Hall D K, Mathews F, Pearce J
Department of Nursing, York University, Toronto, Ontario, Canada.
Child Abuse Negl. 1998 Oct;22(10):1045-63. doi: 10.1016/s0145-2134(98)00078-7.
To identify variables associated with the presence of sexual behavior problems in young sexually abused children.
Data were gathered from the clinical records of 100 sexually abused boys and girls ages 3-7 years enrolled in two treatment programs. Information was coded systematically on approximately 350 areas related to the child and family's history and functioning, the sexual abuse experience, and treatment outcome. The children were grouped and compared according to their presenting sexual behavior into three categories: (1) developmentally "expected"; (2) "sexualized/self-focused"; and (3) problematic "interpersonal" sexual behavior.
Bivariate and multivariate analyses highlighted five variables which were predictive of sexual behavior problems among sexually abused children. Sexual arousal of the child during his/her sexual abuse, the perpetrator's use of sadism, and a history of physical and emotional abuse differentiated between those children with and without "interpersonal" sexual behavior problems. Who the child blamed for his/her sexual abuse further contributed to the distinction between children whose sexual behavior was exclusively "self-focused" (sexualized) versus "interpersonal."
The five major predictor variables, as well as other variables identified in this study, have potential utility in assessing child risk for negative outcomes and determining referral priorities for sexual abuse treatment. Given that sexual arousal and who the child blames for the abuse are prominent variables associated with sexual problems and self-blame, clinicians will need to ensure that sexually abused children and their caregivers are given specific opportunities to deal with these areas in the supportive context of treatment. Children with sexual behavior problems differ not only in the type and level of sexual behavior they exhibit but in most other areas as well, suggesting a need for differential assessment and individualized treatment approaches.
确定与遭受性虐待的幼年儿童出现性行为问题相关的变量。
从参与两个治疗项目的100名年龄在3至7岁的遭受性虐待的男孩和女孩的临床记录中收集数据。对与儿童及其家庭的病史和功能、性虐待经历以及治疗结果相关的约350个领域的信息进行系统编码。根据儿童呈现的性行为将其分为三类进行分组和比较：（1）发育上“预期的”；（2）“性化/自我关注的”；（3）有问题的“人际间”性行为。
双变量和多变量分析突出了五个可预测遭受性虐待儿童性行为问题的变量。儿童在性虐待期间的性唤起、施虐者的施虐行为以及身体和情感虐待史区分了有无“人际间”性行为问题的儿童。儿童将性虐待归咎于何人进一步促成了性行为仅为“自我关注”（性化）与“人际间”性行为的儿童之间的区别。
这五个主要预测变量以及本研究中确定的其他变量在评估儿童出现负面结果的风险以及确定性虐待治疗的转诊优先级方面具有潜在效用。鉴于性唤起以及儿童将虐待归咎于何人是与性问题和自责相关的突出变量，临床医生需要确保在支持性的治疗环境中给予遭受性虐待的儿童及其照顾者特定机会来处理这些方面。有性行为问题的儿童不仅在他们表现出的性行为类型和程度上不同，在大多数其他方面也不同，这表明需要进行差异化评估和个性化治疗方法。
