Assessing children for the effects of sexual victimization.

In summary, the psychological assessment of sexually abused children is complicated significantly by the fact that there is no single syndrome that reflects the impact of sexual abuse (Kendall-Tackett, Williams, and Finkelhor, 1993). A number of generic measures of psychopathology in children continue to find large percentages of children relatively asymptomatic. This is due to the variability in impact of sexual abuse, but also reflects the need to develop abuse-specific outcome measures. Because we are discussing the evaluation of children, psychological assessment must be developmentally sensitive and reflect the context of the child (Stewart, Bussey, Goodman, and Saywitz, 1993). Consequently, information should be obtained not only from parents and children, but from the entire family. Unless an evaluation includes some abuse-specific measures and examines findings about the child in the context of the larger family environment, it is not likely to be valid. The interrelationship of abuse impact on parental perception and subsequent parental accuracy in reporting also must be examined in more detail. Not surprisingly, maternal reports of their sexually abused child's emotional states are strongly correlated with their own distress (Newberger, Geremy, Waternaux, and Newberger, 1993). This confound necessitates input from teachers or other objective observers of the child. The evaluation of sexually abused children should be theoretically driven. I strongly recommend assessing both the child and the parents with regard to attachment quality, difficulties with self-regulation, and an impaired sense of self. There are a number of measures pertinent to both parents and children across each of these domains. However, measures must be developed and validated that allow for parent, child, and teacher report in the areas of sexual behavior, sexual concerns, sexual meaning, body integrity, abuse-specific aspects of self (such as blame, shame, and dissociation), PTSD, abuse-specific fears, and family-related variables of rejection and role reversal. There is a developing literature that supports the need to assess each of these domains in a multimodal manner.