Sexually and physically abused children

Child physical abuse (CPA) and child sexual abuse (CSA), although not psychiatric disorders, are prevalent and stressful life events that often result in the need for mental health interviewing services. The US Department of Health and Human Services (2008) recorded 142,041 cases of CPA and 78,120 cases of CSA reported to Child Protective Services (CPS) in the United States in 2006. These data are probably an underestimation, as many incidents of child abuse are not reported. Multiple factors, including the child's developmental level, race, ethnicity, abuse severity, and relationship with the perpetrator influence whether the abuse is disclosed (Hanson et al., 2003; Paine & Hansen, 2002). However, disclosure does not necessarily mean that the abuse is reported. For example, a national survey of adolescents found that 65% of physical abuse cases and 86% of sexual abuse cases experienced by the adolescents surveyed were never reported to authorities (Kilpatrick, Saunders, & Smith, 2003). The sequelae of abuse vary considerably, and there is no single pattern that typifies postabuse distress in children. In fact, not all children who are abused will display psychiatric symptoms or functional impairments (Haskett, Nears, Ward, & McPherson, 2006; Kendall-Tackett, Williams, & Finkelor, 1993; Putnam, 2003) and those who do show symptoms are a heterogeneous group presenting with a wide range of symptoms including posttraumatic stress disorder (PTSD), depressive disorders, anxiety disorders, and behavioral disorders (i.e., conduct disorder, oppositional defiant disorder, and attention-deficit/ hyperactivity disorder; Kaplan, Pelcovitz, & Labruna, 1999; Putnam). Sexually and physically abused children are at increased risk for suicidality, alcohol and drug abuse, risk-taking behaviors, socioemotional problems, and cognitive and academic difficulties (Kaplan et al.; Nagy, Adcock, & Nagy, 1994; Watts-English, Fortson, Gibler, Hooper, & De Bellis, 2006). Furthermore, CSA has been associated with childhood sexualized behavior problems and risky sexual behavior (Putnam; Senn, Carey, & Vanable, 2008) and CPA is specifically linked with aggression and delinquent behavior (Kaplan et al.).