The effectiveness of a trauma-focused psycho-educational secondary prevention program for children exposed to interparental violence: study protocol for a randomized controlled trial

Background: Children who witness interparental violence are at a heightened risk for developing psychosocial, behavioral and cognitive problems, as well as posttraumatic stress symptoms. For these children the psycho-educational secondary prevention program 'En nu ik...!' ('It's my turn now!') has been developed. This program includes specific therapeutic factors focused on emotion awareness and expression, increasing feelings of emotional security, teaching specific coping strategies, developing a trauma narrative, improving parent-child interaction and psycho-education. The main study aim is to evaluate the effectiveness of the specific therapeutic factors in the program. A secondary objective is to study mediating and moderating factors. Methods/design: This study is a prospective multicenter randomized controlled trial across cities in the Netherlands. Participants (N = 140) are referred to the secondary preventive intervention program by police, social work, women shelters and youth (mental health) care. Children, aged 6-12 years, and their parents, who experienced interparental violence are randomly assigned to either the intervention program or the control program. The control program is comparable on nonspecific factors by offering positive attention, positive expectations, recreation, distraction, warmth and empathy of the therapist, and social support among group participants, in ways that are similar to the intervention program. Primary outcome measures are posttraumatic stress symptoms and emotional and behavioral problems of the child. Mediators tested are the ability to differentiate and express emotions, emotional security, coping strategies, feelings of guilt and parent-child interaction. Mental health of the parent, parenting stress, disturbances in parent-child attachment, duration and severity of the domestic violence and demographics are examined for their moderating effect. Data are collected one week before the program starts (T1), and one week (T2) and six months (T3) after finishing the program. Both intention-to-treat and completer analyses will be done. Discussion: Adverse outcomes after witnessing interparental violence are highly diverse and may be explained by multiple risk factors. An important question for prevention programs is therefore to what extent a specific focus on potential psychotrauma is useful. This trial may point to several directions for optimizing public health response to children's exposure to interparental violence

The child sexual behavior inventory: Reliability and validity in a Dutch normative and clinical sample

Background: The Child Sexual Behavior Inventory (CSBI) is one of the few instruments available to assess sexual behavior in children. Because of cross-cultural differences in the definition of normal and atypical sexual behaviors, the CSBI is not generalizable to other countries. Objective: The current study examined psychometric properties of the Dutch version of the CSBI. Participants and setting: The study represents 3206 children from a normative sample, and 932 children from clinical samples. Methods: Parents ratings on the CSBI, and questionnaires for psychosocial problems were obtained to assess psychometric properties. Results: Results showed that Dutch parents interpret more CSBI items as developmentally appropriate than USA parents. Reliability coefficients indicated internal consistency (α = .39–.82), test-retest (r = .86, p .05). Positive correlations between the CSBI total scale and the subscales demonstrated content validity (r = .32–.96, p < .01). Differences between normative and clinical samples on the CSBI total (ηp2 = .01–.65, p < .000), DRSB (ηp2 = .00–.03, p = .00–.38) and SASI scales (ηp2 =.00–.18, p < .01) indicated construct validity. Within the clinical samples, highest associations were found between the CSBI score and convergent measures (r = .64, p < .000). Lowest associations were found between the CSBI scores and divergent measures r = .14–.54, p = n.s.−<.000. Conclusions: Cross-cultural differences in the perception of developmental appropriate sexual behavior underscore the importance of country-specific normative data. Good psychometric properties of the Dutch version of the CSBI were supported by this study

Self-Reported Quality of Life of Maltreated Children Who Have Been Reported to Advice and Reporting Centers On Child Abuse and Neglect

Objectives: To examine the self-reported quality of life of maltreated children, shortly after submission of a report to an advice and reporting center on child abuse and neglect, and the extent to which child and maltreatment characteristics were associated with quality of life. Methods: Participants were 228 maltreated children aged 5–16 years (M = 9.99; SD = 3.20) and their primary caregiver. Children completed the Pediatric Quality of Life Inventory. One-sample t-tests were used to compare the self-reported quality of life of the maltreated children with scores from normative populations. Stepwise multiple regression analyses were used to explore whether maltreated children’s age, gender and type of maltreatment were associated with their quality of life, controlling for socio-demographic characteristics. Results: Significant differences were found between the study sample and three different normative populations regarding overall quality of life and the psychosocial health dimension of quality of life, indicating a poorer quality of life and psychosocial health for the maltreated children in this study. In addition, the socio-demographic characteristic of financial problems in the family as reported by the parent(s) was associated with children’s poorer self-reported quality of life. Conclusions: The results of this study suggest that child maltreatment is negatively related to self-reported quality of life. Future research should further address the effects of child maltreatment on quality of life after child protection system interventions

Interparental Violence and the Mediating Role of Parental Availability in Children's Trauma Related Symptoms

This cross-sectional study examined the hypothesis that parental psychopathology in Interparental Violence (IPV) families crosses over to children, because parental psychopathology spills over to parental functioning. In a high-risk sample of IPV exposed families, we tested whether parental psychopathology spills over to parental availability, which, in turn, shows a crossover effect to children's trauma-related symptoms. The study population consisted of 78 IPV exposed children (4-12 years), and their 65 custodial parents referred to outpatient Children's Trauma Centers in the Netherlands for intervention. Consistent with our hypotheses, parental psychopathology was negatively related to parental availability, suggesting a spillover effect. Although parental psychopathology was not associated with children's trauma-related symptoms directly, we found evidence for the predicted indirect, crossover effects. We found an indirect crossover effect from parental psychopathology to children's trauma-related anxiety, depression, and anger, through the spillover effect of parental availability. Clinical implications for treatment and study limitations are discussed

Design of a prospective study on mental health and quality of life of maltreated children (aged 5-16 years) after a report to an advice and reporting center on child abuse and neglect

BACKGROUND: Child maltreatment is recognized as a widespread problem with huge implications for mental health and quality of life. Studies have repeatedly shown that victims of child maltreatment report significantly more adverse life outcomes than non-victims. The main objective of the study is (1) to examine the mental health and quality of life of maltreated children over a 1.5 year period beginning shortly after a report has been filed with an Advies- en Meldpunt Kindermishandeling (AMK) (advice and reporting center on child abuse and neglect). Secondary objectives are: (2) to examine how relevant determinants influence the mental health and quality of life of maltreated children, and (3) to examine differences in mental health and quality of life outcomes when comparing families of Dutch origin with families originating from Morocco and Suriname. METHODS/DESIGN: A prospective study will be performed, in which parent–child dyads will be followed over a 1.5 year period. Participants will be recruited shortly after the report to the AMK and they will be asked to complete a questionnaire four times, at baseline and every six months thereafter. Data will be analyzed using a longitudinal multi-level analysis. DISCUSSION: The study is expected to yield evidence about the mental health and quality of life of maltreated children and about determinants that influence their mental health and quality of life outcomes. Strengths of this study are (1) the design which makes it possible to start examining outcomes shortly after or even during the actual maltreatment and to follow parent–child dyads for 1.5 years, and (2) asking children as informants about their own situation by making use of self-report questionnaires as much as possible. Limitations include the risks of selection bias and loss to follow-up during 1.5 years of data collection. TRIAL REGISTRATION: NTR3674, funded by ZonMw, project 15700.2012

Interparental Violence and the Mediating Role of Parental Availability in Children's Trauma Related Symptoms

This cross-sectional study examined the hypothesis that parental psychopathology in Interparental Violence (IPV) families crosses over to children, because parental psychopathology spills over to parental functioning. In a high-risk sample of IPV exposed families, we tested whether parental psychopathology spills over to parental availability, which, in turn, shows a crossover effect to children's trauma-related symptoms. The study population consisted of 78 IPV exposed children (4-12 years), and their 65 custodial parents referred to outpatient Children's Trauma Centers in the Netherlands for intervention. Consistent with our hypotheses, parental psychopathology was negatively related to parental availability, suggesting a spillover effect. Although parental psychopathology was not associated with children's trauma-related symptoms directly, we found evidence for the predicted indirect, crossover effects. We found an indirect crossover effect from parental psychopathology to children's trauma-related anxiety, depression, and anger, through the spillover effect of parental availability. Clinical implications for treatment and study limitations are discussed

Talking About Feelings: Mother-Child Emotion Dialogues Among Sexually Abused Children

Mother-child dialogues about children's emotional experiences are associated with children's adaptive coping with stressful situations and mental health. Despite these findings, dialogues have not been examined yet in the context of child sexual abuse. This gap is surprising given that mother-child dialogues may particularly promote children's recovery from traumatic events. The current exploratory study examined the quality of mother-child emotion dialogues, as well as the quality of child and maternal contributions to dialogues, among dyads with sexually abused children ( n = 30; 60% female; M age = 8.03), as compared with dyads with nonabused children ( n = 30; 60% female; M age = 8.20). Quality of dialogues was assessed using the Autobiographical Emotional Events Dialogue. Mothers reported on their own childhood maltreatment history and psychopathological symptoms. Results showed that dyads with abused children were more likely to engage in overwhelming/excessive dialogues and dialogues lacking content, as compared with dyads with nonabused children. After controlling for differences in background characteristics, mothers of abused children showed lower sensitive guidance. Although mothers of abused children had more experiences of childhood maltreatment and higher levels of psychopathology, they did not add to explain group differences in maternal sensitive guidance. Our findings suggest that the ability to discuss emotional experiences may be impaired among mother-child dyads with sexually abused children. This may be an important target in the treatment of sexually abused children and their families