Reports of childhood sexual abuse by adolescents and young adults: stability over time

Journal of Sex Research, Nov, 2002 by Matthew C. Aalsma, Gregory D. Zimet, J. Dennis Fortenberry, Margaret Blythe, Donald P. Orr

Surveys of adolescent behavior often rely upon single-item, self-report measures. When this method is used, it is quite possible to misclassify experiences, particularly when assessing sensitive subjects such as adolescent sexual experiences (Newcomer & Udry, 1988). Given this reality, researchers have attempted to assess the reliability of certain behaviors in adolescent sexuality research, such as timing of initial sexual experiences and lifetime sexual intercourse (Alexander, Somerfield, Ensminger, Johnson, & Kim, 1993; Capaldi, 1996). The consistency of adolescent self-report of initial sexual experience timing, for example, appears poor (Alexander et al., 1993; Capaldi, 1996). In light of this fact, it seems possible that self-report of other sensitive experiences, such as childhood sexual abuse (CSA), may also be inconsistently reported in adolescent populations. Hence, the goal of this study is to assess the consistency of CSA reporting by adolescents.

CSA is linked to wide-ranging emotional, behavioral, and adjustment problems including adolescent pregnancy, aggression, anxiety, depression, risky sexual behaviors, low self-esteem, school problems, and withdrawn behaviors (Kendall-Tackett, Williams, & Finkelhor, 1997; Luster & Small, 1997). The relationship between CSA and future behavioral problems has previously been demonstrated; however, the specific psychosocial mechanisms leading to these outcomes are not clearly understood. One reason for this lack of clarity is methodological in nature, given that CSA measurement varies greatly across studies (Briere, 1992; Goldman & Padayachi, 2000; Roosa, Reyes, Reinholtz, & Angelini, 1998). For example, in many self-report questionnaire studies, CSA is measured by a single item (Bensley, Van Eenwyk, Spieker, & Schoder, 1999; Luster & Small, 1997; Thompson, Potter, Sanderson, & Maibach, 1997), which eliminates the possibility of assessing internal reliability. Other studies have used more extensive measurement methods, such as clinical interviews or medical/psychosocial evaluations (Brown, Kessel, Lourie, Ford, & Lipsitt, 1997; Meyer, Muenzenmaier, Cancienne, & Struening, 1996). Using an interview to assess CSA allows for information concerning the duration and nature of the abuse to be gained. However, these methods are time intensive and the reliability of interview methods has been poorly evaluated. Even relatively brief scales assessing childhood sexual abuse, such as the Early Sexual Experiences Checklist (Miller & Johnson, 1998) and the Unwanted Childhood Sexual Experiences Questionnaire (Stevenson, 1998), are lengthy: 20 items and 13 items respectively. In sum, studies using brief scales to assess CSA are noticeably absent. Using a brief self-report assessment of CSA is important when assessing a wide range of behaviors and psychosocial attitudes in one study.

Methodological research concerning the stability of CSA reporting over time has not been conducted even though researchers have called for data to be collected at more than one time point to assess for developmental differences in symptomatology (Kendall-Tackett, Williams, & Finkelhor, 1997). In an extensive literature search of studies related to CSA reporting, only one recent study (Costello, Angold, March, & Fairbank, 1998) measured the reliability of CSA reporting across two time points. In this study--the focus of which was to assess the utility of a measure of post-traumatic stress disorder (PTSD) with children--10 participants indicated they had been sexually abused. Two weeks later, 9 participants reported that they had been sexually abused, resulting in a Cohen's Kappa correlation of .81. Hence, a significant gap in the CSA research literature exists in terms of stability of reporting.

Self-report consistency at different time points is one approach to assessment of reporting stability (i.e., correctly identifying as non-CSA or CSA). This method has proven effective in past studies of adolescent self-report consistency (Alexander et al., 1993; Capaldi, 1996). Using two time points is expected to create three distinct groups of CSA reporting: consistent nonreporters (deny CSA at both time points), inconsistent reporters (endorse CSA at one point and deny at the other time point), and consistent reporters (endorse CSA at both time points). If the two-time-point approach reduces misclassification, we expect the following: the consistent nonreporters group will include a lower proportion of persons with a tree experience of abuse; the inconsistent reporters group will include persons with true positive and false positive reports; and the consistent reporters group will include a larger proportion of true positive reports and a smaller proportion of false positive reports.

If the preceding premise is true, we would then expect problem behaviors associated with CSA to be differentially distributed across the three groups. This is expected given that CSA is associated with specific problem behaviors (see previous review). As a result, we expect consistent nonreporters to have lower levels of problem behaviors, inconsistent reporters to have intermediate levels, and consistent reporters to have higher levels. We expect intermediate levels of problem behavior among inconsistent reporters because their identification of CSA experiences may be influenced by temporal stress, such as relationship difficulty or other life stressors. The demonstration of differential problem behavior involvement will provide another measure of validity. Additionally, endorsement of two or more CSA items should be related to an increased likelihood of consistent reporting. Hence, the prediction of consistent and inconsistent CSA reporting will be explored via the number of CSA items endorsed.