Annotated bibliography: Clinical and mixed samples

This bibliography includes single studies and literature reviews based on clinical samples, or on a mixture of samples which included clinical samples. Clicking on the title will take you to more details from the article or book. Titles with an asterisk (*) will open an off-site article in a new window.

Beitchman, J., Zucker, K., Hood, J., DaCosta, G., & Akman, D., "A Review of the Short-Term Effects of Child Sexual Abuse," Child Abuse and Neglect, vol. 15, 1991, pp. 537-556.

The authors reviewed the literature on the immediate impact CSA has on children. They note the frequent finding that CSA victims suffered from a wide range of serious social, psychological, and school problems, and the limitations of these findings due to the fact that the studies relied mostly on clinical samples and failed to use comparison groups or to control for other factors that may have caused the symptoms. They write that CSA victims tended to have prior histories of psychopathology or to come from disadvantaged or disturbed homes, so that it was difficult to attribute outcomes in these samples solely to sexual abuse. However, sexualized behavior seemed to be related to CSA.

Beitchman, J., Zucker, K., Hood, J., DaCosta, G., Akman, D., & Cassavia, E., "A Review of the Long-Term Effects of Child Sexual Abuse," Child Abuse and Neglect, vol. 16, 1992, pp. 101-118.

The authors reviewed 32 studies on the effects of CSA on later adult adjustment. They describe findings of sexual disturbances among CSA victims, and, as in their earlier study of short-term effects, note that the studies were based on clinical samples and did not control for pre-existing psychopathology and family disruption commonly found in such samples. However, they do note that frequent invasive sexual abuse was associated with trauma or harm. Data suggested that CSA impacted negatively on adjustment, mental health status, and other psychiatric symptoms, but results were not certain. Beitchman et al. conclude that the evidence does not support a link between CSA and any particular syndrome or set of symptoms, including multiple personality disorder or borderline personality disorder.

Constantine, L.L., "The effects of early sexual experiences: A review and synthesis of research," in Constantine, L.L. & Martinson, F.M. (eds.), Children and sex: New findings, new perspectives, Boston: Little, Brown & Co., 1981, pp. 217-244.

Constantine reviewed 30 studies examining short-term and long-term impact of childhood sexual experiences with peers, family members, and unrelated adults. Findings of these studies varied greatly, ranging from all children harmed to none harmed. Clinical and criminal studies tended to show more harm, although some still found the majority of children were unharmed. While research leaves little doubt that some children do initiate the contacts and many participate willingly, the child’s interest is different from the adult’s, and children may be particularly harmed when they appear to cooperate but are actually unwilling. Constantine concludes that there is no set of reactions that is a single inevitable outcome of adult-child sexual interaction. Negative outcomes are associated with violence or coercion, tense situations, sex-negative attitudes, sexual ignorance, and unsupportive or judgmental adult reactions.

Fergusson, D.M. & Mullen, P.E., Childhood sexual abuse: An evidence based perspective, Thousand Oaks, California: Sage Publications, 1999.

Fergusson & Mullen examined a review of 26 studies as well as 15 individual studies (12 using community samples) and concluded that children known to have been sexually abused show vulnerability to a wide range of emotional and behavior symptoms. They qualify this finding by writing that research may overestimate the impact of CSA due to biased sample selection and failure to control for confounding influences such as disturbed and disadvantageous family backgrounds which may contribute to the children’s problems. They find no evidence to support the belief that CSA is linked to specific types of dissociative disorders or a CSA-specific pattern of symptoms. In addition, they estimate that up to 40% of minors exposed to CSA may be symptom free. Whether or not symptoms occur seems to depend on the severity of the incident, the extent of family support and nurturance, and the child’s attitudes and coping skills.

Ingram, M., "Participating victims: A study of sexual offenses with boys," in Constantine, L.L. & Martinson, F.M. (eds.), Children and sex: New findings, new perspectives, Boston: Little, Brown & Co., 1981, pp. 177-187.

British child counselor Michael Ingram describes cases of man-boy sexual interaction that occurred with 74 prepubescent boys he saw in his practice. Two incidents involved traumatic sexual assault by a stranger, while the rest involved willing sex-play or affectionate interactions. Some of the boys seemed healthy and required no further counseling, while others seemed quite disturbed. Ingram examines reasons for the boys’ differing adjustment.

Kilpatrick, A., "Childhood Sexual Experiences: Problems and Issues in Studying Long-Range Effects," Journal of Sex Research, vol. 23, No. 2, 1987, pp.173-196.

Kilpatrick evaluated 34 studies of the long-range consequences of childhood sexual experiences, and narrowed them down to ten which did not suffer from major methodological problems. She found no evidence to support the hypothesis that childhood sexual experiences inevitably lead to particular long-term effects—negative, neutral, or positive. Harm was associated with childhood incest experiences, disadvantaged backgrounds, older age at cessation of molestation, stronger negative feelings, higher frequency, and longer duration.

Li, C.K., "Adult sexual experiences with children," in Li, C.K., West, D.J., & Woodhouse, T.P., Children’s sexual encounters with adults, London: Duckworth, pp. 139-316, 1990a.

Reviewing the literature, Li found that clinical studies find a majority of CSA victims experience a wide range of serious psychological symptoms, but probability sample studies find only a very small minority of children exhibit any harm. He writes that studies often do not make distinctions between unwanted sexual incidents and those willingly engaged in, so there is significant disagreement about psychological harm when no coercion occurs. He also addresses situations in which researchers resort to speculation, neglect confounding factors, examine the data selectively, or base their definitions or interpretations on their own moral values.

Ney, P., Fung, T., & Wickett, A.R., "The worst combinations of child abuse and neglect," Child Abuse and Neglect, v. 18, no. 9, 1994, pp. 705-714.

Ney et al. surveyed a combination clinical, criminal, and probability sample of 167 children and adolescents, asking them about physical abuse, physical neglect, emotional neglect, verbal abuse, and sexual abuse. They attempted to determine which combinations of different kinds of abuse were most related to negative outlooks for the future. Combinations involving physical or verbal abuse seemed most strongly correlated with negative outcomes.

Oellerich, T.D., "Child Sexual Abuse: Is the Routine Provision of Psychotherapy Warranted?"*, Issues In Child Abuse Accusations, vol. 11, no. 1, 2001.

Ohio University Social Work Professor Thomas Oellerich reviewed the literature on the effects of childhood or adolescent sexual activity with adults, and found that many popular beliefs were not supported. Many studies suffered from methodological problems, and those that didn’t found that children and adolescents showed a wide range of reactions to sexual abuse.

West, D.J., "Boys and Sexual Abuse: An English Opinion," Archives of Sexual Behavior, Dec. 1998.

British criminologist Donald J. West reviews evidence for gender differences in reactions to childhood sexual experience with adults. He discusses the potential for harm in such activity, but finds no support for the supposed link between sexual abuse in childhood and later abusive behavior as an adult.