NSPCC National Clinical Assessment and Treatment Service and the Behavioural & Brain Sciences Unit, Institute of Child Health, University College London, London, UK.
J Child Psychol Psychiatry. 2013 May;54(5):503-15. doi: 10.1111/jcpp.12047. Epub 2013 Feb 12.
The assessment of victims of child sexual abuse (CSA) is now a recognized aspect of clinical work for both CAMH and adult services. As juvenile perpetrators of CSA are responsible for a significant minority of the sexual assaults on other children, CAMH services are increasingly approached to assess these oversexualized younger children or sexually abusive adolescents. A developmental approach to assessment and treatment intervention is essential in all these cases.
This review examines research on the characteristics of child victims and perpetrators of CSA. It describes evidence-based approaches to assessment and treatment of both groups of children. A selective review of MEDLINE, Psycinfo, Cochrane Library, and other databases was undertaken. Recommendations are made for clinical practice and future research.
The characteristics of CSA victims are well known and those of juvenile perpetrators of sexual abuse are becoming recognized. Assessment approaches for both groups of children should be delivered within a safeguarding context where risk to victims is minimized. Risk assessment instruments should be used only as adjuncts to a full clinical assessment. Given high levels of psychiatric comorbidity, assessment, treatment, and other interventions should be undertaken by mental health trained staff.
Victims and perpetrators of CSA present challenges and opportunities for professional intervention. Their complex presentations mean that their needs should be met by highly trained staff. However, their youth and developmental immaturity also give an opportunity to nip problem symptoms and behaviors in the bud. The key is in the earliest possible intervention with both groups. Future research should focus on long-term adult outcomes for both child victims and children who perpetrate CSA. Adult outcomes of treated children could identify problems and/or strengths in parenting the next generation and also the persistence and/or desistence of sexualized or abusive behavior.
儿童性虐待（CSA）受害者的评估现在是儿童心理健康和成人服务临床工作的一个公认方面。由于青少年 CSA 肇事者负责相当一部分对其他儿童的性侵犯，因此越来越多的儿童心理健康服务机构被要求评估这些过度性化的年幼儿童或性虐待青少年。在所有这些情况下，评估和治疗干预都需要采用发展方法。
本综述考察了 CSA 受害儿童和肇事者的特征研究。它描述了针对这两组儿童的基于证据的评估和治疗方法。对 MEDLINE、Psycinfo、Cochrane 图书馆和其他数据库进行了选择性回顾。为临床实践和未来研究提出了建议。
CSA 受害儿童的特征众所周知，青少年性虐待肇事者的特征也逐渐得到认识。应在保护受害者风险最小化的背景下提供这两组儿童的评估方法。风险评估工具只能作为全面临床评估的辅助手段。鉴于精神疾病共病率高，应由受过心理健康培训的工作人员进行评估、治疗和其他干预。
CSA 的受害者和肇事者为专业干预提出了挑战和机遇。他们复杂的表现意味着需要由高度训练有素的人员满足他们的需求。然而，他们的年轻和发展不成熟也为扼杀问题症状和行为提供了机会。关键是要尽早对这两组人进行干预。未来的研究应集中在 CSA 受害儿童和肇事者的长期成人结局上。经过治疗的儿童的成人结局可以确定下一代育儿的问题和/或优势，以及性化或虐待行为的持续存在和/或消失。
