. The person is unable to remember
important personal information, the extent of which cannot be
explained by normal forgetfulness. Each personality state may have
its own distinct history, identity, and self-image (American
Psychiatric Association, 1994).
Impaired Self-Reference. Although 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). Stem (1985) defined the self as a distinct and
integrated aspect of an individual's personality. He described the
self as the "agent of actions, the experiencer of feelings, the maker of
intentions, the architect of plans" (pp. 5-6). Impaired self-reference
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40
refers to an individual who, due to severe early childhood trauma
and/or maltreatment, loses partial access to his or her sense of self
"whether or not she or he can refer to, and operates from, an internal
awareness of personal existence that is stable across contexts,
experiences, and affects" (Briere, 1992, p. 43).
Noncontact Child Sexual Abuse. Child sexual abuse between
an adult and a child that consists of exhibitionism, exposure to
pornographic material, etc. that does not involve a physical
interaction.
Posttraumatic Stress Disorder. The essential feature of this
disorder is the development of characteristic symptoms following
exposure to an extreme traumatic event that involves threatened
death or serious injury; or the witnessing of death, threatened death
or injury of a person; or learning about the unexpected death,
threatened death, or injury of a family member or close associate.
The person's response to the event must involve intense fear,
helplessness, and/or horror, a numbing of general responsiveness,
and the individual must undergo persistent reexperiendng of the
traumatic event (American Psychiatric Association, 1994).
Symptom Approach. This is a method of research in the
study of the long-term effects of child sexual abuse. The symptom
approach limits itself to problems that are reportable or observable,
such as posttraumatic stress, dissociation, sleeping disturbance,
anxiety, depression, and sexual concerns. This approach examines
variations between sexually abused and non-sexually abused
individuals. The actual data obtained from self-administered
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41
questionnaires specifically designed to be sensitive to sexual abuse
issues are used to supplement our understanding of the exact form
of sexual abuse-related symptomatology (Elliott & Briere, 1991b).
Outline of the Remainder of the Study
The remainder of this paper will follow the following
sequence. Chapter two presents information regarding the
community and school settings where the study took place,
demographic facts about the subjects, procedures used in data
collection, descriptions of the instruments 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 implications for theory
and intervention, and discusses implications for future research.
Footnote
1. The current author holds a credential in the State of
California as a school psychologist, and has worked extensively
with special education students during the past twelve years.
Clinical experience with this population has suggested that special
education students may be at higher risk for sexual victimization
than their regular education peers.
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42
Chapter I I : Method
This chapter presents information regarding the community
and school settings where the study took place, demographic facts
about the subjects, procedures used in data collection, descriptions
of the instruments used in the study, and a description of the
statistical techniques used in the analysis of the data.
Setting
The study took place in a city 15 miles east of Los Angeles,
California. This suburban community consisted of 80,600 people at
the time of the study, and its median household income is above the
median household income for Los Angeles County (Homor, 1995).
According to 1990 Federal Census Data, the ethnic composition of
this community is as follows: White - 34.4 percent, Hispanic - 39.0
percent, Asian-Americans - 3.3 percent, African-Americans - 1.3
percent, and Other - 22.0 percent (Homor, 1995). The study took
place in a comprehensive high school of 1,854 9th-12th grade
students, 14-19 years of age. The school's student population at the
time of the study was 71.1 percent Hispanic, 23.3 percent White, 2.3
percent Asian-American, 1.2 percent African-American, and 2.1
percent were designated as Other. School district statistics
indicated that 22 percent of the students at this school lived with
parent/guardians who were receiving Aid to Families with
Dependent Children (AFDC).
Subjects
Subjects for the study were drawn from a target group of 760
junior and senior students aged 16-19 attending the high school
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43
described above. The target group was represented by 53.8 percent
females, 46.2 percent males, 69.1 percent Hispanics, 25.4 percent
White students, 3 percent Asian-Americans, 1.1 percent African-
Americans, and 1.4 percent students identified as Other.
Parent informed-consent letters (see Appendix A) in English
were mailed home to the guardians of all of the students in the
target group. In addition, a Spanish translation of the parent
informed-consent letter (see Appendix B ) was mailed to the home of
each target group student with a Spanish surname. The parent
informed-consent letter detailed the general purposes of the study,
explained the possible risks to individuals who participated in the
study, emphasized that participation in the study was completely
voluntary, and included telephone numbers where the researcher
could be contacted to answer questions about the research. The
parent consent letter encouraged guardians to attend one of two
information meetings that the researcher planned as an opportunity
for guardians to clarify any concerns they might have about the
research project, and to give them the opportunity to study the
materials used in the study. Parent/guardians were asked to return
signed parent consent forms to the researcher in a stamped and
addressed envelope provided tc them by the researcher.
The researcher visited each junior and senior English class at
the target high school, and gave a series of five minute presentations
about the research project. At the conclusion of each presentation,
parent informed-consent letters were given to each student in either
English or Spanish depending on the preference of the individual
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44
students. The parent informed-consent letters distributed in the
junior and senior English classes were identical to the consent
letters mailed to the target subjects' homes, except, instead of asking
the guardian to mail the signed parent consent letter to the
researcher, the researcher requested signed letters to be returned
immediately to the high school. Distributing the parent informed-
consent letter twice, once through the mail, and once through the
classroom visitations mentioned above, was done in order to
maximize the sample size. A total of 226 (29.7 percent of the target
group) signed parent informed-consent letters were returned to the
researcher; those students for whom consent was given formed the
initial sample for the current study. The sample was reduced by
three subjects when prior to data collection, one student moved out
of the area, one parent rescinded consent, and one student requested
that she be excluded from the study.
The final sample of 223 16-19 year old students represented
29.3 percent of the target group, and included 145 (65 percent)
females, 78 (35 percent) males, 142 (63.7 percent) Hispanics, 54 (24.2
percent) White students, 6 (2.7 percent) Asian-Americans, 4 (1.8
percent) African-Americans, and 17 (7.6 percent) students identified
as Other. The mean age of the subjects was 17.2 years at the time
the study was conducted.
Table 1 contrasts the demographic characteristics of the target
school population with the demographic characteristics of the
study's sample. Significantly more female students than male
students volunteered to be subjects for this study than would have
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45
Table 1
Demographic Characteristics
Characteristic
Target
School
Population
N %
Sample
n %
Chi-Square
£
Females 409 53.8 145 65.0 Chi-Square (1, N = 760) = 15.96,
Males 351 46.2 78 35.0 £ < .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, M = 760) = .02,
12th Graders 340 44.7 100 44.8 £<90
Hispanics 516 67.9 142 63.7
Whites 201 26.4 54 24.2 Chi-Square (3, N = 749) = 2.90,
Asian-Americans 24 3.2 6 2.7 £ < .50
African-Americans 8 1.1 4 1.8
Other 11 1.4 17 7.6 See Note
Female Hispanics 284 39.6 96 49.0
Female Whites 109 15.2 32 16.3 Chi-Square (3, N = 717) = 12.69,
Male Hispanics 232 32.4 46 23.5 £ < .01
Male Whites 92 12.8 22 11.2
Note. More subjects identified themselves as "Other" than were indicated in school
records. Some subjects identified themselves as "Other" even though school records
had them registered as either White, Hispanic, Asian-American, or African-American,
n/a = not avalable.
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46
been expected given the gender make-up of the target school
population (chi-square [1, N = 760] = 15.96, p < .001). There were
no significant differences between the target population and the
sample in the number of eleventh and twelfth grade students (chi-
square [1, N = 760] = .02, p < .90), or in the number Hispanic, White,
Asian-American, or African-American students that participated in
the study (chi-square [3, n = 749] = 2.90, p < .50). However,
significantly more Hispanic females and significantly fewer
Hispanic males participated in his study than would have been
expected given the ethnic/gender make-up of the target school
population (chi-square [3, n = 717] = 12.69, p < .01). Finally, more
subjects identified their race/ethnicity as "Other" than were
indicated in the school records for the target population. Some
subjects identified themselves as "Other" even though school
records had them registered as either, African-American, Asian-
American, Hispanic, or White.
Procedure
In accordance with the high school's established procedures,
subjects were summoned individually out of their classes and
reported to an office in the school library. Subjects were informed
verbally regarding the following issues (see Appendix 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
anonymity of their responses to research items; and (4) the limits of
confidentiality. Subjects were asked to read the subject informed-
consent form (see Appendix D) that delineated all of the areas listed
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47
above, and included statements regarding the possible risks to
individuals who participated in the study, and information about
whom subjects could contact if they had questions about the study.
All 223 subjects agreed to participate in the study and signed
informed-consent forms.
Subjects were seated in a room or a private area isolated from
other individuals and given a packet containing two surveys.
Subjects were told to read the instructions for each survey carefully
and answer all items. Subjects were asked to place their completed
surveys in the provided unmarked 9 x 12 inch envelopes before
returning them to the researcher. These measures were taken for
two reasons: (1) to protect the anonymity and confidentiality of the
subjects' responses to the surveys; and (2) to comply with
California's suspected child abuse law which mandates the
reporting of all suspected cases of child abuse to law enforcement
and/or child welfare agencies. When subjects completed and
returned the research materials, the researcher gave them a resource
sheet (Appendix E) that listed the following: (1) the Los Angeles
County child abuse hotline telephone number; (2) local agencies
that provide low-cost counseling services for victims of child abuse;
and (3) reading references that focus on various aspects of child
abuse.
Instruments
Childhood Maltreatment Interview Schedule—Short Form
(CMIS—SF; Briere 1991a; Appendix F). This self-report
retrospective measure contains items that elicit information from
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48
the following areas: (1) demographic data such as age, race, and
gender; (2) mental health treatment history; (3) parental disorder; (4)
parental psychological availability; (5) psychological abuse; (6)
physical abuse; and (7) child sexual abuse. The author of this
measure does not offer reliability or validity information for the
CMIS—SF, but this measure gives subjects multiple opportunities to
disclose sexual abuse history through a series of descriptive
questions that probe child sexual abuse history. These descriptive
questions give the measure face validity. Peters, Wyatt, and
Finkelhor (1986) reported that the number and types of questions
asked subjects influence identification of individuals who have
experienced child sexual abuse. The CMIS—SF demographic
information and the child sexual abuse data were used in the
current study.
At the request of school district officials, certain sexual abuse
items on the CMIS—SF were modified, and other items were
eliminated completely. School officials believed that asking high
school students about specific sexual acts (e.g., anal intercourse,
placement of an object into the vagina) were not appropriate areas of
inquiry with adolescents. The measure's effectiveness at
discriminating between individuals sexually abused as children
from nonabused individuals may have been diminished with these
changes. The researcher, however, believed that even with these
modifications, the CMIS—SF would provide the information
needed to categorize subjects as former child sexual abuse victims
or as nonabused.
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49
Subjects were designated as victims of child sexual abuse if
their answers to the sexual abuse questions on the CMIS—SF
satisfied one or more of the following criteria: (1) sexual contact
between an adult and a child younger than 17 years of age (sexual
contact was defined as being kissed in a sexual manner, being
touched in a sexual manner, or being forced to touch someone else's
sexual parts); (2) sexual contact between minors, when one
individual is 5 years or more younger than the other individual; and
(3) forced sexual contact between 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 items that they had not been
sexually abused; (2) they responded consistently across all sexual
abuse items that they had been sexually abused; or (3) they reported
inconsistently across the sexual abuse items that they had been
sexually abused. In order to avoid misplacing subjects within the
child sexual abuse independent variable, three levels of child sexual
abuse history were formed that coincided with the response
patterns mentioned above.
Trauma Symptom Inventory (TSI; Briere, 1991, Briere,
Cotman, Harris, & Smiljanich, 1992; Appendix G). This self
administered instrument measures the possible outcomes of child
and adult traumas using a symptom approach that limits itself to
problems, feelings, or conditions that subjects can clearly describe
(for further discussion on the symptom approach, please see
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50
Chapter I). Items on this measure were derived from the knowledge
gained from research on the impacts of trauma on children and
adults.
The authors of the TSI divided childhood victimization into
two categories: interpersonal and non-interpersonal trauma.
Subjects were classified as having experienced childhood
interpersonal victimization 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 when the victim was 5 or more
years younger than the perpetrator). Childhood non-interpersonal
trauma was defined as individuals experiencing prior to age 17 an
accident or natural 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).
Adult victimization was also classified as either interpersonal
or non-interpersonal trauma. Adult interpersonal trauma was said
to be experienced if after age 17 subjects were physically or sexually
assaulted within or outside of a sexual relationship. Subjects were
classified as having an adult non-interpersonal trauma 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, &
Smiljanich, 1993).
The TSI is a major revision and expansion of earlier measures
(Trauma Symptom Checklist—33 [TSC—33]; Trauma Symptom
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51
Checklist—40 [TSC—40]) developed by Briere and Runtz (1989) and
Elliott and Briere (1992). These earlier developed versions of
symptom approach measures have been used in numerous studies
to delineate the impacts of child sexual abuse, and to differentiate
between individuals that have been sexually abused as children
and those who have not been sexually abused (Briere & Runtz, 1989;
Elliott & Briere, 1991a; Gold, Milan, Mayall, & Johnson, 1994).
While the earlier versions of this instrument were intended as
research measures, Briere, Elliott, and Smiljanich (in press)
indicated that when the TSI is fully developed, it may become a
valuable tool in clinical settings as a means of identifying the
impacts of various forms of child abuse and other posttraumatic
events.
The TSI consists of 119 items. The items are summed to
produce 12 scales: (1) Atypical Response; (2) Response Level; (3)
Anxious Arousal; (4) Anger/Irritability; (5) Defensive Avoidance; (6)
Depression; (7) Dissociation; (8) Dysfunctional Sexual Behavior; (9)
Intrusive Experiences; (10) Impaired Self Reference; (11) Sexual
Concerns; and (12) Tension Reduction Behavior. The measure also
includes a total score. Subjects respond to the 119 symptoms by
rating how often they have experienced each in the last six months
(from 0 = never to 3 = often).
The TSI demonstrated acceptable internal consistency, with
individual scales ranging in reliability from .78 to .93 for university
subjects (mean a=.87), and from .87 to .92 for adult clinical subjects
(mean a=.90). Furthermore, the TSI exhibited predictive validity for
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52
childhood trauma and interpersonal victimization for both male
and female adults. Additionally, concurrent and incremental
validity were demonstrated with the Brief Symptom Inventory and
two measures of dissociation (Briere, Elliott, & Smiljanich, 1993).
At the request of school district officials, four items on the TSI
were eliminated, one item from the Dysfunctional Sexual Behavior
scale, and three items from the Sexual Concerns scale. These items
were viewed as unacceptable because school officials saw them as
presuming that the respondent was involved in a sexual
relationship.
Data Analysis
All 223 adolescents (145 females and 78 males) completed
both the TSI and the set of items derived from the CMIS— SF.
Missing values on the TSI were replaced by the mean values of
specific gender by sexual abuse history by ethnicity groups. For
example, the missing values of a sexually abused Hispanic female
subject were replaced with the mean values of the sexually abused
Hispanic female group. This procedure was employed as a more
precise alternative to replacing missing values with group means of
the total sample. This method allowed for the possibility that
differences existed among specific gender by sexual abuse history
by ethnic groups.
The race/ethnicity variable was collapsed into three
categories, Hispanic (n = 142), White (n = 54), and Other (n = 27).
Asian-Americans (n = 6), African-Americans (n = 4 ), and Other (n
= 17) were combined to become "Other" because of small sample
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53
sizes. For this reason, racial/ethnicity comparisons were limited
only to Hispanic and White students.
The initial statistical technique utilized in the data analysis
addressed the issue of reliability. Cronbach's Index of Internal
Consistency was performed to address the reliability of the TSI.
Preliminary Multivariate Analyses of Variance (MANOVAs)
were conducted to determine the suitability of combining those
students who consistently reported on the CMIS— SF that they had
been victims of child sexual abuse with subjects who inconsistently
reported on the CMIS— SF that they had been sexually victimized
into one "sexually abused" group.
Demographic data was analyzed employing nonparametric
measures. The percentages of four ethnic/gender groups (female
Hispanics, female Whites, male Hispanics, & male Whites)
reporting sexual abuse victimization were compared. In addition,
the identities and gender of the perpetrators of child sexual abuse
were explored, and the relationships of the perpetrators of child
sexual abuse to the victims of sexual abuse were analyzed.
A 3-way MANOVA was conducted to evaluate overall effects
and control for inflations in alpha level due to the computation of
multiple comparisons. This 2X2X2 MANOVA was employed to
assess the interaction effects of sexual abuse history by gender by
race/ethnicity.
Three 2-way MANOVAs and three one-way MANOVAs were
conducted to evaluate the interaction effects and main effects of
sexual abuse history by gender, sexual abuse history by
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54
race/ethnicity, race/ethnicity by gender, sexual abuse history,
gender, and race/ethnicity.
In addition, the TSI Total Score was analyzed separately. The
Analysis of Variance (ANOVA) and Analysis of Covariance
(ANCOVA) procedures were utilized to explore this data.
Finally, the TSI's ability to predict subjects' self-reported
histories of child sexual abuse was explored. A discriminant
analysis (DA) was conducted to address the predictive ability of the
TSI.
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55
Chapter El: Results
This chapter presents the results of the study. The statistical
analysis is presented in eight sections: Reliability, Preliminary
Multivariate Analyses of Variance, Prevalence of Child Sexual
Abuse, Perpetrators of Child Sexual Abuse, Final Multivariate
Analyses of Variance, TSI Total Score, Predictive Validity, and the
Summary.
Reliability
The internal consistency of the Trauma Symptom Inventory
was investigated to measure the extent to which the items on the
scale relate to the same construct as indicated by their inter
relatedness and homogeneity. The coefficient Alpha (Cronbach,
1951) procedure was employed to measure reliability in terms of
overlapping variance among scale items. The reliability coefficients
obtained for each of the twelve subscales and for the TSI total score
are reported in Table 2. Nine of the thirteen Alpha coefficients
reached the .79-.90 range, while two coefficients fell within the .74-
.77 range. Only the Tension Reduction Behavior reliability
coefficient (.69) fell slightly below the .70 level. In addition, the
reliability coefficient for the TSI Total Score was found to be above
.97.
Preliminary Multivariate Analyses of Variance
Multivariate Analysis of Variance (MANOVA) indicated that
students assigned to the three levels of child sexual abuse history
(sexually abused, nonabused, and those who inconsistently
reported that they had been sexually abused) differed significantly
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Table 2
56
Reliability Analysis: Cronbach's Index of Internal Consistency
Trauma Symptom Inventory
(TSI) Scale
Number of
Cases
a
Value
Atypical response 223 .74
Response Level 223 .79
Anger/Irritability 223 .87
Anxious Arousal 223 .77
Defensive Avoidance 223 .88
Depression 223 .89
Dissociation 223 .82
Dysfunctional Sexual Behavior 223 .79
Impaired Self Reference 223 .84
Intrusive Experiences 223 .87
Sexual Concerns 223 .83
Tension Reduction Behavior 223 .69
TSI Total Score 223 .97
across the dependent variables, F (2,220) = 2.43, p < .0005 (see
Figure 1). The MANOVA procedure further indicated that the main
effect of the sexually abused group vs. the inconsistent group, F (1,
83) = .11, p. = .684, and the main effect of the inconsistent group vs.
the nonabused group, F (1,155) = 1.23, p = .265, were not significant.
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25 VI
2 0.
15'
10-
J2 < .0005
Q Sexually Abused Subjects
I Inconsistent Subjects
H Nonabused Subjects
Atypical Response Anger/ Anxious Defensive D epressionD issocistion Dysfunc. Im paired Intrusive Sexual
Response Level Irritability Arousal Avoidance Sexual Self Experiences Concerns Reduction
Behavior Reference Behavior
TSI Scale
Figure 1. Means of the Sexually Abused group, the Inconsistent group, and the Nonabused group across the dependent
variables.
U i
V I
58
Given the exploratory nature of this preliminary analysis and
to examine the data further, post hoc comparisons were conducted
in order to give the reader a broader view of the main effects. Group
means were compared through one-way analyses of variance
(ANOVAs), employing both nonadjusted p values and the
Bonferroni correction for multiple comparisons (adjusted p value =
.004). As indicated in Table 3, across all dependent variables, there
were no significant differences between the responses of the
students who indicated consistently across all sexual abuse items
on the CMIS— SF that they had been sexually abused as children,
and those subjects who reported inconsistently across the sexual
abuse history items that they had been sexually abused as children.
In contrast, Table 4 indicates that the nonabused and inconsistent
groups differed significantly across four dependent variables,
approached significance on two dependent variables, and mean
scores were in the expected direction on the six other dependent
variables (see Figure 2).
Subjects were classified as sexually abused if on any item of
the CMIS— SF they offerred information that met the study's
operational definition of child sexual abuse. This procedure of
classifying subjects was based on the conceptualization that victims
of child sexual abuse often require several opportunities to divulge
their sexual victimization in a research setting. Accordingly, in the
current study, subjects who consistently indicated that they had
been victims of child sexual abuse were combined with subjects
who inconsistently reported their child sexual abuse victimization
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Table 3
F Tests of Sexually Abused and Inconsistent Group Scores on Each
Dependent Variable
Abused Inconsistent
Trauma Symptom Mean Mean Univariate
Inventory (TSI) Scale (n =66) (n = 19) F
Atypical response 5.52 5.32 .02
Response Level 21.83 20.63 .85
Anger/Irritability 15.35 15.26 .00
Anxious Arousal 12.79 12.26 .21
Defensive Avoidance 13.98 11.21 3.24
Depression 13.33 11.79 1.04
Dissociation 12.21 12.68 .13
Dysfunctional Sexual
Behavior 5.41 4.21 .92
Impaired Self Reference 14.17 13.58 .16
Intrusive Experiences 11.95 9.53 2.60
Sexual Concerns 5.09 3.84 .95
Tension Reduction
Behavior 7.47 7.21 .06
Note, df = (1,83).
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60
Table 4
F Tests of Nonabused and Inconsistent Group Scores on Each
Dependent Variable
Trauma Symptom
Inventory (TSI) Scale
Nonbused
Mean
(n = 138)
Inconsistent
Mean
in = 19)
Univariate
F
Atypical response 3.09 5.32 6.81**
Response Level 18.24 20.63 3.00
Anger/Irritability 12.29 15.26 3.32
Anxious Arousal 9.67 12.26 4.84**
Defensive Avoidance 9.20 11.21 1.67
Depression 9.36 11.79 2.49
Dissociation 8.41 12.68 10.19***a
Dysfunctional Sexual
Behavior 2.58 4.21 3.61*
Impaired Self Reference 10.78 13.58 3.48*
Intrusive Experiences 7.39 9.53 2.35
Sexual Concerns 3.56 3.84 .09
Tension Reduction
Behavior 5.02 7.21 5.24**
Note. df= (1,155).
aF value is statistically significant when Bonferroni correction for
multiple comparisons is applied (p value = .004).
*p< .065. **g_< .03. ***£_< .003.
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4 1 = .265 Inconsistent Subjects
20
Nonabused Subjects
Atypical
Response
Response
Level
Anger/
Irritability
Defensive
Avoidance
Depression Dissociation Dysfunc. Impaired Self Intrusive
Sexual Reference experiences
Behavior
TSI Scale
Sexual
Concerns
Tension
Reduction
Behavior
Figure 2. Means of nonabused subjects and subjects inconsistently reporting child sexual abuse across the
dependent variables.
62
into one "sexually abused" group for the remainder of the analysis
of the data.
The inconsistent subjects responded to the items on the CMIS-
-SF in three distinctive patterns. In order to better understand these
three groups of subjects, the following discussion delineates each of
these response patterns.
Group 1 consisted of 8 subjects who identified perpetrators of
child sexual abuse by gender and/or relationship in early items on
the CMIS— SF, but in later items responded with "zeros" or "no
answer" to items that asked about the number of perpetrators of
child sexual abuse or the number of incidents of sexual abuse. The
current writer hypothesizes that these subjects initially identified
perpetrators, but because of their denial regarding their sexual
victimization later retracted these disclosures. Another possible
explanation for the inconsistent response pattern of this group is
their willingness to disclose sexual abuse perpetrators, but their
refusal to provide specifics regarding the number of perpetrators or
the number of sexual abuse incidents.
Group 2 consisted of 7 subjects who did not identify
perpetrators of sexual abuse by gender or relationship in early items
of the CMIS— SF, but in later items identified one or more
perpetrators of child sexual abuse, and one or more incidents of
sexual abuse. The current author hypothesizes that these subjects
did not wish to identify the relationship and/or gender of their
perpetrators of sexual abuse (e.g., "I can't disclose that my mother
molested me!"), but felt comfortable indicating the number of
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63
perpetrators and the number of sexual abuse incidents that they had
experienced.
Group 3 consisted of 4 subjects who did not supply specific
information regarding the gender or relationship of their
perpetrators, and responded with "zeros" or "no answer" to items
that asked about the number of perpetrators of child sexual abuse
and the number of incidents of sexual abuse experienced. However,
they responded "yes" when asked if they had been sexually abused
before the age of 17. The current writer theorizes that although these
subjects did not feel comfortable supplying specific information
regarding their sexual victimization (e.g., relationship and gender of
perpetrator, number of incidents of sexual abuse), they were
comfortable acknowledging that they had indeed been sexually
victimized as children. Another possible explanation for the
response pattern of this group may have to do with the items that
were eliminated from the version of the CMIS— SF employed in the
current study. These deleted items (e.g., "About how many times
did anyone...have oral, anal, or vaginal intercourse with you...before
age 17...?") may have more accurately described the sexual
victimization experienced by the subjects in this group. With the
absence of these descriptive items, these subjects may have decided
to endorse a general item regarding child sexual abuse while
ignoring other items that did not accurately describe their sexual
victimization.
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64
Prevalence of Child Sexual Abuse
Analysis of the ethnicity/gender data was revealing, with
27.3% of White males, 28.1% of White females, and 23.9% of
Hispanic males reporting that they had been victims of child sexual
abuse. In contrast, 54.2% of female Hispanic females reported being
sexually abused. These results are significant, chi-square (3, n =
196) = 16.38, p < .001, and suggested that the female Hispanics of
this sample were significantly more likely to be sexually abused as
children than the White adolescents and the male Hispanic
adolescents who participated in the study (see Figure 3).
Table 5 compares the subjects who identified themselves as
victims of child sexual abuse with nonabused subjects. Gender data
indicated that 45.5 percent of female subjects reported that they had
been victims of child sexual abuse. In contrast, 24.4 percent of male
subjects reported child sexual victimization. These results are
significant, chi-square (1, N = 223) = 10.09, p < .01. Race/ethnicity
data revealed that 44.4 percent of Hispanic subjects indicated that
they had been victims of child sexual abuse, while 27.8 percent of
the White subjects disclosed that they were sexually victimized 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
sample indicated they had been victims of child sexual abuse.
Perpetrators of Child Sexual Abuse
Table 6 addresses the identity and gender of the perpetrators
of child sexual abuse. Male victims were significantly more likely
than female victims to be sexually abused by female perpetrators,
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65
54.20%
D < .001
C
0 >
M
< U
C h
304
204
10 -
0 +
28.10%
I I
I I
Female Male Female Male
Hispanics Hispanics White White
Subjects
Figure 3. Subjects self-identified as victims of child sexual abuse,
grouped by ethnicity/gender.
and female victims were significantly more likely than male victims
to be sexually abused by male perpetrators (chi-square [1, n = 79] =
14.76, p. < .001) When female victims of child sexual abuse
identified the gender of their assailants, male perpetrators were
identified 91.9 percent of the time. In contrast, when male victims
reported the gender of their assailants, female perpetrators were
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66
Table 5
Subjects Self-Identified as Victims of Child Sexual Abuse. Grouped
by Gender. Race/Ethnicity, and Ethnicity/Gender
Abused Nonabused Chi-Square
Group n
%
n
%
1 2 .
Females 66 45.5 79 54.5 Chi-Square (1,N = 223) =
Males 19 24.4 59 75.6 10.09, £ < .01
Hispanics 63 44.4 79 55.6 Chi-Square (1, n = 196) =
Whites 15 27.8 39 72.2 4.62, £ < .05
Female Hispanics 52 54.2 44 45.8
Female Whites 9 28.1 23 71.9 Chi-Square (3, a = 196) =
Male Hispanics 11 23.9 35 76.1 16.38, £ < .001
Male Whites 6 27.3 16 72.7
identified in 52.9 percent of cases. Additionally, while 6.9 percent of
female victims reported being sexually assaulted by both male and
female perpetrators, all male subjects reported being sexually
victimized exclusively by either male or female perpetrators (see
Figure 4).
The relationship of the perpetrator of sexual abuse to the
victim of sexual abuse yielded interesting findings (see Table 6).
Female adolescents identified a parent figure as the perpetrator of
sexual abuse 9.1 percent of the time, while males identified a parent
figure as the perpetrator in 5.3 percent of sexual assaults (chi-square
[1, n = 85] = .2860, g. = .593). Female adolescents identified family
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67
Table 6
Identity and Gender of Perpetrator
Females
In = 66) .
Males
In = 19).
Identity and Gender3 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
aSubjects had the opportunity to identify an unlimited number of
perpetrators of both genders and various identitiies.
bPercentages do not equal 100% since students could have been
sexually abused by more than one perpetrator.
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68
91.90%
s
u
«-i
0 )
C i *
Male Victims of
Sexual Abuse
Female Victims
of Sexual Abuse
- r l
52.90%
8.10%
_p < .001
Male Female Male and
Perpetrator Perpetrator Female
Perpetrators
Perpetrators of Abuse
Figure 4. Subjects self-identified as victims of child sexual abuse,
grouped by gender of perpetrator.
members as the perpetrators in 53.2 percent of the cases, while
males identified family members as the perpetrators of sexual abuse
in 57.9 percent of the sexual assaults. In addition, 12.9 percent and
26.3 percent of female and male subjects respectively reported being
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69
sexually abused by both family members and non-family members
(chi-square [2, n = 80] = 1.99, g = .370).
Female subjects were significantly more likely than male
subjects to be sexually abused by a parent figure (chi-square [1, n =
7] = 7.00, g < -01). Only one male adolescent (5.3 percent) and no
female adolescents identified a mother figure as the perpetrator of
sexual abuse. In contrast, six female adolescents (9.1 percent) and
no males identified father figures as perpetrators of child sexual
abuse.
Table 7 illustrates the number of perpetrators identified by the
male and female adolescents who participated in this study. The
majority of the sample (62.1 percent of females and 52.6 percent of
males, chi-square [1, n = 81] = .55, g = .461) indicated that they had
been sexually abused by one perpetrator, while 90.6 percent
indicated that they had been sexually abused by three or less
perpetrators (92.4 percent for females and 84.2 percent for males,
chi-square [1, n = 81] = 1.87, g = .171).
Final Multivariate Analyses of Variance
Multivariate Analysis of Variance (MANOVA) can be
properly used with a particular data set if two underlying
assumptions are satisfied. The first assumption addresses the
degree to which the dependent variables correlate. In the current
data analysis, the Bartlett test of sphericity (1582.19 with 66 df)
showed that the dependent variables were sufficiently interrelated
to meet the assumptions for the MANOVA procedure. The second
important assumption is that of homogeneity of variance on all
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Table 7
Number of Perpetrators
70
Females Males
(n = 66) (n = 19)
n % n %
One 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
More Than Five 1 1.5 2 10.5
Number Not Identified 3 4.5 1 5.3
variables. This assumption was not met (see Table 8), indicating
that some of the data represent a non-normally distributed
population. Therefore, the results obtained from MANOVA
analyses in this study must be viewed with caution. However, the
current researcher felt that given the robustness of this test, the use
of this parametric statistical analysis was warranted.
Tables and figures are presented to clarify the results of the
study. Table 9,10,11,12,13,14,15, and 16 present the mean scores
on the TSI scales for subjects divided by child sexual abuse history
(abused vs. nonabused) by race/ethnicity by gender, sexual abuse
history by gender, sexual abuse history by race/ethnicity,
race/ethnicity by gender, race/ethnicity, gender, gender with sexual
abuse history as a covariate, and sexual abuse history. Furthermore,
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71
Table 8
Variables
Trauma Symptom Inventory
(TSI) Scale
Bartlett Box F
(7,10877)
£
Value
Atypical response 3.92 .00a
Response Level 2.00 .05
Anger/Irritability 1.42 .19
Anxious Arousal 1.32 .23
Defensive Avoidance 1.15 .33
Depression .70 .67
Dissociation 1.37 .21
Dysfunctional Sexual Behavior 2.80 .01a
Impaired Self Reference 1.01 .43
Intrusive Experiences 1.16 .32
Sexual Concerns .96 .46
Tension Reduction Behavior 1.24 .27
aThis f> value suggests a nonhomogeneous population.
given the exploratory nature of this study, post hoc comparisons are
provided in order to give the reader a more complete view of the
interaction and main effects. Group means were compared through
one-way analyses of variance (ANOVAs), employing both
nonadjusted values and the Bonferroni correction for multiple
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72
comparisons (adjusted p value = .004). Finally, figures 5, 6 and 7
depict the means for the main effects of race/ethnicity, gender, and
sexual abuse history.
MANOVAs were performed to assess the interaction effects of
the predictor variables. The 3-way MANOVA indicated that the
interaction effect of race/ethnicity by sexual abuse history by gender
was not significant, F (12,177) = .93, p = .520 (see Table 9). Given
the nonsignificant outcome of the 3-way MANOVA, three 2-way
MANOVAs were conducted. The 2-way interaction effects of sexual
abuse history by gender (F [12,208] = .52, p = .903), sexual abuse
history by race/ethnicity (F [12,181] = 1.09, p = .370), and
race/ethnicity by gender (F [12,181] = .418, p = .955) were also not
significant (see Tables 10,11, & 12). To explore the data further, post
hoc one-way ANOVAs were performed. There was only one
significant finding discovered from the post hoc comparisons made
on the 2-way MANOVAs. Sexually abused White subjects were
found to score significantly higher on the Anxious Arousal
dependent variable than sexually abused Hispanic subjects, F (1,
192) = 4.04, p < .05.
The nonsignificant results obtained from the 3-way and 2-
way MANOVAs prompted the researcher to perform one-way
MANOVAs to assess the main effects of race/ethnicity, gender, and
sexual abuse history. The main effect of race/ethnicity, F (12,183) =
1.61, p = .092, was marginally nonsignificant. To explore the data
further, post hoc univariate comparisons were performed and
revealed that Hispanic subjects scored significantly higher on the
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Table 9
P Tests on Each Dependent Variable by Sexual Abuse History. Race/Ethnicity, and Gender
Abused Nonabused Abused Nonabused Abused Nonabused Abused Nonabused
Female Female Male Male Female Female Male Male
TSI Hispanic M Hispanic M Hispanic M Hispanic M White M White M White M White M E
Scale (n = 52) (n = 44)
(n = H) (n = 35) (n = 9) (n = 23) 01 = 6) (n = 16) Value
AR 6.27 3.84 4.45 2.77 3.56 3.26 4.83 1.81 1.33
RL 21.69 18.57 19.18 17.60 23.11 19.61 24.67 16.88 2.09
AI 15.83 12.91 13.36 12.17 15.56 12.74 16.67 10.00 1.42
AA 12.56 10.27 11.27 9.54 14.56 9.61 15.17 8.56 .41
DA 14.21 11.18 10.36 8.20 11.44 10.39 15.33 7.88 2.59
D 13.15 10.89 13.18 8.57 12.33 9.39 14.67 7.94 .10
D1S 12.48 9.57 10.91 8.06 13.22 8.78 13.50 6.63 .39
DSB 5.08 2.52 6.73 2.91 3.78 3.35 4.67 2.25 .06
ISR 14.40 12.25 13.27 11.03 13.78 10.30 15.50 9.44 .32
IE 12.08 9.57 9.55 6.63 1 1 .0 0 7.39 11.33 6.13 .08
SC 4.98 3.48 4.73 3.94 4.33 4.13 7.17 3.25 1.85
TRB 7.58 5.27 7.27 4.97 6.67 5.65 7.67 4.63 .45
Note, df = (1,188)- M = Mean; AR = Atypical Response; RL = Response Level; AI = Anger/Irritability; AA = Anxious
Arousal; DA = Defensive Avoidance; D = Depression; D1S = Dissociation; DSB = Dysfunctional Sexual Behavior;
ISR = Impaired Self Reference; IE = Intrusive Experiences; SC = Sexual Concerns; TRB = Tension Reduction Behavior.
Table 10
F Tests on Each Dependent Variable by Sexual Abuse History and
Gender
Abused Nonabused Abused Nonabused
TSI Male M Male M Female M Female M F
Scale (n = 19) (n = 59) (n = 66) (n = 79) Value
AR 4.68 2.32
RL 20.68 17.00
AI 13.84 11.03
AA 12.47 8.83
DA 11.89 7.69
D 12.89 7.76
DIS 11.89 7.15
DSB 6.37 2.69
ISR 13.53 9.88
IE 9.95 6.19
SC 5.32 3.44
TRB 7.26 4.59
5.70 3.66 .07
21.82 19.16 .37
15.76 13.23 .02
12.73 10.30 .72
13.79 10.33 .15
13.02 10.54 1.96
12.44 9.34 .99
4.79 2.49 1.20
14.18 11.44 .24
11.83 8.29 .01
4.67 3.65 .40
7.45 5.34 .20
Note, df = (1,219). M = Mean; AR = Atypical Response; RL =
Response Level; AI = Anger/Irritability; AA = Anxious Arousal;
DA = Defensive Avoidance; D = Depression; DIS = Dissociation;
DSB = Dysfunctional Sexual Behavior; ISR = Impaired Self
Reference; IE = Intrusive Experiences; SC = Sexual Concerns; TRB =
Tension Reduction Behavior.
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75
Table 11
F Tests on Each Dependent Variable by Sexual Abuse History and
Race/Ethnicity
Abused Nonabused Abused Nonabused
TSI Hispanic Hispanic White White F
Scale M (n = 63) \L(n = 79) M.(n = 15) M_(n = 39) Value
AR 5.95 3.37
RL 21.25 18.14
AI 15.40 12.58
AA 12.33 9.95
DA 13.54 9.86
D 13.16 9.86
DIS 12.21 8.90
DSB 5.37 2.70
ISR 14.21 11.71
IE 11.63 8.27
SC 4.40 3.68
TRB 7.52 5.14
4.06 2.67 .70
23.73 18.49 1.25
16.00 11.62 .51
14.80 9.18 4.04*a
13.00 9.36 .00
13.27 8.79 .31
13.33 7.90 1.29
4.13 2.90 .99
14.47 9.95 .95
11.13 6.87 .19
5.47 3.77 .08
7.07 5.23 .15
Note, df = (1,192). M = Mean; AR = Atypical Response; RL =
Response Level; AI = Anger/Irritability; AA = Anxious Arousal;
DA = Defensive Avoidance; D = Depression; DIS = Dissociation;
DSB = Dysfunctional Sexual Behavior; ISR = Impaired Self
Reference; IE = Intrusive Experiences; SC = Sexual Concerns; TRB =
Tension Reduction Behavior.
aF value is not statistically significant when Bonferroni correction
for multiple comparisons is applied (p value = .004).
*p < .05.
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76
Table 12
F Tests on Each Dependent Variable by Race/Ethnicity and Gender
Female Male Female Male
TSI Hispanic M Hispanic M White M White M E
Scale (n = 96) (n = 46) (n = 32) (n = 22) 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
Note, df = (1,192). M = Mean; AR = Atypical Response; RL =
Response Level; AI = Anger/Irritability; AA = Anxious Arousal;
DA = Defensive Avoidance; D = Depression; DIS = Dissociation;
DSB = Dysfunctional Sexual Behavior; ISR = Impaired Self
Reference; IE = Intrusive Experiences; SC = Sexual Concerns; TRB =
Tension Reduction Behavior.
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77
Atypical Response dependent variable than White subjects. In
addition, although the mean differences between Hispanic and
White subjects were not significant across the remaining dependent
variables, Hispanic subjects' mean scores were higher than White
subjects' mean scores on ten of twelve dependent variables (see
Table 13 and Figure 5). In contrast, the main effect of gender, F (12,
210) = 2.02, p = .024, was significant, with female subjects scoring
significantly higher than male subjects on nine of the twelve
dependent variables (see Table 14). When compared to their male
4 ?eers, female subjects were found to exhibit significantly higher
levels of Atypical Response and Response Level, and demonstrate
significantly more symptoms of Anger/Irritability, Anxious
Arousal, Defensive Avoidance, Depression, Dissociation, Impaired
Self Reference, and encounter more Intrusive Experiences.
Interestingly, when a one-way MANCOVA procedure was
employed to explore the main effect of gender with sexual abuse
history as a covariate, the main effect of gender, F (12,209) = 1.55, p
= .108, was not significant. However, to explore the data further,
post hoc univariate comparisons of the MANCOVA results
indicated that when compared to their male peers, female subjects
were found to score significantly higher across seven dependent
variables (see Table 15). Furthermore, Figure 6 shows that female
subjects scored higher than male subjects on eleven of twelve
dependent variables. Finally, the main effect of sexual abuse history
was highly significant, F (12, 210) = 4.30, p < .0005. On all
dependent variables, sexually abused subjects scored significantly
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78
Table 13
F Teste of Hispanic Students and White Students Scores on Each
Dependent Variable
Trauma Symptom
Inventory (TSI) Scale
Hispanic
Mean
(n = 142)
White
Mean
(n = 54)
Univariate
F
Atypical Response 4.51 3.06 4.67*a
Response Level 19.52 19.94 .21
Anger/Irritability 13.83 12.83 .93
Anxious Arousal 11.01 10.74 .12
Defensive Avoidance 11.49 10.37 1.18
Depression 11.32 10.04 1.65
Dissociation 10.37 9.41 1.11
Dysfunctional Sexual
Behavior 3.88 3.24 .87
Impaired Self Reference 12.82 11.20 2.71
Intrusive Experiences 9.76 8.06 3.03
Sexual Concerns 4.24 4.24 .00
Tension Reduction
Behavior 6.20 5.74 .47
Note. df= (1,196).
aF value is not statistically significant when Bonferroni correction
for multiple comparisons is applied (g. value = .004).
*p < .04.
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25
Hispanic Subjects
20
White Subjects
15
10
5
O H ----
Atypical Anger/ Defensive Depression Dissociation Dysfunc. Impaired Self Intrusive Sexual Tension Response Anxious
Response Level Irritability Arousal Avoidance Sexual Reference Experiences Concerns Reduction
Behavior Behavior
TSI Scale
Figure 5. Means of Hispanic and White subjects across the dependent variables.
VO
80
Table 14
F Tests of Male and Female Scores on Each Dependent Variable
Trauma Symptom
Inventory (TSI) Scale
Male
Mean
(n = 78)
Female
Mean
(n = 145)
Univariate
F
Atypical Response 2.90 4.57 8.65**a
Response Level 17.90 20.37 10.04**a
Anger/Irritability 11.72 14.38 8.54**a
Anxious Arousal 9.72 11.41 6.30*
Defensive Avoidance 8.72 11.90 12.46**a
Depression 9.01 11.67 9.08**a
Dissociation 8.31 10.75 9.83**a
Dysfunctional Sexual
Behavior 3.59 3.54 .01
Impaired Self Reference 10.77 12.69 5.06*
Intrusive Experiences 7.10 9.90
11 H**a
Sexual Concerns 3.90 4.11 .12
Tension Reduction
Behavior 5.24 6.30 3.35
Note. df= (1,221).
aF value is statistically significant when Bonferroni correction for
multiple comparisons is applied (p value = .004).
*£<.03. **p<.01.
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81
Table 15
F Tests of Male and Female Scores on Each Dependent Variable with
Sexual Abuse History Used as a Covariate
Trauma Symptom
Inventory (TSI) Scale
Male
Mean
(n = 78)
Female
Mean
(n = 145)
Univariate
F
Atypical Response 2.90 4.57 4.72*a
Response Level 17.90 20.37 5.72*a
Anger/Irritability 11.72 14.38 5.31*a
Anxious Arousal 9.72 11.41 2.77
Defensive Avoidance 8.72 11.90 7.33**a
Depression 9.01 11.67 5.08*a
Dissociation 8.31 10.75 4.94*a
Dysfunctional Sexual
Behavior 3.59 3.54 1.15
Impaired Self Reference 10.77 12.69 2.29
Intrusive Experiences 7.10 9.90 6.11*a
Sexual Concerns 3.90 4.11 .01
Tension Reduction
Behavior 5.24 6.30 1.02
Note. df= (1,220).
aF value is not statistically significant when Bonferroni correction
for multiple comparisons is applied (d value = .004).
*£<.04. **£<.01.
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25
Female Subjects
20
Male Subjects
15
10
5
0-1---
Atypical Defensive Depression Dissociation Dysfunc. Impaired Self Intrusive Sexual Tension Anxious Response
Response Level Irritability Arousal Avoidance Sexual Reference Experiences Concerns Reduction
Behavior Behavior
TSI Scale
Figure 6. Means of male and female subjects across the dependent variables.
oo
N >
83
higher than their nonabused peers (see Figure 7). Table 16 indicates
that sexually abused subjects scored significantly higher than their
nonabused counterparts in Atypical Response and Response level,
and demonstrated more indicators of Anger/Irritability,
Anxious/Arousal, Defensive Avoidance, Depression, Dissociation,
Dysfunctional Sexual Behavior, Impaired Self Reference, Intrusive
Experiences, Sexual Concerns, and Tension Reduction Behavior
than their nonabused peers.
To complement the MANOVA results discussed above, one
way analyses of variance (ANOVAs) were conducted to determine
the equality of sexually abused and nonabused subjects' means on
all dependent variables across a variety of subsamples, including;
females, males, Hispanics, Hispanic females, Hispanic males,
White females, and White males. Results of these ANOVAs
employing both nonadjusted p values and the Bonferroni correction
for multiple comparisons (adjusted p value = .004) are found in
Table 17. Findings indicated that significant differences
were found between sexually abused and nonabused subjects on the
majority of the dependent variables across the subsamples of
female, male, Hispanic, and White subjects. Only the dependent
variable Sexual Concerns had nonsignificant F values across these
subsamples. In contrast, nonsignificant differences were found
between sexually abused and nonabused subjects on the majority of
the dependent variables across the subsamples of Hispanic female,
Hispanic male, White female, and White male subjects.
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1 Sexually Abused Subjects p < .0005
Nonabused Subjects
Atypical
Response
Anger/
Irritability
Defensive
Avoidance
Depression Dissociation Dysfunc. Impaired Self Intrusive
Sexual Reference Experiences
Behavior
TSI Scale
Response
Level
Sexual
Concerns
Tension
Reduction
Behavior
Figure 7. Means of sexually abused subjects and nonabused subjects across the dependent variables.
o o
4 ^
85
Table 16
F Tests of Sexually Abused and Nonabused Group Scores on Each
Dependent Variable
Abused Nonabused
Trauma Symptom
Inventory (TSI) Scale
Mean
(n = 85)
Mean
(n = 138)
Univariate
F
Atypical response 5.47 3.09 18.66**a
Response Level 21.56 18.24 19.58**a
Anger/Irritability 15.33 12.29 11.72*3
Anxious Arousal 12.67 9.67 21.97**a
Defensive Avoidance 13.36 9.20 23.06**a
Depression 12.99 9.36 18.33**a
Dissociation 12.32 8.41 28.21**a
Dysfunctional Sexual
Behavior 5.14 2.58 21.20**3
Impaired Self Reference 14.04 10.78 15.83**3
Intrusive Experiences 11.41 7.39 25.18**3
Sexual Concerns 4.81 3.56 4.49*
Tension Reduction
Behavior 7.41 5.02 18.89**3
Note. df= (1,221).
aF value is statistically significant when Bonferroni correction for
multiple comparisons is applied (p value = .004).
*p < .04. **p < .0005.
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Table 17
F Tests on Sexually Abused and Nonabused Subjects' Means on Each Dependent Variable. Grouped By All Subjects.
Gender. Race/Ethnicity, and Race/Ethnicitv Bv Gender
Hispanic Hispanic White White
All Female Male Hispanic White Female Male Female Male
Subjects' Subjects' Subjects' Subjects' Subjects' Subjects' Subjects' Subjects’ Subjects'
F Value F Value F Value F Value F Value F Value F Value F Value F Value
TSI df= (1,221) df = (1,143) df= (l,76) df = (l, 140) df = (1,52) df= (l,9 4 ) df = (1,44) df = (l,30) df = <1,20)
Scale (N = 223) (n = 145) (n = 78) (n = 142) (n = 54) (1 1 = 96) (1 1 = 46) (Q = 32) (a = 22)
AR 18.66*” “ 7.65* 9.08*® 12.05**“ 2.30 5.98* 2.26 .05 5.80*
RL 19.58***“ 9.65*® 5.62’ 10.35*® 13.40’* ® 7.84’ .53 3.91 11.30*“
AI 11.72’* “ 5.85* 2.59 6.64’ 5.92* 4.67* .31 2.12 3.77
AA 21.97’**“ 10.19*® 8.46* 9.23*“ 16.18**“ 6.29* .97 6.75’ 9.89*
DA 23.06*’* ® 10.61*® 7.27* 11.24*" 4.84* 5.33* .99 .21 11.87*“
D 18.33***® 6.00’ 10.01*“ 9.41*“ 8.26* 3.25 3.87 2.01 8.09*
DIS 28.21***® 12.73**® 10.86*“ 11.47**“ 18.68” “ 6.40’ 1.82 7.94* 11.29*"
DSB 21.20***® 11.00*® 13.41’* ® 13.36**“ 1.27 8.25* 6.57* .07 4.38*
ISR 15.83’* ® 8.27* 4.75* 5.80* 7.30* 3.38 .86 2.42 5.44*
IE 25.18***® 12.60**® 7.21* 10.22*" 8.33* 3.83 2.03 3.13 5.84*
SC 4.50* 1.84 3.37 2.69 1.91 2.34 .33 .02 4.24
TRB 18.89***® 9.28*® 7.62* 12.49**" 2.04 7.45* 3.08 .33 2.61
AR = Atypical Response; RL = Response Level; AI = Anger/Irritability; AA = Anxious Arousal; DA = Defensive Avoidance;
D = Depression; DIS = Dissociation; DSB = Dysfunctional Sexual Behavior; ISR = Impaired Self Reference;
IE = Intrusive Experiences; SC = Sexual Concerns; TRB = Tension Reduction Behavior.
aF value is statistically significant when Bonferroni correction for multiple comparisons is applied (p value = .004). O O
*p < .05. * ’p < .001. ” *p < .00005 O N
87
TSI Total Score
The TSI Total Score was not entered into the MANOVA
analyses. The analysis of variance (ANOVA) procedure was used to
explore these interaction effects and main effects. A 3-way ANOVA
indicated that the interaction effect of race/ethnicity by sexual abuse
history by gender was not significant, F (1,188) = 1.32, p = .252.
Given the nonsignificant outcome of the 3-way ANOVA, three 2-
way ANOVAs were conducted. The 2-way ANOVAs indicated that
the 2-way interaction effects of sexual abuse history by gender (F [1,
219] = .96, p = .329), sexual abuse history by race/ethnicity (F [1,192]
= -37, p = .544), and race/ethnicity by gender (F [1,192] = .94, p =
.334) were not significant. The nonsignificant results obtained from
the 3-way and 2-way ANOVAs prompted the researcher to perform
separate one-way ANOVAs to assess the main effects of
race/ethnicity, gender, and sexual abuse history. The main effect of
race/ethnicity, F (1,194) = 2.42, p = .121, was not significant. The
mean TSI total score for Hispanic subjects was 132, while the mean
TSI total score for White subjects was 118. The main effect of
gender, F (1, 221) = 9.86, p = .002, was significant. The mean TSI
total score of 134 for female subjects was significantly higher than
the mean TSI total score of 109 for male subjects. Furthermore, a
one-way ANCOVA was performed on gender with sexual abuse
history as a covariate. This ANCOVA procedure, F (1,220) = 4.49, p
< .04, was also significant. Finally, similar to the MANOVA results
discussed earlier, the main effect for sexual abuse history was
highly significant, F (1, 221) = 36.93, p < .0005. The mean TSI total
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88
score for victims of child sexual abuse was 153, while the mean TSI
total score for nonabused subjects was 108. Results of the TSI Total
Score analyses employing both nonadjusted p values and the
Bonferroni correction for multiple comparisons (adjusted p value =
.004) are found in Table 18.
Predictive V alidity
A discriminant analysis was performed on the twelve
dependent variables to determine the overall predictive validity of
the TSI. Classification results derived from the discriminant
analysis indicated that the TSI correctly classified 64.7 percent of the
sexually abused group as sexually abused, while 35.3 percent of the
sexually abused group were incorrectly classified as nonabused. In
contrast, the TSI correctly classified 71.7 percent of the nonabused
group as nonabused subjects, while 28.3 percent of the nonabused
group was incorrectly classified as sexually abused (see Table 18).
Overall, the TSI accurately classified 69.1 percent of the cases as
either sexually abused or nonabused. Furthermore, the
discriminant function when combining all of the dependent
variables of the TSI, chi-square (12, N = 223) = 47.22, p < .00005,
was highly significant.1
Discriminant analyses were conducted on several
subsamples of subjects to determine whether or not the TSI had
predictive utility within these subgroups. Table 19 indicates the
results of these analyses. The discriminant functions for female
subjects, chi-square (12, n = 145) = 23.35, p < .03, and male subjects,
chi-square (12, n = 78) = 21.63, p < .05, were significant. Female
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89
Table 18
ANOVA/ANCOVA: F Tests for TSI-Total Score
Interaction Effects/Main Effects
Degrees of
Freedom
F Value
Sexual Abuse History by Gender by
Race/Ethnicity (1,188) 1.32
Sexual Abuse History by Gender
(1, 219) .96
Sexual Abuse History by Race/Ethnicity (1,192) .37
Race/Ethnicity by Gender (1,192) .94
Race/Ethnicity (1,194) 2.42
— Hispanic Mean = 132
— White Mean = 118
Gender
(1, 221) 9.86**a
— Female Mean = 134
— Male Mean = 109
Gender with Sexual Abuse History as a
Covariate (1, 220) 4.49*
Sexual Abuse History (1, 221) 36.93***a
— Sexually Abused Mean = 153
— Nonabused Mean = 108
aF value is statistically significant when Bonferroni correction for
multiple comparisons is applied (p value = .004).
*p < .04. **p < .003. ***p < .0005.
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Table 19
Predictive Ability of the TSI on Various Groups of Subjects: Discriminant Analyses Results
Category
All
Subjects
%
(N = 223)
Female
Subjects
%
(n = 145)
Male
Subjects
%
(n = 78)
Hispanic
Subjects
%
(n = 142)
White
Subjects
%
(n = 54)
Hispanic
Female
Subjects
%
(n = 96)
Hispanic
Male
Subjects
%
(n = 46)
White
Female
Subjects
%
(n = 32)
White
Male
Subjects
%
(n = 22)
Subjects correctly
classified as abused 64.7 60.6 68.4 57.1 73.3 59.6 63.6 77.8 83.3
Subjects incorrectly
classified as abused 35.3 39.4 31.6 42.9 26.7 40.4 36.4 22.2 16.7
Subjects correctly
classified as nonabused 71.7 70.9 76.3 72.2 82.1 72.7 85.7 82.6 93.7
Subjects incorrectly
classified as nonabused 28.3 29.1 23.7 27.8 17.9 27.3 14.3 17.4 6.3
Subjects correctly
classified as abused and
nonabused 69.1 66.2 74.4 65.5 79.6 65.6 80.4 81.3 90.9
VO
O
91
subjects were correctly classified at a rate of 66.2 percent, while male
subjects were accurately classified at a rate of 74.4 percent. In
addition, the discriminant functions for Hispanic subjects, chi-
square (12, n = 142) = 26.21, p < .02, and White subjects, chi-square
(12, n = 54) = 23.01, p < .03, were significant, with accurate
classification rates of 65.5 percent and 79.6 percent respectively. In
contrast, the discriminant functions for Hispanic females, chi-
square (12, n = 96) = 15.84, p = .20, and Hispanic males, chi-square
(12, n = 46) = 11.24, p = .51, were not significant, while
demonstrating accurate classification rates of 65.6 percent and 80.4
percent respectively. Finally, the discriminant functions for White
females, chi-square (12, n = 32) = 13.94, p = .30, and White males,
chi-square (12, n = 22) = 14.90, p = .24, were not significant, even
though discriminant analyses revealed accurate classification rates
of 81.3 and 90.9 respectively.
Discriminant analyses were performed to determine the
accuracy of the individual subscales in predicting sexual abuse
history. The dependent variable Dissociation was the single most
accurate predictor of group membership, correctly classifying 67.3
percent of the cases (chi-square [1, N = 223] = 26.49, p < .00005).
The ranking of the remaining dependent variables according to their
ability to correctly classify cases as sexually abused and nonabused
was as follows (classification rate and discriminant function in
parentheses): Tension Reduction 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), Dysfunctional Sexual Behavior
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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), Atypical Response (63.2 percent, chi-square [1, N = 223] =
17,87, p < .00005), Anxious Arousal (61.9 percent, chi-square [1, N =
223] = 20.90, p < .00005), Defensive Avoidance (61.4 percent, chi-
square [1, N = 223] = 21.88, p < .00005), Depression (61.4 percent,
chi-square [1, N = 223] = 17.57, p < .00005), Response Level (61.4
percent, chi-square [1, N = 223] = 18.72, p < .00005), Impaired Self
Reference (60.1 percent, chi-square [1, N = 223] = 15.25, p < .001),
Anger/Irritability (59.6 percent, chi-square [1, N = 223] = 11.39, p <
.001), and Sexual Concerns (54.7 percent, chi-square [1, N = 223] =
4.44, p < .04). The discriminant analyses suggested that each of the
dependent variables had a measure of utility in accurately
classifying subjects as sexually abused and nonabused.
Summary
Reliability analysis indicated that the TSI demonstrated
marginally acceptable reliability in the current study. Across most
dependent variables, subjects who inconsistently reported on a self-
report measure that they were sexually abused were found to be
similar on the TSI dependent variables to subjects who consistently
reported that they had been victims of child sexual abuse. Hispanic
females reported being victims of child sexual abuse at significantly
higher rates than their Hispanic male and White peers. Female
victims of sexual abuse identified male perpetrators in the great
majority of cases, while male victims of sexual abuse identified
females perpetrators in the majority of cases. MANOVA results
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93
indicated that sexually abused subjects differed significantly from
their nonabused counterparts on all dependent variables. In
addition, no significant overall differences were found on the
dependent variables between sexually abused males and females,
and no overall differences were found between sexually abused
Hispanic and White subjects. Finally, discriminant analysis
indicated that the TSI demonstrated statistically significant and
marginally acceptable levels of predictive ability.
Chapter 4 discusses the results of the study, and considers the
wider implications of its findings. The results are discussed as they
relate to the hypotheses and other areas of concern, implications for
theory and intervention are discussed, and ideas for future research
are addressed.
Footnote
1. It is important to remember that although a chi-square
distribution based on Wilks lambda may be significant, it provides
minimal information regarding the effectiveness of the discriminant
function in classification. It serves as a test of the null hypothesis
that the sample means are equal (Norusis, 1994).
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94
Chapter IV : Discussion
This chapter discusses the results of the study, and considers
the wider implications of its findings. The chapter is divided into
six sections: The Findings as They Relate to the Hypotheses,
General Discussion of the Findings, Implications for Theory,
Intervention Implications, Future Research, and Conclusion.
The Findings as They Relate to the Hypotheses
Hypothesis 1 stated: The Trauma Symptom Inventory will be
found to demonstrate sufficient reliability and validity to be used in
future child sexual abuse research on adolescents. Individual TSI
scales ranged in reliability from .69 to .89 (mean a = .82). These
alpha levels are considerably lower than the TSI alpha levels
reported by Briere, Elliott, and Smiljanich (1993) for university
subjects ( mean a = .87) and adult clinical subjects (mean a = .90). It
appears that the elimination of three items from the Sexual
Concerns scale and one item from the Dysfunctional Sexual
Behavior scale in the version of the TSI employed in the current
study may have lowered the alpha levels of these scales, and in turn
compromised the overall reliability of the TSI in the current study.
The question of how large these coefficients must be before
they are accepted as evidence of the measure's reliability must be
addressed. Guilford (1956) and Helmstadter (1964) have indicated
that alpha coefficients of .70 to .80 are reasonable for most tests.
Salvia and Ysseldyke (1988) argued that coefficients in the .80s are
sufficient for screening purposes, while Hammill, Brown, and
Bryant (1989) concluded that .80 is the minimum level of acceptable
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95
reliability, while .90 is preferred. Using these guidelines as
benchmarks, the TSI demonstrated marginally acceptable reliability
in the current study, and with some modifications (e.g., restoring the
TSI items that were eliminated for the current study) could have a
measure of utility in future sexual abuse research with adolescents.
Overall, the TSI accurately classified 69.1 percent of the cases
as either victims of child sexual abuse or nonabused. The
Dissociation scale was the single most accurate predictor of group
membership, correctly classifying 67.3 percent of the cases, with the
other scales correctly classifying 54.7-65.9 percent of the subjects as
either sexually abused or nonabused. The four TSI items that were
not administered to the subjects in the current study may have
compromised this measures ability to accurately classify subjects as
sexually abused or nonabused.
In the current study, the predictive ability of the TSI had its
foundation in the degree of accuracy demonstrated by the CMIS— SF
to classify the subjects as either sexually abused or nonabused.
Although the CMIS— SF was modified for use in this study to
maximize its ability to correctly classify adolescents in a school
setting, additional modifications will make it a much more accurate
instrument. For example, the CMIS— SF did not adequately address
the issue of "date rape", a topic that has received a significant
amount of attention by adolescents through the media in recent
years. Furthermore, the issue of force was addressed only once in
the sexual abuse section of the CMIS— SF. The lack of emphasis on
the issue of force on the CMIS— SF may have made it an easy topic
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96
for subjects to choose to ignore. Finally, the overall format of the
CMIS— SF is flawed. The fill-in the blank, only answer the portions
that apply to you format, gives individuals far too much latitude in
selecting which parts of the measure they may wish to complete. A
more forced-choice format (similar to the TSI) would be more
appropriate. For example, the CMIS— SF asks, "Has anyone ever
kissed you in a sexual way, or touched your body in a sexual way,
or made you touch their sexual parts?" Subsequently, subjects are
provided the opportunity to place a check mark in a space for "yes"
or "no", and they are provided with the opportunity to identify by
check marks a variety of family members who have interacted with
them in the manner described in the item presented above. With
this format, subjects have the opportunity to selectively choose
which parts of the measure to answer. More accurate information
would be obtained if the subjects were asked specific information
about specific individuals. For example asking; (1) H as your father
or male guardian ever kissed you in a sexual way, or touched your
body in a sexual way, or made you touch their sexual parts?"; (2)
"Has your mother or female guardian ever kissed you in a sexual
way, or touched your body in a sexual way, or made you touch their
sexual parts?"; etc. For each such item, the subjects would be
presented with the forced choice of "yes" or "no". These types of
items would make it more difficult for subjects to arbitrarily ignore
certain sections of the CMIS— SF. Given the noted shortcomings of
the CMIS— SF, and the limitations placed on the researcher by the
school district regarding the use of certain items of the TSI, the TSI
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97
demonstrated marginally acceptable predictive ability could have
application in future child sexual abuse research with adolescents.
Hypothesis 2 stated : The TSI will demonstrate clinical utility
in discriminating adolescents that have been sexually abused from
their nonabused peers. Although the findings of the current study
suggested that the TSI has application in future child sexual abuse
research, the clinical use of this measure is far more uncertain.
Table 19 gives an overview of the TSI's ability to accurately classify
individuals as sexually abused and nonabused. While over 90
percent of White males were correctly classified as sexually abused
and nonabused, only 57.1 percent of Hispanic subjects were
correctly classified as sexually abused. Although the findings of the
current study indicated that there is some evidence that the TSI
could have clinical utility for some groups of individuals, much
more research is required before the TSI can be used effectively as a
clinical measure with adolescents.
Hypothesis 3 stated: The Dysfunctional Sexual Behavior and
Sexual Concerns scales of the TSI will be found to be significantly
more accurate than the other scales of the TSI in identifying sexual
abuse history. This hypothesis was not supported by the findings of
the current study. The Dysfunctional Sexual Behavior scale
accurately classified 64.6 percent of subjects as sexually abused and
nonabused in the current study. Two other scales (Dissociation and
Tension Reduction Behavior) classified subjects at higher rates. The
Sexual Concerns scale accurately classified 54.7 percent of subjects
as sexually abused and nonabused. This represented the worst rate
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98
of accuracy in classification among the dependent variables. As
mentioned earlier, the deleted items from both of these scales may
have compromised their ability to accurately classify subjects.
Hypothesis 4 stated: On the CMIS— SF, adolescents who
inconsistently reported that they had been sexually abused will not
differ significantly across all dependent variables from adolescents
who reported consistently that they had been sexually abused. This
hypothesis was supported by the preliminary MANOVA findings.
Although the MANOVA procedures employed to explore the main
effects of the sexually abused group versus the inconsistent group
and the nonabused group versus the inconsistent group were not
significant, post hoc analyses clearly indicated that the inconsistent
group was more similar to the sexually abused group than to the
nonabused group. These findings support the concept advanced by
Peters, Wyatt, and Finkelhor (1986), that the number and types of
questions asked of subjects are related to successful identification of
individuals that have been victims of child sexual abuse. These
results were obtained despite the fact that several items of the
Childhood Maltreatment Study— Short Form designed specifically to
differentiate sexually abused subjects from nonabused subjects were
eliminated when school officials characterized the excluded items
as inappropriate areas of inquiry with nondinical adolescents in a
public school setting.
Hypothesis 5 stated: No significant differences will be found
across the dependent variables between Hispanic adolescents and
White adolescents who have been sexually abused. This hypothesis
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99
was largely supported by the findings of the study. The 2-way
MANOVA, sexual abuse history by race/ethnicity, was not
significant. Furthermore, post hoc analysis of variance found only
one significant difference across the dependent variables. Sexually
abused White subjects were found to score significantly higher on
the Anxious Arousal dependent variable than their sexually abused
Hispanic peers.
Hypothesis 6 stated: No significant differences will be found
across the dependent variables between female and male
adolescents who have been sexually abused. This hypothesis was
supported by the results of the study. The 2-way MANOVA, sexual
abuse history by gender, was not significant. Furthermore, post hoc
analysis of variance indicated no significant differences on all
dependent variables. These results support the findings of other
researchers who have looked specifically at the gender differences
among individuals that have been sexually abused (e.g., Briere,
Evans, Runtz, & Wall, 1988; Urquiza & Crowley, 1986; Young,
Bergandi, & Titius, 1994).
Hypothesis 7 stated: Sexually-abused adolescents will differ
significantly from their nonabused peers across all dependent
variables. This hypothesis was supported by the findings of the
study. The one-way MANOVA for sexual abuse history was highly
significant. In addition, post hoc univariate analysis discovered
significant differences on all dependent variables. These results are
similar to a large body of research that has investigated the negative
impacts of child sexual victimization (e.g., Beitchman, Zucker,
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100
Hood, daCosta, & Akman, 1991; Briere, 1992; Browne & Finkelhor,
1986; Russell, 1983,1984,1986). The results suggested that similar
to research findings on adults sexually abused as children, sexually
abused adolescents experience significant negative impacts as a
result of their victimization.
General Discussion of the Findings
Prevalence of Child Sexual Abuse. The most revealing
finding of this study involved the ethnicity/gender of those subjects
that indicated that they had been victims of child sexual abuse.
Hispanic females who participated in this study were found to be
significantly more likely to report being victims of child sexual
abuse than their Hispanic male and White male and female peers.
Hispanic females reported child sexual abuse at a rate of 54.2
percent, compared to the child sexual abuse rates of 23.9 percent,
27.3 percent, and 28.1 percent reported by Hispanic males, White
males, and White females respectively. In some ways these results
are similar to the findings of a self-report postal questionnaire study
conducted by Kercher and McShane (1984) in Texas. In that study,
21.7 percent of the Hispanic women who filled out and returned a
survey booklet reported that they had been victims of child sexual
abuse compared to 10.4 percent of African-American women and
9.8 percent of White women. A return rate of 53 percent in the
Kercher and McShane (1984) study hampered the researchers ability
to generalize their results to the adult population in Texas.
Similarly, a participation rate of 29.3 percent in the current study
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loi
hinders any attempts to generalize the results of this study to the
entire population of the target high school.
Although it is important to use caution when attempting to
generalize the findings of any study, it is equally important not to
ignore the possible ramifications of research data. Lynch, Stem,
Oates, and O'Toole (1993) studied the families of 187 children with
histories of sexual abuse. This study was designed to assess the
behavioral and emotional effects of sexual abuse in children
immediately after the abuse was revealed, and 18 months after
initial disclosure. The researchers found that the more
dysfunctional families in their research sample refused to
participate in their research project. Furthermore, the study families
and the non-participating families did not significantly differ on the
sexual abuse variables. Although there is no way of ascertaining
the child sexual abuse rates of those students who did not
participate in the current study, the Lynch, Stem, Oates, and O'Toole
study mentioned above suggests that a factor in the non
participation of some of the adolescents in this study may have been
a result of familial dysfunction and not necessarily due to the lack of
sexual abuse victimization in the non-participating group.
Perpetrators of Abuse. A second meaningful finding of the
nonparametric analyses was the gender of those individuals
identified as child sexual abuse perpetrators. Female victims of
sexual abuse identified male perpetrators in 91.9 percent of sexual
assaults. These results are consistent with a large body of research
that have explored the gender of sexual abuse perpetrators when
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females are the victims of child sexual abuse (e.g., Mennen, 1994;
Russell, 1984). In contrast, male victims of child sexual abuse
identified female perpetrators in 52.9 percent of cases. While these
results are contrary to the findings of several studies that have
reported the preponderance of sexual abuse perpetrators to be men
even when the victims are boys (e.g., Faller, 1987; Reinhart, 1987), a
growing body of research has identified female perpetration rates
that are similar to those found in this study (e.g., Mendel, 1995;
Olson, 1990; Ramsey-Klawsnik, 1990; Risen & Koss, 1987).
Results of the current study indicated that 6.1 percent of
female subjects that indicated that they had been sexually abused,
reported being sexually victimized by a parent. In each case the
identified perpetrator was a father figure. In contrast, only one male
subject, or 5.3 percent of the male abused group, reported being
sexually victimized by a parental figure. In this one case, a mother
figure was identified as the perpetrator. At initial glance this data
would seem to support the theory that the prevalence of mother-
child incest is low— significantly lower than the father-child rate of
incest. However, these findings need to be viewed within the
context of how subjects were included in this study. Initially,
written parental informed-consent was needed before individual
students were approached regarding their participation in the
research project. In addition, over 78 percent of the parental
informed-consent forms were signed by mothers or female
guardians. It seems reasonable to assume that parents that gave
their permission to allow their students to participate in a child
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103
maltreatment study would also be those parents who have not
perpetrated sexual abuse upon their children. Following this line of
reasoning, mothers that have perpetrated mother-child incest may
have refused to allow their adolescents to participate in the current
study. Furthermore, the rate of father-child incest reported in this
study may be a low estimate of the true prevalence of father-child
incest for similar reasons.
Interaction Effects. The nonsignificant 3-way MANOVA
(sexual abuse history by gender by race/ethnicity) findings of the
current study are similar to the findings obtained by Mennen (1994),
who found no significant differences in the symptoms of
depression, anxiety, and self-concept among Hispanic, African-
American, and White sexually abused girls. However, the current
findings are contrary to Russell's (1986) findings which found that
higher percentages of Hispanic women reported significant trauma
as a result of their sexual victimization as compared to White,
Asian-American and African-American women.
Race/ethnicity. The main effect of race/ethnicity was
marginally nonsignificant (g = .092), and Hispanic subjects' mean
scores were found to be higher than White subjects' mean scores
across eleven of twelve dependent variables. In addition, an
ANOVA performed on the TSI Total Score found that Hispanic
subjects scored significantly higher on TSI Total Score than their
White peers. These findings may indicate that Hispanic subjects are
more emotionally at-risk than their White peers. Wyatt (1990) has
hypothesized that ethnic minority children in the United States are
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often subjected to numerous forms of victimization in addition to
child sexual abuse because they are exposed to institutionalized
racism throughout their lives. While the discussion of racial/ethnic
issues apart from the issue of child sexual abuse is beyond the scope
of this paper, Wyatt's (1990) assertions regarding the trauma
imposed upon ethnic minority children due to their generally lower
socioeconomic status, exposure to inordinate amounts of violence,
and an internalization of stigmas imposed upon them by a racist
society is one explanation that may account for the higher means
obtained by the Hispanic subjects.
Gender. Although the main effect of gender was found to be
statistically significant when entered into a one-way MANOVA,
gender was found not to be statistically significant when entered
into a MANCOVA with sexual abuse history as a covariate. These
findings suggested that the differences found between male and
female subjects across the dependent variables were on large part
due to the fact that more female than male subjects in this study
were found to be victims of child sexual abuse. However, post hoc
univariate analysis of the MANCOVA results found female subjects'
means to be significantly higher than their male counterparts on
seven dependent variables. In addition, an ANCOVA performed on
the TSI Total Score with sexual abuse history as a covariate found
that female subjects scored significantly higher on TSI Total Score
than their male peers. Furthermore, MANCOVA results aside,
female mean scores were higher than male mean scores on eleven of
the twelve dependent variables. The results are inconclusive, but it
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105
is clear that even after controlling for sexual abuse history, the
female subjects that participated in this study tended to
demonstrate more signs of Anger/Irritability, Intrusive Experiences,
Depression, Dissociation, and Defensive Avoidance than their male
peers.
Implications for Theory
The theory proposed in the introduction of this paper
suggested that instruments similar to the TSI that are developed
with items sensitive to sexual abuse-specific symptomatology
provide an accurate means of statistically differentiating sexually
abused individuals from their nonabused counterparts. The items
of these symptom approach measures are developed from the
research on the impacts of child sexual abuse. The overall findings
of the current study strongly support this claim. The differences
found between abused and nonabused subjects in this study on all
of the dependent variables were significant. However, the findings
of this study are much less definitive on this issue when the
differences between sexually abused and nonabused subjects within
subsamples are analyzed (see Table 17). While sexually abused and
nonabused Hispanic females and White males were differentiated
at statistically significant levels on the majority of the dependent
variables, Hispanic males and White females were differentiated at
statistically significant levels on very few dependent variables.
Although subsample size plays a role in this issue, much more
research is needed to determine whether or not the TSI has equal
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106
utility in statistically differentiating sexually abused and
nonabused individuals across demographic groups.
The theory presented in the introduction of this paper also
implied that symptom approach measures can accurately classify
subjects as either victims of child sexual abuse or nonabused. The
issue of the TSI's utility at such classification is a matter of degree.
Although, as discussed above, the TSI demonstrated the ability to
discriminate sexually abused and nonabused individuals at a
highly significant level, statistically significant differences do not
always translate into effectiveness in classification (Norusis, 1994).
For example, the TSI’ s classification rate of 69.1 percent derived
from the current study, may or may not meet the needs of
researchers, and would be considered a low rate of classification for
clinical use. Furthermore, similar to the inconsistent manner that
the TSI statistically differentiated subsamples of abused and
nonabused subjects, classification rates varied widely across the
subsample groups. While 93.7 percent of White males were
accurately classified as nonabused, only 59.6 percent of Hispanic
females were accurately classified as sexually abused (see Table 19).
Although it is premature to say that the TSI should be used for
classification purposes for White males and not for Hispanic
females, one matter is certain, more research is needed to determine
the TSI's utility in the classification of individuals as sexually
abused or nonabused.
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Intervention Implications
Prevention. Child abuse prevention efforts occur at the
primary, secondary, and tertiary levels. Primary intervention efforts
target the general population as a way of reducing or preventing
maltreatment, and include high school life skills classes that
promote positive parenting skills training, and school-based sexual
abuse prevention programs. Secondary prevention programs focus
on identified high-risk groups in their attempt to prevent
maltreatment, such as parenting skills training for groups (e.g.,
step-fathers) considered at risk of perpetrating child sexual abuse.
Finally, tertiary prevention programs target services to perpetrators
or victims of abuse as a means to reduce or prevent child abuse.
Examples of tertiary programs include therapeutic programs for
known pedophiles, and programs that emphasize the development
of parenting skills among individuals that have been identified as
abusive to children. (Thompson, 1994). The great majority of sexual
abuse prevention programs are of the primary prevention variety,
and largely consist of the sexual abuse prevention programs that
have been created for and implemented in schools.
Given the tremendous numbers of children and adolescents
that are being sexually abused each year, and the mounting
evidence that indicates that sexual abuse causes negative symptoms
in these groups, programs with proven efficiency at preventing
child sexual abuse need to be devised and implemented. There has
been a widespread proliferation of primary prevention programs in
the past fifteen years, which has led to efforts at documenting their
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108
effectiveness. The reviews of primary prevention programs have
produced disparate results. Some researchers (e.g., Finkelhor &
Strapko, 1992; Tutty, 1990) have reported predominately positive
results, while other researchers (e.g., Reppucd & Haugaard, 1989)
have indicated that it continues to remain unclear whether or not
primary prevention programs actually work. Furthermore, some
have suggested that preventing child sexual abuse is impossible
(e.g., Melton, 1992).
Not only are adolescents frequently the victims of child sexual
abuse, they are very often the perpetrators of sexual abuse (Becker,
Cunningham-Rathner, & Kaplan, 1986). In a study of ninety-one
child sex offenders, Elliott, Browne, and Kilcoyne (1995) reported
that a third of the offenders that participated in their study had
committed their first offense as juveniles. For these reasons,
adolescents appear to be an appropriate target population for
preventive programs.
High schools are viewed as good settings for the
implementation of primary prevention programs since they are the
source of a large percentage of child sexual abuse reports (Powers &
Eckenrode, 1986). In addition, high schools offer a promising
environment for interactive instruction of large numbers of
adolescents (Barth, Derezotes, & Danforth, 1991).
In their review of 60 high school-level child abuse prevention
programs, Barth, Derezotes, and Danforth (1991) found that
programs were typically less than two hours in duration, were not
integrated into existing family life education programs, and focused
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on "date rape", sexual abuse prevention, male perpetrators, female
victims, and the basics of reporting abuse. Furthermore, most
primary prevention programs limited their instructional methods to
demonstration and lecture, even though the authors reported that
role playing was the most effective learning strategy. The
researchers found that in general these programs did not emphasize
content designed to help adolescents avoid becoming child abusers.
When this topic was addressed, it was covered briefly. When the
topic of protection from child abuse was discussed apart from date
rape, generally self-protection skills from male strangers were
taught, ignoring the possible threats posed by family members and
friends of the family. Furthermore, many preventive programs
emphasized the "say no" strategy that is often employed in primary
prevention programs for younger children, even though researchers
(e.g., Sang, 1994) are finding that this strategy may have adverse
effects on children when they use this intervention and it is not
successful in preventing sexual abuse victimization. Finally, the
researchers noted that most primary prevention programs
presented information on the identification and reporting of child
abuse in a relatively straight forward manner without discussing
the rather complex and controversial aspects of identifying and
reporting child abuse.
Existing adolescent sexual abuse primary prevention
programs all aim to increase students' awareness and
understanding of sexual abuse. Far fewer preventive programs
attempt to assist students to alter their attitudes, skills, and
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110
behaviors so that they will be less likely to be abused or abuse, and
more likely to report sexual abuse (Barth, Derezotes, & Danforth,
1991).
A large body of prevention research employing adolescents as
subjects and intended to prevent smoking, substance abuse, and
teen pregnancy has provided a wealth of information that is often
not incorporated in the designs of sexual abuse prevention
programs (Evans, 1988; Kirby, 1984; Klepp, Halper, & Perry, 1986).
Preventive studies outside the area of sexual abuse have indicated
that altering behavior requires more than exposure and awareness.
Practicing, observing, and rehearsing in the home and in the
community are seen as critical factors in changing behavior
(Prochaska & DiClemente, 1986; Schwartz, 1988). The issue of
rehearsing sexual abuse preventive measures in the home is
supported by Barth, Derezotes, and Danforth (1991). These
researchers indicated that parents have influence on adolescents,
and focusing on creative tactics of involving parents in preventive
programs may prove beneficial in influencing adolescents views of
sexual abuse. Barth, Middleton, & Wagman (1989) indicated that
prevention programs can influence knowledge, but behavior change
is rarely achieved without incorporating the practice of skills. These
assertions are supported by child abuse prevention programs that
found that role playing increased program efficiency (Harvey,
Forehand, Brown, & Holmes, 1988; Wurtele, Marrs, & Miller-Perrin,
1987).
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Although an impressive body of research has established that
children and adolescents do learn the concepts taught by primary
prevention sexual abuse programs, these programs continue to
flourish even though there is no evidence that suggests that primary
prevention programs actually help children and adolescents avoid
sexual abuse victimization (Finkelhor & Strapko, 1992). Melton
(1992) indicated that a substantially stronger research base for these
primary prevention programs must be developed before these
programs should continue to be initiated or expanded. Rosenberg
and Reppucd (1985) suggested that ecologically oriented research is
needed to identify the necessary and sufficient conditions for child
abuse. Furthermore, these researchers indicated that comparative
studies of preventive approaches are needed to ascertain the
strategies that are most effective for specific target groups. Finally,
the need for long-term follow-up studies are viewed as essential in
order to realize the full potential of preventive efforts.
Teaching our children and adolescents awareness of the
issues surrounding child sexual abuse, facilitating their behavioral
changes on this issue, and developing their understanding on how
they can receive assistance if they have been sexually victimized
should be among the highest priorities in education. It is far more
difficult for children and adolescents to learn in school if they are
being sexually traumatized and/or suffering the negative impacts
of sexual abuse. Rather than teach sexual abuse awareness and
prevention as a separate unit, a far better approach would be to
infuse sensitive topics such as sexual abuse into existing school
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112
curricula. This approach would allow students to explore various
aspects of child sexual abuse through English, social studies, and
science classes, and get away from the inadequate two-hour
presentation format that many schools currently employ. Limited
and inadequate sexual abuse prevention programs may ease the
minds of educators who are desperate to address the tragedy of
child sexual abuse, but as mentioned above, the research on the
effectiveness of such limited programs is highly questionable.
The prevention of child sexual abuse through teacher training
has yielded some promising preliminary results. Randolph and
Gold (1994) conducted a study which utilized a teacher training
curriculum developed by Hazzard, Kleemeier, Pohl, and Webb
(1988). In their study, 21 kindergarten-12th grade teachers received
six hours of training in three two-hour sessions. The training
consisted of a series of workshops presented by professionals
knowledgeable in victim symptomology, statistics, short- and long
term effects of sexual abuse, reporting procedures, emotions felt
while reporting, and handling disclosures. An equal number of
teachers received no special training and served as a control group.
Both groups were given pretest, posttest, and follow-up measures.
Relative to the control group, trained teachers demonstrated
significant increases in the following areas: knowledge about child
sexual abuse, attitudes regarding prevention, distinguishing
behavioral indicators of abuse, and appropriate interventions in
suspected abuse cases. A 3-month follow-up revealed that when
compared to control subjects, trained teachers were more likely to
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113
have participated in behaviors related to the training. These
behaviors included talking to children about abuse issues and filing
suspected child abuse reports.
There is a need to develop primary prevention programs that
are developmentally and culturally appropriate for teenagers and
their parents. Adolescents are easily alienated if the content of a
program or its presentation are not matched to their level of
maturity and understanding. Furthermore, programs may need to
be adjusted depending on the cultural composition of the audience.
For example, an adolescent from one ethnic group may view
suggestions made regarding assertiveness on a date differently than
an adolescent from another ethnic group (Barth, Derezotes, &
Danforth, 1991). In the current study, the majority of Hispanic
female subjects reported that they had been victims of child sexual
abuse. It would be culturally insensitive to assume that prevention
programs developed from research conducted with White females
would automatically be appropriate for Hispanic females. Millan
and Rabiner (1992) suggested that when providing sexual abuse
prevention programs for Latino children, not only must the
prevention strategies being taught be age appropriate, the variables
of English language development, acculturation level, and cultural
and socioeconomic issues must be addressed. Herrerias (1988)
indicated that a comprehensive child abuse primary prevention
program for Latino parents should include a bilingual/bicultural
curriculum, in-home and group parenting lessons, individual and
family counseling sessions, and other supportive services such as
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114
information on formal education courses and employment
opportunities. Furthermore, researchers (e.g., Nevid & Javier, 1992;
Costantino, Malgady, & Rogler, 1986) have indicated that
presenting information in the form of "novelas" (i.e., soap operas)
and "cuentos" (i.e., story telling) may be an effective way of
presenting a wide range of possible situations and behaviors to
Latino participants as a means of generating discussion and
exploration of sensitive topics. Finally, sexual abuse prevention
programs need to be delivered by individuals who are culturally
sensitive, and who are accepted and trusted by the Latino
community (Millan & Rabiner, 1992).
The study of child sexual abuse perpetrators is another area of
research that may have a significant impact on which elements
should be included in sexual abuse primary prevention programs.
Elliott, Browne, and Kilcoyne (1995) interviewed 91 child sex
offenders about the methods they employed to target children for
victimization. Through these interviews, the authors compiled
dozens of suggestions made by perpetrators that may be important
factors to consider when developing sexual abuse preventive
programs.
Finally, Rosenberg and Reppucd (1985) suggested that
community-wide media campaigns may also play a crucial role in
the primary prevention of child abuse. These authors stressed that
offering crisis services as an integral part of such a media campaign
in the form of telephone hot lines may give parents and other
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115
individuals that are under stress valuable information and options
prior to committing acts of maltreatment against children.
Researchers (e.g., Garbarino & Kostelny, 1994; Rosenberg &
Reppucd, 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 and/or environmental factors are at
higher jeopardy than other groups of abusing children.
Unfortunately, existing research indicates that conventional
socioeconomic and demographic risk factors are less salient for
child sexual abuse than for other forms of child maltreatment such
as physical abuse and neglect (Garbarino & Kostelny, 1994). In
addition, variables related to family communication account for
significantly less of the variance in sexual abuse (Melton, 1992).
However, Kaufman and Zigler (1992) indicated that there is some
evidence that suggests that children living within certain family
structures do experience increased prevalence rates of child sexual
abuse. These environments include single-parent families, step-
families, and children of teen mothers. The authors suggested that
an alternative to universal primary prevention programs may be the
targeting of these at-risk groups for intervention. In addition, these
researchers indicated that given that many children are sexually
exploited by neighbors, strangers, and relatives while their parents
are at work, the expansion of extended after-school programs
staffed by trained professionals and paraprofessionals would be an
alternative method of decreasing the risk of child sexual abuse.
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116
The majority of child sexual abuse prevention programs have
implicitly or otherwise implied that children and adolescents are
responsible for preventing their own sexual victimization. These
programs are often based on the concept that youth can learn
strategies that will discourage offenders, even though it is
recognized that adults have the ability to manipulate and
physically overpower children and adolescents. Society must take
responsibility for the protection of its children, and make efforts at
keeping adults' behaviors with youth within suitable bounds
(Kaufman & Zigler, 1992).
Legislation. In recent years, a growing number of states have
enacted new and innovative laws aimed at protecting children from
convicted sex offenders. This legislation can be grouped into three
areas: (1) laws that require sex offenders to register with law
enforcement agencies; (2) laws authorizing public notification when
a convicted sex offender moves into a community; and (3)
legislation that permits the involuntary incarceration of violent
sexual predators even after these individuals have served their
criminal sentences (Myers, 1996). The purpose of these laws is to
increase community awareness regarding the whereabouts of
convicted sex offenders, and in some cases to ensure that sexual
predators never have access to children. Preliminary research has
indicated that although public notification of sex offenders living in
a community has not appeared to lower recidivism, sexual
offenders who participated in community notification programs
were arrested for new sexual crimes much more quickly than sexual
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117
offenders who were released without public notification
(Washington State Institute for Public Policy, 1995).
There are those (e.g., Freeman-Longo, 1996) who contend that
these laws violate the constitutional rights of convicted sex
offenders, their families, and in some cases the rights of sexual
abuse victims and their families. In addition, this type of legislation
may have little effect on the actions of sex offenders who have not
been convicted of a sexual offense. Nevertheless, these laws are an
indication that some legislators, no doubt due in part to the
prodding of the constituencies that they represent, are finally taking
some assertive steps to address the issue of child sexual abuse
through legislation.
Investigation and Prosecution. The organizational model of a
law enforcement agency will determine how various reported
crimes are addressed. Humphreys (1996) compared two different
models of police intervention in child sexual abuse cases in New
South Wales, Australia. The researcher compared a "fragmented"
police child mistreatment unit with a "closed" police child
mistreatment unit. The "fragmented" unit was composed of police
officers that would interview child witnesses of child sexual abuse
crimes, and then refer the case to a generalist detective to complete
the investigation. The "closed" unit consisted of officers actively
involved in child abuse prevention programs and training. These
officers interviewed child witnesses of child sexual abuse crimes,
and carried out the full investigation within their ranks.
Humphreys found that significantly more child victims of sexual
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118
abuse were interviewed by the "closed" mistreatment unit than the
"fragmented" police unit. In addition, significantly more alleged
perpetrators of child sexual abuse were interviewed by the "closed"
unit than the "fragmented" police unit. Finally, during the period of
the study, 52 percent of the alleged perpetrators in the "closed"
police unit's child sexual abuse cases were prosecuted, compared to
the 24 percent of alleged perpetrators that were prosecuted as a
result of the "fragmented" police unit's investigations. The
researcher reported that of the parents of the sexually abused
children that agreed to be interviewed as part of the research study,
all parents who had experienced the "closed" unit reported that they
were satisfied with the police response they experienced. In
contrast, no parent interviewed from the "fragmented" police unit
sample made any positive remarks regarding their experience of the
police response they encountered.
The response of law enforcement agencies to reported cases of
child sexual abuse is a critical factor in the fight to eliminate or
substantially reduce sexual crimes against children and
adolescents. The effective, assertive, and compassionate
investigation and prosecution of child sexual abuse cases may have
the effect of having more victims of sexual abuse come forward to
the authorities, and serve as a strong warning to individuals that
prey sexually on youth that their sexual crimes will not go
unpunished.
Community Response. Effective sexual abuse prevention and
the prosecution of individuals that sexually abuse children
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demands the cooperation of many facets of a community, including:
parents, educators, school boards, churches, community leaders,
legislators, community mental health providers, law enforcement,
and private therapists. It must be understood that once adolescents
are encouraged to dialog about sexual abuse, those who have been
sexually victimized will often need to have access to quality and
low-cost therapeutic services in the form of counseling groups,
individual therapy, self-help groups, etc. Ideally, therapists with
expertise in the area of sexual abuse would provide counseling
services in schools, churches and other community locations
already frequented by victims of sexual abuse and their families.
This accommodation would maximize the possibility that they will
receive the expert mental health treatment they need for proper
healing.
Professionals in fields that have contact with adolescents
need to become well aware of the behavioral and emotional
symptoms of child sexual abuse. Furthermore, these professionals
need to become comfortable discussing sexual abuse issues with
adolescents, and routinely ask adolescents who are demonstrating
symptoms of sexual abuse if they currently are or have been victims
of sexual abuse. The mere fact that an adult has shown genuine
concern by asking questions to rule out sexual abuse will serve
notice to the adolescent that there is at least one individual who is
concerned about his/her welfare.
Implementation of a wide ranging plan to prevent child
sexual abuse, and the offering of therapeutic services to all victims
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of sexual abuse who require such services would be a vast departure
from society's current view of the child sexual abuse issue. The
research on the prevalence and effects of child sexual abuse
suggests that this issue has reached epidemic proportions.
Unfortunately, society has refused to accept this view, and
continues to offer meager resources and solutions to meet this crisis.
Future Research
Race/Ethnicity and Gender as Risk Factors. Given the
substantial interest that has been generated over the issue of child
sexual abuse in the general population and among researchers over
the last several years, it is surprising and somewhat alarming how
little research has been conducted on ethnic minority individuals
who have been victims sexual victimization. Similar to other areas
of inquiry, most studies on child sexual abuse are conducted with
White subjects. Although the majority of researchers are careful to
note that the findings obtained with White subjects should not be
generalized to minority populations, research employing ethnic
minority subjects to substantiate or negate findings from these
studies often never takes place. Most researchers would steadfastly
claim that they limit their investigations to issues of importance.
Unfortunately, most researchers examine areas of concern while
ignoring large portions of the population that are affected by these
issues.
The Kercher and McShane (1984) study reviewed earlier and
the current study have indicated that female Hispanics may be
more at risk for child sexual abuse than other groups. The results of
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these two studies form the foundation for an area of inquiry that
needs to fully investigated. Prevalence research needs to be
conducted to ascertain whether the results of these studies was
caused by sampling error, or if indeed Hispanic females are more at
risk than other groups of being sexually victimized.
The issue of gender as a risk factor of child sexual abuse
needs further exploration in order to conclusively determine
whether or not the experience of male victims of child sexual abuse
substantially differs from the experience of female victims.
Although the current study found no significant gender by sexual
abuse interaction effect, more research is needed in this area.
Furthermore, as more and more research is conducted with male
victims of child sexual abuse, we may gain understanding not only
of the effects of child sexual abuse on males and how they coincide
and differ from the experience of female victims, but also gain
insight on the gender of the perpetrators of sexual abuse. Not long
ago, the predominant impression was that the great majority of
child sexual abuse was perpetrated by males. The results of this
study and others reviewed in this paper (e.g., Fromuth & Burkhart,
1989; Mendel, 1995) clearly indicate that the numbers of female
perpetrators of sexual abuse— especially when boys are the targets of
abuse— are much higher than previously imagined.
Development of Test Instrum ents. Although the TSI
demonstrated marginally acceptable levels of reliability and
predictive ability in the current study, continued research is
warranted in order to develop the TSI's utility with adolescent
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122
samples. Furthermore, although the current findings are
encouraging, much more data is needed in order that norms may be
developed for various groups (e.g., clinical and nonclinical
adolescents, Hispanics, females, etc.). This normative data is
essential if the TSI is to be developed into a useful clinical
instrument for adolescents. Additionally, future research is needed
to assess whether or not extreme scores on the Atypical Response
and Response Level scales indicate an invalid protocol, similar to
the validity scales on the MMPI-2. Finally, other forms of validity
(e.g., concurrent validity) need to be established for this measure.
The CMIS— SF proved reasonably effective in classifying
adolescent subjects into sexually abused and nonabused categories
in the current study, but as noted earlier, several key changes in the
format of this measure could significantly improve its utility with
adolescent samples. Furthermore, efforts at establishing the
reliability and validity of this survey are needed to justify its use in
child sexual abuse research.
Cumulative Effects of Childhood Trauma. The plethora of
media attention and research on child sexual abuse in recent years
has heightened the awareness of clinicians and the general
population regarding the effects and treatment of sexual
victimization. Unfortunately, other forms of childhood trauma have
not received the same level of scrutiny. Despite a growing
awareness on the part of clinicians about the possible negative
effects experienced by children from natural disasters, poverty,
exposure to neighborhood violence, physical and mental abuse, and
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institutional racism, few studies have addressed the cumulative
effects of childhood trauma on psychological functioning. This is
one factor that makes it very difficult to predict sexual abuse history,
for example, from an instrument such as the TSI. Individuals who
have not been sexually abused may score high on the TSI because of
a childhood trauma that is unrelated to sexual abuse. In addition,
research is needed to discover whether certain types of childhood
trauma are more prone to negative effects than other forms of
childhood trauma. Furthermore, more research is required to
determine whether or not individuals that experience numerous
types of traumatic events are more emotionally at risk than
individuals who have experienced fewer forms of traumatic life
events.
University/Secondary School Partnerships. There is a dearth
of research on nonclinical adolescents across a wide range of topics
(including child sexual abuse) and relatively few universities are
attempting to employ adolescents from high school settings as
subjects in their research projects. This unfortunate situation
deprives researchers access to a large pool of nonclinical adolescent
subjects, and denies high school districts valuable information
about their clients that would assist them in providing meaningful
programs for students. Additionally, the lack of research on
nonclinical adolescents limits our understanding of one of the most
turbulent and critical stages of human development. Universities
should promote mutually advantages partnerships with high
school districts that encourage trusting relationships based on the
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124
strong commitment and sincere desire of both groups to better
understand and meet the needs of adolescents. These partnerships
would be an opportunity for universities to move away from
employing samples of convenience in their research projects— such
as middle to upper-middle class White college students— and
provide high school districts with a valuable ally in their efforts to
meet the educational and emotional needs of students.
Conclusion
Child sexual abuse research is a very important area of study.
Each year millions of children in this country are sexually
victimized, and as a result many experience the negative impacts
that have been well documented by research. Research efforts need
to be expanded to include ethnic minorities, males, and nonclinical
adolescents. Furthermore, there is a need for research that attempts
to identify individuals who have been victims of child sexual abuse,
but who have not come forward to receive therapeutic interventions
that may decrease the negative impacts of sexual victimization.
Without such studies, researchers and society in general will never
fully understand the widespread negative impacts of child sexual
abuse.
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125
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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 at ________ High
School in order to complete my Ph.D. in Counseling Psychology. I have worked
for the _______________ 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 at ________ High School
fill-out two surveys that ask explicit questions related to family 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 not
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 ngt 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
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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 the ________ 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 (909) __________ .
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 (909) ___________ during the Fall, 1995
semester.
PLEASE RETURN THIS FORM TO DAVID MUftOZ. ONTARIO. CA 9 1 7 6 1 . A S
SO O N A S P O S S IB L E IN THE STAM PED AND A D D R E S S E D ENVELOPE
PROVIDED.
Thank you for you time and your consideration.
David T. Munoz, M.S.
School Psychologist
Michael Newcomb, Ph.D.
Professor/Dissertation Committee Chairperson, Division of Counseling
Psychology
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146
Appendix B : Parent Consent— Spanish Form
Estimados Padres/Guardianes:
Mi nombre es David Munoz y soy candidate ai doctorado de la Universidad del Sur
de California (USC). Estoy conduciendo un proyecto de investigacidn en la
Escuela Secundaria ________ para completar mi doctorado en psicologfa. He
trabajado como psicdlogo en el distrito escolar de _________ por diez anos y
ultimamente estoy asignado a las escuelas secundarias de ________ y de
Por medio de esta carta estoy pidiendo su permiso para que su hijo/a participe
en mi investigacidn. Su autorizacidn le dard 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
expli'citas relacionadas a la vida familiar, preocupaciones sexuales de
adolescentes, violencia familiar, experiencias traumdticas, y otras areas que
preocupan a los adolescentes. La participacidn de su estudiante requiere
aproximadamente veinte minutos de tiempo escolar. La maestra/o no catigard a
su estudiante por tomar tiempo de sus lecciones para participar con este
proyecto de investigacidn.
Todas las respuestas a los cuestionarios serdn anonimas para protejer a los
estudiantes. El nombre de su estudiante no aparecerd en ningun reporte de
investigacidn o documento. Ninguna persona, escuela o agenda trendrd accesso
a las respuestas de su estudiante. La participacidn en este proyecto es
voluntaria. Si en cualquier tiempo usted y su hijo/a desean revocar su
consentimiento y participacidn en el estudio, podrdn hacerlo sin dar ninguna
explicacidn al investigador y sin que su estudiante sea perjudicado.
El propdsito de esta investigacidn es para ampliar la validez de las medidas que
se usdn en este estudio y para aumentar nuestra base de conocimiento respeto a
los estudiantes de escuela secundaria. La informacidn obtenida por medio de la
investigacidn proveera a educadores un entendimiento mds acertado acerca de
los adolescentes, proveerd entrenamiento mds significdtivo para los maestros,
identificard problemas que pueden afectar el comportamiento escolar de los
estudiantes, y identificard las areas de servicios estudiantiles que no se estdn
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 experimentar un poco de molestia emocional al tratar temas delicados.
A la conclusidn de su participacidn en este proyecto, se les dard informacidn
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147
acerca de personas con las que pueden hablar y materiales que pueden leer y
consultar para obtener mds informacidn acerca 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
contacto con el senor David Munoz al siguiente numero: (909)___________ .
Los padres estdn invitados a asistir una de dos juntas informativas que se
llevardn acabo el jueves, 30 de marzo, y martes, el 4 de abril a las siete de la
noche en la biblioteca de la Escuela Secundaria ________ . Durante estas
juntas, los padres tendrdn la oportunidad de conocer al investigador, discutir el
estudio , y repasar los materiales que se usardn en el proyecto de investigacidn.
Si tiene preguntas acerca del proyecto y no puede asistir a la reunidn, por favor
ponganse en contacto con David Munoz al siguiente numero: (909)_________ .
En la Universidad del Sur de California (USC) hay un comitd que se conoce como
la Mesa de Repaso Institucional a donde se pueden y deben dirigir preguntas
acerca de este proyecto. Se puede comunicar con este comite en ia la siguiente
direccidn: USC Administration 300, MC 4019, University Park, L.A., CA 90089-
4019. O pueden llamara al siguiente numero: (213) 740-6711.
Su firma indica que usted ha lefdo y ha comprendido esta forma y que estd 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)
Relacidn al estudiante____________________________ Teldfono__________
Personas interesados en obtener informacidn acerca de los resultados del
estudio deben ponerse en contacto con David Munoz al siguiente numero: (909)
...............durante el semestre del otorio de 1995.
POR FAVOR DEVUELVA E ST A FORMA A DAVID MUNOZ. ONTARIO. CA
91 7 6 1 . LO MAS PRONTO POSIBLE EN EL SO BR E INCLUIDO.
Gracias por su atencidr. y consideracidn.
David Munoz, M.S.
Psicdlogo Escolar
Michael Newcomb, Ph.D.
Profesor, Moderador del Comitd del Disertacidn, Ramo de Psicologfa
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Appendix C : Verbal Instructions to Subjects
148
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 I 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. I 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.
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149
Appendix D: Student Consent Form
Dear Student:
My nam e 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, hum an sexuality, dom estic
violence, relationships, and o ther a re a s 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 te a c h e r inservice training, to identify student
co ncerns th at may affect classroom perform ance, and to
identify a re a s of student need that are not adequately
addressed by the school system at this time.
To protect your identity, all of your an sw e rs will be
anonymous. This m eans that your responses to items on the
surveys can not be linked to you. Under no circumstances will
your responses be m ade available to any individual, school, or
agency, unless you choose to v e r b 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 case s, the
appropriate authorities will be informed, and in most c a se s
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 d o n e without
explanation to the researcher, and without penalty to you.
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150
The potential risks to you from participating in this study are
minimal. Some students may experience a degree of emotional
upset from answ ering questions that a d d re ss sensitive life
issues. When you have completed the surveys you will be given
an information sh e et listing both individuals you can speak to
and reading m aterials 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 s p e a k to Mrs. ________________ , A ssistant
Principal of Guidance at _________ High School. In addition,
you can contact me directly at (213) __________, ext. ___ 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 (P lease print)________________________________
Thank you for you time and your consideration.
David T. Munoz, M.S.
School Psychologist
Michael Newcomb, Ph.D.
Professor/D issertation Com m ittee C hairperson, Division of
Counseling Psychology
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151
Appendix E : Subject Resource Sheet
RESOURCES
ORGANIZATIONS/COUNSELING AGENCIES
Child Abuw Hotline for Los Anqilw 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 S. Broadway, Whittier, CA 90606, (310) 692-0383. This
agency provides individual counseling services to children and adolescents through age 18. Fees 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.*
Prolect SISTER. P.O. Box 621, Claremont, CA 91711, (909) 626-HELP (626-4357). This program offers
comprehensive 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 emphasize 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 Profect SISTER headquarters, the caller will be directed to low-cost
and/or free counseling services available in the caller's area of residence.
RAINN fRaoe. 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 Bass 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-Bass, 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.
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152
Appendix F : Child Maltreatment Interview Scale-Short
Form
Childhood Maltreatment Interview Schedule -- Short Form (REVISED)
CMIS - SF(R)
John Briere, Ph.D.
Department of Psychiatry
University of Southern California School of Medicine
1991
Adapted from the full CMIS. published as an appendix in J. Briere (in press),
Child Abuse Trauma: Theory and Treatment of the Lasting Effects. Newbury
Park, CA: Sage Publications.
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153
Age:_____ Grade:_____
Sex: Male Female_____
Race: Caucasian/White Black Asian_____
Hispanic Other_____
Are you currently receiving or have you ever received counseling or psychiatric
treatment?
Yes No_____
The follow in g su rvey a sk s about th in gs that may have
happened to you in the past, or that you are currently
experiencing. P lease 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-mother
Step-father
Foster-mother
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. 1
GO TO NEXT PAGE
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154
2) Have you ever seen one of your parents hit or beat up your other
parent?
Yes No_____
If yes, how many times can you recall this happening?
times
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._____ 1
Has one or more of these times resulted in someone needing medical
care or the police being called?
Yes No_____
3) On average, before age 8. 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
4) On average, before age 8. how much did you feel that your
m other/step-m other/foster-m oth er 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
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155
6) On average, from age 8 through age 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 Very much
1 2 3 4
7) When you were 16 or younger, how often did the following happen
to you in the average year? Answer for your parents or step-parents
or foster parents or other adult in charge of you as a child:
Once Twice 3 -5 6 -10 11-20 Over 20
a a times times times times
Never year year a year a year a year a year
A) Yell at you 0 1 2 3 4 5 6
B) Insult you 0 1 2 3 4 5 6
C) 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 0 1 2 3 4 5 6
were a bad
person
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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-mother
Step-father
Foster-mother
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? (_
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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.)
Mother/step-mother/foster-mother
Father/step-father/foster-father
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 years 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_____________ )
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158
A family member (Please check all that apply.)
Mother/step-mother/foster-mother
Father/step-father/foster-father
Brother Sister
Grandfather Grandmother
Uncle Aunt
Male cousin Female cousin
Other (Please specify individual's gender and
relationship to you. ___________________ 1
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._________________________ )
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At what ages did this occur? (.
X
Overall, about how many times were you kissed or touched in a
sexual way or made to touch someone else's sexual parts by someone
five or more years older than you before age 17?
times
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) Physically abused? Yes No_____
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160
P lease answ er th e follow ing q u estio n s 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.
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Appendix G : The Trauma Symptom Inventory
161
T S I
Trauma Symptom Inventory
John Briere, Ph.D.
DIRECTIONS: P lease indicate how often each of the follow ing
e x p erien ces have happened to in the last six m onths.
Reproduced by special permission of the Publisher, Psychological Assessment Resources, 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.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
162
1
2
3
4
5
6
7
8. Feeling em pty inside........................................................................
9. S a d n e ss .....................................................................................................
10. ’Flashbacks" (sudden memories or images of upsetting
th in g s).......................................................................................................
11. Not being able to say ’no* when someone wanted to have sex
Getting angry about something that wasn't very important....
12. Feeling like you were outside of your body.............................
13. Lower back pain...............................................................................
14. Sudden disturbing memories when you were not expecting
th em ............................................................................................................
15. W anting to cry ...................................................................................
16. Bad feelings about sex...................................................................
17. Not feeling happy.............................................................................
18. Becoming angry for little or no reason....................................
19. Feeling like you don't know who you really are......................
20. Feeling d e p re sse d ..............................................................................
21. Being bothered by memories........................................................
2 2 . Having sex with someone you hardly knew..............................
23. Thoughts or fantasies about hurting som eone.........................
24. Your mind going blank..................................................................
25. F ainting .....................................................................................................
Never Often
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
0 TO NEXT PAGE
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163
N ever Often
26. Not enjoying things you used to enjoy----------------------------
0 1 2 3
27. Periods of trembling or shaking................................................
0 1 2 3
28. Pushing painful memories out of your mind............................ 0 1 2 3
29. Not understanding why you did something...............................
0 1 2 3
30. Threatening or attem pting suicide............................................. 0 1 2 3
31. Feeling like you were watching yourself from far away------ 0 1 2 3
32. Feeling guilty......................................................................................
0 1 2 3
33. Feeling tense or "on edge*..........................................................
0 1 2 3
34. Getting into trouble because of sex.......................................... 0 1 2 3
35. Not feeling like your real self...................................................
0 1 2 3
36. Wishing you were dead..................................................................
0 1 2 3
37. Worrying about things....................................................................
0 1 2 3
38. Not being sure of what you want in life..................................
0 1 2 3
39. Feeling like you weren't really yourself.................................
0 1 2 3
40. Being easily annoyed by other people......................................
0 1 2 3
41. Starting argum ents or picking fights to get your anger
o u t..............................................................................................................
0 1 2 3
42. Suddenly feeling afraid for little or no reason....................... 0 1 2 3
43. Having sex or being sexual to keep from feeling lonely or
s a d .............................................................................................................
0 1 2 3
44. Getting angry when you didn't want to..................................... 0 1 2 3
45. Not being able to feel your emotions....................................... 0 1 2 3
46. Confusion about your sexual feelings....................................... 0 1 2 3
47. Using drugs other than marijuana.............................................
0 1 2 3
48. Feeling jumpy...................................................................................... 0 1 2 3
49. A bsent-m indedness.............................................................................. 0 1 2 3
50. Feeling paralyzed for minutes at a time.................................. 0 1 2 3
51. Needing other people to tell you what to do............................
0 1 2 3
GO TO NEXT PAGE
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
164
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66 .
67.
6 8 .
69.
70.
71.
72.
73.
74.
Never Often
Yelling or telling people off when you felt you shouldn't
have....................................................................................................... 0 1 2 3
Flirting or "coming on" to someone to get attention.............. 0 1 2 3
Sexual thoughts or feelings when you thought you shouldn't
have them.......................................................................................... 0 1 2 3
Intentionally hurting yourself (for example, by scratching,
cutting, or burning) even though you weren't trying to
commit suicide................................................................................ 0 1 2 3
Aches and pains............................................................................ 0 1 2 3
Having a feeling that something bad was about to happen 0 1 2 3
Sexual fantasies about being dominated or overpowered 0 1 2 3
High anxiety..................................................................................... 0 1 2 3
Wishing you had more money................................................... 0 1 2 3
Nervousness........................................................................................ 0 1 2 3
Getting confused about what you thought or believed............. 0 1 2 3
Avoiding things that you knew would upset you..................... 0 1 2 3
Feeling tired..................................................................................... 0 1 2 3
Feeling mad or angry inside..................................................... 0 1 2 3
Getting into trouble because of your drinking....................... 0 1 2 3
Staying away from certain people or places because they
reminded you of something....................................................... 0 1 2 3
One side of your body going numb........................................... 0 1 2 3
Wishing you could stop thinking about sex............................. 0 1 2 3
Suddenly remembering something upsetting from your past.. 0 1 2 3
Wanting to hit someone or something..................................... 0 1 2 3
Feeling hopeless............................................................................. 0 1 2 3
Hearing someone talk to you who wasn't really there 0 1 2 3
Suddenly being reminded of something bad............................. 0 1 2 3
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75. Getting into relationships that were bad for you....................
Never
0 1 2
165
Often
3
76. Sudden feelings of anger............................................................... 0 1 2 3
77. Trying to block out certain memories...................................... 0 1 2 3
78. Sexual p roblem s................................................................................. 0 1 2 3
79. Using sex to feel powerful or important.................................. 0 1 2 3
80. Violent d ream s.................................................................................... 0 1 2 3
81. Acting "sexy" even though you didn't reslly want sex........... 0 1 2 3
82. Ju st for a moment, seeing or hearing something upsetting
that happened earlier in your life............................................. 0 1 2 3
83. Using sex to get love or attention.............................................. 0 1 2 3
84. Frightening or upsetting thoughts popping into your mind.... 0 1 2 3
85. Getting your own feelings mixed up with someone else's....... 0 1 2 3
86. Wanting to have sex with someone who you knew was bad for
you.............................................................................................................. 0 1 2 3
87. Feeling down and unhappy........................................................... 0 1 2 3
88. Feeling asham ed about your sexual feelings or behavior....... 0 1 2 3
89. Trying to keep from being alone............................................... 0 1 2 3
90. Losing your sen se of taste.......................................................... 0 1 2 3
91. Trouble paying attention to people............................................ 0 1 2 3
92. Having the sam e (or nearly the same) bad dream over and
over a g ain ............................................................................................. 0 1 2 3
93. Your feelings or thoughts changing when you were with
other p eo p le......................................................................................... 0 1 2 3
94. Worrying that someone is trying to steal your ideas............. 0 1 2 3
95. Taking drugs or alcohol to stop your feelings......................... 0 1 2 3
96. Not letting yourself feel bad about the past............................ 0 1 2 3
97. Feeling like things weren't real................................................. 0 1 2 3
98. Feeling like you were in a dream.............................................. 0 1 2 3
GO TO NEXT PAGE
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99.
100 .
10 1 .
102 .
103.
104.
105.
106.
107.
108.
109.
110 .
111 .
112 .
113.
114.
115.
166
Never Often
Not eating or sleeping for two or more days............................ 0 1 2 3
Drinking or taking drugs to stop certain thoughta or
memories.............................................................................................. 0 1 2 3
Trying not to have any feelings about something that once
hurt you............................................................................................. 0 1 2 3
Painful and disturbing memories............................................... 0 1 2 3
D aydream ing........................................................................................... 0 1 2 3
Trying not to think or talk about things in your life that
were painful..................................................................................... 0 1 2 3
Feeling like life w asn't worth living.......................................... 0 1 2 3
Being startled or frightened by sudden noises........................ 0 1 2 3
Seeing people from the spirit world.......................................... 0 1 2 3
Trouble controlling your tem per................................................ 0 1 2 3
Being easily influenced by others............................................ 0 1 2 3
Wishing you didn't have any sexual feelings........................... 0 1 2 3
Wanting to set fire to a public building................................... 0 1 2 3
Feeling afraid you might die or be injured............................. 0 1 2 3
Feeling so depressed that you avoided people.......................... 0 1 2 3
Thinking th at som eone was reading your mind........................ 0 1 2 3
Feeling w o rth le ss............................................................................... 0 1 2 3
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167
T S I Scoring Sheet
Directions: Sum individual items to form scale scores. Critical items are
interpreted individually.
Client Name:_____________________________
Validity S ca les Clinical Scales
Atypical
Rasponaa
Raaponsa
Laval
Anxioua
Arouaal
A ngar/
Irrita b ility
Defanaiva
Avoidance Depreaaion Diaaociation
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
111 60 108 103
114 64
Sum Sum Sum Sum Sum Sum Sum
Critical
Dysfunctional
Sexual Intruaiva
im paired
Self Sexual
Tension
Reduction
Item s Bahavior Experiencea Reference Concerna Bahavior
23 22 2 8 46 30
30 34 10 19 54 41
34 43 14 29 69 43
36 53 70 38 78 52
47 79 74 51 88 53
55 81 80 62 110 55
58 83 82 85 79
66 86 84 93 89
105 109
Sum Sum Sum Sum Sum
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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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