Factors Surrounding and Influencing the Primary Disclosure in Child Sexual Abuse

FACTORS SURROUNDING AND INFLUENCING THE PRIMARY DISCLOSURE IN SEXUAL ABUSE OF CHILDREN. Kira O’Neil Bona (Sponsored by Dr. John M. Leventhal). Department of Pediatrics, Yale University School of Medicine, New Haven, CT. This study aimed to investigate the context within which children initially disclose their sexual abuse. The study sought to identify triggers that prompted the initial disclosure event, and to investigate the relationship between the choice of initial confidante and the child’s age and likelihood of disclosing during formal interview. Data were obtained in a prospective fashion from 60 alleged child sexual abuse victims referred to the Yale Child Sexual Abuse Clinic (CSAC). Inclusion criteria required that a child must have disclosed to a confidante prior to referral to the Clinic; 57 of 60 children met this criterion and are included. Victim and perpetrator demographics, details of the initial disclosure event, and any identified triggers were obtained in a systematic fashion as part of the standard clinical evaluation by CSAC social workers. Analysis was conducted to investigate the relationship between child’s age and choice of confidante, and child’s choice of confidante and likelihood of disclosing in a formal interview. Of 57 children, 23% were abused by immediate family members and 39% by extended family members; 49% of cases involved penetrative abuse; and 51% of perpetrators were aged 18 or younger. The three most common triggers for disclosure included: questioning by an adult (26.3%), witnessed abuse (12.3%), and safety of being away from perpetrator (10.5%). The three most common initial confidantes included parent-figures (42%), DCF workers or police (15%), and child peers (12%). The majority of children (81%) disclosed during a formal interview with a Clinic social worker. There was a statistically significant relationship between victim’s age and choice of confidante: 60% of children aged 2-7 initially disclosed to a parent figure, in comparison to only 28% of children aged 8-15 (p=0.034). Additionally, 21% of older children first disclosed to a child peer or sibling, while no younger children did so. We found no relationship between a child’s initial choice of confidante and likelihood of disclosing during formal interview (p=0.06). No relationship existed between a child’s age and likelihood of disclosing during formal interview (p=0.43); older children, however, were more likely to provide detailed disclosures during formal interview than younger children (p=0.054). In support of our first hypothesis, our data showed a statistically significant relationship between victim’s age and choice of confidante. Of equal interest, the results did not support our hypothesis that there would exist a relationship between a child’s initial choice of confidante and likelihood of disclosing during the formal interview, nor our hypothesis that educational programs or discussions would result in spontaneous disclosures. Of central importance to the understanding of children’s disclosures, our sample most frequently disclosed to a parent-figure while at home and often while engaging in one-on-one activities with the trusted adult confidante to whom they disclosed. Acknowledgments I would like to thank Dr. John Leventhal for taking a chance with me, and for his support and guidance on this thesis. This research project would not have been possible without the wonderful work of the Yale Child Sexual Abuse Clinic social workers. Thanks to Julie Monteagudo for early help with the details of organizing this study. Enormous thanks to Kate Ellingson for turning my raw data into meaningful statistics. Special thanks to Lyla Johnson, whose tireless and patient work were invaluable. Finally, my deep appreciation to my amazing family and friends who help keep life in perspective.