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Journal of Child & Adolescent Trauma
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Short-Term Correlates of Child Sexual Abuse: An Exploratory Study Predicting
Girls' Academic, Cognitive, and Social Functioning 1 Year Later
Isabelle V. Daignault
a
; Martine Hébert
b
a
Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
b
Department of
Sexology, Université du Québec à Montréal, Montréal, Québec, Canada
Online Publication Date: 10 December 2008
To cite this Article Daignault, Isabelle V. and Hébert, Martine(2008)'Short-Term Correlates of Child Sexual Abuse: An Exploratory
Study Predicting Girls' Academic, Cognitive, and Social Functioning 1 Year Later',Journal of Child & Adolescent Trauma,1:4,301 —
316
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Journal of Child & Adolescent Trauma, 1:301–316, 2008
Copyright © 2008 by The Haworth Press. All rights reserved.
ISSN: 1936-1521 print / 1536-153X online
DOI: 10.1080/19361520802505693
WCAT1936-15211536-153XJournal of Child & Adolescent Trauma, Vol. 1, No. 4, October 2008: pp. 1–34Journal of Child & Adolescent Trauma
Short-Term Correlates of Child Sexual Abuse:
An Exploratory Study Predicting Girls’ Academic,
Cognitive, and Social Functioning 1 Year Later
Academic, Cogn itive, and Social Funct ioning in Sexually Abused G irlsI. V. Daignault and M. Hébert
ISABELLE V. DAIGNAULT
1
AND MARTINE HÉBERT
2
1
Department of Psychology, Université du Québec à Montréal, Montréal,
Québec, Canada
2
Department of Sexology, Université du Québec à Montréal, Montréal,
Québec, Canada
The purpose of this study was to explore factors influencing the academic, cognitive,
and social functioning of 50 Canadian French-speaking sexually abused girls (age 7 to
12 years). Contextual, personal, and family factors characterizing the environment of
children postdisclosure were examined as potential predictors of outcomes 1 year
later. The severity and duration of the abuse, exposure to other forms of victimization,
and symptoms of dissociation were associated with outcomes over time in one or more
of the three domains assessed. Personal variables were also identified as important
protective factors, including younger age at disclosure, greater use of approach
coping strategies, and children’s involvement in structured extracurricular activities.
Results are discussed in terms of clinical implications.
Keywords child sexual abuse, school functioning, academic performance, social
problems, cognitive skills, extracurricular activities, coping
Child sexual abuse (CSA) is likely to influence children’s functioning in different contexts
throughout the various stages of their life (Banyard, Williams, & Siegel, 2001; Putnam,
2003). The school context is one that is critical for children’s learning and social develop-
ment. Yet few empirical data are available to document the challenges sexually abused
children encounter in this setting. Although exposure to violence often influences child
development negatively, subsequent social and learning experiences are thought to have the
potential to modulate the effects of adversity (Salmon & Bryant, 2002; Sandler, 2001). Since
the educational environment offers a variety of such experiences, the identification of factors
influencing sexually abused children’s adaptation in school deserves further attention.
Child sexual abuse has been associated with various short-term difficulties and trauma-
related symptoms (Paolucci, Genuis, & Violato, 2001). However, potential school-related
difficulties have been scantly explored. Our literature review of studies examining the rela-
tionship between CSA and school functioning identified 30 studies published since 1979
(Daignault & Hébert, 2004), but only 9 were conducted to specifically address this issue
(Eckenrode, Laird, & Doris, 1993; Einbender & Friedrich, 1989; Kinard, 2001; Nugent,
Submitted January 23, 2008; revised May 12, 2008; revised August 18, 2008; accepted
September 23, 2008.
Address correspondence to Isabelle V. Daignault & Martine Hébert, Université du Québec
à Montréal, C.P. 8888, Département de sexologie, succursale Centre-Ville, Montréal (Québec),
Canada, H3C 3P8. E-mail: daignault.isabelle@hotmail.com or hebert.m@uqam.ca
Downloaded At: 18:33 4 January 2009
302 I. V. Daignault and M. Hébert
Labram, & McLoughlin, 1998; Paradise, Roset, Sleeper, & Nathanson, 1994; Reyome,
1993, 1994; Rust & Troupe, 1991; Trickett, McBride-Chang, & Putnam, 1994). Findings
consistently indicate that a number of sexually abused children (10% to 58%) experience
social, cognitive, or academic difficulties in school. In addition, results indicate that sexually
abused children obtain lower scores of academic achievement and cognitive functioning as
well as lower grades in school in comparison with nonabused children (Bromberg &
Johnson, 2001; Einbender & Friedrich, 1989; Kinard, 2001; Trickett et al., 1994).
Study designs show great variability with regard to the timing of evaluation, outcomes
considered, sources of information, as well as sample characteristics and size (Daignault &
Hébert, 2004). The most important drawbacks of many studies are the absence of a baseline
to indicate children’s functioning before the abuse and the paucity of longitudinal designs.
Moreover, less is known about the factors associated with outcomes of CSA in the school
context or about the potential processes involved. In the social sphere, sexual abuse has been
conceptualized as an experience that alters children’s object relations by introducing miscon-
ceptions of appropriate boundaries along with feelings of betrayal, deception, and helpless-
ness, as well as guilt and shame (Cohen, Mannarino, & Deblinger, 2006; Cole & Putnam,
1992). As a result, children may experience feelings of anger and sadness that are ineffi-
ciently internalized or externalized, at times resulting in social withdrawal or peer rejection.
With regard to academic and cognitive difficulties, various hypotheses have been
proposed to describe the link between CSA and school outcomes. First, lower scores on
cognitive and intelligence tests and language delays have been identified as potential risk
factors of CSA (Black, Heyman, Smith, & Amy, 2001; Veltman & Browne, 2001). Intel-
lectual delays may also be correlated with the variables that place children at risk for CSA.
An epidemiological study revealed that intellectually challenged children are four times
more likely to experience sexual abuse than children who are not (Sullivan & Knutson,
2000). Second, researchers have conceptualized academic and social difficulties as
secondary motivational and functional backdrops to the more direct consequences of
trauma-related symptomatology (posttraumatic stress disorder [PTSD], dissociation; Cole
& Putnam, 1992; Dubowitz, Black, Harrington, & Verschoore, 1993; Trickett et al.,
1994). For instance, PTSD symptoms resulting from chronic exposure to trauma in child-
hood have been associated with biological and functional differences in certain frontal
areas of the brain (Koenen et al., 2001). Such differences are expected to influence cogni-
tive development, particularly in terms of verbal intellectual functioning and attention and
concentration skills (Porter, 2003; Silva et al., 2000).
Third, the relevance of considering the preexisting psychosocial context in which
CSA occurs has been outlined (Entwisle & Hayduk, 1988). As CSA is rarely an isolated
event (Finkelhor, Ormrod, & Turner, 2007), the presence of other forms of violence such
as neglect or physical or psychological abuse have been associated with negative out-
comes (Holt, Finkelhor, & Kantor, 2007). Buckle, Lancaster, Powell, and Higgins (2005)
identified exposure to violence as one of two factors predicting academic achievement in a
sample of sexually abused adolescent psychiatric inpatients. Fourth, various personal and
family factors have been found to predict later educational outcome in 1,000 adults who
had been sexually abused in childhood (Boden, Horwood, & Fergusson, 2007). For instance,
age and developmental level at the time of the abuse are thought to influence adaptation
through various processes. Children’s understanding and interpretation of abuse-related
and other stressful life events has been found to influence thoughts, beliefs, perceptions of
support, and coping mechanisms (Friedrich, 1990; Spaccarelli, 1994). In fact, children’s
use of avoidance coping in dealing with sexual abuse or other stressful events has
been found to predict adaptation over and above abuse-related variables (Hébert,
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Academic, Cognitive, and Social Functioning in Sexually Abused Girls 303
Tremblay, Parent, Daignault, & Piché, 2006; Kaplow, Dodge, Amaya-Jackson, & Saxe,
2005; Tremblay, Hébert, & Piché, 1999), as well as academic performance (Compas,
Connor-Smith, Saltzman, Thomsen, & Wadsworth, 2001). Academic and social competence
also may be linked to the number of opportunities children have to build friendships and
skills in various domains (Kiesner, Poulin, & Nicotra, 2003). Larson (2000) observed, in
nonabused children, that participation in structured voluntary activities (sports, arts) is
associated with higher self-esteem, higher educational aspirations, and higher academic
achievement during adolescence. Despite the important theoretical contribution of this
body of research, empirical data remain insufficient to explain the outlined diversity in
profiles of CSA victims, varying from resilience to psychopathology (Paolucci et al.,
2001), and to provide clear guidelines for short-term intervention.
Our proposed model of the relationship between CSA and school adaptation guided
exploration of outcomes in three domains of adaptation: academic, cognitive, and social (see
Figure 1). The conceptual framework is inspired by Friedrich’s (1990) multifactor model
and by Bronfenbrenner’s (1979) ecological system theory. Both models favor cultural speci-
ficity and assume great influence from social interactions in the familial and social contexts.
Purpose of the Study
This exploratory study had three main objectives: (a) to provide a description of sexually
abused children’s adaptation in school as assessed at Time 1 (following disclosure) and as
estimated retrospectively; (b) to assess stability in school functioning over a 1-year period;
and (c) to identify Time 1 factors that predict school adaptation 1 year later. For the latter
objective, of all the factors that may influence outcomes at Time 2, Time 1 school-related
variables were expected to predominate in their predictive value. This study explored whether
other contextual (e.g., severity of the abuse), familial (conflict, cohesion, etc.), and personal
factors (age, coping) provided significant contributions to the prediction of T2 outcomes.
Figure 1. Proposed model of the relationship between child sexual abuse and school adaptation.
Academic
Performance
Social
functioning
Cognitive
functioning
Sexual Abuse
Other
Victimization
Pre-SA
Academic
performance
Pre-SA
Social
functioning
Pre-disclosure context
T1: 1 month
Post-disclosure of SA
T2: 1 year
Post-disclosure of SA
Personal
factors
Symtoms
Family
Factors
School-related
factors
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304 I. V. Daignault and M. Hébert
Methods
Participants
Participants were recruited at the Socio-Judicial Pediatric Clinic of Ste-Justine, a tertiary-
care teaching hospital serving the Montreal urban and suburban communities. The clinic’s
interdisciplinary team performs medical and psychosocial assessments following CSA
disclosure. Families are referred to the clinic by Child Protective Services, the police, or
hospital emergency departments, or may decide to consult on their own. Families were
included in the study when allegations of sexual abuse by girls (age 7 to 12 years) were
assessed as substantiated by the interdisciplinary team. Girls whose medical records indi-
cated a neurodevelopmental or intellectual delay (5% of potential participants) were
excluded from the study, as cognitive and self-report measures were to be used. Analyses
indicated that participants and nonparticipants were equivalent in terms of age, abuse-
related variables, and legal involvement at the time of evaluation. The first phase of the
research project included 100 mother–daughter dyads that were assessed 1 month postdis-
closure (Time 1). The second phase of the project took place approximately 1 year later
(Time 2) with 50 of the initial dyads.
Analysis of variance (ANOVA) and chi-square analyses were conducted to compare par-
ticipants who were assessed at Time 1 only from those who completed both Time 1 and Time
2 assessments in terms of school difficulties, symptoms, Child Behavior Checklist (CBCL;
Achenbach, 2001) scales, abuse severity, and family factors (mother’s level of education,
income). There were no differences between groups except for the mother’s level of educa-
tion, which was higher among Time 2 participants, χ
2
(1, N = 50) = 8.66, p ≤ 0.01. Demo-
graphically, close to 90% of the Time 2 sample (N = 50) was Caucasian. Mean age for the girls
was 8.63 years and the mothers’ age ranged from 22 to 57 years, with a mean of 35 years.
Single-parent families constituted 50% of the sample. For 50% of the families, annual income
before taxes was less than CAN$20,000, which is below the low-income cutoff established for
households with at least one child in urban areas of Canada (Statistics Canada, 2006).
Measures
Academic and Cognition-related Measures
Child Behavior Checklist. The CBCL (Achenbach, 2001) was used at Time 1 to measure
performance in academic subjects (academic performance) and social problems. The CBCL
is designed to assess the behavioral problems (113 items) and competencies (7 items) of
children as reported by parents and teachers (Teacher Report Form [TRF]). The compe-
tence scale assesses children’s performance in academic subjects (failing, or below, within,
or above average). Adequate internal consistencies and validity indices are reported for
these measures (Achenbach, 1991). Internal consistency alpha coefficients for the different
subscales used in this study (Parent and Teacher form) are adequate and vary from .70 to .90.
Clinical scores on this measure were reached at T score < 35 for the performance in
academic subject subscale and T score > 65 for the social problem subscale.
Computerized Aptitude Test for Children (CATC)/Test d’Aptitude Informatisé (TAI enfants;
Version 3.0). Cognitive skills were assessed using the CATC/TAI enfants (Pépin & Loranger,
2001). This measure is an age- and grade-based computerized cognitive and intellectual abili-
ties test. It was standardized with a representative sample of 1,637 French-speaking Quebec
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Academic, Cognitive, and Social Functioning in Sexually Abused Girls 305
children. Three of nine subscales were used to evaluate the following abilities: vocabulary,
arithmetic, and general knowledge. Internal consistency coefficients vary from .82 to .95. A
concurrent validity assessment yielded a correlation coefficient of .71 between global scores on
the CATC and the Wechsler Intelligence Scale for Children (Larue, Pépin, & Loranger, 1996).
Children’s Global Assessment Scale (CGAS). With regard to other school-related variables,
a measure of academic and social functioning prior to the sexual abuse was estimated
retrospectively by mothers and used as a descriptive variable. This measure was obtained
using the reliable and valid format of the CGAS (Schaffer et al., 1983). Functioning scores
were presented on a scale, ranging from 0% to 100%, with higher scores representing a
higher level of functioning. Using this scale, mothers were asked to assess their child’s
previous and current functioning.
Abuse and Victimization Measures
History of Victimization Form (HVF). Contextual and other abuse-related variables were
coded from each child’s medical chart using the HVF (Wolfe, Gentile, & Bourdeau, 1987).
Two dimensions were used in the present study: (a) the nature of abuse (severity, duration,
coercion); and (b) the identity of the perpetrator. A previous analysis of inter-rater reliabilities
of the HVF based on 30 records indicated high agreement. The median intraclass correlation
was 0.86 and the median interrater agreement was 92.8% (Hébert et al., 2006). The HVF
(Wolfe et al., 1987) also served as one of two measures to assess the presence of other forms
of victimization, such as other sexual abuse, neglect, and physical abuse.
Conflict Tactics Scale (CTS). The CTS served as the second measure assessing victimization
history. Mothers completed a 12-item version of the CTS (Straus, Hamby, Boney-McCoy,
& Sugarman, 1996). The CTS is a widely used measure and numerous studies have estab-
lished adequate internal consistencies of scores (Straus, 2006). In accordance with a
method used by Moore and Pepler (1998), each mother was invited to specify the number
of times her child had witnessed conflict situations. They also were asked whether their
child had experienced peer rejection or bullying in the past. A total score ranging from
zero to six victimizations was computed.
Personal Factors and Symptomatology Measures
Children’s Impact of Traumatic Events Scale-Revised (CITES-R). Children completed the
CITES-R (Wolfe & Gentile, 1991), from which a PTSD score and a feeling of guilt score
were determined. The reliability and validity of the CITES-R are adequate (Chaffin & Shultz,
2001). In the present study, the reliability coefficient for the PTSD scores was .85 and .68
for the feeling of guilt scores.
Child Dissociative Checklist (CDC). The 20-item CDC (Putnam, Helmers, & Trickett, 1993)
was completed by mothers to assess symptoms of dissociation in their children. Mothers
specified the presence of symptoms on a 3-point scale, rated from 0 (not true) to 2 (very true).
Cronbach’s alpha coefficient for the global score reached .89.
Self-Report Coping Scale (SRCS). To evaluate children’s coping in relation to sexual abuse,
a brief version of the SRCS (Causey & Dubow, 1992) was completed by the mothers. This scale
conceptualizes coping with two broad types of strategies, namely, approach problem-focused
Downloaded At: 18:33 4 January 2009
306 I. V. Daignault and M. Hébert
coping and avoidance coping (Roth & Cohen, 1986). The scale has shown adequate validity as
established by strong correlations with measures of behavioral problems and peer reports
of coping (Causey & Dubow, 1992). With the brief version, parent’s reports of their child’s
coping strategies were found to correlate with self-reports of coping (Hébert, Parent, & Daig-
nault, 2007). For the purposes of this study, scores were first calculated to represent the
ratio of approach coping strategies in comparison to avoidance strategies (Vitaliano,
Maiuro, Russo, & Becker, 1987).
Extracurricular Activities. Mothers completed a questionnaire assessing their child’s
involvement in community extracurricular activities (nine items). These items were
formulated on the basis of two studies of the Canadian National Longitudinal Survey of
Children and Youth (NLSCY; Statistique Canada, 2003), The Canadian National Survey
on Child Care (Statistique Canada, 1988), and the Ontario Better Beginnings study (Peters
et al., 2000). Mothers specify how often, rated from 1 (never) to 3 (regularly), their children
engage in physical activities (self-defense courses, team sports, swimming lessons, etc.),
cultural activities (painting, music, drawing, etc.), and community programs.
Family-related Measures
In terms of family factors, mothers completed three different questionnaires. First, the 33-item
version of the Source of Stress Inventory (SSI; Chandler, 1981) served to assess the occur-
rence of general stressful events in the past year (e.g., divorce, financial difficulties, illness;
a = .63), as well as stressful events in relation to the abuse (court proceedings, placement of
family member, meeting with prosecutor; a = .70). Second, the Psychological Distress Scale
of Quebec Health (IDPESQ-29; Préville, Boyer, Potvin, Perrault, & Légaré, 1992) was used
to evaluate the mother’s psychological distress. The global score covers four dimensions: anx-
iety, depression, irritability, and cognitive problems (a = .95). Third, each mother completed
the family cohesion subscale (a = .68) of the Family Relationship Index (Holahan & Moos,
1981). Children also completed a modified version of the Social Support Scale for Children
(Harter, 1985), which provided scores of perceived support from the mother (a = .73).
Procedure
The purpose of the study was explained to families and written informed consent was
obtained. Mothers completed the questionnaires while their children completed all child-
report assessments. If the mother consented, consent forms and questionnaires were mailed to
the child’s teachers. The Human Research Review Committee at the Université du Québec
à Montréal and the Ethics Committee of Ste-Justine Hospital approved all study procedures.
Statistical Analysis
Screening of the data revealed the presence of univariate outliers (five participants).
An alteration of scores was thus performed on all three of the outcome variables (school
performance, cognitive functioning, and social problems) so that the scores of these par-
ticipants would remain extreme, but only one unit greater than the highest score of the dis-
tribution (Tabachnick & Fidell, 2001). Data were also screened for multivariate outliers,
and no elimination was necessary. For our first objective, descriptive statistics (frequencies
and percentages) were used. For our second objective (assessing the stability in school
functioning over a 1-year period), paired sample t tests and chi-square tests were computed.
Downloaded At: 18:33 4 January 2009
Academic, Cognitive, and Social Functioning in Sexually Abused Girls 307
Continuous and discrete scores of change were also calculated by subtracting T1 from T2
scores. For our third objective (identifying Time 1 factors that predict school adaptation at
Time 2), bivariate correlations were first examined to verify multicolinearity and to screen
for associations between predictors and outcome. The variables that were not correlated
with outcomes at Time 2 or that were marginally significant were excluded from further
regression analyses, so that a maximum of seven predictors per outcome were considered.
To conduct the hierarchical multiple regression analyses, an ecological perspective that
included five levels of factors served as the model for analysis. Factors were entered in a
specific order, from those that are closely related to the sexual abuse experience (abuse related
and other victimization, personal, symptom related, familial) to those that are school related.
Potential moderator and mediation effects were verified for each regression model.
Results
Analysis of the data describing the nature of the sexual abuse experience indicated that 46%
of the girls experienced intrafamilial abuse. The abuse was severe, involving penetration or
attempted penetration in 55% of the cases, and lasted for more than 6 months for 33% of the
girls. Half of the sample reported being exposed to at least one other type of victimization.
As estimated retrospectively by mothers, 21% of the girls were struggling academically
prior to the abuse and 14% were experiencing social problems. Following disclosure, results at
Time 1 indicated that 39% of the girls obtained CBCL scores falling in the clinical range aca-
demically and 30% obtained clinical scores on the social problems scale. In terms of cognitive
functioning, one third of the girls also obtained scores classifying them as at least 2 years
behind their peers on verbal subscales. About half of the sample had grades below average and
verbal cognitive skills scores classifying them below the 25th percentile.
With regard to adaptation over time, mothers’ (n = 50) and teachers’ (n = 38) evaluations
on the CBCL and TRF measures were compared to assess changes in social and academic
functioning from Time 1 to Time 2. Paired-sample t tests indicated no difference between the
two sources of information for scores of change (T2–T1) in school performance, t(36) = −1.12,
ns, and social problems, t(38) = .033, ns. Regarding the mothers’ assessments, paired-sample
t tests were conducted with global scores of adaptation in the academic, cognitive, and social
domains. Results indicated no significant difference between academic performance as mea-
sured by the CBCL from Time 1 (M = 38.5) to Time 2 (M = 37.94). Similar results were found
with regard to social problems (M = 61.66 vs. 61.52) and Z scores of cognitive functioning
(M = −.69 vs. −.58). In terms of symptoms, paired-sample t tests indicated no differences over
time for PTSD symptoms between Time 1 (M = 22.73) and Time 2 (M = 21.17). However, sig-
nificant differences were found for dissociation symptoms, indicating an increase in symptoms
from Time 1 (M = 6.4, SD = 4.76) to Time 2 (M = 10.07, SD = 6.48), t(49) = −5.26, p < .001.
While results for the entire sample did not show a significant change in mean scores
over time on school and academic outcomes, within-group exploration suggested consid-
erable variability. For instance, according to mothers and teachers, 30% to 44% of the
girls obtained lower academic and social functioning scores at Time 2, indicating deterio-
ration. The social domain was the area in which girls were most likely to experience diffi-
culty over time, according to teachers and mothers.
Predictors of School Adaptation
Table 1 presents bivariate correlations between predictors and outcome variables. Results
indicated that family income, family cohesion, mother’s psychological distress, perceived
Downloaded At: 18:33 4 January 2009
308 I. V. Daignault and M. Hébert
maternal support, and children’s feeling of guilt were not significantly correlated with all
three outcomes measured at Time 2 (school performance, cognitive functioning, and
social problems). Table 2 presents a summary of hierarchical regression equations predict-
ing academic performance, cognitive functioning, and social problems at Time 2. The
percentage of explained variance for each group of variables is illustrated with summary
statistics for the total regression. No significant moderator or mediation effect was found.
Academic Performance
Results of the first step of the regression showed that the severity of the abuse partially
accounted for academic performance, explaining 13% of the variance. Within personal
factors, girls’ age and use of approach coping strategies added to the prediction of academic
performance 1 year later. Total stressful events as a family factor was correlated with aca-
demic performance but did not contribute to its prediction when academic performance at
Table 1
Correlations Between Considered Factors and Outcome Variables (n = 50)
Time 2: 1-year
postallegation
Academic
performance
Cognitive
functioning
Social
problems
T1 Contextual factors
Severity of the abuse −.27* −.15 .09
Duration −.23 −.35* −.16
Level of coercion −.29 (m) −.24 −.01
Proximity of perpetrator −.25 −.17 −.09
Number of victimizations −.02 −.34** .24
T1 Personal factor
Age −.38** −.42** .09
Feelings of guilt −.02 −.11 .29 (m)
Ratio of approach coping .32* .16 −.44**
Extracurricular activities .14 .05 −.27*
T1 Symptoms
Dissociation −.20 −.34** .60**
PTSD −.05 −.12 .21
T1 Family factors
Family cohesion .28 (m) .11 −.22
Perceived maternal support .17 .06 −
.01
Total stressful events −.31* −.32* .16
Mother’s psychological distress −.03 −.11 .14
Family income .22 .27(m) −.13
T1 Control and school-related variables
T1 Cognitive functioning (Time 1) .50**** .75** −.24
T1 Academic performance (Time 1) .73**** .58** −.37**
T1 Social problems (Time 1) −.37* −.48** .58**
Note. *p < .05. **p < .01. ***p < .001. ****p < .0001. (m) = marginal effect (p <.10).
Downloaded At: 18:33 4 January 2009
Academic, Cognitive, and Social Functioning in Sexually Abused Girls 309
Time 1 was accounted for. For the final step, results indicated that academic performance
at Time 1 explained an additional 23% of the variance, while the girls’ cognitive skills at
Time 1 did not increase the percentage of explained variance. When all factors were con-
sidered simultaneously, the final equation achieved significance and explained 51% of the
variance. Of all variables considered, only age maintained a unique contribution when
controlling for Time 1 academic performance.
Cognitive Skills
Results revealed that children’s Time 2 cognitive functioning was partially accounted
for by exposure to other forms of victimization and by the duration of the abuse, explain-
ing 15% of the variance. In terms of personal factors, children’s age also explained an
Table 2
Summary of Hierarchical Multiple Regression Equations Presenting Categories
of Factors Predicting Academic Performance, Cognitive Functioning, and Social
Problems at Time 2 (n = 50)
b tR
2
Total Model b
School performance (T2)
Contextual: Severity of abuse −.37 −2.78** .13 −.01
Personal: Age −.27 −1.90 (m) −.24 *
Proportion of approach coping .29 2.12* .22 .11
Familial: Total stressful events −.30 −2.08* .28 −.17
School-related: Cognitive functioning (T1) −.02
School performance (T1) .57***
Total R
2
.51
Cognitive functioning (T2)
Contextual: Duration of abuse −.30 −2.19* −.21*
Number of victimizations −.32 −2.33* .15 −.28*
Personal: Age −.46 −3.83*** .35 −.19*
Symptoms: Dissociation −.26 −2.13* .40 .07
Familial: Total stressful events .04 .236 .39 .11
School-related: Cognitive functioning (T1) .58***
Social problems (T1) −.25 (m)
Total R
2
.69
Social problems (T2)
Personal: Ratio of approach coping −.42 −3.49*** −.05
Extracurricular activities −.23 −1.90* .22 −.26*
Symptoms: Dissociation .50 4.23**** .40 .31*
School-related: School performance (T1) −.18
Social problems (T1) .31*
Total R
2
.49
Note: Category of factors: (a) contextual, (b) personal, (c) symptoms, (d) familial, (e) school-related.
Note. All Fs significant (p < .05). *p < .05. **p < .01. ***p < .001. ****p < .0001.
(m) = marginal effect (p < .10).
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310 I. V. Daignault and M. Hébert
additional 20% of the variance. In step 3, children’s dissociation scores were correlated
with cognitive functioning at Time 2 but did not maintain a contribution when Time 1
cognitive functioning was considered. For the final step of the regression, cognitive func-
tioning at Time 1 increased the percentage of explained variance significantly, while
Time 1 social problems had a marginal contribution. When all variables were considered
simultaneously, the final equation achieved significance and explained 69% of the
variance. Of all the variables taken into account, the duration of the abuse, number of vic-
timizations, and age maintained a unique contribution when controlling for cognitive
skills at Time 1.
Social Problems
Results concerning the contribution of personal factors indicated that involvement in
structured activities and proportion of approach coping strategies contributed to the
prediction of social problems at Time 2, explaining 22% of the variance. In step 2, results
revealed that symptoms of dissociation also contributed to the prediction of social
problems at Time 2. In the last step, consideration of school-related variables indicated
that social problems at Time 1 predicted problems at Time 2. When all variables were
considered simultaneously, the final equation reached significance and explained 49% of
the variance. Participation in structured activities and symptoms of dissociation main-
tained a unique contribution when social problems at Time 1 were considered.
Discussion
The first objective of this exploratory study was to describe children’s adaptation in
school in relation to CSA disclosure. As reported in previous studies, results revealed that
a substantial number of sexually abused girls experience cognitive, social, and academic
difficulties in the school context (Calam, Horne, Glasgow, & Cox, 1998; Kinard, 2001;
Porter, 2003). Prior to the abuse, as estimated retrospectively by mothers, one girl out of
five (20%) was struggling academically and one girl out of eight (12%) was experiencing
difficulty getting along with peers. Following disclosure at Time 1, assessments indicate a
higher proportion of girls presenting with difficulties in school. Mothers reported that one
fourth (24%) of the girls had repeated a grade and that 15% were in a remedial class for
behavioral or academic problems. Findings also indicated that one third of the girls pre-
sented with severe academic difficulties (39%) and social problems (28%), falling within
the clinical range on the CBCL scales. In addition, almost 50% of the girls were rated as
receiving below average grades. The mother’s assessment of the children’s functioning at
Time 1 was largely corroborated by cognitive skills scores. One third of the girls (28%)
obtained scores classifying them as 2 years behind their same-grade peers, which is indic-
ative of severe difficulties. A larger proportion of girls, representing approximately half
of the sample, obtained scores falling below the 25th percentile, or significantly below
average, in the verbal subscales. These results are concordant with those of Porter (2003),
who observed that sexually abused children obtained lower Verbal and Full Scale IQ
scores than nonabused children.
This study also aimed to assess change over a 1-year period following disclosure.
Results revealed no significant change in the overall mean scores of academic performance,
cognitive functioning, and social problems over time. However, analysis of within-subgroup
variability indicated that for 30% to 44% of the girls, performance deteriorated over 1 year.
This result is concordant with the findings of Tong, Oates, and McDowell (1987), who
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Academic, Cognitive, and Social Functioning in Sexually Abused Girls 311
found that mothers and teachers observed deterioration in school work for 32% of sexually
abused children and in behavior for 28% of the sample 2 years postdisclosure. These
results underline the importance of considering variability in profiles of adaptation within
a sample of sexually abused children to identify their needs for intervention (Daignault &
Hebert, in press). With regard to symptomatology, while girls’ self-reports did not reveal
changes in PTSD symptoms over the 1-year period, mothers perceived a significant
increase in symptoms of dissociation. This result may be explained by the high proportion
of children who reported other forms of victimization in addition to CSA.
The third objective of this study was to explore potential factors predicting sexually
abused girls’ adaptation in school over time. Our aim was to provide a better understand-
ing of the mechanisms exacerbating and protecting against school adaptation difficulties
following sexual abuse disclosure. As expected, results revealed that Time 1 school-
related variables were the best predictors of school functioning at Time 2. Thus children
who are most at risk to be struggling in school can be identified rather quickly following
disclosure. The strong influence of school-related variables was most observable with
regard to academic performance. When controlling for all variables in the final step of the
hierarchical model, factors that predicted the girls’ performance at Time 2 were the girls’
age and academic performance at Time 1. These results are concordant with the findings
of Buckle et al. (2005), who found that when considering family and personal factors, the
best predictor of academic achievement in sexually abused adolescent girls was intelli-
gence scores. These findings suggest that the relationship between CSA and academic
performance probably involves many interrelated factors and may be best defined as an
exacerbating effect rather than a causal effect.
Findings also reveal that personal factors have an important contribution in predicting
school functioning over time. For instance, age was found to predict lower academic and
cognitive functioning. More specifically, girls who were older at the time of disclosure
(Time 1) were more likely to experience academic and cognitive difficulties. Older chil-
dren may experience more difficulty functioning academically and cognitively in school
because they are more advanced in the process of comprehending social norms, as well as
the meaning of CSA. Older children also may be more likely to have experienced abuse of
a longer duration, which was also found to predict the level of cognitive functioning. The
use of approach coping strategies was also identified as a personal protection factor for
both academic and social problems. Prior studies have similarly identified the clinical
relevance of encouraging children to make greater use of approach coping strategies in
influencing symptomatology and outcome (Hébert et al., 2006; Kaplow et al., 2005;
Tremblay et al., 1999). Participation in structured extracurricular activities was also iden-
tified as a protective factor for social problems. The influence of such activities outside
school has rarely been studied in the area of CSA, but findings suggest that they may
constitute an interesting target for intervention planning.
Symptoms related to the abuse were expected to have an influence on school
functioning. Dissociation symptoms have been identified as key risk factors for social
problems over time. This result underlines the necessity of early postdisclosure interven-
tion aimed at attending to these symptoms. Conversely, results indicated that symptoms of
PTSD were not correlated with any of the outcomes. Past research has suggested a link
between trauma exposure, trauma-related symptomatology, and cognitive deficits (Koenen
et al., 2001; Porter, 2003). The present study’s findings do not support a relationship
between PTSD or dissociation symptoms and cognitive functioning. However, the results
do support an association between trauma exposure and cognitive difficulties. In effect, the
number of victimizations children had experienced (witnessing family violence, physical
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312 I. V. Daignault and M. Hébert
abuse and neglect, peer humiliation) as well as the duration of the abuse were found to be
significant predictors of cognitive functioning at Time 2. This result is consistent with the
findings of Holt et al. (2007), who found that youth who had experienced multiple forms
of victimization obtained lower grades in school and experienced greater distress than
children who had experienced less victimization.
With regard to abuse-related variables, the severity and duration of the abuse were
identified as predictors of school functioning. In fact, abuse severity partly accounted
for academic performance when Time 1 performance was not controlled, and duration
predicted Time 2 cognitive functioning. Concerning the social sphere, the literature
suggests that CSA, like other forms of trauma, introduces complex and negative beliefs
and feelings (Cohen et al., 2006) thought to influence children’s ability to function
socially. Findings did not reveal a direct relationship between the severity of the sexual
abuse experienced or exposure to other forms of trauma and Time 2 social functioning.
However, results indicated that processes associated with the abuse experience, such as
symptoms of dissociation and girls’ use of approach coping strategies at Time 1, predicted
social problems 1 year later.
Personal and symptom-related factors were found to predominate over family factors,
which were not found to predict adaptation in school (cohesion, maternal support,
mother’s psychological distress, total stressful events, and income). Although family
factors are thought to greatly influence various aspects of children’s development (Boden
et al., 2007; Spaccarelli, 1994; Tremblay et al., 1999), the factors chosen in this study may
not be the most influential in predicting children’s school adaptation after CSA. In the
present study, as mother’s solicited medical services following the sexual abuse allegation,
they may represent a homogeneous sample of mothers in terms of maternal support.
In summary, the severity and duration of the abuse, exposure to other forms of
victimization, and symptoms of dissociation are risk factors that have been found to
relate to functioning in the academic, cognitive, or social domains of sexually abused
girls 1 year after disclosure. Even with the consideration of school-related variables,
protective factors such as the use of approach coping strategies, younger age, and partici-
pation in structured extracurricular activities have been identified. These factors may
serve as guidelines for intervention. Although results suggest that some proximal factors
do maintain a unique contribution when school-related factors are considered, estimates
of school functioning before the abuse and at Time 1 were the most potent predictors of
school adaptation over time.
Implications
The results of this study underline the importance of assessing sexually abused children’s
cognitive, academic, and social functioning in school. Between 30% to 50% of the girls’
functioned at a level below average, and levels of functioning for the overall sample were
found to be quite stable over the 1-year period. This suggests that children who are most at
risk for long-term struggles can be easily identified following disclosure and benefit from
early school-oriented interventions. Findings also indicated that school functioning of a
subgroup of girls is likely to deteriorate over time. The present data may offer initial cues
as to those most in need of intervention. Results indicated that girls who are older at the
time of disclosure, those who present with long-lasting school functioning difficulties, and
those who present with symptoms of dissociation following disclosure are more likely to
struggle in school 1 year later. Similarly, girls who were exposed to multiple forms of
victimization and to more severe CSA experiences of a longer duration are most likely
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Academic, Cognitive, and Social Functioning in Sexually Abused Girls 313
to experience significant difficulties in the school context. Since correlational findings
revealed that school functioning domains influence one another, intervention programs
that focus on one of the three spheres identified may have enhancing effects on the other
spheres. Helping children make greater use of approach coping strategies is likely to be
associated with better adaptation in the school context. Finally, introducing children to
extracurricular activities may constitute a protective factor offering opportunities for the
development of positive social relationships and feelings of competence.
Strengths and Limitations of the Study
In conducting this study, we attempted to respond to the limitations of past research by
using a sample of girls of a restricted age range, adding a follow-up design, assessing
cognitive skills with a standardized instrument, and integrating multiple sources of infor-
mation as well an estimate of preabuse functioning as a descriptive variable. The use of a
cognitive measure developed specifically for and standardized with a French-speaking
Canadian population also represents a strong point of this study, as it corroborated teachers’
and mothers’ assessments. These aspects constitute the strongest assets of our research
design. However, a longer term follow-up design is needed to determine whether the
identified factors continue to exert an influence over time. The size of the present sample
limited the number of considered factors and only allowed the detection of large effects.
Thus the study may have been insufficiently powered to detect other significant findings.
Mothers’ estimation of preabuse school functioning was also an important limit of our
study. Such an estimate may be biased by limitations of memory with respect to onset,
duration, and timing of disclosure of the abuse and by the mother’s perception of CSA.
For this reason, it was used only as a descriptive measure. Future research should attempt
to integrate such a measure of preabuse functioning. With regard to the use of continuous
scores assessing the presence of PTSD symptoms and dissociation, further studies should
use diagnostic tools, as some of the symptoms may be confounded with general misbehavior.
This study relied on an ecological model that considered three spheres of adaptation
as well as factors at various levels of influence. Although risk and protection factors
influencing sexually abused children’s functioning were identified, future research needs
to replicate findings with a larger sample, longer term follow-ups, and prospective longi-
tudinal designs. Despite these limitations, this study contributed to a better understanding
of the relationship between CSA and school functioning. Further research may help in
fostering desirable outcomes for the school adaptation and later functioning of sexually
abused children.
Acknowledgments
Work on this study was supported by a grant from the Social Sciences and Humanities Research
Council of Canada (SSHRC) to Martine Hébert and by doctoral scholarships awarded to the first
author by the SSHRC, the Fonds Québecois de la recherche sur la société et la culture (FQRSC),
the Centre de recherche interdisciplinaire sur les problèmes conjugaux et les agressions sexuelles
(CRIPCAS), and the Centre de Recherche du Centre hospitalier Universitaire Mère-Enfant de
l’Hôpital Sainte-Justine. The authors wish to thank the mothers and children who participated in this
study, along with Dr. Anne-Claude Bernard-Bonnin, Dr. Claire Allard-Dansereau, and the members
of the Clinique de pédiatrie socio-juridique du CHU Mère-Enfant de l’Hôpital Sainte-Justine. We
also wish to acknowledge the contribution of Nathalie Parent and Manon Robichaud in managing
the databank.
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314 I. V. Daignault and M. Hébert
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