Impact of Maternal History of Child Sexual Abuse on Caregiving

Michele ManyMichele M. Many, Assistant Professor, Department of Psychiatry, Louisiana State University School of Medicine

Summary: The author describes how a mother’s history of childhood sexual abuse places her at risk for depression, substance abuse and behaviors that impair her ability to care for her child and lead to involvement with the child welfare system.

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Recent events at Penn State have cast a light on the issue of child sexual abuse (CSA). The media initially focused on the perpetrator, then sought to educate the public about the harmful short and long-term impacts of CSA on victims. According to the Fourth National Incidence Study of Child Abuse and Neglect, in 2005–2006 approximately 180,000 children were sexually abused. (http://www.acf.hhs.gov/programs/opre/abuse_neglect/natl_incid/index.html).

While much research has been done on the long- and short-term effects of child sexual abuse, relatively little attention has been given to how a history of sexual abuse impacts maternal caregiving and involvement with child welfare. One study looked at 104 mother-child dyads when the children were one year old and again when the children were four and a half years old (Spieker, Bensley, McMahon Fung, & Ossiander, 1996). In the initial interview the mothers were asked about any history of abuse and were observed in interactions with their infants. In the second interview mothers were asked about any contact with Child Protective Services (CPS) since the birth of their children. Significantly, among the mothers reporting CPS contacts only 15.4% of the mothers  with no history of CSA had had contact with CPS while 38.5% of the  mothers who had a history of one episode of CSA had had contact with CPS, and 83.3% of the mothers who had a history of chronic child sexual abuse had had contact with CPS. These percentages indicate a strong relationship between maternal histories of CSA and later abuse and neglect by those mothers of their own children.  

Schuetze and  Eiden, (2005) found that: “CSA was associated with higher maternal depression and higher partner violence and that these three factors were associated with more negative parental perceptions and higher punitive discipline” (p. 645). Appleyard, Berlin, Rosanbalm and Dodge (2011) found a significant pathway from maternal history of CSA to substance use to offspring victimization. They urged assessment and early intervention for maternal histories of maltreatment and substance use problems, and integration of child welfare and parenting programs with substance use treatment. Noll, Trickett, Harris and Putnam (2009) compared the children of mothers with a history of CSA and those without such a history over 18 years.   Children whose mothers had a history of CSA were more likely to be born preterm, to be born to a teenaged mother and to be involved with Child Protective Services. Mothers with a history of CSA were more likely to be high school dropouts, to be obese and to experience psychiatric problems, substance dependence and interpersonal violence. 

These studies highlight the hidden social and familial costs of child sexual abuse. Survivors of CSA exhibit increased risk-taking behaviors, self-harm, substance abuse, sexual revictimization and domestic violence, and these problems are too often carried through to the next generation, creating an intergenerational cycle of abuse and neglect. Indeed, while the research converges on a figure of about 33% of abused children becoming abusive parents, perhaps of greater concern is the more pervasive and insidious risk of increased prevalence of depression, substance abuse, poorer physical health outcomes, risk-taking and self-harming behaviors among women with a history of CSA. Trickett, Noll and Putnam (2011) stated that “mothers who were sexually abused do not necessarily become abusers themselves… Those that did have children involved with CPS were either neglectful (mostly attributable to substance abuse issues) or in other ways recreated environmental conditions in which abuse was allowed to persist across generations” (p. 116).    Further, they are more likely to fail to protect their children from abusers (Banyard, 1977). So the traumas endured by the mother may be revisited on the child directly through abuse or neglect, or more often indirectly through exposure to poorer health, relational and environmental risks. These outcomes echo the concerns raised in the adverse childhood experiences” study: that the cumulative effect of adverse experiences contributes to long-term physical and emotional illness and premature death (Felitti, Anda, Nordenberg, Williamson, Spitz, Edwards, Koss, & Marks,, 1998).   

How can those working in the child welfare and juvenile justice fields beneficially impact this rising tide of neglect and maltreatment? We can familiarize ourselves with substantive research on the impact of CSA on maternal caregivers. We can require that all mothers of children in the foster care and juvenile justice systems undergo at least one trauma-informed assessment to attempt to discern a maternal history of abuse. This is important because research has established that most CSA goes unreported, even when victims are directly asked about a history of CSA  (Anderson, Mullen, Martin, Romans, & Herbison, 1993; Russell, 1983; Smith, Letourneau, Saunders, Kilpatrick, Resnick, & Best, 2000). Since these mothers are three times more likely than non-abused women to abuse substances as a negative coping mechanism, substance abuse treatment should be mandated as part of case plans when there is a history of both sexual abuse and substance abuse, and should start before any therapy to address the CSA is begun. And finally, evidence-based treatments should be implemented to address any established maternal history of CSA. Only by facing the CSA “ghost in the nursery” can the cycle be interrupted and a healthier family system be made possible.  

Author biography:

Michele M. Many, MSW, LCSW, is a licensed clinical social worker and is the chief of the Section of Social Work for the Louisiana State University Health Sciences Center, Department of Psychiatry. She coordinates the St. Bernard Project Wellness and Mental Health Clinic and is a primary clinician in several multidisciplinary teams including the Orleans Parish Infant Team, the Orleans Parish Court Team, the Victim Assistance Program, and the Early Trauma Treatment Network. Many also provides consultation in local Head Starts.  Her areas of expertise include, and child abuse, professional self-care and grief and loss. 

References

Anderson, J; Mullen, J; Martin, P; Romans, S; Herbison, P (1993). Prevalence of Childhood Sexual Abuse Experiences in a Community Sample of Women   Journal of Child and Adolescent Psychiatry 32(5), 911-919. 

Appleyard, K; Berlin, LJ; Rosanbalm, KD & Dodge, KA. (2011). Preventing early child maltreatment: Implications from a longitudinal study of maternal abuse history, substance abuse problems, and offspring victimization. Prevention Science 12(2) 139-149.

Banyard, VL. (1997). The impact of childhood sexual abuse and family functioning on four dimensions of women’s later parenting practices Child Abuse and Neglect 21(11) 1095-1107.

Felliti, VJ; Anda, RF; Nordenberg, D; Williamson, DF; Spitz, AM; Edwards, V; Koss, MP & Marks, JS (1998).   Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study, American Journal of Preventive Medicine 14(4), 245-258.

Noll, JG; Trickett, PK; Harris, WW & Putnam, FW. (2009). The cumulative burden borne by offspring whose mothers were sexually abused as children: Descriptive results from a multigenerational study. Journal of Interpersonal Violence, 24(3) 424-499. 

Russell, DEH (1983). The incidence and prevalence of intrafamilial and extrafamilial sexual abuse of female children; Child Abuse and Neglect 7(2), 133-146.

Schuetze, P and Eiden, RD. (2005). The relationship between sexual abuse during childhood and parenting outcomes: Modeling direct and indirect pathways. Child Abuse and Neglect, 29 (6), 645-659.

Smith, DW; Letourneau, EJ; Saunders, BE; Kilpatrick, DJ; Resnick, HS & Best, CL (2000). Delay in disclosure of childhood rape: results from a national survey. Child Abuse and Neglect 24(2), 273-287. 

Spieker, SJ, Bensley, L, McMahon, RJ; Fung, H & Ossiander, E. (1996). Sexual abuse as a factor in child maltreatment by adolescent mothers of preschool aged children, Development and Psychopathology, 8 (3) 497-509.  

Trickett PK; Noll, JG & Putnam, FW. (2011). The impact of sexual abuse on female development: Lessons from a multigenerational, longitudinal research study, Development and Psychopathology 23, 101-124. 

 

 

 

 

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