Daignault Isabelle V, Hébert Martine
Child Abuse Negl. 2009 Feb;33(2):102-15. doi: 10.1016/j.chiabu.2008.06.001.
The short-term outcomes of child sexual abuse (CSA) on academic, behavioral and social adaptation at school were examined in order to: (1) document the proportion of sexually abused (SA) girls struggling in school and define the nature of their difficulties, (2) explore whether different profiles of school adaptation could be identified, and (3) examine the different constellations of contextual, personal, and familial correlates of abuse for each profile.
The sample consisted of 100 French-speaking mother-daughter dyads. Girls (aged 7-12, M= 8.64) were administered cognitive functioning tests and completed self-report measures to assess symptomatology, perception of abuse, and support provided. Mothers and teachers completed questionnaires to assess child's emotional, social, behavioral, and academic functioning in school.
Descriptive analyses showed that a substantial number of girls (54%) presented clinical school adaptation difficulties in at least one of the three domains evaluated. Cluster analysis revealed four distinctive school functioning profiles: (1) academic-specific, (2) acting out/withdrawn, (3) polyclinical, and (4) resilient. These were distinguished by degree of school functioning difficulties and number of domains affected. The profiles were further discriminated by elements of the CSA experience and contextual, familial, and personal factors. The number of spheres of functioning affected was proportional to the number of risk factors to which girls were exposed.
Results suggest the need for a systematic and thorough assessment of SA child functioning at school and may guide mental health professionals in providing differential treatment on the basis of the emerged typology.
Sexually abused children demonstrate a wide variability of responses, rendering the elaboration of a "one size fits all" treatment rather difficult. The emerged typology underscores the complex heterogeneity of school adjustment profiles and suggest that secondary effects of abuse on child's level of school functioning require specific assessment and close monitoring. This study raises practical questions as to whether such secondary effects could best be addressed as a primary treatment objective, or in addition to a trauma-focused approach, or as the sole treatment objective.
研究儿童性虐待（CSA）对学业、行为及学校社交适应方面的短期影响，以便：（1）记录在学校遇到困难的性虐待（SA）女孩的比例，并明确其困难的性质；（2）探究是否能识别出不同的学校适应模式；（3）针对每种模式，研究虐待相关的背景、个人及家庭因素的不同组合情况。
样本包括100对说法语的母女。女孩（年龄7 - 12岁，平均年龄8.64岁）接受了认知功能测试，并完成了自我报告测量，以评估症状、对虐待的认知及所获得的支持。母亲和教师完成问卷，以评估孩子在学校的情绪、社交、行为及学业功能。
描述性分析表明，相当数量的女孩（54%）在评估的三个领域中至少一个领域存在临床学校适应困难。聚类分析揭示了四种不同的学校功能模式：（1）特定学业型；（2）外向/退缩型；（3）多临床型；（4）适应良好型。这些模式通过学校功能困难程度和受影响领域数量来区分。这些模式还通过CSA经历的因素以及背景、家庭和个人因素进一步区分。受影响的功能领域数量与女孩所接触的风险因素数量成正比。
结果表明需要对受性虐待儿童在学校的功能进行系统、全面的评估，并可能指导心理健康专业人员根据出现的类型提供差异化治疗。
受性虐待儿童表现出广泛的反应差异，使得制定“一刀切”的治疗方案相当困难。出现的类型强调了学校适应模式的复杂异质性，并表明虐待对儿童学校功能水平的次要影响需要进行具体评估和密切监测。这项研究提出了实际问题，即这种次要影响是否最好作为主要治疗目标来解决，或者除了以创伤为重点的方法之外，还是作为唯一的治疗目标。
