Summary: Cohen JA and Mannarino AP. "A treatment study for sexually abused preschool children: Outcome during a one-year follow-up," Journal of the American Academy of Child and Adolescent Psychiatry vol 36(9): 1228-1235. 1997.

The study that is reported upon in this article had two goals. The first goal was to compare a treatment model called cognitive-behavioral therapy for Sexually Abused Preschoolers (CBT-SAP) to nondirective supportive therapy to see which did a better job of helping children who had been sexually abused. The second goal was to learn what demographic, developmental, and family factors were related to treatment outcome. This article addresses the first issue-treatment effectiveness.

CBT-SAP is a short-term treatment that targets the symptoms that many children who have been sexually abused have, such as aggression, sadness, and sexually inappropriate behavior. Parents are also involved in the treatment, which requires the children to discuss their abuse and their reactions to it. The treatment it was compared to, nondirective supportive therapy (NST), which is designed to help sexually abused children and their parents deal with the isolation, frustration, anxiety, and hopelessness that they might have and to help them understand their feelings abuse the abuse that occurred. NST therapists do not offer directive advice or suggestions or make interpretations of feelings or behavior.

The 43 children who participated in the study were randomly assigned to one of the treatments; 28 were in the group receiving CBT-SAP, while 15 were in the NST group. Each group received 12 treatment sessions. Before treatment began, the children's behavioral and adjustment problems were measured using two different checklists and a log that parents completed. Treatment outcomes were measured three times-at the end of treatment, 6 months after treatment ended, and 12 months after treatment ended. The children in the CBT-SAP group had better behavioral outcomes than those in the NST group in the follow-up period. The CBT-SAP treatment produced more reduction in sexually inappropriate behavior more quickly than NST. In fact, six children who had been assigned to the NST group at the start of the study were removed from that group and treated with CBT-SAP instead, because of persistent sexually inappropriate behavior. In the 12 months following treatment, eight children who had received NST were retreated using CBT-SAP for the same reason.

This study lends support to the value of treating sexually abused children with cognitive-behavioral therapy that encourages them to directly address and discuss the abuse they experienced.